Assessment of a clinical pharmaceutical service for hypertensive and/or diabetic patients in a primary healthcare center

Objectives: The present study aimed to assess the short- and long-term outcomes of a clinical service provided by a pharmacist structured in a primary healthcare center (PHC) in Fortaleza, Ceará, Brazil. Methods: A longitudinal-type study was conducted. Data were collected from pharmacotherapy follow-up (PTF) records from the Pharmaceutical Care Unit of the PHC Dr. Anastácio Magalhães. The PTF was provided to patients diagnosed with hypertension and/or diabetes mellitus. Two groups were formed: records of patients who intended to undergo six months or more of PTF (PTF group) and those who opted not to go through with it after the first session (control). In addition, new blood pressure and glucose measurements were obtained after invitation by phone call at least six months after the completion of the PTF to assess maintenance of the benefits gained. The control patients were invited for this new data collection as well for comparison purposes. Research Ethics Committee approval protocol no. 329.717. Results: A total of 224 patients were considered, 109 in the complete PTF group and 115 in the control group, where the following main results were obtained: systolic pressure (mean ± SD) went from 139.43±20.6 to 128.31±16.03 mmHg; diastolic pressure, from 82.45±11.44 to 77.68±9.21 mmHg; blood glucose, from151.78±75.8 to 121.39±47.56 mg/dL; and cardiovascular risk, from 21.59±9.42 to 18.95±9.06%. In comparison, the control group did not show significant changes on the above parameters. In the post-PTF analysis, the benefits gained tended to be maintained even at least six months after its conclusion. Conclusions: Thus, the findings of the present study suggest that the provision of the clinical pharmaceutical service assessed at the primary healthcare level offers benefits to patients who attended it for at least six months. Furthermore, the data also suggest that these benefits are maintained in the long term.

Medication errors in critical patients during medication reconciliation: analyses and clinical management

Abstract Medication errors (ME) are frequent in the admission of patients to the ICU and can be identified and prevented through medication reconciliation (MR). Our aim was to evaluate the incidence, type and severity of MEs and associated factors, identified during MR in the ICU. This is a prospective, analytical approach, performed in the ICU of a private hospital, where the MRs were evaluated from April to June 2016. The SPSS and Stata programs were used to analyse the data. Logistic regression was performed to determine the factors associated with MEs. MR was performed with 136 patients, of whom 126 (92.6%) used drugs regularly. The incidence of MEs was 16.3% (95% CI 11.5-21.2). The main classes of drugs involved were those acting on the nervous and cardiovascular systems. There were 128 pharmaceutical interventions (acceptance: 71.1%). Regarding severity, 65.5% (n=80) of the errors reached the patient, but there was no harm. The risk factors for MEs identified were: age ≥60 years, number of comorbidities >1 and previous use of drugs ≥9. The incidence of MEs found and the significant association with age, comorbidities and polymedication alert to the need for specific attention to prevent admission errors in the most susceptible patient groups.

Medication adherence in patients with juvenile idiopathic arthritis.

OBJECTIVE: The aim of this study was to investigate pharmacological treatment adherence of patients with juvenile idiopathic arthritis, attended in an outpatient pharmacy at a tertiary hospital in northeastern Brazil. METHODS: The analysis of adherence was performed along with caregivers, through a structured questionnaire based on Morisky, Green and Levine, which enabled the categorization of adherence in "highest", "moderate" or "low" grades, and through evaluating medication dispensing registers, which classified the act of getting medications at the pharmacy as "regular" or "irregular". Drug Related Problems (DRP) were identified through the narrative of caregivers and classified according to the Second Granada Consensus. Then, a pharmaceutical orientation chart with information about the therapeutic regimen was applied, in order to function as a guide for issues that influenced adherence. RESULTS: A total of 43 patients was included, with a mean age of 11.12 years, and 65.1% (n=28) were female. Applying the questionnaire, it was found "highest" adherence in 46.5% (n=20) patients, "moderate" adherence in 48.8% (n=21), and "low" adherence in 4.7% (n=2). Through an analysis of the medication dispensing registers, a lower level of adherence was observed: only 25.6% (n=11) of the participants received "regularly" the medications. Twenty-six DRP was identified, and 84.6% (n=22) were classified as real. There were no significant associations between socio-demographic variables and adherence, although some caregivers have reported difficulty in accessing the medicines and in understanding the treatment. CONCLUSION: Our findings showed problems in the adherence process related to inattention, forgetfulness and irregularity in getting medicines, reinforcing the need for the development of strategies to facilitate a better understanding of treatment and to ensure adherence.

