Pharmaceutical intervention in the rational use of intravenous omeprazole.

OBJECTIVE: To describe the pharmaceutical interventions of a vertical clinical pharmacy service to promote the rational use of intravenous omeprazole. METHODS: A prospective and descriptive study carried out at a university hospital in the Midwestern Region of Brazil, from November 2014 to May 2015. The service consisted of the analysis of adequacy of the route of administration of omeprazole in relation to the clinical conditions of the patient, as well as the use of the appropriate diluent. Interventions were recorded in medical records and subsequently evaluated for acceptance. RESULTS: A total of 770 prescriptions were evaluated. Interventions related to diluent replacement were more accepted (p<0.001), and surgeons were the specialty that used the intravenous route inappropriately (p<0.001). CONCLUSION: Although partially accepted, pharmaceutical interventions could contribute to improve patient safety, since they allowed the use of a safer route of administration.

Pharmaceutical intervention in the rational use of intravenous omeprazole / Intervenção farmacêutica no uso racional de omeprazol intravenoso

ABSTRACT Objective: To describe the pharmaceutical interventions of a vertical clinical pharmacy service to promote the rational use of intravenous omeprazole. Methods: A prospective and descriptive study carried out at a university hospital in the Midwestern Region of Brazil, from November 2014 to May 2015. The service consisted of the analysis of adequacy of the route of administration of omeprazole in relation to the clinical conditions of the patient, as well as the use of the appropriate diluent. Interventions were recorded in medical records and subsequently evaluated for acceptance. Results: A total of 770 prescriptions were evaluated. Interventions related to diluent replacement were more accepted (p<0.001), and surgeons were the specialty that used the intravenous route inappropriately (p<0.001). Conclusion: Although partially accepted, pharmaceutical interventions could contribute to improve patient safety, since they allowed the use of a safer route of administration.

RESUMO Objetivo: Descrever as intervenções farmacêuticas de um serviço farmacêutico clínico vertical, para a promoção do uso racional do omeprazol intravenoso. Métodos: Estudo prospectivo e descritivo realizado em um hospital universitário da região Centro-Oeste do Brasil, no período de novembro de 2014 a maio de 2015. O serviço consistia na análise da adequabilidade da via de administração do omeprazol em relação às condições clínicas do paciente, bem como a utilização do diluente adequado. As intervenções eram registradas em prontuário e, posteriormente, avaliadas quanto à aceitação. Resultados: Foram avaliadas 770 prescrições. As intervenções relacionadas à substituição do diluente foram mais aceitas (p<0,001), e os cirurgiões foram a especialidade que utilizou a via intravenosa de maneira inadequada (p<0,001). Conclusão: Embora parcialmente aceitas, as intervenções farmacêuticas puderam contribuir com a melhoria da segurança dos pacientes, uma vez que permitiram a utilização de uma via de administração mais segura.

Educação permanente em saúde: práticas desenvolvidas nos municípios do estado de Goiás / Ongoing education in health: practices developed in the unicipalities of the state of Goiás, Brazil / Educación continua en salud: prácticas desarrolladas en los unicipios del estado de Goiás, Brasil

Resumo A educação permanente em saúde é orientadora de processos significativos de aprendizagem e propõe a produção de resultados efetivos nas ações de saúde. O estudo teve por objetivo delinear o perfil das práticas de educação permanente em saúde nos municípios de Goiás, na perspectiva dos representantes da área. Esta pesquisa transversal utilizou questionário semiestruturado, respondido online pelos participantes. A maioria dos informantes é referência local da educação permanente em saúde (68,9%), são enfermeiros e com função de Coordenadores da Atenção Primária (31,8%). Predominaram municípios que identificam a existência de educação permanente em saúde em seu território (66,2%). Em geral, as ações são promovidas pelo próprio município (61,3%) ou pela regional de saúde (37,9%), destacando-se a educação continuada, seguida da (re)organização dos processos de trabalho e a educação em saúde. Fatores atitudinais, de relações interpessoais e de recursos humanos foram apontados como os desafios mais frequentes. Com base nesse diagnóstico, entende-se que a maioria dos problemas identificados é passível de intervenção. Este estudo apresenta subsídios para planejamento estratégico de educação permanente em saúde, apoio às instâncias responsáveis pelo seu fomento e gerenciamento nos municípios, bem como fortalecimento de suas ações nos serviços de saúde.

