An Analysis of Drug-Related Problems in the Neurology Ward of a Tertiary Teaching Hospital: A Cross-Sectional Study.

Background and objective Drugs that act on the central nervous system have a high potential to cause drug-related problems (DRPs). A clinical pharmacist aided by collaborative efforts within an interdisciplinary healthcare team can prevent, detect, and resolve DRPs, thereby contributing to the promotion of medication safety and improving the quality of life of individuals under care. This study aimed to assess DRPs identified in the neurology ward of a tertiary hospital from February 2016 to November 2019. Methods This was a descriptive study with a cross-sectional and retrospective design involving secondary data collected from pharmaceutical care (PC) records. Student's t-tests, Pearson correlation coefficients, Poisson models, and logistic regression models were used to analyze the associations between age, number and type of medications, duration of hospitalization, and the occurrence of DRPs. Results A total of 130 patients were included in the study, and a total of 266 DRPs were detected, with 93 patients experiencing more than one DRP and 37 not presenting any DRPs. Necessity-related DRPs were the most prevalent (46.6%) type, followed by safety-related DRPs (28.6%). The prevalence of safety-related DRPs was higher in individuals older than 60 years (p<0.001). Conclusions Of note, 84.6% of the interventions suggested by pharmacists to resolve DRPs were accepted by the healthcare team. The high number of DRPs found underscores the importance of the clinical role of the pharmacist and interprofessional collaboration in the care of neurological patients, especially in the pharmaceutical follow-up of elderly individuals.

Prediction of adverse drug reactions in geriatric patients admitted to intensive care units. / [Artículo traducido] Predicción de reacciones adversas a medicamentos en pacientes geriátricos ingresados en unidades de cuidados intensivos.

INTRODUCTION: Intensive Care Units (ICUs) pose challenges in managing critically-ill patients with polypharmacy, potentially leading to Adverse Drug Reactions (ADRs), particularly in the elderly. OBJECTIVE: To evaluate whether the severity and clinical prognosis scores used in ICUs correlate with the prediction of ADRs in aged patients admitted to an ICU. METHODS: A cohort study was conducted in a Brazilian University Hospital ICU. APACHE II and SAPS 3 assessed clinical prognosis, while GerontoNet ADR Risk Score and BADRI evaluated ADR risk at ICU admission. Severity of the patients' clinical conditions was evaluated daily based on the SOFA score. Adverse Drug Reaction (ADR) screening was performed daily through the identification of ADR triggers. RESULTS: 1295 triggers were identified (median 30 per patient, IQR = 28), with 15 suspected ADRs. No correlation was observed between patient severity and ADRs at admission (p=0.26), during hospitalization (p=0.91), or at follow-up (p=0.77). There was also no association between death and ADRs (p=0.28) or worse prognosis and ADRs (p>0.05). Higher BADRI scores correlated with more ADRs (p=0.001). CONCLUSIONS: The data suggest that employing the severity and clinical prognosis scores used in Intensive Care Units is not sufficient to direct active pharmacovigilance efforts, which are therefore indicated for critically ill patients.

Pharmacotherapy assessment and adverse drug reactions in older patients admitted to intensive care.

INTRODUCTION: Older patients are more susceptible to medication use, and physiological changes resulting from aging and organic dysfunctions presented by critically ill patients may alter the pharmacokinetic or pharmacodynamic behavior. Thus, critically ill older people present greater vulnerability to the occurrence of pharmacotherapeutic problems. OBJECTIVE: To evaluate pharmacotherapy and the development of potential adverse drug reactions (ADRs) in older patients admitted to an intensive care unit (ICU). METHOD: A cohort study was conducted in an ICU for adults of a Brazilian University Hospital during a 12-month period. The patients' pharmacotherapy was evaluated daily, considering the occurrence of ADRs and drug-drug interactions (DDIs), the use of potentially inappropriate medications (PIMs) for older people, and the pharmacotherapy anticholinergic burden (ACB). A trigger tool was used for active search of ADRs, with subsequent causality evaluation. PIM use was evaluated by means of the Beers criteria and the STOPP/START criteria. The ABC scale was employed to estimate ACB. The Micromedex® and Drugs.com® medication databases were employed to evaluate the DDIs. RESULTS: The sample of this study consisted of 41 patients, with a mean age of 66.8 years old (±5.2). The 22 triggers used assisted in identifying 15 potential ADRs, and 26.8% of the patients developed them. The mean estimated ACB score was 3.0 (±1.8), and the patients used 3.1 (±1.4) and 3.3 (±1.6) PIMs according to the Beers and the STOPP criteria, respectively. A total of 672 DDIs were identified, with a mean of 16.8 (±9.5) DDIs/patient during ICU hospitalization. Our findings show an association between occurrence of ADRs in the ICU and polypharmacy (p=.03) and DDIs (p=.007), corroborating efforts for rational medication use as a preventive strategy. CONCLUSIONS: Using tools to evaluate the pharmacotherapy for older people in intensive care can assist in the recognition and prevention of pharmacotherapeutic problems, with emphasis on the identification of ADRs through the observation of triggers and subsequent causality analysis.