Medication adherence in patients with juvenile idiopathic arthritis / Adesão ao tratamento farmacológico em pacientes com artrite idiopática juvenil por meio de questionários

ABSTRACT Objective: The aim of this study was to investigate pharmacological treatment adherence of patients with juvenile idiopathic arthritis, attended in an outpatient pharmacy at a tertiary hospital in northeastern Brazil. Methods: The analysis of adherence was performed along with caregivers, through a structured questionnaire based on Morisky, Green and Levine, which enabled the categorization of adherence in “highest”, “moderate” or “low” grades, and through evaluating medication dispensing registers, which classified the act of getting medications at the pharmacy as “regular” or “irregular”. Drug Related Problems (DRP) were identified through the narrative of caregivers and classified according to the Second Granada Consensus. Then, a pharmaceutical orientation chart with information about the therapeutic regimen was applied, in order to function as a guide for issues that influenced adherence. Results: A total of 43 patients was included, with a mean age of 11.12 years, and 65.1% (n = 28) were female. Applying the questionnaire, it was found “highest” adherence in 46.5% (n = 20) patients, “moderate” adherence in 48.8% (n = 21), and “low” adherence in 4.7% (n = 2). Through an analysis of the medication dispensing registers, a lower level of adherence was observed: only 25.6% (n = 11) of the participants received “regularly” the medications. Twenty-six DRP was identified, and 84.6% (n = 22) were classified as real. There were no significant associations between socio-demographic variables and adherence, although some caregivers have reported difficulty in accessing the medicines and in understanding the treatment. Conclusion: Our findings showed problems in the adherence process related to inattention, forgetfulness and irregularity in getting medicines, reinforcing the need for the development of strategies to facilitate a better understanding of treatment and to ensure adherence.

RESUMO Objetivo: Investigar a adesão ao tratamento farmacológico de pacientes com artrite idiopática juvenil, atendidos na farmácia ambulatorial de hospital terciário do Nordeste do Brasil. Métodos: A análise da adesão foi feita junto aos cuidadores, por meio de questionário estruturado com base no teste de Morisky, Green e Levine, que viabilizou a categorização da adesão em “máxima”, “moderada” ou “baixa”, e da avaliação dos registros de dispensação dos medicamentos, que classificou a retirada de medicamentos na farmácia como “regular” ou “irregular”. Os problemas relacionados com medicamentos (PRM) foram identificados por meio da narrativa dos cuidadores e classificados conforme o Segundo Consenso de Granada. Em seguida, aplicou-se uma tabela de orientação farmacêutica, que contém informações sobre o esquema terapêutico, de forma a esclarecer questões que influenciavam a adesão. Resultados: Participaram 43 pacientes, com média de 11,12 anos, 65,1%, (n = 28) do sexo feminino. Por meio do questionário, verificou-se adesão “máxima” em 46,5% (n = 20) dos pacientes, “moderada” em 48,8% (n = 21) e “baixa” em 4,7% (n = 2). Pelo registro de dispensação, observou-se um nível de adesão menor: apenas 25,6% (n = 11) dos participantes receberam os medicamentos “regularmente”. Identificaram-se 26 PRM, 84,6% (n = 22) classificados como “reais”. Não foram observadas associações significativas entre as variáveis sociodemográficas e a adesão, embora alguns cuidadores tenham relatado dificuldade de acesso ao medicamento e de compreensão do tratamento. Conclusão: Nossos achados demonstraram falhas no processo de adesão, relacionadas ao descuido, esquecimento e à irregularidade para receber os medicamentos, o que reforça a necessidade de estratégias para facilitar a compreensão do tratamento e garantir a adesão