Abstract Ongoing education in health guides significant learning processes, and proposes the production of effective results in health actions. This study had the goal of outlining the profile of the practices of ongoing education in health in the municipalities of the state of Goiás, Brazil, under the perspective of the representatives of the field. The present cross-sectional research used a semi-structured questionnaire that was filled out online by the participants. Most of the respondents are local references regarding ongoing education in health (68.9%); they are nurses who also work as primary care coordinators (31.8%). There was a predominance of municipalities that identify the existence of ongoing education in their territories (66.2%). In general, the actions are promoted by the municipalities themselves (61.3%) or by the regional health department (37.9%), and ongoing education stands out, followed by the (re)organization of the work processes and education in health. Factors regarding attitude, interpersonal relationships and human resources were pointed out as the most frequent challenges. Based on this diagnosis, we understand that most of the problems identified could be subjected to intervention. This study provides inputs for the strategic planning of ongoing education in health, for the support to the agencies responsible for its promotion and management in the municipalities, and to strengthen the ongoing education actions in the health services.

Resumen La educación continua en salud es orientadora de procesos significativos de aprendizaje, y propone la producción de resultados efectivos en las acciones de salud. El estudio tuvo el objetivo de describir el perfil de las prácticas de educación continua en salud en los municipios del estado de Goiás, Brasil, bajo la perspectiva de los representantes del área. Esta investigación transversal utilizó un cuestionario semiestructurado, contestado online por los participantes. La mayoría de los informantes es referencia local de la educación continua en salud (68,9%); son enfermeros que tienen la función de coordinadores de la atención primaria (31,8%). Predominaron municipios que identifican la existencia de educación continua en salud en su territorio (66,2%). En general, las acciones son promovidas por el municipio mismo (61,3%) o por el departamento regional de salud (37,9%), y se destacan la educación continua, seguida de la (re)organización de los procesos de trabajo y de la educación en salud. Factores actitudinales, de relaciones interpersonales y de recursos humanos fueron apuntados como los retos más frecuentes. Con base en ese diagnóstico, se entiende que la mayoría de los problemas identificados son pasibles de intervención. Este estudio presenta contribuciones para la planificación estratégica de educación continua en salud, para el apoyo a las instancias responsables por su fomento y gestión en los municipios, y para el fortalecimiento de sus acciones de educación continua en los servicios de salud.

Potential drug-drug interactions in older adults: A population-based study.

AIM: To evaluate the potential drug-drug interactions (PDDI) between drugs used by older adults, any associated factors and recommended clinical management. METHODS: A cross-sectional, population-based study was carried out through a home survey of 934 older adults (from December 2009 to April 2010). A questionnaire was applied, and the participants were asked to show all the drugs used and their respective prescriptions, thus providing data to identify polypharmacy, self-medication and PDDI. PDDI, their consequences, severity and clinical management were identified using Micromedex. RESULTS: Overall, 2846 drugs and 665 PDDI were identified, 71.0% of which were moderate and 22.4% serious. The prevalence of PDDI was 36.9%. Drugs with a narrow therapeutic index were involved in 17.0% of the PDDI. The variables female sex (PR = 1.11, 95% CI 1.02-1.20), age ≥80 years (PR = 1.15, 95% CI 1.03-1.28), no polypharmacy (PR = 0.72, 95% CI 0.67-0.78) and no hospitalization in the past year (PR = 0.90, 95% CI 0.82-0.97) remained associated with the presence of three or more PDDI in the final multivariate analysis model. CONCLUSIONS: Most PDDI were related to routinely used drugs (enalapril, hydrochlorothiazide, calcium, captopril, levothyroxine and simvastatin), and more than one-third of the older adults were exposed to PDDI with the possible risk of serious health consequences. Drugs with a narrow therapeutic index were involved in several PDDI, with increased risk of toxicity. The clinical management procedures most recommended are dose adjustment and dosing changes, control of the drugs' serum levels, and monitoring of the clinical conditions. Geriatr Gerontol Int 2017; 17: 2336-2346.

