Dione Marçal Lima

Consumo de medicamentos por idosos, Goiânia, Brasil

OBJETIVO: Analisar o padrao de consumo de medicamentos entre idosos e sua associacao com aspectos socioeconomicos e autopercepcao de saude. METODOS: Estudo de base populacional e delineamento transversal com 934 idosos de Goiânia, GO, Brasil, entre dezembro de 2009 e abril de 2010. Os dados foram coletados por meio de questionario. As variaveis estudadas foram: numero de medicamentos consumidos, sexo, estado civil, escolaridade, tipo de moradia, idade, renda e autopercepcao de saude. Os medicamentos foram classificados segundo o Anatomical Therapeutic and Chemical Classification. Os medicamentos improprios para idosos foram identificados segundo o Criterio de Beers-Fick. Os testes utilizados foram Qui-quadrado (X2) e exato de Fisher e p foi considerado significativo quando < 0,05. RESULTADOS: Os idosos consumiam 2.846 medicamentos (3,63 medicamentos/idoso). Os mais usuais atuavam no aparelho cardiovascular (38,6%). A prevalencia de polifarmacia foi de 26,4% e da automedicacao de 35,7%. Os medicamentos mais ingeridos por automedicacao foram os analgesicos (30,8%); 24,6% dos idosos consumia medicamento considerado improprio. Mulheres, viuvos, idosos com 80 anos ou mais e com pior autopercepcao de saude praticavam mais a polifarmacia. A maior pratica da automedicacao esteve associada com menor escolaridade e pior autopercepcao de saude. CONCLUSOES: O padrao do consumo de medicamentos por idosos foi semelhante ao encontrado em idosos de outras regioes do Brasil. O numero de medicamentos usados, a prevalencia das praticas da polifarmacia e automedicacao e consumo de medicamentos improprios estiveram dentro da media nacional.OBJECTIVE To analyze the pattern of use of medications use in aged people and associate it with socioeconomic aspects and with the self-rated health. METHODS A population-based cross-sectional design study with 934 elderly people from Goiania, Midwestern Brazil, between December 2009 and April 2010. Data were collected through a questionnaire. The dependent variable was the number of medications consumed and the independent variables were sex, marital status, education, type of residence, age, income, and self-rated health. Drugs were classified according to the Anatomical Therapeutic Chemical Classification. The inappropriate drugs for the elderly were identified according to the Beers-Fick criteria. The tests used were Chi-square and Fishers exact test, p was considered significant when < 0.05. RESULTS The elderly consumed 2,846 medicines (3.63 medications/person). The most commonly consumed were those which act in the cardiovascular system (38.6%). The prevalence of polypharmacy was 26.4% and self-medication was 35.7%. The most used drugs for self-medication were analgesics (30.8%), 24.6% of the elderly consumed drug considered inappropriate. Women, widows, those aged 80 or over and with worse self-rated health were more likely to practiced more polypharmacy. Most self-medication was associated with lower levels of education and worse self-rated health. CONCLUSIONS The pattern of drug use by the elderly was similar to that found in the elderly in other regions of Brazil. The number of drugs used, the prevalence of self-medication and practice of polypharmacy and inappropriate drug use were within the national average.

Stability and in vitro release profile of enalapril maleate from different commercially available tablets: Possible therapeutic implications

Stability of enalapril maleate formulations can be affected when the product is exposed to higher temperature and humidity, with the formation of two main degradation products: enalaprilat and a diketopiperazine derivative. In this work, stability and drug release profiles of 20 mg enalapril maleate tablets (reference, generic and similar products) were evaluated. After 180 days of the accelerated stability testing, most products did not exhibit the specified amount of drug. Additionally, drug release profiles were markedly different from that of the reference product, mainly due to drug degradation. Changes in drug concentration and drug release profile of enalapril formulations are strong indicators of a compromised bioavailability, with possible interferences on the therapeutic response for this drug.

