Claudia Giraldo-Giraldo

Farmacovigilancia activa en pacientes afiliados al sistema general de seguridad social en salud

Objetivos Determinar los posibles resultados negativos asociados a la medicacion mediante la metodologia de busqueda activa de posibles interacciones medicamentosas en bases de datos de pacientes afiliados al Sistema General de Seguridad Social en Salud. Metodos A partir de las bases de datos de dispensacion de medicamentos de Audifarma S.A a unos 4 millones de usuarios del pais, se hizo una revision sistematica de estadisticas de una serie de medicamentos identificados por presentar interacciones de riesgo, dosis diferentes a las recomendadas o dispensacion irregular. Los casos son socializados con las EPS responsables. Resultados Se encontro un caso de nefrotoxicidad por acido zoledronico; el 37,0 % de los usuarios de clopidogrel recibian concomitantemente omeprazol, que reduce la efectividad del primero; el 29,9 % de los pacientes que toman losartan estan recibiendo dosis superiores a las recomendadas para su indicacion; el 2,0 % de los pacientes que toman metoprolol o verapamilo, los recibe simultaneamente, con riesgo de generar bradicardia sinusal, bloqueos auriculoventriculares o disfuncion sistolica. Todos los casos fueron notificados a los responsables en la EPS que atienden estos pacientes. Discusion La farmacovigilancia activa permite optimizar recursos, prevenir eventos adversos que puedan potencialmente causar morbilidad importante o incluso letalidad o determinar problemas que podrian ser responsables del fracaso terapeutico. Este tipo de estrategia se anticipa a la aparicion de posibles riesgos para el paciente por lo que se recomienda considerarla para reforzar los programas de vigilancia de uso de medicamentos en el pais.

Calidad de la prescripción de verapamilo de liberación convencional en pacientes con hipertensión arterial

OBJECTIVE To identify patients who were being treated for hypertension with conventional release verapamil (CRV), and to notify the professional responsible for their health care on cardiovascular risk to which they are exposed and achieve a reduction in the number of patients who are treated with this drug. METHODS A quasi-experimental prospective before and after study without a control group was conducted on 7289 patients diagnosed with hypertension who were on treatment with CRV, between October 1, 2012 and December 31, 2012 in 8 Colombian cities, collected from a database for dispensing medicines. Socio-demographic and pharmacological variables were evaluated. A total of 108 educational interventions were performed on those responsible for their health care, and evaluated within three months with the proportion of suspension of the prescriptions of CRV being evaluated. Multivariate analysis was performed using SPSS 22.0. RESULTS The mean age of patients was 67.9±11.8 years (range: 26-96 years), of which 70.6% were men. Withdrawal of treatment with CRV was achieved in a total of 1922 patients (26.3% of users), distributed as follows: 1160 (60.4%) were the presentation of 120mg, while 762 (39.6%) the 80mg. The variable being treated in the city of Medellin (OR: 17.6; 95% CI: 11.949 to 25.924; P<.01) was statistically significantly associated with the replacement of CRV for another antihypertensive. CONCLUSIONS A relatively moderate adherence to recommendations about the proper use of CRV in hypertensive patients, was found. Intervention programs that reduce inappropriate prescribing of potential risks to patients of insurance companies and cities where the change was not achieved, must be enforced.