Reações Adversas a Medicamentos e Farmacovigilância: Conhecimentos e Condutas de Profissionais de Saúde de um Hospital da Rede Sentinela / Pharmacovigilance: Professional Knowledge and Conduct at a Teaching Hospital

RESUMO Introdução As reações adversas a medicamentos são objeto de estudo da farmacovigilância, ciência que utiliza, sobretudo, as notificações espontâneas feitas por profissionais de saúde. Há dificuldade de reconhecimento dos profissionais quanto a sua importância na segurança do paciente. As causas da subnotificação são atribuídas a falta de conhecimentos, percepção e compreensão dos incidentes. Objetivo Identificar o conhecimento e as condutas dos profissionais de saúde de um hospital de ensino em relação às reações adversas a medicamentos e à farmacovigilância e se há associação com o seu perfil profissiográfico. Métodos Estudo transversal, utilizando-se um instrumento validado que aborda questões sobre caracterização da população estudada, conhecimentos e condutas. Resultados Os médicos demonstraram maior conhecimento sobre reações adversas a medicamentos, e os técnicos em enfermagem, menor. No entanto, o entendimento sobre farmacovigilância foi maior entre os farmacêuticos. O tempo de formação e atuação na instituição está associado ao conhecimento sobre as reações adversas a medicamentos Conclusão: Os resultados deste estudo evidenciaram que a formação do profissional influencia seu conhecimento e condutas frente às reações adversas a medicamentos.

ABSTRACT Introduction Adverse Drug Reactions are studied by the science of pharmacovigilance, which makes particular use of spontaneous reports made by health professionals, although such professionals experience difficulties in recognizing adverse reactions and their importance in patient safety. The causes of underreporting are attributed to a lack of knowledge, awareness and understanding of incidents. Objective Methods: A cross-sectional study was conducted using a validated instrument in order to characterize the population under study, determining its knowledge and behaviors Results: Doctors demonstrated a greater knowledge of adverse drug reactions than nursing technicians; however an understanding of pharmacovigilance was higher among pharmacists. The length of time spent in training and working in an institution were also associated with a knowledge of adverse drug reactions Conclusion The results of this study show that professional training influences knowledge and behaviors on adverse drug reactions.

Medication adherence in patients in treatment for rheumatoid arthritis and systemic lupus erythematosus in a university hospital in Brazil.

Medication adherence is essential for the control of symptoms and progression of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The aim of the study was to investigate medication adherence in outpatients in treatment for RA and SLE in a university hospital in Brazil. This was a quantitative, cross-sectional analytical study. A total of 92 patients (55 RA patients and 37 SLE patients) were included in the study. A structured questionnaire for patients' interview and a form for collecting data from medical records were used for data collection. Adherence to drug treatment was assessed by the Morisky scale questionnaire. Data storage and analysis were performed using Epi Info 3.5.4 and statistical analysis by Stata/SE 12.0. The Pearson's chi-squared test and Fisher's exact test were applied for statistical and bivariate analyses. For multivariate data analysis the Poisson regression and the Wald test were used. The prevalence of adherence to drug treatment was 16.4% in RA patients and 45.9% in SLE patients. The final model of the multivariate analysis demonstrated associations between medication adherence and the following covariates for both RA and SLE groups: duration of therapy for rheumatic disease at the institution greater than 15 years and presence of more than six chronic comorbidities. The parameter "acquisition of medication at the high-cost pharmacy" was differently associated with medication adherence by group, and for the SLE group, living outside the city of Goiânia was a protective factor associated with adherence. This study demonstrated a low prevalence of medication adherence in patients in treatment for RA and SLE treated at this institution. These findings will serve as a base for future studies to elucidate what factors may positively or negatively affect medication adherence in this population. In addition, multidisciplinary approaches are needed to enhance adherence to drug treatment in patients in treatment for rheumatic disease.

