Klinički ishodi i njihova povezanost s potencijalno neprikladnim lijekovima

master's thesis

• Title (english): Assessment of potentially inappropriate medications and clinical outcomes
• Author: Patricia Marić
• Mentor: Iva Mucalo (mentor)
• Mentor: Maja Ortner Hadžiabdić (mentor)
• Committee member: Iva Mucalo (predsjednik povjerenstva)
• Committee member: Maja Ortner Hadžiabdić (član povjerenstva)
• Committee member: Živka Juričić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; Zagreb
• Defense date and country: 2016-09-30, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Cilj istraživanja bio je odrediti PNL-e u bolesnika starije životne dobi koristeći Sveobuhvatni protokol te odrediti učestalost
povezanosti PNL-a s mjerenim kliničkim ishodima. Prospektivno opservacijsko istraživanje provedeno je u razdoblju od
listopada 2014. do prosinca 2015. godine u Klinici za unutarnje bolesti Kliničke bolnice Dubrava. U istraživanje su bili
uključeni akutno i elektivno hospitalizirani bolesnici u dobi od 65 i više godina starosti koji su u terapiji imali najmanje
jedan redoviti receptni lijek. Za svakoga bolesnika prikupljeni su podaci o lijekovima prije hospitalizacije i pri otpustu,
podaci o komorbiditetima te osnovni laboratorijski nalazi uvidom u medicinsku dokumentaciju, temperaturnu listu, iz
razgovora s bolesnicima, a prema potrebi s liječnicima obiteljske medicine, skrbnicima i/ili članovima obitelji. Podaci o
kliničkim ishodima prikupljeni su putem telefonskog razgovora s bolesnicima ili članovima obitelji dva ili više mjeseca
nakon njihovog otpusta iz bolnice. Ishodi su uključivali podatke o ponovnoj hospitalizaciji, prijemu u hitnu medicinsku
službu, neplaniranom odlasku liječniku obiteljske medicine, promjeni terapije i nuspojavama. U istraživanje je bilo
uključeno 248 bolesnika prosječne dobi 72,9 ± 6,2 godina koji su u prosjeku koristili 5,9 ± 3,3 lijekova te imali 6,7 ± 3,0
dijagnoza. Pomoću Sveobuhvatnog protokola otkriveno je 177 PNL-a te 148 potencijalno opasnih lijek-lijek interakcija.
Najčešće propisivani PNL-ovi su bili benzodiazepini, moksonidin te antikoagulansi. Upotreba lijekova koji mogu uzrokovati
hiperkalijemiju bila je najučestalija interakcija. Klinički ishodi ustanovljeni su u 117 (47,2%) pacijenata. Za 23 PNL-a
smatramo da su povezani s nepovoljnim kliničkim ishodima. Najčešći ishodi uključivali su krvarenje korištenjem varfarina i
antikoagulansa te vrtoglavicu i opću slabost primjenom benzodiazepina. Pomoću Sveobuhvatnog protokola identificirana je
velika prevalencija PNL-ova čijim se sprječavanjem može postići racionalnije propisivanje lijekova, smanjiti rizik od
nastanka nuspojava i interakcija te smanjiti ukupni troškovi liječenja.

Abstract (english)

The objective of this study was to identify PIMs by using a validated originally developed protocol and assess their impact on
measured clinical outcomes. A cross-sectional observational study was conducted in the period from October 2014 to
December 2015 in Department of Internal Medicine, University Hospital Dubrava. Patients older than 65 years submitted by
emergency or elective admission and with at least one drug after discharge were included. For each patient full drug history at
hospital admission and discharge, comorbidities and basic laboratory reports were retrieved. Clinical outcomes were obtained
by telephone interview following two or more months hospital discharge and included the incidence of hospital readmission
and emergency department visits, side-effects and therapy amendments. There were included 248 patients in this study average
age 72,9 ± 6,2 that had average 5,9 ± 3,3 medications and 6,7 ± 3,0 comorbidities. Using comprehensive protocol, there were
177 PIMs detected, and 148 potentially dangerous drug-drug interactions (DDIs). The most common prescribed medications
were long-acting benzodiazepines, moxonidine and anticoagulant and antiplatelet drugs. Concomitant use of drugs that possibly
lead to hyperkalemia is detected as most usual interaction. A total of 117 clinical outcomes were obtained and 23 were
associated with PIMs. The most common were bleeding caused by warfarin and other anticoagulant drug and dizziness and
general weakness using benzodiazepines. Using comprehensive protocol a high incidence of PIMs was detected whose
prevention may achieve more rational prescribing, decrease a risk of side-effects and interactions including total costs of
treatment.

• Keywords: starije osobe; potencijalno neprikladni lijekovi; sveobuhvatni protokol; interakcije lijekova; klinički ishod
• Keywords (english): elderly; potentially inappropriate medications; comprehensive protocol; drug interactions; clinical outcomes
• Language: croatian
• URN:NBN: urn:nbn:hr:163:622031
• Study programme: Title: Pharmacy; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: magistar/magistra farmacije (magistar/magistra farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Access restricted to students and staff of home institution
• Created on: 2016-12-06 13:56:38