Medicine use by the elderly in Goiania, Midwestern Brazil

OBJETIVO: Analisar o padrao de consumo de medicamentos entre idosos e sua associacao com aspectos socioeconomicos e autopercepcao de saude. METODOS: Estudo de base populacional e delineamento transversal com 934 idosos de Goiânia, GO, Brasil, entre dezembro de 2009 e abril de 2010. Os dados foram coletados por meio de questionario. As variaveis estudadas foram: numero de medicamentos consumidos, sexo, estado civil, escolaridade, tipo de moradia, idade, renda e autopercepcao de saude. Os medicamentos foram classificados segundo o Anatomical Therapeutic and Chemical Classification. Os medicamentos improprios para idosos foram identificados segundo o Criterio de Beers-Fick. Os testes utilizados foram Qui-quadrado (X2) e exato de Fisher e p foi considerado significativo quando < 0,05. RESULTADOS: Os idosos consumiam 2.846 medicamentos (3,63 medicamentos/idoso). Os mais usuais atuavam no aparelho cardiovascular (38,6%). A prevalencia de polifarmacia foi de 26,4% e da automedicacao de 35,7%. Os medicamentos mais ingeridos por automedicacao foram os analgesicos (30,8%); 24,6% dos idosos consumia medicamento considerado improprio. Mulheres, viuvos, idosos com 80 anos ou mais e com pior autopercepcao de saude praticavam mais a polifarmacia. A maior pratica da automedicacao esteve associada com menor escolaridade e pior autopercepcao de saude. CONCLUSOES: O padrao do consumo de medicamentos por idosos foi semelhante ao encontrado em idosos de outras regioes do Brasil. O numero de medicamentos usados, a prevalencia das praticas da polifarmacia e automedicacao e consumo de medicamentos improprios estiveram dentro da media nacional.OBJECTIVE To analyze the pattern of use of medications use in aged people and associate it with socioeconomic aspects and with the self-rated health. METHODS A population-based cross-sectional design study with 934 elderly people from Goiania, Midwestern Brazil, between December 2009 and April 2010. Data were collected through a questionnaire. The dependent variable was the number of medications consumed and the independent variables were sex, marital status, education, type of residence, age, income, and self-rated health. Drugs were classified according to the Anatomical Therapeutic Chemical Classification. The inappropriate drugs for the elderly were identified according to the Beers-Fick criteria. The tests used were Chi-square and Fishers exact test, p was considered significant when < 0.05. RESULTS The elderly consumed 2,846 medicines (3.63 medications/person). The most commonly consumed were those which act in the cardiovascular system (38.6%). The prevalence of polypharmacy was 26.4% and self-medication was 35.7%. The most used drugs for self-medication were analgesics (30.8%), 24.6% of the elderly consumed drug considered inappropriate. Women, widows, those aged 80 or over and with worse self-rated health were more likely to practiced more polypharmacy. Most self-medication was associated with lower levels of education and worse self-rated health. CONCLUSIONS The pattern of drug use by the elderly was similar to that found in the elderly in other regions of Brazil. The number of drugs used, the prevalence of self-medication and practice of polypharmacy and inappropriate drug use were within the national average.

Medication adherence in patients in treatment for rheumatoid arthritis and systemic lupus erythematosus in a university hospital in Brazil