Caracterização dos casos suspeitos de dengue internados na capital do estado de Goiás em 2013: período de grande epidemia / Characteristics of suspected dengue patients admitted to hospital in Goiás state capital in 2013: a period of severe outbreak / Caracterización de los casos sospechosos de dengue hospitalizados en la capital de Goiás en 2013: período de gran epidemia

OBJETIVO: descrever o perfil clínico-epidemiológico e a distribuição espacial dos casos suspeitos de dengue com hospitalização em Goiânia-GO, Brasil, durante a epidemia de 2013. MÉTODOS: estudo descritivo sobre dados do Sistema de Informação de Agravos de Notificação, Sistema Gerenciador de Ambiente Laboratorial, Sistema de Regulação de Leitos, e do Sistema da Companhia de Processamento de Dados de Goiânia. RESULTADOS: foram incluídos 616 casos suspeitos de dengue com idade média de 36 anos (desvio-padrão: 14,8), 55,2% do sexo feminino, 9,3% confirmados laboratorialmente e 9,7% apresentando comorbidades; a comorbidade mais frequente foi hipertensão arterial (20%); os sinais de alarme mais frequentes foram vômitos persistentes (23,7%) e plaquetopenia (22,7%); verificou-se positividade dos resultados laboratoriais inclusive nas coletas inoportunas, após cinco dias do inicio dos sintomas, e grande dispersão na distribuição espacial dos casos. CONCLUSÃO: entre os casos suspeitos de dengue internados, predominaram adultos e com presença de sinais e sintomas de alarme.

OBJECTIVE: to describe the clinical and epidemiological features and the spatial distribution of suspected dengue cases admitted to hospital in Goiânia, state of Goiás, during the 2013 epidemic. METHODS: this was a descriptive study of suspected dengue cases admitted to hospital in Goiânia based on four databases. RESULTS: 616 suspected dengue cases were included in the study; patients' mean age was 36 years (SD: 14.8), 55.2% were female, 9.3% were laboratory confirmed and 9.7% had comorbidities; the most common comorbidity was hypertension (20%); the most common warning signs were persistent vomiting (23.7%) and thrombocytopenia (22.7%); laboratory results were positive including for late sample collections taken five days after the onset of symptoms. There was great dispersion in the spatial distribution of cases. CONCLUSION: the majority of suspected dengue cases admitted to hospital were adults who had warning signs and symptoms.

OBJETIVO: describir el perfil clínico-epidemiológico y la distribución espacial de los casos sospechosos de dengue con hospitalización en Goiania-GO, durante la epidemia de 2013. MÉTODOS: estudio descriptivo basado en datos del "Sistema de información de Enfermedades de Declaración Obligatoria", "Sistema de gestión ambiental y laboratorio", "Sistema de regulación de camas" y "Sistema de la compañía de procesamiento de datos de Goiana". RESULTADOS: se incluyeron 616 casos sospechosos de dengue; la media de edad fue de 36 años (Desviación Estándar: 14,8), el 55,2% eran mujeres, 9,3% fueron confirmados en laboratorio y 9,7% presentaron comorbilidades; la comorbilidad más frecuente fue hipertensión arterial (20%). Las señales de alarma más frecuentes fueron vómitos persistentes (23,7%) y trombocitopenia (22,7%); hubo resultados positivos de laboratorio inclusive en las colectas inadvertidas, después de cinco días del inicio de los síntomas y hubo gran variación en la distribución espacial de los casos. CONCLUSIÓN: entre los casos sospechosos de dengue internados, predominaron los adultos y la presencia de signos y síntomas de alarma.

Avaliação do serviço de saúde prestado aos pacientes diabéticos em uma unidade de saúde de Goiânia-GO / Evaluation of the health service provided to diabetic patients at health units in Goiânia, GO

O diabetes mellitus é uma síndrome de etiologia múltipla e um dos principais agravos de saúde pública no Brasil. O controle desse agravo nos serviços básicos é fundamental, em virtude de sua magnitude crescente, transcendência e complexa vulnerabilidade. O objetivo deste estudo foi avaliar o tratamento e acompanhamento de pacientes diabéticos, segundo as recomendações da Sociedade Brasileira de Diabetes (SBD), em duas unidades básicas de saúde do município de Goiânia ? GO. Os dados foram obtidos por meio da revisão de prontuários médicos referentes ao período de janeiro de 2007 a dezembro de 2009, totalizando 250 prontuários, consolidados no software Epi InfoTM . Houve maior frequência de diabetes mellitus tipo 2 (96,65%) em relação ao tipo 1. Em 78% dos prontuários, havia descrição de hipertensão arterial e, destes, 77,4% tinham prescrição de IECA, e em 30,4% dos prontuários havia prescrição de AAS. Em média, pequena porcentagem de prontuários atendeu às recomendações da SBD: quase 50% dos pacientes estavam com pressão arterial controlada na unidade UBESF ?A? e 35%, na unidade UBESF ?B?; cerca de 25% estavam com LDL inferior a 100mg/dL em ambas as unidades e aproximadamente 25% dos prontuários da unidade UBESF ?B? tinham HbA1c inferior a 7%, e 18%, na UBESF ?A?. Quanto ao estudo de utilização de medicamentos, 41,1% dos prontu- ários tinham prescrição de metformina e um secretagogo, e apenas 20,4% dos pacientes com HbA1c>9% tinham prescrição de insulina.