Instruments to assess diabetes knowledge, skills and attitudes of people living with diabetes mellitus: A COSMIN-based systematic review.

AIMS: Since knowledge, skills, and attitudes influence the adherence to self-care behaviours, the purpose of this review was to identify available instruments that measure diabetes knowledge, skills or attitudes of people living with this health condition and to evaluate their measurement properties. METHODS: A systematic search was conducted in PubMed, EMBASE, SCOPUS, Web of Science and CINAHL databases. The methodological quality of the included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments. Risk of Bias checklist. The results of each study were rated by the updated criteria for good measurement properties and the quality of evidence was graded using a modified Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: This review included 38 instruments that assess diabetes knowledge (n = 26) or skills (n = 6) or attitudes (n = 5) or both three constructs (n = 1). About 40% had satisfactory results for relevance, comprehensiveness, and comprehensibility, and about 30% had unsatisfactory results for comprehensiveness, but these results were supported by very low evidence. Most studies showed indeterminate results for structural validity (50%), internal consistency (98%) and reliability (84%). Instruments that had satisfactory results for construct validity and reliability were supported by low to very low evidence. One responsiveness study was identified, and the result was satisfactory, but supported by low evidence. The Diabetes Knowledge Questionnaire is the instrument with best evidence for use. CONCLUSIONS: To plan more assertive interventions, researchers need to follow up guidelines to develop instruments with good quality of the measurement proprieties.

Validated medication deprescribing instruments for patients with palliative care needs palliative care: A systematic review. / [Artículo traducido] Instrumentos validados de desprescripción de medicamentos para los pacientes con necesidades de cuidados paliativos: una revisión sistemática.

OBJECTIVES: Patients with life-limiting illnesses are prone to unnecessary polypharmacy. Deprescribing tools may contribute to minimizing negative outcomes. Thus, the aims of the study were to identify validated instruments for deprescribing inappropriate medications for patients with palliative care needs and to assess the impact on clinical, humanistic, and economic outcomes. METHODS: A systematic review was conducted in LILACS, PUBMED, EMBASE, COCHRANE, and WEB OF SCIENCE databases (until May 2021). A manual search was performed in the references of enrolled articles. The screening, eligibility, extraction, and bias risk assessment were carried out by two independent researchers. Experimental and observational studies were eligible for inclusion. RESULTS: Out of the 5,791 studies retrieved, after excluding duplicates (n = 1,050), conducting title/abstract screening (n = 4,741), and full reading (n = 41), only one study met the inclusion criteria. In this included study, a randomized controlled trial was conducted, which showed a high level of bias risk overall. Adults 75 years or older (n = 130) with limited life expectancy and polypharmacy were allocated to two groups [intervention arm (deprescribing); and control arm (usual care)]. Deprescribing was performed with the aid of the STOPPFrail tool. The mean number of inappropriate medications and monthly medication costs were significantly lower in the intervention arm. No statistically significant differences were found in terms of unscheduled hospital presentations, falls, fractures, mortality, and quality of life. CONCLUSIONS: Despite the availability of several instruments to support deprescribing in patients with palliative care needs, only one of them has undergone validation and robust assessment for effectiveness in clinical practice. The STOPPFrail tool appears to reduce the number of inappropriate medications for older people with limited life expectancy (and probably palliative care needs) and decrease the monthly costs of pharmacotherapy. Nevertheless, the impact on patient safety and humanistic outcomes remain unclear.

Pharmacist-led medication reconciliation in emergency hospital services in Brazil: A scoping review.

OBJECTIVE: This scoping review aimed to map the evidence of pharmacist-led  medication reconciliation in hospital emergency services in Brazil. METHOD: We performed a scoping review by searching electronic databases LILACS, Pubmed, Embase, CINAHL, Scopus, Web of Science, Clinical  trials, REBEC e Cochrane and conducting a manual search to identify studies published up to 20 October 2021. Studies that addressed pharmacist-led medication reconciliation in hospital emergency  services in Brazil, regardless of clinical conditions, and outcomes evaluated,  were included. RESULTS: A total of 168 studies were retrieved, with three matching the inclusion criteria. Most studies performed pharmacist-led medication reconciliation at emergency department admissions, but it was not  the primary pharmaceutical attribution in this setting. Medication errors were identified during the medication reconciliation process, being drug  omission the most reported. Studies did not describe the concerns in collecting the best medication history from patients and the humanistic,  economic, and clinical outcomes of pharmacist-led medication reconciliation. Conclusions: This scoping review revealed the lack of evidence about the  pharmacist-led medication reconciliation process in the emergency setting in  Brazil. The findings suggest the need for future studies in this context.

