High-risk pregnancy: characterization of medication use profile and association with clinical and sociodemographic factors / Gestação de alto risco: caracterização do perfil de utilização de medicamentos e associação com fatores clínicos e sociodemográficos

Abstract Objectives: describe the profile of medication use and adherence, and the association with clinical and sociodemographic characteristics of high-risk pregnant women attended at a university hospital. Methods: cross-sectional study with data collected through a questionnaire applied on 386 pregnant women. Results: most participants were seen only by the gynecologist (75.1%), started prenatal in the first gestational trimester (86.8%), did not plan the pregnancy (61.9%), and performed an average of 8.2 (SD=4.4) prenatal consultations. The most frequent diagnoses were arterial hypertension (20.5%) and diabetes mellitus (19.7%). Prevalence of medication use was 99.7%, with an average of 5.1 (SD=2.1) medication per woman and 12.7% self-medication. Antianemics (88.9%) and analgesics (63.2%) were the most prevalent classes and 17.9% of the women reported the use of medication with significant gestational risk. Only 36.5% were considered adherent, 32.9% declared they were unaware of the indication of the medication in use and 42% did not receive guidance on the use of the medication during pregnancy. There is no evidence of association between the number of the medication used and clinical and sociodemographic aspects. Conclusions: there is a need to develop strategies to improve the care of this population, with emphasis on strengthening multi-professional care.

Resumo Objetivos: descrever o perfil de utilização de medicamentos e de adesão, e a associação com as características clínicas e sociodemográficas de gestantes de alto risco atendidas em um hospital universitário. Métodos: trata-se de um estudo transversal com dados coletados mediante um questionário estruturado aplicado à 386 gestantes. Resultados: a maior parte das participantes era acompanhada apenas pelo ginecologista (75,1%), iniciou o pré-natal no primeiro trimestre gestacional (86,8%), não planejou a gravidez (61,9%) e realizou em média 8,2 (DP=4,4) consultas de pré-natal. Os diagnósticos mais frequentes foram hipertensão arterial (20,5%) e diabetes mellitus (19,7%). A prevalência de uso de medicamentos foi 99,7%, com média de 5,1 (DP=2,1) medicamentos por mulher e 12,7% de automedicação. Os antianêmicos (88,9%) e analgésicos (63,2%) foram as classes farmacológicas mais prevalentes e 17,9% das gestantes referiram uso de fármacos com risco gestacional relevante. Apenas 36,5% das gestantes foram consideradas aderentes ao tratamento, 32,9% declararam desconhecer a indicação dos medicamentos em uso e 42% não receberam orientações sobre o uso de medicamentos durante a gestação. Não há evidências de associação entre o número de medicamentos utilizados e os aspectos clínicos e sociodemográficos. Conclusão: é necessário desenvolver estratégias para melhorar o atendimento desta população e o uso racional de medicamentos, com ênfase no fortalecimento do cuidado multiprofssional.

Sociodemographic and pharmacoepidemiological profile of people on antiretroviral therapy in the coast of the state of Paraná

The aim of this study was to investigate possible factors related to antiretroviral therapy (ART) that contribute to the understanding of the highest rate of Aids detection on the coast of the state of Paraná, a port region identified administratively as the 1stRegional Health Division (1stHD) in the state of Paraná. Data on the sociodemographic profile of the population undergoing antiretroviral treatment (ART), medication changes, dropout of therapy, proportion of the population undergoing treatment and viral load were obtained through computerized systems. Between July 1, 2018 and June 31, 2019, 1,393 people were on ART in the 1stRS. Of these, 57.6% were male. During this period, 110 people started ART with a predominance of the age group between 30 and 39 years old. ART was switched for169 people and 211 patient dropouts were detected. The proportion of people diagnosed with HIV without treatment (gap) is still high, however 92.7% people on ART have suppressed viral load. It can be concluded that the lower educational level of the population undergoing treatment, the late diagnosis of those infected and the treatment gapprobably contribute to the highest rate of Aids detection in the 1stRS.