Farmácias Vivas: caracterização de marcadores químicos ativos para avaliação da qualidade da matéria-prima, intermediário e fitoterápico à base de cidreira (Lippia alba), Quimiotipo II / Live Pharmacies: characterization of active chemical markers for evaluation of the quality of raw material, intermediate and phytotherapeutic based on bushy matgrass (Lippia alba), Chemotype II

A cidreira (Lippia alba (Mill.) N.E. Brown), quimiotipo II, é referidapopularmente como cidreira carmelitana, rica em óleo essencial(limoneno e citral) e foi selecionada pelo Comitê Estadual de Fitoterapiapara integrar o elenco de plantas medicinais de uso nas Farmácias Vivasdo Estado do Ceará, fazendo parte da Relação de Plantas Medicinais-REPLAME/CE (Portaria 275/2012), como terapia complementar àscrises de ansiedade e insônia de leves a moderadas. Vários estudostêm relatado ações farmacológicas do citral - uma mistura de dois isômeros: trans-geranial e cis-neral – especialmente atividade sedativa.O presente trabalho tem como objetivo realizar a caracterização destes marcadores químicos ativos para avaliação da qualidade da matériaprima,intermediário e fitoterápico à base de cidreira (Lippia alba),Quimiotipo II. A metodologia utilizada consistiu em: 1) Caracterização macro e micro morfológica das folhas de L. alba;2) Extração do óleo essencial 3) Preparação do Elixir de L. alba a 8%; 4) Análises por Cromatografia Gasosa acoplada a Espectrômetro de Massas (CG-EM)e Cromatografia em Camada Delgada. Observou-se que a metodologia utilizada pode ser aplicada nos trabalhos de rotina de controle de qualidade de L. alba, quimiotipo II, tanto para caracterização macro e micromorfológica da espécie, como para caracterização do marcadoresquímicos ativos do óleo essencial (citral/neral e geranial). Observouse,ainda, que as técnicas utilizadas para obtenção do extrato fluido edo elixir extraíram estes constituintes ativos do óleo essencial, os quais influenciam na qualidade e atividade destas preparações. O elixir de cidreira pode representar uma alternativa terapêutica simples, segura e de baixo custo para o SUS, em consonância com a Política Nacional de Plantas Medicinais e Fitoterápicos.

Identification and determination of the inulin content in the roots of the Northeast Brazilian species Pombalia calceolaria L.

A polysaccharide was extracted from the roots of Pombalia calceolaria, a plant used in folk medicine in Northeastern Brazil, by decoction followed by precipitation with methanol, yielding a concentration of 13.0% w/w, and purification with acetone. The molar mass peak was estimated to be 4.0×10(3)Da using gel permeation chromatography (GPC). Polarized light photomicrography of histological sections revealed the presence of inulin in the cortical parenchyma. The chemical composition of inulin was identified by 1D and 2D NMR and FT-IR spectroscopy and the findings were compared with the literature. This is the first time inulin has been identified on FT-IR and NMR for the species Pombalia calceolaria.

Himatanthus Willd. ex Schult. (Apocynaceae): Review.

The genus Himatanthus Wild. ex Schult. (Apocynaceae) includes about 13 species and five subspecies widely distributed in South America, especially Brazil. The phytochemical reports on this genus have revealed mainly triterpenes and iridoids. The plants are traditionally used as anthelmintic, antitumor, and antiinflammatory agents. The most used parts of the plant are its bark, leaves, and latex. This review emphasizes the phytochemical constituents and medicinal properties, which may help in future research. The research was conducted with data obtained from books about medicinal plants, theses, dissertations, and articles in refereed journals.

