Bulas de medicamentos cardiovasculares: elas têm informações sobre precauções necessárias aos idosos? / Cardiovascular drug labeling: Do they have information on necessary precautions for older people?

OBJETIVO: Analisar a existência de informações, em bulas destinadas aos profissionais de saúde, sobre precaução de uso de medicamentos cardiovasculares em idosos. METODOLOGIA: Trata-se de estudo documental realizado por meio de análise de dados contidos em bulas de medicamentos. Analisou-se a existência, na bula, de informações sobre precauções no uso de medicamentos para idosos, conforme descrito no Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016. RESULTADOS: Dos 29 medicamentos pertencentes ao grupo do sistema cardiovascular que devem ser evitados por idosos e estão disponíveis no Brasil, 15 independem da condição clínica prévia do paciente para que sejam vetados para os idosos. Desses 15, apenas 3 medicamentos (20%) têm informações explícitas concordantes com o Consenso (metildopa, digoxina e espironolactona); 2 (13,33%) têm informações explícitas ausentes; 4 (26,66%) têm informações explícitas discordantes; e 6 bulas (40%) foram categorizadas como informações não explícitas. Quanto às precauções dos medicamentos de acordo com a condição clínica do paciente, incluíram-se 14 medicamentos que devem ser evitados por idosos e estão disponíveis no Brasil. Destes, 12 (85,71%) têm em suas bulas recomendações concordantes com o Consenso, porém não explícitas, e 2 (14,28%) não têm as contraindicações. CONCLUSÕES: A maioria das bulas carece de informações sobre precauções de uso de medicamentos para a população idosa.

OBJECTIVE: To analyze the existence of information on drug labeling intended for health professionals on the precaution of cardiovascular drugs use in older people. METHODS: This is a documentary study, carried out with the analysis of data contained in drug labelings. The existence of information on precautions in the use of drugs for older people as described in the 2016 Brazilian Consensus on Potentially Inappropriate Drugs for Older People (Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016). RESULTS: Of the 29 drugs belonging to the cardiovascular system group that should be avoided by older people and are available in Brazil, 15 are independent of the clinical condition. Of these fifteen, only three drugs (20%) have explicit information in accordance with the Consensus (methyldopa, digoxin, and spironolactone); two (13.33%) have missing explicit information; four (26.66%) have explicitly discordant information; and six drug labels (40%) were categorized as non-explicit information. Regarding drug precautions according to clinical condition, 14 drugs were included. Of these, 12 (85.71%) have equal contraindications of that of Consensus on their drug labels, however, non-explicit; and two (14.28%) contraindications are missing. CONCLUSION: Most drug labels lack information on the precautions for the use of drugs in older people.

INAPPROPRIATE PRESCRIBING PATTERN AMONG ELDERLY PATIENTS TREATED IN THE TERTIARY LEVEL HOSPITAlS / Монголын эм зүй, эм судлал

Background: The main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce the health care costs.Assessing the drug related problems in elderly patients is a main health care and safety issue for the health care system.Ischemic heart disease (IHD) is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.Objective: Aim of this study was to conduct a retrospective study on inappropriate prescribing pattern among elderly patients with Ischemic heart disease who were treated in tertiary level hospitals of Ulaanbaatar.Methods: Total of 438 patient’s records who were treated with diagnosis of IHD during the 2011 – 2012, was collected randomly from main three state hospitals of Ulaanbaatar. A retrospective analysis of inappropriate drug prescription was used Beers criteria (2012).Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.Results: The mean age of the participants was 67.38±0.24 and 54.6% of participants were male and 44.4% were female.The trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I state hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total use drug per patients were from standard therapeutic guideline.The most common inappropriately used drugs were as follows: amiodarone (16% at the I state hospital; 10% at the II state hospital; 3% at the III state hospital), dipyridamole (51% at the I state hospital; 3% at the II state hospital), amitriptyline (29% at the I state hospital; 20% at the III state hospital), nifedipine (33% at the II state hospital).The use of that are inappropriate with certain medical conditions were common in case of IHD patients with peptic ulcer comorbidity. Non-steroid anti-inflammatory drug + acetyl salicylic acid combination were used in 3% of patients at the I state hospital, in 4% of patients at the II state hospital and 1% of patients at the III state hospital.Conclusion: Among the medications used to elderly patients with IHD, 15 medications were listed in potentially inappropriate medication in elderly (Beers criteria) independent of diagnosis. In I and II state hospitals, usage of potentially inappropriate medication were greater than III state hospital.

A retrospecti ve anal ysis of inappropriate prescribing pattern / Монголын эм зүй, эм судлал

Background: The main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If the treatment plan can be evidence based, it will improve treatment efficacy andsafety, can prevent from drug related adverse event and reduce the health care costs. Assessing the drug related problems in elderly patients is a main health care and safety issue for the health care system. Ischemic heart disease (IHD) is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.Objective: Aim of this study was to conduct aretrospective study on inappropriate prescribingpattern among elderly patients with Ischemic heart disease who were treated in tertiary level hospitals ofUlaanbaatar.Methods: Total of 438 patient’s records who were treated with diagnosis of IHD during the 2011 –2012, was collected randomly from main three state hospitals of Ulaanbaatar. A retrospective analysis of inappropriate drug prescription was used Beers criteria (2012).Variables of study were patient’s diagnosis, age, sex,names, doses and route of medications.Results: The mean age of the participants was67.38±0.24 and 54.6% of participants were male and 44.4% were female. The trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I state hospital, number and cost of drug per patients werehigher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total used drug per patients were from standard therapeutic guideline. The most common inappropriately used drugs were as follows: amiodarone (16% at the I state hospital; 10% at the II state hospital; 3% at the III state hospital),dipyridamole (51% at the I state hospital; 3% at the II state hospital), amitriptyline (29% at the I state hospital; 20% at the III state hospital), nifedipine (33% at the II state hospital).The use of that are inappropriate with certain medicalconditions were common in case of IHD patients with peptic ulcer comorbidity. Non-steroid anti-inflammatory drug + acetyl salicylic acid combination were used in 3% of patients at the I state hospital, in 4% of patients at the II state hospital and 1% of patients at the III state hospital.Conclusion: Among the medications used for elderly patients with IHD, 15 medications were listed in potentially inappropriate medication in elderly (Beers criteria) independent of diagnosis. In I and II state hospitals, usage of potentially inappropriate medication were greater than III state hospital.Key words: inappropriate drug, Beers criteria,ischemic heart disease, treatment guideline