Iskustva ljekarnika u neposrednom radu s korisnicima ljekarničkih usluga za vrijeme trajanja pandemije COVID-19 virusne bolesti

master's thesis

• Title (english): Pharmacists' experiences while working directly with pharmacy customers during the COVID-19 pandemic
• Author: Ana Prološčić
• Mentor: Josip Burušić (mentor)
• Committee member: Josip Burušić (predsjednik povjerenstva)
• Committee member: Karmela Barišić (član povjerenstva)
• Committee member: Živka Juričić (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of pharmacology); Zagreb
• Defense date and country: 2021-04-26, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

U posljednjih desetak godina nekoliko je oralnih antikoagulansa odobreno za upotrebu u indikacijama povezanim s profilaksom i liječenjem venske i arterijske tromboembolije. Direktni oralni antikoagulansi (DOAK) ili novi oralni antikoagulansi su lijekovi koji svoj antikoagulacijski učinak ostvaruju izravnom inhibicijom trombina (dabigatran) ili izravnom inhibicijom faktora Xa (rivaroksaban, apiksaban, edoksaban i betriksaban). Antagonisti vitamina K (VKA) dugo su bili antikoagulansi prvog izbora, ali DOAK imaju mnogo prednosti u odnosu na VKA, poput jednostavnijeg doziranja, brzog nastupa i prekida djelovanja, predvidljivog odgovora na dozu, stupanja u manje interakcija s drugim lijekovima, a nije potrebno niti laboratorijsko praćenje. S druge strane, kontraindicirani su kod pacijenata s teškim oštećenjem bubrega i imaju višu cijenu od varfarina. U ovom radu opisuju se farmakološka svojstva DOAK-a, njihova djelotvornost, sigurnost i podaci iz ključnih studija koji podržavaju trenutno odobrene indikacije. Farmakokinetičke karakteristike dostupnih DOAK-a (dabigatran, rivaroksaban, apiksaban, edoksaban, betriksaban) bitno se razlikuju u pogledu oralne bioraspoloživosti, vezanja na proteine plazme, načina i stupnja biotransformacije, kao i načina eliminacije. Posljednjih godina na tržištu su dostupni i specifični antidoti: andeksanet-alfa za rivaroksaban i apiksaban te idarucizumab za dabigatran. Mogućnost zaustavljanja djelovanja antikoagulansa kada je to nužno, dodatno je utjecala na veću sigurnost propisivanja i primjene ovih lijekova.

Abstract (english)

In the last ten years, several oral anticoagulant drugs have become available for use in indications related to prophylaxis and treatment of venous and arterial thromboembolism. Direct oral anticoagulant drugs (DOACs) or new oral anticoagulant drugs are medicines that achieve their anticoagulant effect by the direct inhibition of thrombin (dabigatran) or by the direct inhibition of factor Xa (rivaroxaban, apixaban, edoxaban and betrixaban). Vitamin K antagonists have been anticoagulants of the first choice for a long time, but DOACs have many advantages in related to VKA, such as simpler dosage, rapid onset and interruption of action, a predictable dose response, few drug–drug interactions and no laboratory monitoring is required. However, they are contraindicated in patients with severe renal impairment and their price is several times higher than warfarin. In this dissertation, the pharmacological characteristics of DOACs, their efficacy, safety and data from pivotal studies that support currently approved indications are described. The pharmacokinetic characteristics of available DOACs (dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban) differ substantially as regards oral bioavailability, plasma protein binding, type and phase of biotransformation and way of elimination. In recent years, specific antidotes: andexanet-alpha for rivaroxaban and apixaban and idarucizumab for dabigatran are available. The ability to stop the action of anticoagulants, when necessary, further affects the greater safety of prescribing and administration of these drugs.

• Keywords: direktni inhibitori trombina; inhibitori faktora Xa; antidoti; faktor Xa; tromboprofilaksa; antikoagulans
• Keywords (english): direct thrombin inhibitors; factor Xa inhibitors; antidotes; factor Xa; thromboprophylaxis; anticoagulant
• Language: croatian
• URN:NBN: urn:nbn:hr:163:963510
• 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: Open access
• Created on: 2022-02-03 13:05:25