Silvia Regina Secoli

Polifarmácia: interações e reações adversas no uso de medicamentos por idosos

O artigo tem por objetivo refletir sobre a polifarmacia em idosos com enfase nas reacoes adversas e nas interacoes medicamentosas. A vulnerabilidade dos idosos aos problemas decorrentes do uso de medicamentos e bastante alta, o que se deve a complexidade dos problemas clinicos, a necessidade de multiplos agentes terapeuticos e as alteracoes farmacocineticas e farmacodinâmicas inerentes ao envelhecimento. Deste modo, racionalizar o uso de medicamentos e evitar os agravos advindos da polifarmacia serao, sem duvida, um dos grandes desafios da saude publica desse seculo.The article has for objective to reflect on the polypharmacy of the aged with emphasis in the adverse drug reactions and the drug-drug interactions. The vulnerability of the elderly to the problems related from the use as of drugs is pretty upswing, the one to in case that must the complexity of the problems clinical, at the must as of need pharmacotherapeutic interventions, and to the update pharmacokinetic and pharmacodynamic changes inherent to the aging. In this way, to rationalize the drugs utilization and to avoid the injury related to the polypharmacy will be, doubtless, one of the biggest challenges for public health in this century.

Polifarmácia entre idosos do Município de São Paulo - Estudo SABE

Polypharmacy for the elderly and associated factors were assessed. A cross-sectional study was conducted using data from the SABE Study (Health, Well-being and Aging), 2006. 1,115 individuals representing 422,377 elderly aged 65 or more, living in Sao Paulo City, were interviewed. Polypharmacy was defined as the use of five or more medications. A multivariate regression logistics was used. Polypharmacy prevalence was 36%. Female (OR = 1.7; IC 95%: 1.0; 2.9), age over 75 years (OR = 1.9; CI 95%: 1.3; 2.7), higher income (OR = 1.8; CI 95%: 1.2; 2.8), working (OR = 1.8; CI 95%: 1.1; 2.9), regular self assessed health (OR = 1.6; CI 95%: 1.1; 2.3) or poor (OR = 2.6; CI 95%: 1.4; 4.9), hypertension (OR = 2.0; CI 95%: 1.4; 2.9), diabetes (OR = 4.1; CI 95%: 2.2; 7.5), rheumatic diseases (OR = 2.3; CI 95%: 1.5; 3.6) and cardiac problems (OR = 2.9; CI 95%: 1.9; 4.5) were associated positively with polypharmacy. Using only the public health system (OR = 0.5, 95% CI: 0.3; 0.7) was inversely associated with polypharmacy. Medicines for the cardiovascular system and for the alimentary tract and metabolism were the most used. The knowledge of factors associated with polypharmacy, such as those identified in this study, may be useful to alert health professionals about the importance of identifying and monitoring the elderly groups most vulnerable to polypharmacy.

Interações medicamentosas: fundamentos para a pratica clínica da enfermagem

Nowadays drugs interactions constitute one the most important subjects of pharmacological for clinical practive of health professionals. The concomitant use of many drugs as therapeutic strategy and the growing number of agents available contribute to enlarge the benefical effects of therapy. Besides, these factors can also permit the mutual interference of pharmacological actions that result in alteractions of therapeutics effects. The aim of this article is to review the principles pharmacological related to the mechanisms of drugs interactions, to describe the types of interactive drugs; the groups of risk patients and to suggest specific nursing interventions aiming the prevention of occurrence of adverse reactions from accidental interactions.

Uso de medicamentos potencialmente inapropriados por idosos do Município de São Paulo, Brasil: Estudo SABE