Pharmacoepidemiology of the antiglaucoma drugs in Brazil from 2012 to 2018 / Farmacoepidemiologia das drogas antiglaucomatosas no Brasil de 2012 a 2018

Abstract Purpose: To outline the epidemiological profile of clinical treatments for glaucoma provided by the Brazilian Unified Health System (SUS, acronym in Portuguese) between January 2012 and December 2018. Methods: A quantitative and descriptive study was conducted using available data based on the outpatient information system from SUS (SIA/SUS, acronym in Portuguese). The variables were monocular treatment with first, second, and third-line drugs; monocular treatment with combinations of two drugs and three drugs from different lines; binocular treatment with first, second, and third-line drugs; and binocular treatment with combinations of two drugs and three drugs from different lines. Results: During the analysis period, the prevalence of clinical therapies for glaucoma increased from 2012 to 2017 and decreased from 2017 to 2018. Of the clinically treated patients, 96% were carriers of binocular glaucoma. Among the regions of Brazil, the Northeast had the highest prevalence of binocular glaucoma (about 60% of the number of cases), and the most common therapy was combinations of two drugs from different lines. The Southeast region had the highest concentration of monocular glaucoma (53% of cases), and the predominant therapy was combinations of three drugs from different lines. The Midwest region had the lowest prevalence of monocular-treatments for glaucoma (less than 6%). Conclusion: In Brazil, the highest number of treatments offered by the public health system was in the Northeast and Southeast regions. There is a high national prevalence and potential for the morbidity of this disease. Therefore, it is necessary to strengthen programs aimed at early diagnosis and appropriate treatment to reduce adverse outcomes.

Resumo Objetivo: Traçar o perfil epidemiológico do tratamento clínico para o glaucoma no Brasil fornecido pelo Sistema Único de Saúde (SUS), no período de janeiro de 2012 a dezembro de 2018. Métodos: Estudo quantitativo e descritivo, utilizando a base de dados disponível no Sistema de Informações Ambulatoriais do SUS (SIA/SUS). As variáveis utilizadas foram: tratamento monocular com drogas de primeira, de segunda e de terceira linha; tratamento monocular com combinações de duas drogas e de três drogas de diferentes linhas; tratamento binocular com drogas de primeira, de segunda e de terceira linha; e tratamento binocular com combinações de duas drogas e de três drogas de diferentes linhas. Resultados: Durante o período analisado, a prevalência de terapias clínicas para o glaucoma aumentou entre 2012 e 2017 e diminuiu entre 2017 e 2018. Dos pacientes tratados clinicamente, 96% eram portadores de glaucoma binocular. Entre as regiões do Brasil, o Nordeste teve a maior prevalência de glaucoma binocular (cerca de 60% do número de casos), e a terapia mais comum foi a combinação de duas drogas de diferentes linhas. A região Sudeste teve a maior concentração de glaucoma monocular (53% dos casos), e a terapia predominante foi a combinação de três drogas de diferentes linhas. A região Centro-Oeste apresentou a menor prevalência de tratamentos monoculares para o glaucoma (menos de 6%). Conclusão: No Brasil, o maior número de tratamentos oferecidos pelo sistema público de saúde foi nas regiões Nordeste e Sudeste. Existe uma alta prevalência nacional e um alto potencial para morbidade desta doença. Portanto, é necessário fortalecer programas voltados para o diagnóstico precoce e para o tratamento adequado a fim de reduzir os resultados adversos.

Farmacovigilancia en el programa de Farmacología de la carrera de Medicina / Pharmacovigilance in the program of Pharmacology of Medicine pre-grade studies

Introducción: la Farmacología como ciencia es muy amplia, y comprende todos los aspectos relacionados con los fármacos o medicamentos. Constituye el sustento científico de la terapéutica que se imparte en todas las asignaturas clínicas. Objetivo: identificar los contenidos de farmacovigilancia en el programa de la asignatura de Farmacología en la carrera de Medicina. Materiales y Métodos: estudio descriptivo transversal que constató la presencia de la farmacovigilancia en el programa de Farmacología de la carrera de Medicina. Se aplicó una metodología propuesta para el análisis documental. Resultados: el análisis de los documentos arrojó que en los objetivos educativos de la Farmacología se encuentra: desarrollar una concepción, conducta y actuación que contribuyan a la educación en el uso racional y científico de los medicamentos, en todos los niveles de atención de la salud con énfasis en la primaria. Se incluyen los principales grupos de sustancias tendentes a ocasionar dependencia en el hombre, así como la aplicación de los conocimientos sobre las bases farmacológicas de la dependencia o adicción. Se constató la existencia de ejemplos de plantas medicinales y medicamentos herbarios que pueden producir reacciones adversas o interacciones con medicamentos. Conclusiones: los estudiantes de Medicina deben recibir formación sobre los principios de la prescripción racional antes de participar en la asistencia médica. Incorporar el estudio de la seguridad de los medicamentos desde la óptica del consumo, puede traducirse tanto en términos beneficiosos como perjudiciales, esta última condición se refleja en las reacciones adversas que pueden aparecer siempre que haya exposición a un fármaco (AU).

