Potential drug interactions in intensive care patients at a teaching hospital (original) (raw)
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Redalyc.Prevalência de interações medicamentosas em unidades de terapia intensiva no Brasil
2020
Objective: To determine the prevalence of drug interactions in intensive care units and to analyze the clinical significance of interactions identified. Methods: A multicenter, retrospective and cross sectional study conducted with 1124 patients in the seven intensive care units of teaching hospitals in Brazil. Information on drugs administered at 24 hours and 120 hours of hospitalization was obtained from the prescriptions. Results: Within 24 hours, 70.6% of patients had at least one drug interaction; the number at 24h was 2299, at 120 h it was 2619. Midazolam, fentanyl, phenytoin and omeprazole were the drugs with higher frequency of drug interactions. Conclusion: In this sample, moderate and severe drug interactions were more prevalent. In light of these findings, all actions of health professionals who provide care to these patients must be integrated in order to identify and prevent possible drug events. Resumo Objetivo: Determinar a prevalência de interações medicamentosas em Unidades de Terapia Intensiva-UTI brasileiras e analisar seu significado clínico. Métodos: Estudo multicêntrico, retrospectivo, desenvolvido com 1.124 prontuários em sete UTI de hospitais de ensino brasileiros. As informações sobre os medicamentos prescritos e administrados em pacientes com 24 horas e 120 horas de internação foram obtidas baseadas nas prescrições. Resultados: Em 24 horas, 70,6% dos pacientes de UTI tinham, pelo menos uma interação medicamentosa. O número total de interações detectadas foi de 2.299 em 24 horas, e 2.619 em 120 horas. Midazolam, Fentanyl, Phenytoin e Omeprazole foram os medicamentos que apresentaram maior frequência de interação medicamentosa. Conclusão: Na amostra estudada, as interações medicamentosas graves e moderadas foram mais prevalentes. Neste sentido, todas as ações dos profissionais de saúde que prestam cuidados a esses pacientes devem ser integradas no intuito de identificar e prevenir possíveis eventos com medicamentos.
Clinics, 2011
OBJECTIVES: To investigate the prevalence of potential drug interactions at the intensive care unit of a university hospital in Brazil and to analyze their clinical significance. METHODS: This cross-sectional retrospective study included 299 patients who had been hospitalized in the intensive care unit of the hospital. The drugs administered during the first 24 hours of hospitalization, in the 50 th length-ofstay percentile and at the time of discharge were analyzed to identify potential drug-drug and drug-enteral nutrition interactions using DRUG-REAXH software. The drugs were classified according to the anatomical therapeutic chemical classification. RESULTS: The median number of medications per patient was smaller at the time of discharge than in the 50 th length-of-stay percentile and in the first 24 hours of hospitalization. There was a 70% prevalence of potential drug interactions at the intensive care unit at the studied time points of hospitalization. Most of the drug interactions were either severe or moderate, and the scientific evidence for the interactions was, in general, either good or excellent. Pharmacodynamic interactions presented a subtle predominance in relation to pharmacokinetic interactions. The occurrence of potential drug interactions was associated with the number of medications administered and the length of stay. Medications that induced cytochrome P450, drugs that prolong the QT interval and cardiovascular drugs were pharmacotherapy factors associated with potential drug interactions. CONCLUSION: The study showed that potential drug interactions were prevalent in the intensive care unit due to the complexity of the pharmacotherapies administered. The interactions were associated with the number of drugs, the length of stay and the characteristics of the administered medications.
2006
Cruciol-Souza JM, Thomson JC. A pharmacoepidemiologic study of drug interactions in a brazilian teaching hospital. Clinics. 2006;61(6):515-20. PURPOSE: Although drug-drug interactions constitute only a small proportion of adverse drug reactions, they are often predictable and therefore avoidable or manageable. There are few studies on drug-drug interactions from Brazil. This study aimed to assess the frequency of drug-drug interactions in prescriptions and their potential clinical significance in patients of a Brazilian teaching hospital. METHODS: From January to April 2004, a sample of 1785 drug prescriptions was drawn from a total of 11,250. Drug-drug interactions were identified by using Micromedex ® DrugReax ® System. Patients ´ records with major drug-drug interactions were reviewed by a pharmacist and a medical doctor looking for signs, symptoms, and lab tests that could indicate adverse drug reactions due to such interactions. RESULTS: From the 1785 prescriptions examined, 10...
Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde, 2019
The risk of drug interaction (DI), especially in the hospital setting, increases along with the number of drugs used by the patient. Studies that evaluate drug interactions based on patient prescriptions are therefore useful to know this risk and guide strategies to improve drug use. The present study is aimed to identify studies that evaluated DI in patients of Brazilian hospitals. As of bibliographic search in several databases, we collected articles describing prescribing evaluations which focused on the analysis and identification of drug interactions in Brazilian hospitals. The search was conducted in 2017 and there was no restriction of publication time. Of a total of 273 articles retrieved, 23 were included for analysis. Most was published after 2010, and the predominant design was cross-sectional studies. The Micromedex® database was the most used to categorize the interactions, and midazolam and fentanyl was the most commonly reported potential DI in the studies. The result...