Medication adherence is essential for the control of symptoms and progression of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The aim of the study was to investigate medication adherence in outpatients in treatment for RA and SLE in a university hospital in Brazil. This was a quantitative, cross-sectional analytical study. A total of 92 patients (55 RA patients and 37 SLE patients) were included in the study. A structured questionnaire for patients’ interview and a form for collecting data from medical records were used for data collection. Adherence to drug treatment was assessed by the Morisky scale questionnaire. Data storage and analysis were performed using Epi Info 3.5.4 and statistical analysis by Stata/SE 12.0. The Pearson’s chi-squared test and Fisher’s exact test were applied for statistical and bivariate analyses. For multivariate data analysis the Poisson regression and the Wald test were used. The prevalence of adherence to drug treatment was 16.4% in RA patients and 45.9% in SLE patients. The final model of the multivariate analysis demonstrated associations between medication adherence and the following covariates for both RA and SLE groups: duration of therapy for rheumatic disease at the institution greater than 15 years and presence of more than six chronic comorbidities. The parameter “acquisition of medication at the high-cost pharmacy” was differently associated with medication adherence by group, and for the SLE group, living outside the city of Goiânia was a protective factor associated with adherence. This study demonstrated a low prevalence of medication adherence in patients in treatment for RA and SLE treated at this institution. These findings will serve as a base for future studies to elucidate what factors may positively or negatively affect medication adherence in this population. In addition, multidisciplinary approaches are needed to enhance adherence to drug treatment in patients in treatment for rheumatic disease.

A High Performance Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) Method Using Solid Phase Extraction for the Simultaneous Determination of Plasma Concentrations of Enalapril and Enalaprilate in Hypertensive Patients Treated With Different Pharmaceutical Formulations

Enalapril maleate, available on the market in a variety of different pharmaceutical formulations, is commonly used for the control of systemic arterial hypertension. Many therapeutical failures have been reported thus far in clinical practice with respect to switching between different pharmaceutical formulations of the same product during pharmacological therapy. In the present study, plasma concentrations of enalapril and enalaprilate were measured in hypertensive patients undergoing treatment with different pharmaceutical formulations. Materials and methods: Pharmaceutical formulations studied included the reference brand product, a generic formulation, and a third drug product marketed as “similar”; plasma samples were obtained from 30 hypertensive volunteer patients. Drug was extracted from the plasma by solid phase extraction and determined by liquid chromatography-tandem mass spectrometry. The method was validated for the main analytical parameters. Results: The analytical method developed in this study, using liquid chromatography-tandem mass spectrometry, was confirmed as suitable for application in the determination of plasma concentrations in patients and subsequently revealed statistically significant differences in plasma concentrations between the 3 treatment groups. Conclusions: Such differences reinforce the hypothesis that the bioequivalence tests currently proposed by the regulatory authorities to promote interchangeability between pharmaceutical formulations may not in fact represent a definitive parameter for guaranteeing similar plasma concentrations.

Pharmaceutical Care for hypertensive patients provided within the Family Health Strategy in Goiânia, Goiás, Brazil

A Atencao Farmaceutica tem como objetivo conseguir resultados concretos que melhorem a qualidade de vida do paciente, contribuindo especialmente em doencas cronicas, como a Hipertensao Arterial. O objetivo deste estudo foi analisar um modelo de Atencao Farmaceutica a pacientes com Hipertensao Arterial assistidos pela Estrategia Saude da Familia (ESF). Trata-se de um estudo longitudinal realizado com pacientes assistidos pela ESF de uma Unidade Basica de Saude de Goiânia-GO. Participaram do estudo, 14 pacientes que receberam seis visitas domiciliares para Atencao Farmaceutica. Registraram-se 142 Problemas Relacionados a Medicamentos (PRM) sendo mais frequente a falta de efetividade do tratamento (33,8%). Realizaram-se 135 intervencoes farmaceuticas, das quais 92,6% foram com a comunicacao farmaceutico-paciente, em que 48,8% das intervencoes foram implementadas. Observou-se reducao do risco cardiovascular em tres pacientes e nove pacientes nao apresentaram alteracao no nivel de risco cardiovascular. Entre os pacientes hipertensos e diabeticos observou-se reducao da glicemia de jejum em seis. O modelo de Atencao Farmaceutica proposto foi capaz de detectar PRM propondo intervencoes para resolve-los e preveni-los e, consequentemente, pode ter contribuido na melhora de parâmetros clinicos como glicemia de jejum e risco cardiovascular em pacientes hipertensos assistidos pela ESF.

Potential drug–drug interactions in older adults: A population-based study

To evaluate the potential drug–drug interactions (PDDI) between drugs used by older adults, any associated factors and recommended clinical management.