Diabetes mellitus is a syndrome of multiple etiology and a major public health problem in Brazil. The control of this disease in basic services is crucial because of its growing magnitude, transcendence, and complex vulnerability. This retrospective study aimed to evaluate the treatment and monitoring of diabetic patients according to the Brazilian Diabetes Society guidelines in two basic health units (UBESFs) in the city of Goiânia/GO. Data were collected by review of medical records from January 2007 to December 2009, resulting in 250 records, consolidated in the Epi InfoTM software. There was a higher frequency of diabetes mellitus type 2 (96.65%) compared to type 1. In 78% of the records, arterial hypertension had been detected and of these, 77.4% had a prescription for ACE inhibitors. In 30.4% of the records, aspirin had been prescribed. On average, a small percentage of the medical records met the recommendations of the Brazilian Diabetes Society: almost 50% of the patients had controlled blood pressure in UBESF unit ?A? and over 35% in UBESF unit ?B?; about 25% had LDL less than 100mg/dL in both units, and approximately 25% had HbA1c below 7% in UBESF unit ?B? and 18% in UBESF unit ?A?. As to the study of medication use, 41.1% of the records had prescriptions for metformin and a secretagogue, and only 20.4% of the patients with HbA1c >9% had an insulin prescription.

Medicine use by the elderly in Goiania, Midwestern Brazil.

OBJECTIVE: To analyze the pattern of use of medications use in aged people and associate it with socioeconomic aspects and with the self-rated health. METHODS: A population-based cross-sectional design study with 934 elderly people from Goiania, Midwestern Brazil, between December 2009 and April 2010. Data were collected through a questionnaire. The dependent variable was the number of medications consumed and the independent variables were sex, marital status, education, type of residence, age, income, and self-rated health. Drugs were classified according to the Anatomical Therapeutic Chemical Classification. The inappropriate drugs for the elderly were identified according to the Beers-Fick criteria. The tests used were Chi-square and Fisher's exact test, p was considered significant when < 0.05. RESULTS: The elderly consumed 2,846 medicines (3.63 medications/person). The most commonly consumed were those which act in the cardiovascular system (38.6%). The prevalence of polypharmacy was 26.4% and self-medication was 35.7%. The most used drugs for self-medication were analgesics (30.8%), 24.6% of the elderly consumed drug considered inappropriate. Women, widows, those aged 80 or over and with worse self-rated health were more likely to practiced more polypharmacy. Most self-medication was associated with lower levels of education and worse self-rated health. CONCLUSIONS: The pattern of drug use by the elderly was similar to that found in the elderly in other regions of Brazil. The number of drugs used, the prevalence of self-medication and practice of polypharmacy and inappropriate drug use were within the national average.

Consumo de medicamentos por idosos, Goiânia, Brasil / Consumo de medicamentos por ancianos, Goiania, Brasil / Medicine use by the elderly in Goiania, Midwestern Brazil