Um estudo farmacoepidemiológico de interações medicamentosas em um hospital universitário brasileiro
2006
PURPOSE: Although drug-drug interactions constitute only a small proportion of adverse drug reactions, they are often predictable and therefore avoidable or manageable. There are few studies on drug-drug interactions from Brazil. This study aimed to assess the frequency of drug-drug interactions in prescriptions and their potential clinical significance in patients of a Brazilian teaching hospital. METHODS: From January to April 2004, a sample of 1785 drug prescriptions was drawn from a total of 11,250. Drug-drug interactions were identified by using Micromedex® DrugReax® System. Patients'records with major drug-drug interactions were reviewed by a pharmacist and a medical doctor looking for signs, symptoms, and lab tests that could indicate adverse drug reactions due to such interactions. RESULTS: From the 1785 prescriptions examined, 1089 (61%) were from the male adult ward. Patients' average age was 52.7 years (SD = 18.9; range, 12-98). The median number of drugs in each ...
Journal of Pharmacy & Pharmacognosy Research, 2019
Context: Patients in intensive care units have a high risk of experiencing a pharmacological interaction due to complex pharmacotherapy, severe disease, and comorbidities; increasing the risk of adverse effects of medications. Electronic databases are useful sources to identify drug-drug interactions (DDI), especially when new therapeutic alternatives are added to conventional treatments. Aim: To identify the frequency and severity of potential drug-drug interactions (pDDIs) in ICU patients using three electronic databases. Methods: Clinical pharmacists collected data on medication dosage and route of administration, sex, age, length of stay, comorbidities, and APACHE II score using patient records. Micromedex, Medscape, and Lexicomp databases were used to identify and categorize pDDIs. Intensivists confirmed if a pDDI was clinically present. kappa concordance test was utilized as a measure of agreement among databases. Results: Of the 93 ICU patients studied, pDDIs were identified in 89. A positive incremental relationship was found between number of medications, length of stay, and number of pDDIs. Patients with respiratory pathologies were most predisposed to presenting DDIs. Agreement among databases was mixed. Intensivists confirmed 5% of pDDIs. Conclusions: Discrepancies among databases and in intensivist judgment highlight a significant information gap in the identification of DDIs.
Ciência, Cuidado e Saúde, 2020
Objetivo: investigar na literatura evidências sobre interações advindas de prescrições de medicamentos de pacientes adultos internados. Método: Trata-se de uma revisão integrativa da literatura, realizada por meio de seis etapas. A coleta de dados ocorreu em julho de 2020, nas bases de dados da BDENF, LILACS via BVS, CINAHL, SCOPUS, Web of Science via Portal Periódicos Capes e SciELO, com os descritores drug interactions, drug prescriptions e patient safety. Selecionaram-se 18 produções no recorte temporal de 2008 a 2020. Resultados: dos artigos selecionados, dez eram estudos nacionais e oito internacionais. As unidades de terapia intensiva e emergência foram os cenários mais investigados. Os resultados foram categorizados em três eixos temáticos: prescrições e interações medicamentosas; aprazamento e interações medicamentosas; intervenções e interações medicamentosas. Conclusão: as interações medicamentosas possuem altas taxas, principalmente nas prescrições medicamentosas com poli...
Potential drug-drug interactions in a Brazilian teaching hospital: age-related differences?
Journal of Basic and Applied Pharmaceutical Sciencies, 2016
This study proposes to measure frequency and to characterize the profile of potential drug interactions (pDDI) in a general medicine ward of a teaching hospital. Data about identification and clinical status of patients were extracted from medical records between March to August 2006. The occurrence of pDDI was analyzed using the database monographs Micromedex® DrugReax® System. From 5,336 prescriptions with two or more drugs, 3,097 (58.0%) contained pDDI. The frequency of major and well document pDDI was 26.5%. Among 647 patients, 432 (66.8%) were exposed to at least one pDDI and 283 (43.7%) to major pDDI. The multivariate analysis identified that factors related to higher rates of major pDDI were the same age (p< 0.0001), length of stay (p< 0.0001), prevalence of hypertension [OR=3.42 (p< 0.0001)] and diabetes mellitus [OR=2.1 (p< 0.0001)], cardiovascular diseases (p< 0.0001) and the number of prescribed drugs (Spearman’s correlation=0.640622, p< 0.0001). Between...
Escola Anna Nery, 2019
Objective: to identify the factors associated to Potential Drug Interactions with High Alert Medications in the Intensive Care Unit of a Sentinel Hospital. Methods: a cross-sectional, retrospective study using a quantitative approach carried out at a Sentinel Hospital in Rio de Janeiro. The research was based on the analysis of the prescriptions of patients hospitalized in the Intensive Care Unit of the Hospital, in a period of one year, in order to identify the drug interactions related to high alert medications in these prescriptions. Results: Of the 60 prescriptions analyzed, 244 were selected. In these prescriptions, 846 potential drug interactions related to high alert medications and 33 high alert medications were identified. Of the 112 types of potential drug interactions identified, some were more recurrent: tramadol e ondansetron, midazolam and omeprazole, regular insulin and hydrocortisone, fentanyl and midazolam, and regular insulin and noradrenaline. The variables polyph...