Endpoints in strategies to reduce polypharmacy

Polypharmacy is closely associated with potentially inappropriate prescriptions that can have negative effects on patients. It is present in approximately 58% of those over 65 years of age and can occur in 70% of nursing home residents [1]. Along with the pharmacokinetic changes induced by ageing, polypharmacy plays an important role in the occurrence of adverse drug events [2] and is associated with multiple clinical problems, such as poor adherence to treatment, drug interactions, development of geriatric syndromes and increased care costs [3]. Recently, Johansson et al. published a meta-analysis on the impact of strategies to reduce polypharmacy in clinically important outcomes (hospitalization and death), and found that there is no evidence of their effectiveness [4]. The included strategies were divided into interventions focusing on pharmacists, other multidisciplinary teams, or medical personnel. It is interesting to note that, of the 25 trials included in the review, the highest proportion of studies (three-quarters of the studies) showing some positive impact on all-cause mortality were those with physician-led interventions [4]. Some of these achieved a significant decrease in the utilization of medical services, the number of drugs per patient and the number of drugs initiated during the intervention [4]. Our research group has conducted various medical education interventions aimed at rationalizing the use of drugs. We gained a good response from the medical community and achieved variable adherence to the recommendations. The success of these activities resulted in a reduction in the number of drugs prescribed and the number of patients with inappropriate prescriptions, avoided the possible occurrence of adverse drug reactions and even generated significant savings in drug costs [5, 6]. We consider the strengthening of the various medical education activities aimed at improving and ensuring appropriate drug use to be of great importance, in order to provide adequate, rational and cost-effective therapies. The meta-analysis of Johansson et al. [4] is a motivation not only to generate new studies seeking to change prescribing patterns and reduce the total number of drugs taken, but also to determine the final impact of these adjustments.

Prescripción de paroxetina en adolescentes Colombianos

RESUMEN Objetivo Determinar la frecuencia de uso de paroxetina en pacientes adolescentes menores de 20 anos afiliados al sistema de salud colombiano. Metodos Estudio de corte transversal, a partir de una base de datos poblacional de personas afiliadas al Sistema General de Seguridad Social en Colombia entre primero de enero 2011 y 31 diciembre 2015 buscando los pacientes menores de 20 anos que hubiesen recibido cualquier presentacion de paroxetina. Para el analisis de datos se establecieron frecuencias y proporciones. Resultados Se hallaron 777 sujetos prescritos con paroxetina durante los cinco anos de evaluacion, con edad promedio de 53,8±16, dos anos Solo 36 pacientes menores de 20 anos lo recibian, especialmente hombres (n=24; 64,8%) con edad media de 17,7±1,8 anos. La mayoria estaban siendo tratados en la ciudad de Bogota (58,3%), seguidos de Medellin (16,7%) y Cartagena (8,3%). Conclusiones Una baja proporcion de adolescentes estan recibiendo paroxetina en Colombia lo que reduce el riesgo que puede representar este farmaco para ellos.

Uso de dipiridamol como monoterapia para la prevención secundaria cardiovascular

El accidente cerebrovascular (ACV) se reconoce como una enfermedad devastadora, causa mortalidad significativa y discapacidad a largo plazo. El riesgo anual estimado de un evento vascular mayor es 9,0% en ausencia de medidas, asi la eleccion de una estrategia eficaz para la prevencion secundaria del ACV es esencial. El empleo de dipiridamol en la prevencion secundaria de ACV corresponde a un uso inadecuado del mismo por la falta de evidencia de su eficacia. Por tal motivo se buscaron pacientes mayores de 65 anos que recibieran este farmaco en monoterapia y en esta cohorte n o se encontro dicha PPI, incluso ningun paciente recibio dipiridamol.

RISK IDENTIFICATION OF TOXICITY AND OTHER PROBLEMS RELATED TO DRUGS IN PATIENTS AFFILIATED TO A HEALTH SYSTEM

Introduction: Few studies are published on the drug transfer into human breastmilk and it’s possible risks to the infant. Analgesics (nalbuphine) and non steroidal antiinflammatories (ibuprofen, ketoprofen and fenoprofen) are presently popular for therapy of pain, inflammation in nursing mothers. Although, morphine and profenid are allowed during puerperal period, recent studies showed the dangerous effect of codeine. Few data have been published about the use of analgesic after the early post-partum stage. New studies should be made to ensure a safe prescription and to provide a better understanding of the kinetics of ketoprofen, nalbuphine and ibuprofen drug entry into “mature breastmilk”.