Medication adherence in patients with juvenile idiopathic arthritis. / Adesão ao tratamento farmacológico em pacientes com artrite idiopática juvenil por meio de questionários.

OBJECTIVE: The aim of this study was to investigate pharmacological treatment adherence of patients with juvenile idiopathic arthritis, attended in an outpatient pharmacy at a tertiary hospital in northeastern Brazil. METHODS: The analysis of adherence was performed along with caregivers, through a structured questionnaire based on Morisky, Green and Levine, which enabled the categorization of adherence in "highest", "moderate" or "low" grades, and through evaluating medication dispensing registers, which classified the act of getting medications at the pharmacy as "regular" or "irregular". Drug Related Problems (DRP) were identified through the narrative of caregivers and classified according to the Second Granada Consensus. Then, a pharmaceutical orientation chart with information about the therapeutic regimen was applied, in order to function as a guide for issues that influenced adherence. RESULTS: A total of 43 patients was included, with a mean age of 11.12 years, and 65.1% (n=28) were female. Applying the questionnaire, it was found "highest" adherence in 46.5% (n=20) patients, "moderate" adherence in 48.8% (n=21), and "low" adherence in 4.7% (n=2). Through an analysis of the medication dispensing registers, a lower level of adherence was observed: only 25.6% (n=11) of the participants received "regularly" the medications. Twenty-six DRP was identified, and 84.6% (n=22) were classified as real. There were no significant associations between socio-demographic variables and adherence, although some caregivers have reported difficulty in accessing the medicines and in understanding the treatment. CONCLUSION: Our findings showed problems in the adherence process related to inattention, forgetfulness and irregularity in getting medicines, reinforcing the need for the development of strategies to facilitate a better understanding of treatment and to ensure adherence.

Cardiovascular risk rate in hypertensive patients attended in primary health care units: the influence of pharmaceutical care

Cardiovascular complications are relevant due to their frequency and severity on the hypertension scenario. Studies refer Pharmaceutical Care (PC) as capable of decreasing cardiovascular risk rate (%CVR) on hypertensive patients. This study aimed to investigate, through a randomized clinical assay, the influence of PC service on the %CVR of hypertensive patients assisted in a health primary care unit from Fortaleza-Ceará. Two study groups were formed: i. Intervention Group (IG), which received orientation about taking medicines, actions aiming to prevent/solve medicine interactions and adverse effects and non-pharmacological interventions for 9 months and, ii. Control Group (CG), which received traditional assistance of the unit and was monitored during the same period. It was observed a statistically significant reduction on %CVR (10.76 to 7.86; p=0.04) and systolic blood pressure levels (SBP) (137.69 to 131.54; p<0.01) in the IG, while, in the CG, there was no significant alteration. 151 Drug Related Problem (DRP) were identified and it was realized 124 pharmaceutical interventions, with 89.2% of them resulting on solution/prevention of the problem. Our findings indicated that the inclusion of the PC service in the hypertensive health assistance was more effective at the %CVR and the SBP reduction in comparison to the traditional assistance offered.

As complicações cardiovasculares apresentam relevância devido à sua freqüência e gravidade no contexto da hipertensão. Estudos referem que a prestação do Cuidado Farmacêutico (CF) é capaz de reduzir a taxa de risco cardiovascular (%RCV) em hipertensos. Esse trabalho objetivou investigar, com um ensaio clínico randomizado, a influência da prestação do CF na %RCV em hipertensos atendidos em uma unidade de atenção primária à saúde de Fortaleza-Ceará. Formarm-se dois grupos de estudo: i. Grupo Intervenção (GI), que recebeu orientações sobre tomada dos medicamentos, ações visando prevenir/resolver interações medicamentosas e reações adversas e intervenções não-farmacológicas por 9 meses e ii. Grupo Controle (GC), que recebeu assistência tradicional da unidade e foi monitorado durante o mesmo período. Observou-se redução estatisticamente significativa nas %RCV (10,76 to 7,86; p=0,04) e nos níveis de pressão arterial sistólica (PAS) (137,69 to 131,54; p<0,01) no GI, enquanto no GC, não houve alteração significativa. Identificaram-se 151 Problemas Relacionados com Medicamentos (PRM) e foram realizadas 124 intervenções farmacêuticas, das quais, 89,2% resultaram em solução/prevenção dos problemas. Nossos achados indicaram que a inclusão do serviço de CF na assistência ao paciente hipertenso foi mais eficaz na redução da %RCV e níveis de PAS em comparação à assistência tradicional.

