Guacira Corrêa de Matos

Interações medicamentosas potenciais entre idosos em uso dos anti-hipertensivos da Relação Nacional de Medicamentos Essenciais do Ministério da Saúde do Brasil

The aim of this study was to estimate the prevalence of potential interactions between antihypertensives and other drugs. A household survey was conducted with individuals 60 years or older residing in Rio de Janeiro, Brazil. Potential moderately or very severe drug-drug interactions with antihypertensives, documented as suspected, probable or established, were identified. A total of 577 elderly were interviewed (mean age = 72 years), 45.2% of whom were using antihypertensives, of which 31.0% were subject to potential drug-drug interactions. Most of the interactions were moderately severe. Compared to the other elderly, those with potential drug-drug interactions showed more than fourfold odds of using five or more medicines and more than twofold odds of having been hospitalized in the previous year. Among the most frequent pairs of interactions, 75% cause a reduction in the hypotensive effect (65/87), which can result in low effectiveness of blood pressure control, prescribing of more drugs, and risk of other adverse events and interactions.

Aprazamento de medicamentos por enfermeiros em prescrições de hospital sentinela

This study was aimed at identifying the distribution profile of intravenous medicine schedules and analyzing potential severe interactions due to the scheduling. A cross-sectional study with documentary analysis was undertaken. Approval was obtained from the ethics committee of the hospital where the research was developed between January and April 2008. The sample consisted of 135 prescriptions with 1847 doses. Results showed an average of 8.8 doses per prescription (±1.05) and 17.6 (±0.9) at the emergency and intensive care service, respectively. Scheduling was predominant in the evening hours (57.11%) in both sectors. Forty-three severe interactions were found, with a prevalence rate of 1.85 and an odds ratio of 5.7, in prescriptions with more than five drugs. The prevalent drugs involved in interactions with a potential for serious injury were sodium phenytoin, vancomycin and ranitidine hydrochloride. It is concluded that the prevalent scheduling within four hours favors the appearance of interactions even in prescriptions with up to five drugs. DESCRIPTORS: Drug interactions. Nursing. Intensive care. Emergencies.This study was aimed at identifying the distribution profile of intravenous medicine schedules and analyzing potential severe interactions due to the scheduling. A cross-sectional study with documentary analysis was undertaken. Approval was obtained from the ethics committee of the hospital where the research was developed between January and April 2008. The sample consisted of 135 prescriptions with 1847 doses. Results showed an average of 8.8 doses per prescription (±1.05) and 17.6 (±0.9) at the emergency and intensive care service, respectively. Scheduling was predominant in the evening hours (57.11%) in both sectors. Forty-three severe interactions were found, with a prevalence rate of 1.85 and an odds ratio of 5.7, in prescriptions with more than five drugs. The prevalent drugs involved in interactions with a potential for serious injury were sodium phenytoin, vancomycin and ranitidine hydrochloride. It is concluded that the prevalent scheduling within four hours favors the appearance of interactions even in prescriptions with up to five drugs. DESCRIPTORS: Drug interactions. Nursing. Intensive care. Emergencies.

DRUG SCHEDULING FOR NURSES IN PRESCRIPTIONS AT SENTINEL HOSPITAL

This study was aimed at identifying the distribution profile of intravenous medicine schedules and analyzing potential severe interactions due to the scheduling. A cross-sectional study with documentary analysis was undertaken. Approval was obtained from the ethics committee of the hospital where the research was developed between January and April 2008. The sample consisted of 135 prescriptions with 1847 doses. Results showed an average of 8.8 doses per prescription (±1.05) and 17.6 (±0.9) at the emergency and intensive care service, respectively. Scheduling was predominant in the evening hours (57.11%) in both sectors. Forty-three severe interactions were found, with a prevalence rate of 1.85 and an odds ratio of 5.7, in prescriptions with more than five drugs. The prevalent drugs involved in interactions with a potential for serious injury were sodium phenytoin, vancomycin and ranitidine hydrochloride. It is concluded that the prevalent scheduling within four hours favors the appearance of interactions even in prescriptions with up to five drugs. DESCRIPTORS: Drug interactions. Nursing. Intensive care. Emergencies.This study was aimed at identifying the distribution profile of intravenous medicine schedules and analyzing potential severe interactions due to the scheduling. A cross-sectional study with documentary analysis was undertaken. Approval was obtained from the ethics committee of the hospital where the research was developed between January and April 2008. The sample consisted of 135 prescriptions with 1847 doses. Results showed an average of 8.8 doses per prescription (±1.05) and 17.6 (±0.9) at the emergency and intensive care service, respectively. Scheduling was predominant in the evening hours (57.11%) in both sectors. Forty-three severe interactions were found, with a prevalence rate of 1.85 and an odds ratio of 5.7, in prescriptions with more than five drugs. The prevalent drugs involved in interactions with a potential for serious injury were sodium phenytoin, vancomycin and ranitidine hydrochloride. It is concluded that the prevalent scheduling within four hours favors the appearance of interactions even in prescriptions with up to five drugs. DESCRIPTORS: Drug interactions. Nursing. Intensive care. Emergencies.