Introduction: Pharmacology is very wide as a science, and includes all the aspects related with the drugs or medications. It is the scientific support of the therapeutics that is taught in all the clinical subjects. Objective: to identify the pharmacovigilance contents in the program of the subject Pharmacology in the Medicine pre-grade studies. Materials and Methods: descriptive, cross-sectional study stating the presence of pharmacovigilance in the Pharmacology program of the Medicine pre-grade studies. A methodology proposed for the documental analysis was used. Results: the documental analysis showed that among the Pharmacology educative aims are: to develop a conception, behaviour and performance contributing to the training in the rational and scientific use of medications in all the levels of the health care, with emphasis in the primary one. There are included the main groups of substances tending to create dependence in people, and also the application of the knowledge on the pharmacological bases of dependence and addiction. It was stated the existence of medicinal plants and herbal medicines that could produce adverse reactions or interactions with medications. Conclusions: Medicine students should be trained on the principles of rational prescription before participating in medical care. Studying medications security from the point of view of their consumption may have both, beneficial and harmful effect. The last ones reveals in adverse reactions that may appear always when there is exposition to a medication (AU).

Reacciones adversas por medicamentos en ancianos cubanos (2003-2013) / Adverse drug reactions reported in the Cuban elderly in the 2003-2013 period

Introducción: Las peculiaridades de las reacciones adversas medicamentosas en ancianos no están bien establecidas en Cuba. Objetivo: Determinar las reacciones adversas medicamentosas en ancianos reportadas al Sistema Cubano de Farmacovigilancia. Métodos: Investigación descriptiva y transversal. El universo, constituido por 26 489 reportes de reacciones adversaspor fármacos del Cuadro Básico de Medicamentos enpacientes de 60 años y más, registradas enla base de datos nacional de farmacovigilancia del 2003 al 2013. Las variables examinadas fueron edad, sexo, reacción adversa, sistema de órgano, medicamento, grupo farmacológico, imputabilidad, gravedad, frecuencia, notificador y nivel de atención de salud. Las medidas de resumen fueron frecuenciaabsoluta, porcentaje y tasas. Resultados: La tasa de notificación fue de 1 479, 4 × 105 ancianos. Las mujeres (1 885,1 × 105) y el grupo de 60 a 69 años (1 559,8 × 105) resultaron los más afectados. Las reacciones adversas medicamentosas predominantes fueron erupción cutánea (148,3 × 105), las leves (741,1 × 105), probables (1097,5 × 105) y las frecuentes (828,8 × 105), producidas más por antibacterianos (341,5 × 105) y captopril (167,7 × 105). Reportaron más los médicos (68,8 por ciento) desde la atención primaria de salud (85,8 por ciento). Conclusiones: Las reacciones adversas medicamentosas en ancianos constituyeron una pequeña proporción de todos los efectos indeseados notificados al Sistema Cubano de Farmacovigilancia del 2003 al 2013; sus características son similares a las reportadas a nivel internacional, excepto el grupo de edad afectado, el tipo de efecto indeseado y los medicamento simplicados(AU)

