Prilagodba doza lijekova u osoba na kroničnoj hemodijalizi koje se liječe na Odjelu za dijalizu Kliničke bolnice Dubrava u Zagrebu

professional thesis

• Author: Ivan Papić
• Mentor: Vesna Bačić Vrca (mentor)
• Committee member: Maja Ortner Hadžiabdić (predsjednik povjerenstva)
• Committee member: Vesna Bačić Vrca (član povjerenstva)
• Committee member: Srećko Marušić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Centre for applied pharmacy); Zagreb
• Defense date and country: 2021-02-05, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Cilj istraživanja: Cilj ovog istraživanja je utvrditi učestalost neprikladnog doziranja lijekova
koji zahtijevaju prilagodbu doze i ostalih farmakoterapijskih problema u osoba na kroničnoj
hemodijalizi, te prihvaćenost farmaceutskih intervencija od strane liječnika.
Ispitanici i metode: U istraživanje su uključeni bolesnici liječeni intermitentnom hemodijalizom
na Odjelu za dijalizu KB Dubrava. Pacijentima je uzeta medikacijska povijest te je učinjen
farmakoterapijski pregled od strane kliničkog farmaceuta. Za lijekove kojima doza nije
bila prilagođena klinički farmaceut uputio prijedlog intervencije liječniku u pisanom obliku.
Ukoliko je farmakoterapijskim pregledom uočen neki drugi farmakoterapijski problem također
je upućena farmaceutska intervencija. Intervencije su se bilježile kao prihvaćene ili neprihvaćene.
Rezultati: U istraživanje je uključeno 60 osoba, od toga 38 muškaraca i 22 žene. Prosječna
dob ispitanika bila je 67.0 ± 12.4 godina. Pacijenti su koristili 12,2 ± 4,4 lijekova, od toga 9,9
± 4,3 u kućnim uvjetima u 13,6 ± 5,9 doza, te 2,2 ± 0,7 lijekova u dijaliznom centru. Za 4,2%
od ukupno 596 propisanih lijekova doza nije bila prilagođena, dok je za 4,5% lijekova postojala
kontraindikacija za primjenu u osoba na hemodijalizi. 55% pacijenta imalo je neprilagođenu
dozu lijeka i/ili kontraindikaciju za primjenu lijeka. Prihvaćenost farmaceutskih intervencija
u ovim slučajevima bila je 37%. Za ostale farmakoterapijske probleme intervencije su
u potpunosti prihvaćene: neadherencija (19), interakcije lijekova (11) i duplikacija terapije
(9). Ukupno je prihvaćeno 64% upućenih farmaceutskih intervencija.
Zaključak: Osobe koje se liječe hemodijalizom koriste veliki broj lijekova, a preko polovice
ispitanika imali su lijek kojem doza nije prilagođena i/ili su koristili lijek koji je kontraindiciran.
Veliki broj farmaceutskih intervencija upućuje na nužnost uključivanja kliničkog farmaceuta
u tim koji skrbi o osobama na kroničnoj hemodijalizi kako bi se osigurali pozitivni ishodi
liječenja, uz smanjenje rizika za nastanak nuspojava i povećanja sigurnosti pacijenata.

Abstract (english)

Objectives: The aim of this study was to determine the frequency of inappropriate dosing of
drugs requiring dose adjustment in patients on chronic hemodialysis and other pharmacotherapeutic
problems and the acceptance rate of pharmaceutical interventions by physicians.
Patients and methods: The study included patients on intermittent hemodialysis at the Dialysis
Department of Clinical hospital Dubrava. Medication history was obtained and a pharmacotherapeutic
review was performed by a clinical pharmacist. Drugs for which the dose was
not adjusted, the clinical pharmacist addressed the suggested intervention to the nephrologyst.
If another pharmacotherapeutic problem is detected during the pharmacotherapeutic review,
pharmaceutical intervention is also referred. Interventions were recorded as accepted or unaccepted.
Results: The study included 60 patients, of which 38 were men and 22 were women. The
mean age of the subjects was 67.0 ± 12.4 years. Patients used 12.2 ± 4.4 drugs, of which 9.9 ±
4.3 at home in 13.6 ± 5.9 doses, and 2.2 ± 0.7 drugs in the dialysis center. 4,2% of 596 prescribed
drugs had the unadjusted dose, while 4,5% drugs were contraindicated in hemodialysis
population. 55% patients had an unadjusted dose and/or contraindication to the used drug.
The acceptance rate of pharmaceutical interventions was 37% in this regard. Pharmaceutical
interventions regarding other drug related problems were completely accepted: nonadherence
(19), duplication of therapy (9) and drug interactions (11). In total, 64 % of all pharmaceutical
interventions were accepted.
Conclusion: People undergoing hemodialysis use a large number of drugs, and over half of
the subjects had a drug whose dose were unadjusted and/or its use was contraindicated. A
large number of pharmaceutical interventions suggest the need to include a clinical pharmacist
in a team caring for people on chronic hemodialysis to ensure positive treatment outcomes,
while reducing the risk of side effects and increasing patient safety.

• Keywords: doziranje lijekova; intermitentna hemodijaliza; kronična hemodijaliza; farmakoterapijski problemi; farmaceutske intervencije; nuspojave lijekova
• Keywords (english): dosing of drugs; chronic hemodialysis; intermittent hemodialysis; pharmacotherapeutic problems; pharmaceutical interventions; side effects of drugs
• Language: croatian
• URN:NBN: urn:nbn:hr:163:276137
• Study programme: Title: Clinical pharmacy; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni/a magistar/sveučilišna magistra kliničke farmacije (sveučilišni/a magistar/sveučilišna magistra kliničke farmacije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-03-22 13:29:22