Human albumin use at hospitals in the Metropolitan Region of Rio de Janeiro, Brazil

The study analyzes the use of human albumin in hospitals in Rio de Janeiro, Brazil, using inpatient data from the information system of Brazils health system between 1999 and 2001. Death was the main outcome as patients died in 32% of admissions in which human albumin was used as compared with 4% of all admissions in the same period and region. The Charlson Comorbidity Index was included for risk adjustment. Human albumin was used in 10,111 in-patients more than 1 year old. 87,774 50-ml bottles of 20% human albumin were consumed at a cost of US

[Potential drug-drug interactions among elderly using antihypertensives from the Brazilian List of Essential Medicines].

1,755. The main diagnoses were neoplasms (29.1%), diseases of the digestive system (17.5%) and circulatory system (16%). Death rate increased with age, public ownership of the hospital, clinical services (as opposed to surgical services), length of stay and use of intensive care. Death was associated with use of more than four bottles of human albumin (PR: 1.30; 99%CI: 1.23-1.37), adjusted for severity and speciality. The results are cause for concern as they may be related to poor compliance with guidelines, excess of risk to patients and unnecessary expenses for the public health system.

Albumina humana prescrita para casos de desnutrição em hospitais do Rio de Janeiro

The aim of this study was to estimate the prevalence of potential interactions between antihypertensives and other drugs. A household survey was conducted with individuals 60 years or older residing in Rio de Janeiro, Brazil. Potential moderately or very severe drug-drug interactions with antihypertensives, documented as suspected, probable or established, were identified. A total of 577 elderly were interviewed (mean age = 72 years), 45.2% of whom were using antihypertensives, of which 31.0% were subject to potential drug-drug interactions. Most of the interactions were moderately severe. Compared to the other elderly, those with potential drug-drug interactions showed more than fourfold odds of using five or more medicines and more than twofold odds of having been hospitalized in the previous year. Among the most frequent pairs of interactions, 75% cause a reduction in the hypotensive effect (65/87), which can result in low effectiveness of blood pressure control, prescribing of more drugs, and risk of other adverse events and interactions.

Suspected adverse drug reactions reported for Brazilian children: cross-sectional study

OBJETIVO: Este estudo descreve e analisa a adequacao da prescricao da AH, para reposicao nutricional, nos hospitais da regiao metropolitana do Estado do Rio de Janeiro, e explora o uso do SIH/SUS para avaliar o perfil e a qualidade da prescricao de medicamentos. METODOS: As informacoes foram extraidas do Sistema de Informacoes Hospitalares do Sistema Unico de Saude (SIH/SUS), entre 1999 e 2001. RESULTADOS: Houve registro de utilizacao de AH para reposicao nutricional em 121 internacoes de maiores de um ano, nas quais a justificativa mais frequente foi a desnutricao proteico-calorica (93%). O uso da AH foi classificado como inadequado em 91% dos casos. Em 51% dos casos ocorreu o obito e a clinica medica foi responsavel 87% das internacoes. A inadequacao de prescricao esteve associada positivamente a duracao da internacao, com RP 1,14 (IC95% 1,01-1,28). O obito mostrou associacao positiva com a idade do paciente, com RP 1,72 (IC 95% 1,19-2,48). A ausencia de parâmetros laboratoriais e a insuficiencia de informacoes clinicas no banco limitaram a analise dos dados. O sub-registro no SIH das internacoes no âmbito do SUS foi outro importante fator limitante para o conhecimento do problema. CONCLUSAO: Apesar das limitacoes, o estudo mostrou o elevado nivel de inadequacao de utilizacao da AH para reposicao nutricional e as possibilidades de uso do banco do SIH/SUS na avaliacao da qualidade da prescricao de medicamentos como a AH incluidos entre os procedimentos especiais.