Introduction: The characteristics of the adverse drug reactions in the elderly are not clearly identified in Cuba. Objective: To determine adverse drug reactions in the elderly reported to the Cuban Pharmacovigilance System.Methods: Descriptive cross-sectional research work. The universe of study was 26 489 adverse reaction reports to drugs from the Basic Drug Group in 60 years-old and over patients, registered in the national pharmacovigilance database from 2003 to 2013. The studied variables were age, sex, kind of adverse reactions, affected organ system, drug, pharmacological group, imputability, severity, frequency, notifying person and health care level. The summary measures were absolute frequencies, percentages and rates.Results: The adverse drug reactions reporting rate was 1 479.4 x 105 elders. Women (1 885.1 × 105) and the 60-69 y old group (1 559.8 × 10 5) were the most affected ones. The predominating adverse drug reactions were skin rash (148.3 × 105), slight (741.1 × 105), probable (1 097.5 × 105) and frequent (828.8 × 10 5) caused mainly by antibacterial drugs (341.5 × 105) and captopril (167.7 × 105). Adverse reactions were mostly reported physicians (68.8 prcent) at the primary health care (85.8 percent).Conclusions: The adverse drug reactions reported in the elderly represent a small proportion of all undesirable effects notified to the Cuban pharmacovigilance System from 2003 to 2013; the main feature of adverse reactions were similar to that reported at international level, except for the affected age group, the kind of undesirable effect and the involved drugs(AU)

Estudo Epidemiológico de Base Populacional sobre o Uso de Medicamentos Potencialmente Inadequados Entre Idosos

O uso de medicamentos potencialmente inadequados (MPI) para idosos pode estar associado a mais riscos que benefícios e sua utilização tem sido documentada internacionalmente. Nesta perspectiva, os objetivos deste trabalho foram: (1) numa abordagem transversal, estimar a prevalência de utilização de MPI entre idosos residentes na Região Metropolitana de Belo Horizonte (RMBH), Minas Gerais, e os fatores associados a essa prática; (2) longitudinalmente, investigar se o uso de MPI constitui fator de risco independente para a mortalidade entre idosos residentes em comunidade. A abordagem transversal foi baseada nos dados coletados junto a uma amostra representativa da população idosa com 60 anos ou mais residentes na RMBH (n=1.158); no cumprimento do segundo objetivo, utilizou-se os dados coletados junto à coorte idosa do Projeto Bambuí (n=1.586), composta em 1997 e acompanhada, anualmente, até 2011.

Para definição do uso de MPI, variável dependente no estudo transversal e exposição de interesse no estudo longitudinal, utilizou-se o critério de Beers 2012. Variáveis sociodemográficas, de condições de saúde, de utilização de serviços de saúde e número de medicamentos foram utilizadas em caráter exploratório no estudo dos fatores associados ao uso de MPI (etapa transversal) e como variáveis de ajuste na investigação da associação entre uso de MPI e mortalidade (vertente longitudinal). A análise da prevalência e dos fatores associados ao uso de MPI foi baseada no modelo de regressão de Poisson; a investigação da associação do uso de MPI e mortalidade foi realizada por meio do modelo dos riscos proporcionais de Cox, adotando-se em ambos os casos, o nível de significância estatística de 5%. Na RMBH, a prevalência do uso de MPI foi de 43,3%. O sexo feminino, o número de doenças crônicas e a polifarmácia apresentaram-se positiva e independentemente associadas ao uso de MPI, sendo a última a variável mais fortemente associada. Em Bambuí, o uso de MPI mostrou-se como fator de risco para mortalidade entre os idosos da coorte. Nossos resultados apontam para a necessidade da seleção de alternativas terapêuticas mais seguras para idosos.

Pharmacoepidemiologic study of warfarin prescription in a Brazilian tertiary hospital.