Caracterização dos casos suspeitos de dengue internados na capital do estado de Goiás em 2013: período de grande epidemia

OBJETIVO: descrever o perfil clinico-epidemiologico e a distribuicao espacial dos casos suspeitos de dengue com hospitalizacao em Goiânia-GO, Brasil, durante a epidemia de 2013. METODOS: estudo descritivo sobre dados do Sistema de Informacao de Agravos de Notificacao, Sistema Gerenciador de Ambiente Laboratorial, Sistema de Regulacao de Leitos, e do Sistema da Companhia de Processamento de Dados de Goiânia. RESULTADOS: foram incluidos 616 casos suspeitos de dengue com idade media de 36 anos (desvio-padrao: 14,8), 55,2% do sexo feminino, 9,3% confirmados laboratorialmente e 9,7% apresentando comorbidades; a comorbidade mais frequente foi hipertensao arterial (20%); os sinais de alarme mais frequentes foram vomitos persistentes (23,7%) e plaquetopenia (22,7%); verificou-se positividade dos resultados laboratoriais inclusive nas coletas inoportunas, apos cinco dias do inicio dos sintomas, e grande dispersao na distribuicao espacial dos casos. CONCLUSAO: entre os casos suspeitos de dengue internados, predominaram adultos e com presenca de sinais e sintomas de alarme.

Characteristics of suspected dengue patients admitted to hospital in Goiás state capital in 2013: a period of severe outbreak

OBJETIVO: descrever o perfil clinico-epidemiologico e a distribuicao espacial dos casos suspeitos de dengue com hospitalizacao em Goiânia-GO, Brasil, durante a epidemia de 2013. METODOS: estudo descritivo sobre dados do Sistema de Informacao de Agravos de Notificacao, Sistema Gerenciador de Ambiente Laboratorial, Sistema de Regulacao de Leitos, e do Sistema da Companhia de Processamento de Dados de Goiânia. RESULTADOS: foram incluidos 616 casos suspeitos de dengue com idade media de 36 anos (desvio-padrao: 14,8), 55,2% do sexo feminino, 9,3% confirmados laboratorialmente e 9,7% apresentando comorbidades; a comorbidade mais frequente foi hipertensao arterial (20%); os sinais de alarme mais frequentes foram vomitos persistentes (23,7%) e plaquetopenia (22,7%); verificou-se positividade dos resultados laboratoriais inclusive nas coletas inoportunas, apos cinco dias do inicio dos sintomas, e grande dispersao na distribuicao espacial dos casos. CONCLUSAO: entre os casos suspeitos de dengue internados, predominaram adultos e com presenca de sinais e sintomas de alarme.

Caracterización de los casos sospechosos de dengue hospitalizados en la capital de Goiás en 2013: período de gran epidemia

OBJETIVO: descrever o perfil clinico-epidemiologico e a distribuicao espacial dos casos suspeitos de dengue com hospitalizacao em Goiânia-GO, Brasil, durante a epidemia de 2013. METODOS: estudo descritivo sobre dados do Sistema de Informacao de Agravos de Notificacao, Sistema Gerenciador de Ambiente Laboratorial, Sistema de Regulacao de Leitos, e do Sistema da Companhia de Processamento de Dados de Goiânia. RESULTADOS: foram incluidos 616 casos suspeitos de dengue com idade media de 36 anos (desvio-padrao: 14,8), 55,2% do sexo feminino, 9,3% confirmados laboratorialmente e 9,7% apresentando comorbidades; a comorbidade mais frequente foi hipertensao arterial (20%); os sinais de alarme mais frequentes foram vomitos persistentes (23,7%) e plaquetopenia (22,7%); verificou-se positividade dos resultados laboratoriais inclusive nas coletas inoportunas, apos cinco dias do inicio dos sintomas, e grande dispersao na distribuicao espacial dos casos. CONCLUSAO: entre os casos suspeitos de dengue internados, predominaram adultos e com presenca de sinais e sintomas de alarme.