The inconveniences of polysemy in the database era—don't call it “drug” unless you mean it

OBJECTIVE To assess spontaneous reports of suspected adverse drug reactions in children aged 0-12 years from the Brazilian Health Regulatory Agency between 2008 and 2013. METHODS A cross-sectional study on suspected adverse drug reactions reports related to medicines and health products in children was carried out for a six-year period (2008-2013). Year of report, origin of report by Brazilian state, gender, age, suspected drug, adverse reaction description and seriousness were included in the analysis. The data obtained was compared to the number of pediatric beds in health services and to global data from the VigiBase (World Health Organization). RESULTS A total of 3330 adverse drug reactions were reported in children in Brazil in the investigated period (54% were in boys). About 28% of suspected adverse drug reactions reports involved 0 to 1-year-old children. Almost 40% of reports came from the Southeast region. Approximately 60% were classified as serious events. There was death in 75 cases. Nearly 30% of deaths involved off-label use; 3875 medicines (465 active substances) were considered suspected drugs. Anti-infective (vancomycin, ceftriaxone, oxacillin, and amphotericin), nervous system (metamizole) and alimentary tract and metabolism medicines were more frequent in reports. CONCLUSIONS The distribution of suspected adverse drug reactions reports by sex and age group corresponded to the profile of children hospitalized in Brazil. Data about seriousness and medicines reported may be useful to encourage regulatory actions and improve the safe use of medicines in children.

Atencao Farmaceutica e Atencao Flutuante: formacoes de compromisso entre Farmacia e Psicanalise

Polysemy is a linguistic characteristic common in many languages that enriches oral expression and is the basis of many puns that constitute a big problem for translators of Shakespeare’s plays into Spanish or French. The context, the intonation or companion words usually avoid interpretation mistakes either in oral or written language. Additionally, nowadays polysemy can be problematic for data mining and medical studies based on databases containing clinical information of patients, up to the point of threatening their usefulness for specific purposes. One example is “drugs”. InPhaedrus, Plato cites the Greekword “pharmakon” and describes its different meanings (“remedy”, “poison” and “drug or philtre”—either for good or bad purposes Q1 ). The text also explains that sometimes beneficial or harmful effects of a pharmakon depend on the administered dosage.1 Later, pharmacology took that Greek root and was used to define “the scientific study of drugs and how they are used in medicine”; so “drug”, whose etymology is not well-known, became a common term to refer both, remedies and substances of abuse.2 The word drug has been introduced to designate any natural or synthetic substance able to produce physiologic or psychological alterations, beneficial or not,2,3 thus keeping the original polysemy of pharmakon. According to the definition, aspirin and penicillin are drugs; marihuana and methadone are drugs, too. The uses and effects of these substances are different, and the meaning and consequences of the same word used to designate them can also be completely different. So, “to sell drugs” can be either a perfectly legal activity carried out by pharmacists, or the illegal doings carried out by dealers in dark alleys. Both meanings require a context3 but in certain circumstances, the context is lacking; this is the case of taxonomy systems such as the International Classification of Diseases (ICD).4 The word “drug” appears in 262 ICD-10 codes where polysemy can be a cause of misunderstanding in two different steps of the process: (i) during the codification of diagnoses and symptoms from clinical charts, and (ii) later, when researchers retrieve electronic registers for analyses and studies. Several authors have already attracted attention to problems derived from polysemy in clinical practice (e.g., promoting healthy eating),5 the management and research using scientific databases,6 and automatic translation systems.7 This is a potential problem because research using large databases will increase in the future.

Prevalencia de interacciones de fármacos en ancianos que toman antihipertensivos dentro de la relación nacional de medicamentos esenciales de Brasil

This paper presents an interdisciplinary overview of the rational use of medicine from a metapsychological standpoint. The need to reinstate the activity of the pharmaceutical professionals vis-a-vis their patients through pharmaceutical care demands the intervention of new know-how that can ensure a revitalization of this human relationship. In this sense, by means of a compilation of passages from the works of Freud, some of the most important metapsychological concepts were presented: psychic apparatus, evenly hovering attention and commitment formations. These concepts were then presented as an applicable theoretical tool for qualitative analysis in pharmaceutical care, though especially for participant observation. Thus, the main objective was to provide new tools for the pharmacists in terms of listening and receptivity, which can enhance their professional routine regarding the relationship with their patients, as well as in the gathering and interpretation of qualitative data concerning human issues involving pharmaceutical care.This paper presents an interdisciplinary overview of the rational use of medicine from a metapsychological standpoint. The need to reinstate the activity of the pharmaceutical professionals vis-a-vis their patients through pharmaceutical care demands the intervention of new know-how that can ensure a revitalization of this human relationship. In this sense, by means of a compilation of passages from the works of Freud, some of the most important metapsychological concepts were presented: psychic apparatus, evenly hovering attention and commitment formations. These concepts were then presented as an applicable theoretical tool for qualitative analysis in pharmaceutical care, though especially for participant observation. Thus, the main objective was to provide new tools for the pharmacists in terms of listening and receptivity, which can enhance their professional routine regarding the relationship with their patients, as well as in the gathering and interpretation of qualitative data concerning human issues involving pharmaceutical care.