Warfarin is among the ten drugs most commonly involved in adverse drug reactions, has a narrow therapeutic index and complex dosage regimen, exhibits enormous variability dose-response and high risk drug-drug interactions. To analyze the profile of pharmacoepidemiological drug prescriptions for warfarin in patients admitted to a Brazilian tertiary hospital. In the cross sectional study the electronic prescriptions of the January 01, 2004-December 31, 2010 of patients using warfarin of the Clinical Hospital of the Faculty of Medicine of Ribeirao Preto were analyzed. Sociodemographic characteristics, clinical data, laboratory test results, and drug therapy data were collected. We identified 3,048 patients who received 154,161 drug prescriptions, 42,120 of which contained warfarin. The mean age was 55.8 ± 19.3 years, 48.2% were elderly, and 4.3% had specific cerebrovascular disease diagnoses. The average International Normalized Ratio (INR; 2.4 ± 1.7) and warfarin dose (5.1 ± 1.8 mg/day) were within therapeutic protocol recommendations. However, approximately 14.0 and 8.5% of the patients had mean INR greater than 3.0 and 3.5, respectively. In addition, 66.4 and 6.1% of the patients received polypharmacy and clopidogrel, respectively, which can increase the risk of drug-drug interactions and bleeding. The average number of drugs per prescription was 7.2 ± 3.8, and 31,595 drug prescriptions (74.0%) consisted of five or more drugs. The study found a high prevalence of elderly patients, polypharmacy, and concomitant use of anticoagulant and antiplatelet drugs, which may favor the occurrence of adverse events.

Farmacoepidemiologia e uso indevido de anti-hipertensivos no estado do Rio de Janeiro / Pharmacoepidemiology and antihypertensive drugs misuse at Rio de Janeiro state

Fundamentos: A Farmacoepidemiologia possibilita que se conheça e se entenda melhor a relação risco benefício do uso dos medicamentos em pacientes. Objetivo: Avaliar o uso de medicamentos por pessoa sem idade produtiva na área metropolitana do estado do Rio de Janeiro. Métodos: Estudo transversal realizado com voluntários domiciliados na região metropolitana do estado do Rio de Janeiro, em 2011. Os dados foram coletados utilizando-se questionário estruturado. Resultados: Anti-inflamatórios não esteroidais (40%), medicamentos usados em doenças cardiovasculares (23%) e anticoncepcionais orais (9%) foram as classes farmacológicas mais usadas pelos 235 entrevistados. Os anti-hipertensivos mais usados foram: inibidores da enzima conversora da angiotensina/bloqueadores do receptor de angiotensina (A, 29-33%), diuréticos (D,28%) e betabloqueadores (B, 21-35%), em 186 indivíduos na faixa etária de 20-60 anos. Conclusões: O controle farmacológico da hipertensão indicado para o grupo estudado abrange monoterapia com A ou B. O uso inadequado de nitrovasodilatadores(N), B e D devem ser evitados, especialmente em terapias combinadas, pois B e D favorecem a intolerância à glicose e hipertrigliceridemia. Mulheres hipertensas em idade reprodutiva devem evitar o uso de A e interações medicamentosas com contraceptivos orais. Assim, o uso de anti-hipertensivos não está plenamente de acordo com o consenso atual.

Background: Pharmacoepidemiology makes possible the better knowing and understanding of patients drugs use risk-benefit ratio. Objective: Our study aims to evaluate the use of drugs by people in productive ages that live in metropolitan area of Rio de Janeiro state. Data collection included as tructured questionnaire applied after an informed consent document signature. Results: Non steroidal antiinflammatories (40%),drugs used in cardiovascular diseases (23%) and oral contraceptives (9%) were the most used pharmacological classes by 235 respondents. Angiotensin converting enzyme inhibitors/angiotensin receptor blockers(A, 29-33%), diuretics (D, 28%) and -blockers (B, 21-35%) were the most antihypertensives used by 186 individuals aged from 20 to 60 years. Conclusions: The hypertension pharmacological management indicated for the studied group covers Aor B monotherapy. It is inappropriate to use N; B must be avoided, such as D, especially in combination therapy because B and D promote glucose intolerance and hypertrigly ceridemia. Hypertensive females in reproductive ages must avoid A and drug interaction with oral contraceptives. So the use of antihypertensive drugs is not entirely in agreement to current consensus.