Various medicines are considered unsuitable for older adults due to alterations in pharmacokinetics/pharmacodynamics, lack of therapeutic efficacy, and/or increased risk of adverse events exceeding potential benefits. The aim of this study was to determine the prevalence of potentially inappropriate medication among older adults in the city of São Paulo, Brazil. A population-based cross-sectional study was conducted in a sample of 1,254 individuals aged 60 years or older (participants in the SABE Study), representing the elderly population of the city in 2006. Potentially inappropriate medication was defined according to the Beers criteria. Prevalence of potentially inappropriate medication was 28%. Potentially inappropriate medication was associated with polypharmacy (p=0.001), two or more diseases (p=0.011), and female gender (p=0.007). Thirty-six potentially inappropriate medicines were identified, the majority of which involving prescription medications. Specific criteria are needed for the Brazilian population, in addition to awareness-raising on clinical pharmacology in older adults. Prescription protocols and software programs could assist in the process of rational prescribing in this age group.Alguns medicamentos sao considerados improprios para o idoso, devido a alteracoes na farmacocinetica e farmacodinâmica, por falta de eficacia terapeutica ou por um risco aumentado de efeitos adversos superando seus beneficios. Verificou-se a prevalencia do uso de medicamentos potencialmente inapropriados, segundo os criterios de Beers, por idosos do Municipio de Sao Paulo, Brasil, participantes do Estudo SABE. Trata-se de um estudo transversal, de base populacional, cuja amostra de 1.254 individuos com 60 anos ou mais representava a populacao idosa do municipio no ano de 2006. Verificou-se a prevalencia de 28% de uso de medicamentos potencialmente inapropriados. No modelo de regressao logistica multipla, as variaveis associadas ao uso foram uso de cinco medicamentos ou mais (p = 0,001), presenca de duas ou mais doencas (p = 0,011) e sexo feminino (p = 0,007). Identificou-se o uso de 36 medicamentos potencialmente inapropriados, a maioria de venda sob prescricao. Sao necessarios criterios especificos para a populacao brasileira e ampla divulgacao da farmacologia clinica do idoso. Protocolos ou softwares para prescricao tambem podem auxiliar a prescricao racional para esse grupo.

Polypharmacy: interaction and adverse reactions in the use of drugs by elderly people

O artigo tem por objetivo refletir sobre a polifarmacia em idosos com enfase nas reacoes adversas e nas interacoes medicamentosas. A vulnerabilidade dos idosos aos problemas decorrentes do uso de medicamentos e bastante alta, o que se deve a complexidade dos problemas clinicos, a necessidade de multiplos agentes terapeuticos e as alteracoes farmacocineticas e farmacodinâmicas inerentes ao envelhecimento. Deste modo, racionalizar o uso de medicamentos e evitar os agravos advindos da polifarmacia serao, sem duvida, um dos grandes desafios da saude publica desse seculo.The article has for objective to reflect on the polypharmacy of the aged with emphasis in the adverse drug reactions and the drug-drug interactions. The vulnerability of the elderly to the problems related from the use as of drugs is pretty upswing, the one to in case that must the complexity of the problems clinical, at the must as of need pharmacotherapeutic interventions, and to the update pharmacokinetic and pharmacodynamic changes inherent to the aging. In this way, to rationalize the drugs utilization and to avoid the injury related to the polypharmacy will be, doubtless, one of the biggest challenges for public health in this century.

Métodos de pesquisa em avaliação de tecnologia em saúde

Currently it is expected a higher efficiency of health care and this can be achieved by health technology assessment. This aims, for one side, to determine the best evidence of efficacy or effectiveness of a given treatment, and, on the other side, to determine the costs associated with this treatment. Only cost-effective alternatives, in other words, efficients, should be adopted in hospitals or public or private health care system. For instances, the increasing costs of biologics treatments in inflammatory bowel disease or hepatology or oncology. There is a need to increase the number of health technology assessment research not only to identify those treatment that works from those does not, but also whether the costs associated with each treatment compensate its use. This young researcher forum article introduce the concepts and basic methods used in health technology assessment studies.

Farmacoeconomia: perspectiva emergente no processo de tomada de decisão

A farmacoeconomia, uma disciplina nova, surgida no cenario internacional na decada de 1980, tem crescido de forma expressiva, especialmente no âmbito dos sistemas de saude. Sua forma de investigacao mais difundida e a avaliacao economica da terapia medicamentosa, em que sao usados metodos oriundos da economia da saude. A farmacoeconomia identifica, calcula e compara custos (recursos consumidos), riscos e beneficios (clinicos, economicos, humanisticos) de programas ou terapias especificas, e determina quais sao as alternativas que produzem os melhores resultados em face dos recursos investidos. O presente artigo aborda os principios norteadores da farmacoeconomia; descreve os tipos de analise e discorre sobre as aplicacoes da disciplina nos diferentes segmentos da sociedade. A farmacoeconomia pode constituir-se num importante instrumento de auxilio a tomada de decisoes, pois introduz nos servicos de saude, entre os profissionais, a racionalidade economica, como o intuito de complementar a clinica. A utilizacao correta dos termos e o conhecimento da metodologia sao, porem, pre-requisitos indispensaveis para aplicar, e interpretar corretamente, os resultados das investigacoes.