OBJETIVO: Analisar o padrão de consumo de medicamentos entre idosos e sua associação com aspectos socioeconômicos e autopercepção de saúde. MÉTODOS: Estudo de base populacional e delineamento transversal com 934 idosos de Goiânia, GO, Brasil, entre dezembro de 2009 e abril de 2010. Os dados foram coletados por meio de questionário. As variáveis estudadas foram: número de medicamentos consumidos, sexo, estado civil, escolaridade, tipo de moradia, idade, renda e autopercepção de saúde. Os medicamentos foram classificados segundo o Anatomical Therapeutic and Chemical Classification. Os medicamentos impróprios para idosos foram identificados segundo o Critério de Beers-Fick. Os testes utilizados foram Qui-quadrado (X²) e exato de Fisher e p foi considerado significativo quando < 0,05. RESULTADOS: Os idosos consumiam 2.846 medicamentos (3,63 medicamentos/idoso). Os mais usuais atuavam no aparelho cardiovascular (38,6%). A prevalência de polifarmácia foi de 26,4% e da automedicação de 35,7%. Os medicamentos mais ingeridos por automedicação foram os analgésicos (30,8%); 24,6% dos idosos consumia medicamento considerado impróprio. Mulheres, viúvos, idosos com 80 anos ou mais e com pior autopercepção de saúde praticavam mais a polifarmácia. A maior prática da automedicação esteve associada com menor escolaridade e pior autopercepção de saúde. CONCLUSÕES: O padrão do consumo de medicamentos por idosos foi semelhante ao encontrado em idosos de outras regiões do Brasil. O número de medicamentos usados, a prevalência das práticas da polifarmácia e automedicação e consumo de medicamentos impróprios estiveram dentro da média nacional.

OBJECTIVE: To analyze the pattern of use of medications use in aged people and associate it with socioeconomic aspects and with the self-rated health. METHODS: A population-based cross-sectional design study with 934 elderly people from Goiania, Midwestern Brazil, between December 2009 and April 2010. Data were collected through a questionnaire. The dependent variable was the number of medications consumed and the independent variables were sex, marital status, education, type of residence, age, income, and self-rated health. Drugs were classified according to the Anatomical Therapeutic Chemical Classification. The inappropriate drugs for the elderly were identified according to the Beers-Fick criteria. The tests used were Chi-square and Fisher's exact test, p was considered significant when < 0.05. RESULTS: The elderly consumed 2,846 medicines (3.63 medications/person). The most commonly consumed were those which act in the cardiovascular system (38.6%). The prevalence of polypharmacy was 26.4% and self-medication was 35.7%. The most used drugs for self-medication were analgesics (30.8%), 24.6% of the elderly consumed drug considered inappropriate. Women, widows, those aged 80 or over and with worse self-rated health were more likely to practiced more polypharmacy. Most self-medication was associated with lower levels of education and worse self-rated health. CONCLUSIONS: The pattern of drug use by the elderly was similar to that found in the elderly in other regions of Brazil. The number of drugs used, the prevalence of self-medication and practice of polypharmacy and inappropriate drug use were within the national average.

OBJETIVO: Analizar el patrón de consumo de medicamentos entre ancianos y su asociación con aspectos socioeconómicos y autopercepción de salud. MÉTODOS: Estudio de base poblacional y delineamiento transversal con 934 ancianos de Goiania, GO, Brasil, entre diciembre de 2009 y abril de 2010. Los datos fueron colectados por medio de cuestionario. Las variables estudiadas fueron: número de medicamentos consumidos, sexo, estado civil, escolaridad, tipo de vivienda, edad, renta y autopercepción de la salud. Los medicamentos fueron clasificados de acuerdo al Anatomical Therapeutic and Chemical Classification. Los medicamentos inadecuados para ancianos se identificaron según el Criterio de Beers-Fick. Las pruebas utilizadas fueron Chi-cuadrado (X2) y exacto de Fisher y el p fue considerado significativo al ser <0,05. RESULTADOS: Los ancianos consumían 2.846 medicamentos (3,63 medicamentos/anciano). Los más consumidos actuaban en el sistema cardiovascular (38,6%). La prevalencia de polifarmacia fue de 26,4% y de la automedicación de 35,7%. Los medicamentos más consumidos por automedicación fueron los analgésicos (30,8%), 24,6% de los ancianos consumía medicamento considerado inadecuado. Mujeres, viudos, ancianos con 80 años o más y con peor autorpercepción de salud practicaban más la polifarmacia. La mayor práctica de automedicación estuvo asociada con menor escolaridad y peor autopercepción de salud. CONCLUSIONES: El patrón de consumo de medicamentos por ancianos fue semejante al encontrado en ancianos de otras regiones de Brasil. El número de medicamentos usados, la prevalencia de las prácticas de polifarmacia y automedicación y consumo de medicamentos inadecuados estuvieron dentro del promedio nacional.