OBJETIVO: Documentar la evidencia de la conciliación de medicamentos dirigida  por farmacéuticos en los servicios de emergencia  hospitalarios en Brasil.Método: Se realizó una revisión sistemática exploratoria de bases de datos  electrónicas LILACS, Pubmed, Embase, CINAHL, Scopus, Web of Science,  Clinical Trials, REBEC y Cochrane para identificar estudios publicados hasta el  20 de octubre de 2021. Los estudios incluidos abordaban la conciliación de  medicamentos dirigida por farmacéuticos en los servicios de emergencia  hospitalarios en Brasil, independientemente de las condiciones clínicas y los  resultados evaluados. RESULTADOS: Se recuperaron un total de 168 estudios, tres de los cuales cumplieron los criterios de inclusión. La mayoría de los estudios  realizaban la conciliación de la medicación dirigida por el farmacéutico en las admisiones al servicio de urgencias, pero ésta no era la principal atribución farmacéutica en ese contexto. Los errores de medicación fueron  identificados durante el proceso de conciliación de medicamentos, siendo la omisión de medicamentos el error más reportado. Los estudios no hacían referencia a la importancia de recabar un historial farmacológico lo más completo posible ni a los resultados humanísticos, económicos y clínicos de la  conciliación de medicamentos dirigida por farmacéuticos. CONCLUSIONES: Esta revisión sistemática exploratoria reveló la falta de evidencia sobre el proceso de conciliación de medicamentos dirigido por  farmacéuticos en los servicios de urgencias de Brasil. Los hallazgos sugieren la  necesidad de seguir investigando sobre este asunto.

Conciliación de medicamentos dirigida por farmacéuticos en los servicios de urgencias hospitalarias de Brasil: Revisión sistemática exploratoria / Pharmacist-led medication reconciliation in emergency hospital services in Brazil: A scoping review

Objetivo: Documentar la evidencia de la conciliación de medicamentos dirigida por farmacéuticos en los servicios de emergencia hospitalarios en Brasil.Método: Se realizó una revisión sistemática exploratoria de bases dedatos electrónicas LILACS, Pubmed, Embase, CINAHL, Scopus, Web ofScience, Clinical Trials, REBEC y Cochrane para identificar estudios publicados hasta el 20 de octubre de 2021. Los estudios incluidos abordabanla conciliación de medicamentos dirigida por farmacéuticos en los servicios de emergencia hospitalarios en Brasil, independientemente de lascondiciones clínicas y los resultados evaluados.Resultados: Se recuperaron un total de 168 estudios, tres de los cualescumplieron los criterios de inclusión. La mayoría de los estudios realizaban la conciliación de la medicación dirigida por el farmacéutico en lasadmisiones al servicio de urgencias, pero ésta no era la principal atribución farmacéutica en ese contexto. Los errores de medicación fueron identificados durante el proceso de conciliación de medicamentos, siendo laomisión de medicamentos el error más reportado. Los estudios no hacían referencia a la importancia de recabar un historial farmacológico lo máscompleto posible ni a los resultados humanísticos, económicos y clínicosde la conciliación de medicamentos dirigida por farmacéuticos.(AU)

Objective: This scoping review aimed to map the evidence of pharmacist-led medication reconciliation in hospital emergency services in Brazil.Method: We performed a scoping review by searching electronic databases LILACS, Pubmed, Embase, CINAHL, Scopus, Web of Science,Clinical trials, REBEC e Cochrane and conducting a manual search toidentify studies published up to 20 October 2021. Studies that addressedpharmacist-led medication reconciliation in hospital emergency servicesin Brazil, regardless of clinical conditions, and outcomes evaluated, wereincluded.Results: A total of 168 studies were retrieved, with three matching theinclusion criteria. Most studies performed pharmacist-led medicationreconciliation at emergency department admissions, but it was not theprimary pharmaceutical attribution in this setting. Medication errors wereidentified during the medication reconciliation process, being drug omission the most reported. Studies did not describe the concerns in collectingthe best medication history from patients and the humanistic, economic,and clinical outcomes of pharmacist-led medication reconciliation. Conclusions: This scoping review revealed the lack of evidence aboutthe pharmacist-led medication reconciliation process in the emergencysetting in Brazil. The findings suggest the need for future studies in thiscontext. (AU)

Development of instrument to report and assess causality of adverse events related to herbal medicines / Desarrollo de un instrumento para reportar y evaluar la causalidad de los eventos adversos asociados a plantas medicinales