Fatores associados ao uso de psicotrópicos por idosos residentes no Município de São Paulo

The objectives of study were to identify the prevalence and factors associated to the use of psychotropic drugs among elderly people in São Paulo city. It is a cross-sectional study. Data were used from the SABE survey (for Health, Well-being and Ageing). The sample was constituted of 1.115 elderly people, aging 65 and over, which were interviewed by standard method. In the data analysis, it was used univariate and multiple logistic regression, stepwise forward and level of significance of 5%. The prevalence of the use of psychotropic drugs of 12,2% and the factors associated were female gender (OR=3,04 IC95%= 1,76-5,23) and polypharmacy (OR=4,91 IC95%=2,74-8,79). The use of psychotropics drugs by the elderly must have their benefits and risks very well established. Elder women, especially those who were submitted to a polipharmacy, deserve special attention to adjust dosage and duration of the treatment, with the purpose of minimizing the adverse outcomes.Los objetivos del estudio fueron identificar la prevalencia y los factores relacionados al uso de psicotropicos entre ancianos del Sao Paulo. Es un estudio trasversal, poblacional, cuyos datos fueron obtenidos del Estudio de Salud, Bien-estar y Envejecimiento. La muestra constituye de 1.115 ancianos de 65 anos o mas, los cuales fueron encuestados, por medio de instrumentos padronizados. El analisis de los datos fue utilizada una regresion logistica univariado y multiple, stepwise forward y nivel de significancia del 5%. La prevalencia de uso de psicotropicos fue 12,2% y los factores asociados fueron sexo femenino (OR= 3,04 IC95%=1,76-5,23) y polifarmacia (OR = 4,91 IC95%=2,74-8,79). El uso de psicotropicos por ancianos debe tener su evaluacion riesgo-beneficio muy bien establecida. Mujeres ancianas, especialmente las que estan sometidas a la polifarmacia merecen atencion diferenciada, en el ajuste posologico y tiempo de tratamiento, con el fin de minimizar los resultados adversos que estan sujetas.

Associação entre flebite e retirada de cateteres intravenosos periféricos

The objective of this prospective study is to verify the incidence of phlebitis among patients with peripheral intravenous catheters and to identify possible relations between this complication and catheter-related variables. Seventy-six adult patients hospitalized in a Brazilian university hospital were evaluated, using charts with patient-related variables, peripheral intravenous catheters, and pharmacological therapy. Phlebitis was evaluated based on Infusion Nurses Society proposed classification. Inferential and descriptive statistics have been used. We observed 25.8% incidence of phlebitis, from which 40% presented pain occurrences, with erythema and edema. Among patients with phlebitis, 60% developed a complication episode, and the average period of permanence of peripheral intravenous catheters with phlebitis was 3.10 days. We observed phlebitis associations to adverse occurrences during the removal of peripheral intravenous catheters (p<0.001). Educational actions and professional training for nursing personnel are necessary for dealing with intravenous therapy, mainly on what is related to early detection of phlebitis. dESCRIpTORS: Intravenous infusions. Phlebitis. Nursing. Nursing care. Peripheral catheterization.Se trata de un estudio prospectivo para determinar la incidencia de flebitis en pacientes con cateter intravenoso periferico e identificar posibles asociaciones de esta complicacion con las variables relacionadas con el cateter intravenoso periferico. Se evaluaron setenta y seis pacientes adultos hospitalizados en el sector de enfermeria de un hospital universitario, mediante un formulario que contiene las variables relacionadas con los pacientes, el cateter intravenoso periferico y la terapia farmacologica. La flebitis fue evaluada de acuerdo a la clasificacion propuesta por la Infusion Nurses Society. Se utilizo la estadistica descriptiva e inferencial. La incidencia de flebitis fue del 25,8%, de los cuales, el 40% presento sintomas clinicos de dolor, con eritema y/o edema. Entre los pacientes con flebitis, el 60% desarrollo un episodio de complicacion, y el tiempo medio de permanencia del cateter intravenoso periferico con flebitis fue 3,10 dias. Se observo una relacion de la flebitis con la retirada de cateter intravenoso periferico por eventos adversos (p<0,001). Se necesitan acciones educativas y capacitacion del personal de enfermeria para el manejo de la terapia intravenosa, especialmente en lo que respecta a la deteccion temprana de flebitis.

Cost-effectiveness analysis of the analgesic therapy of postoperative pain

The study aimed to compare cost-effectiveness of analgesic schemes administered to 89 patients submitted to hemorrhoidectomy, on the 1st postoperative day. The descriptive and retrospective study was carried out in a General Hospital, Sao Paulo, Brazil. In order to carry out the cost-effectiveness analysis, the five most frequently used analgesic schemes were identified in practice. The main outcome was the absence of breakthrough pain episodes. While calculating the costs, analgesics and all devices related to the schemes were taken into consideration. Codeine 120mg+acetaminophen 2000mg was the most effective therapy with the lowest cost per patient with no breakthrough pain episodes (