Pharmaceutical Care for hypertensive patients provided within the Family Health Strategy in Goiânia, Goiás, Brazil

The aim of Pharmaceutical Care programs is to improve patients' quality of life, and such programs are particularly effective in the case of chronic diseases such as hypertension. The objective of this longitudinal study was to analyze a Pharmaceutical Care model for hypertensive patients receiving care within the Family Health Strategy (FHS). All patients were being seen by an FHS team affiliated to a primary healthcare unit in Goiânia, Goiás, Brazil. Fourteen patients participated in the study, with each patient receiving six home visits during the Pharmaceutical Care. Overall, 142 drug-related problems were reported, the most common concerning the ineffectiveness of treatment (33.8%). A total of 135 pharmaceutical interventions were performed, 92.6% of which involved pharmacist-patient communication, with 48.8% of these interventions being implemented. Cardiovascular risk decreased in three patients and remained unchanged in nine. In hypertensive patients with diabetes, fasting glucose levels were reduced in six out of nine cases. The Pharmaceutical Care model proposed here was effective in detecting drug-related problems and in proposing interventions to resolve or prevent these problems. Consequently, this may have contributed towards improving clinical parameters, such as fasting glucose levels and cardiovascular risk in hypertensive patients receiving care within the FHS.

A Atenção Farmacêutica tem como objetivo conseguir resultados concretos que melhorem a qualidade de vida do paciente, contribuindo especialmente em doenças crônicas, como a Hipertensão Arterial. O objetivo deste estudo foi analisar um modelo de Atenção Farmacêutica a pacientes com Hipertensão Arterial assistidos pela Estratégia Saúde da Família (ESF). Trata-se de um estudo longitudinal realizado com pacientes assistidos pela ESF de uma Unidade Básica de Saúde de Goiânia-GO. Participaram do estudo, 14 pacientes que receberam seis visitas domiciliares para Atenção Farmacêutica. Registraram-se 142 Problemas Relacionados a Medicamentos (PRM) sendo mais frequente a falta de efetividade do tratamento (33,8%). Realizaram-se 135 intervenções farmacêuticas, das quais 92,6% foram com a comunicação farmacêutico-paciente, em que 48,8% das intervenções foram implementadas. Observou-se redução do risco cardiovascular em três pacientes e nove pacientes não apresentaram alteração no nível de risco cardiovascular. Entre os pacientes hipertensos e diabéticos observou-se redução da glicemia de jejum em seis. O modelo de Atenção Farmacêutica proposto foi capaz de detectar PRM propondo intervenções para resolvê-los e preveni-los e, consequentemente, pode ter contribuído na melhora de parâmetros clínicos como glicemia de jejum e risco cardiovascular em pacientes hipertensos assistidos pela ESF.

Stability and in vitro release profile of enalapril maleate from different commercially available tablets: possible therapeutic implications.

Stability of enalapril maleate formulations can be affected when the product is exposed to higher temperature and humidity, with the formation of two main degradation products: enalaprilat and a diketopiperazine derivative. In this work, stability and drug release profiles of 20 mg enalapril maleate tablets (reference, generic and similar products) were evaluated. After 180 days of the accelerated stability testing, most products did not exhibit the specified amount of drug. Additionally, drug release profiles were markedly different from that of the reference product, mainly due to drug degradation. Changes in drug concentration and drug release profile of enalapril formulations are strong indicators of a compromised bioavailability, with possible interferences on the therapeutic response for this drug.

Determination of fluconazole in serum and amniotic fluid of rats by gas-chromatography/mass spectrometry (GC/MS)

Rats treated with oral dose of 100 mg/kg of fluconazole during pregnancy had their serum and amniotic fluid quantified for this drug using a GC/MS method. Fluconazole was extracted with ethyl acetate from samples and analysed by a GC-MS Shimadzu QP5050A system using a CBP-5 fused silica capillary column. Tioconazole was used as internal standard. Calibration curve was linear within the range 10.0 - 300.0 µg/mL. The limit of quantification was 0.1 µg/mL and no interference was observed in the blank serum and amniotic liquid. The mean concentrations of the drug in the serum and amniotic fluid were 206.01 ± 105.25 µg/mL and 125.34 ± µg/mL and 125.34 ± 65.24 µg/mL, respectively. This procedure showed to be sensitive and efficient enough for the use in teratogenic studies of fluconazole and other azole drugs