Background: The use of herbal medicines is justified empirically using ethnopharmacological knowledge, which has limitations. Reports of adverse events (AE) may contribute for safety, quality, and effectiveness assessment. Objectives: This study aimed to develop an instrument to allow detection and evaluation of the causal likelihood of AE related to herbal medicines. Methods: A quantitative methodological development research intervention was performed with primary care health professionals. Two cases were distributed in an interval of one week in order to allow for completion of the proposal form. The within-rater reliability was calculated and classified into satisfactory, regular, and unsatisfactory, according to essential, necessary, and recommended items reported. Results: Fifty-seven professionals were enrolled. A high degree of the within-rater reliability was observed for the most essential, necessary, and recommended fields. The instrument contributed to assessment of definite causal association, once the duration of reactions including evolution, withdrawal, and reposition items showed high reliability. Most fields poor and weak filled were related to quality defects, such as popular name and appearance. Conclusions: Data suggest the instrument is adequate to report AE arising from herbal medicines. Owing to information regarding to organoleptic characteristics, the instrument is different from drug instruments. Therefore, it is intended to improve AE reports related to herbal medicines and contribute for appropriate use.

Antecedentes: Hierbas medicinales son utilizadas empíricamente con la base en el conocimiento etnofarmacobotánico, los cuales tienen limitaciones. Los informes de los eventos adversos (EA) pueden contribuir a la seguridad, la calidad y la evaluación de la eficacia de estos productos. Objetivos: El objetivo del estudio fue desarrollar un formulario para permitir la detección y evaluación de la probabilidad causal de EA relacionado al uso de plantas medicinales e fitoterápicos. Métodos: Investigación cuantitativa, de desenvolvimiento se llevó a cabo con los profesionales sanitarios de atención primaria. Dos casos fueran distribuidos, en un intervalo de una semana, con el fin de ser llenado en el formulario propuesto. La fiabilidad inter-observadores del instrumento fue evaluada y los resultados fueran clasificados en satisfactorio, regular e insatisfactorio, según los datos esenciales, necesarios y recomendados que fueran rellenados en el formulario de notificación. Resultados: Cincuenta y siete profesionales fueran elegibles. Se observó alto grado de fiabilidad entre observadores para la mayoría de los campos esenciales, necesarios y recomendados. El formulario contribuyó para la evaluación de la asociación causal definitiva, una vez que los campos de duración de las reacciones; evolución, retirada y re- exposición tuvieran alta fiabilidad. La mayoría de los campos flacamente llenados estaban relacionados con defectos de calidad, tales como: nombre popular y apariencia. Conclusiones: Los datos sugieren que el formulario propuesto es adecuado para reportar EA derivados de hierbas medicinales. Por la información relativa a las características organolépticas, el instrumento es diferente de lo instrumento para notificación de medicamentos. Por lo tanto, se pretende mejorar los informes de EA relacionados con los productos naturales y contribuir para el uso apropiado.

Risk factors for early prediction of adverse drug events related to hospitalizations / Factores de riesgo para la predicción de eventos adversos de medicamentos relacionados con la hospitalización

The prevalence of hospital admissions because of possible adverse drug events (ADEs) vary from 0.56% to 54.5% in Brazil. In addition, nearly 43% of inpatients may develop adverse drug reactions (ADRs) during their hospital stays. Clinical outcomes arising from drug-related problems are almost never identified by health professionals because the signs and symptoms are nonspecific and may mimic pathologies.

Drug interactions and possible serotonin syndrome in a patient with fibromyalgia / Interacciones medicamentosas y posible síndrome serotoninérgico en un paciente con fibromialgia

La depresión asociada con la fibromialgia puede tratarse con inhibidores selectivos de la recaptación de serotonina (ISRS) como fluoxetina, paroxetina o citalopram; o con inhibidores de la recaptación de serotonina y norepinefrina (duloxetina o milnacipran). En los pacientes con fibromialgia, varios metanálisis han demostrado la efectividad de los antidepresivos, en particular la amitriptilina, el antidepresivo tricíclico (TCA), que reduce el dolor, la fatiga, la depresión y los trastornos del sueño. Además, el tramadol, la pregabalina y la gabapentina son otras opciones de tratamiento.

Jaw stiffness and dental extractions due to pharmacodynamic interaction between mirtazapine and chlorpromazine / Bruxismo y extracciones dentales debido a la interacción farmacodinámica entre mirtazapina y la clorpromazina

A comprehensive assessment of the patient's drug related needs allows identifying health problems drug-induced. It has been demonstrated that each dollar spent on clinical pharmacy services reduces the pooled median cost of health by 4.81 dollars. Jaw stiffness (bruxism) can be a serotonergic manifestation related to drugs with serotonin reuptake inhibition activity. Clinical manifestations also include: agitation, tachycardia, high blood pressure, tremor, fever, dyspnea, diarrhea, mental confusion and insomnia