[Results of analysis of the prescriptions for elderly patients in ambulatory practice.]

A randomized retrospective analysis of medical records of patients aged 65 years and older receiving ambulatory medical care was carried out in order to assess drug prescriptions for the detection of polypharmacy and potentially dangerous and significant drug interactions. The average number of visits per patient over 65 is 11,2±8,4. Comorbidity was detected in 89,4% of patients. Polypharmacy was detected in 76,6% of patients. In 1/3 of cases, patients were prescribed not recommended drugs (Beers criteria 2015). Authors found 364 interactions of various hazard categories. The obtained data shows that it is mandatory to implement various systems of prescription audit for the timely detection of potentially hazardous and incompatible drugs, as well as to correct prescriptions and improve efficacy and safety of drug use in patients older than 65 years.

[Polypragmasy: A clinical pharmacologist's view]. / Polipragmaziya: vzglyad klinicheskogo farmakologa.

In the modern world, there is a rapid advance in the design and clinical introduction of a huge number of drugs that are able to cure a patient or to improve his/her health status on the one hand and to cause significant harm to his/her health on the other. Polypragmasy is the desire to enhance the efficiency of treatment and to help the patient recover from all developed diseases inevitably leads to the use of a large number of medications. At the present time, polypragmasy as a result of iatrogenia is a serious public health problem, as it is clinically manifested by a reduction in the effectiveness of pharmacotherapy, by the development of severe adverse drug reactions, and by a considerable increase in healthcare expenditures. The reason for the simultaneous prescription of multiple drugs may be comorbidity (multimorbidity), the availability of drugs, as well as clinical guidelines, manuals of professional medical associations, treatment standards that contain recommendations for using combination therapy with more than 5 drugs for only one disease in some cases, the efficiency of which corresponds to a high level of evidence. Currently, the fight against polypragmasy is one of the important tasks in rendering medical care to elderly and senile patients since it is a major risk factor of adverse drug reactions in this category of people. To minimize polypragmasy in elderly patients, it is necessary to use current methods for analyzing each prescription of a drug (the index of rational drug prescribing; an anticholinergic burden scale) and those for optimizing pharmacotherapy with the use of restrictive lists (Beers criteria, STOPP/START criteria) that will be able to reduce the number of errors in the administration of drugs and to maximize the efficiency and safety of pharmacotherapy.

[The efficiency of combinations of Enalapril and long-acting Nifedipin and Moxonidine in patients with arterial hypertension and a metabolic syndrome].

The aim of the study was to obtain a comparative evaluation of antihypertensive efficacy, tolerability and influence of combine therapy on myocardium mass, diastolic function of a left ventricle, lipid and carbohydrate exchange in patients with arterial hypertension in metabolic syndrome. Out of 40 examined cases 20 patients took enalapril and long-acting nifedipin and 20 ones--enalapril and moxonidine. All examination were been performed before administration of drugs and 6 months after the therapy. The dynamics of indices of ambulatory blood pressure monitoring, echocardiography, cycle ergometry, anthropometry, lipid, carbohydrate exchange and tolerability of conducted therapy was been evaluated. The use of this combination of the drugs may be recommended to be included in the treatment of arterial hypertension within the bounds of metabolic syndrome, as in most of cases they promote an achievement of target blood pressure level, have a cardioprotective action, high tolerability and favorable metabolic profile. The combination of enalapril and long-acting nifedipin has a more evident antihypertensive activity but a therapy with enalapril and moxonidine has a positive effect on the indices of carbohydrate exchange.

[The influence of antihypertensive agents on plasmatic and vascular-thrombocytic homeostasis in metabolic syndrome].

The combined therapy with enalapril and prolonged-release verapamil, as well as with enalapril and moxonidine significantly increases the level of antiatherogenic high-density-lipoprotein cholesterol, reduces the atherogenicity coefficients, decreases the concentrations of glucose, glycosylated hemoglobin, and soluble fibrinmonomeric complexes and the aggregation activity of thrombocytes, activates plasminogen in the blood of patients under conditions of metabolic syndrome with arterial hypertension. At the same time the enalapril monotherapy has no significant influence on the parameters of lipid and carbohydrate metabolism and the plasmatic and vascular-thrombocytic homeostasis.