Phytochemical study guided by the myorelaxant activity of the crude extract, fractions and constituent from stem bark of Hymenaea courbaril L.

ETHNOPHARMACOLOGICAL RELEVANCE: Hymenaea courbaril L. (Caesalpinoideae) is used in Brazilian folk medicine to treat anemia, kidney problems, sore throat and other dysfunctions of the respiratory system, such as bronchitis and asthma, although such properties are yet to be scientifically validated. AIM OF THE STUDY: In order to give a scientific basis to support the traditional use of Hymenaea courbaril, this study was designed to evaluate antioxidant, myorelaxant and anti-inflammatory properties of the ethanol extract from stem bark and its fractions. The myorelaxant effect of astilbin, a flavonoid isolated from the bioactive ethyl acetate fraction (EAF), has also been evaluated. MATERIAL AND METHODS: In the present study ethanol extract from stem bark (EEHC) and fractions were analyzed using bioassay-guided fractionation. The following activities were investigated: antioxidant by 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, myorelaxant on rat tracheal smooth muscle, and anti-inflammatory using ovalbumin-induced leukocytosis and airway hyperresponsiveness in rats. RESULTS: The results of the present investigation show that the whole extract of Hymenaea courbaril and some of its fractions strongly scavenged DPPH radical. The extract showed myorelaxant activity on rat trachea, being EAF its highest efficient fraction. Bio-guided study allowed the isolation of astilbin, a well-known flavonoid. The activity induced by this compound indicates that it may be partly responsible for the myorelaxant effect of EAF. EAF reduced contractions that depended on divalent cation inflow through voltage-operated Ca(2+) channels (VOCCs) or receptor-operated Ca(2+) channels (ROCCs), but it was more potent to inhibit VOCC- than ROCC-dependent contraction induced by Ca(2+) addition in ACh-enriched Ca(2+)-free medium. Oral pretreatment of antigen-challenged animals with EAF prevented airway hyperresponsiveness on KCl-induced contraction and reduced the number of total white cells, particularly eosinophils and neutrophils in bronchoalveolar lavage. CONCLUSIONS: This study provided scientific basis that Hymenaea courbaril presents potential antioxidant, myorelaxant and anti-inflammatory actions, which support its use in folk medicine to treat inflammatory airway diseases.

Larvicidal activity against Aedes aegypti of pacharin from Bauhinia acuruana.

The aim of the present study was to evaluate the activity of pacharin isolated from the ethanol extract from roots of Bauhinia acuruana on third-instar larvae of Aedes aegypti Linn. (Diptera: Culicidae). The crude ethanol extract showed larvicidal activity at the concentration of 500 µg/mL. Given this larvicidal activity, this extract was submitted to chromatographic fractionation on a silica gel column eluted with n-hexane, dichloromethane, ethyl ether, ethyl acetate, and methanol in order to isolate the active compound(s). Pacharin, obtained in pure form from fraction eluted with ethyl ether, was evaluated for their larvicidal effects against A. aegypti. In these bioassays, the larvae were exposed at concentrations of 500, 250, 100, 50, and 25 µg/mL of the crude ethanol extract or pacharin. After 24 h, the number of dead larvae was counted and the LC50 values for larval mortality were calculated. Pacharin showed LC50 value of 78.9 ± 1.8 µg/mL. The structure of isolated compound was identified on the basis of their spectral data (IR, 1D- and 2D-NMR) and by comparison with literature spectral data. The results indicate pacharin as a potential natural larvicide.