La evidencia científica y la intervención farmacológica preventiva en geriatría / Scientific evidence and preventive pharmacological intervention in geriatrics

Los adultos mayores constituyen un grupo poblacional que cada día va en aumento, y son ellos los que requieren mayor atención médica y los que consumen un número elevado de fármacos. Este trabajo intenta hacer una revisión sobre la prescripción de fármacos con fines preventivos en el adulto mayor según las evidencias científicas. La polifarmacia en el anciano incrementa las posibilidades de reacciones adversas a los medicamentos, interacciones entre ellos potencialmente deletéreas, aumento de los ingresos hospitalarios por esta causa y aumento de los gastos en salud. Los fármacos constituyen la primera fuente de trastornos yatrogénicos en los ancianos, atribuible a que muchas veces se indican de forma irracional y se aplican malas prácticas de prescripción sin un sustento científico sólido. Se espera contribuir a que el médico desarrolle la habilidad de prescribir el fármaco de manera eficaz, conveniente, con prudencia clínica y distancie las recomendaciones sesgadas del mercado en términos de terapéutica. Es importante mejorar la prescripción farmacológica en aras de una mejor calidad de vida en el adulto mayor

The older adults are a population group that increases every day and they require more medical care and consume a large number of drugs. This paper was intended to make a review on drug prescription for preventive purposes in the elderly on the basis of scientific evidence. The multiple drug consumption by the elderly increases the possibilities of suffering adverse reactions to drugs, potentially deleterious interactions, rise of admissions at hospital due to this problem and higher health expenses. The drugs are the first source of iatrogenic disorders in the aged people, often attributable to irrational and wrong practices of prescription without any sound scientific support. This paper was expected to contribute to developing the skill of prescribing a drug in an effective, convenient and prudent way, thus paying little attention to the market-biased recommendations in terms of therapeutics. It is important to improve drug prescription towards a better quality of life for the older people

Sobre utilización de Inhibidores de la acidez gástrica en pacientes pediátricos / Overuse of acid-suppressive therapy in pediatric patients

Objetivos: Evaluar los patrones de prescripción deranitidina y omeprazol en pacientes pediátricos ingresados enun hospital de niños; la adecuación de dichas prescripcionesy los costos generados por prescripciones incorrectas.Pacientes y Métodos: estudio de utilización demedicamentos para observar pacientes ingresados en elHospital de Niños (Córdoba –Argentina) durante 1 mes.Resultados: Durante el mes de estudio ingresaron 680pacientes, de los cuales 415 (61%) recibieron inhibidoresde la acidez gástrica (IAG). De estos, 330 pacientes (79,5%)no presentaron factores de riesgo para desarrollar úlcerapor estrés, y en 293 pacientes (70,6%) las indicacionesse consideraron incorrectas. Sólo 81 pacientes (19,5%)presentaron indicaciones y dosis correctas de IAG. Seencontró una relación de la prescripción con el ingreso aquirófano y con el uso concomitante de corticoides a dosisbajas. El consumo innecesario de IAG generó un gasto directomensual de US$ 470,42

Objectives: To evaluate prescription patterns of intravenous ranitidine and omeprazolein pediatric patients hospitalized in a children’s hospital, the adequacy of said prescriptionsand the costs originated by incorrect prescriptions.Patients and Methods: A study of medication usage was designed to observe all patientshospitalized at Hospital de Niños (Córdoba- Argentina) during one month.Results: During the month of study 680 patients were hospitalized, 415 (61%) ofthem received acid-suppressive drugs (ASD). From these, 330 patients (79.5%) did notshow risk factors to develop stress ulcer and indications were considered incorrect in 293patients (70.6%). Only 81 patients (19.5%) showed correct indications and doses of ASD.A relationship was found between prescription and access to the operating room alongwith the concomitant use of corticoid in low doses. The unnecessary consumption of ASDgenerated a direct monthly expenditure of USD 470.42

Sobre utilización de Inhibidores de la acidez gástrica en pacientes pediátricos / Overuse of acid-suppressive therapy in pediatric patients

Objetivos: Evaluar los patrones de prescripción deranitidina y omeprazol en pacientes pediátricos ingresados enun hospital de niños; la adecuación de dichas prescripcionesy los costos generados por prescripciones incorrectas.Pacientes y Métodos: estudio de utilización demedicamentos para observar pacientes ingresados en elHospital de Niños (Córdoba ûArgentina) durante 1 mes.Resultados: Durante el mes de estudio ingresaron 680pacientes, de los cuales 415 (61%) recibieron inhibidoresde la acidez gástrica (IAG). De estos, 330 pacientes (79,5%)no presentaron factores de riesgo para desarrollar úlcerapor estrés, y en 293 pacientes (70,6%) las indicacionesse consideraron incorrectas. Sólo 81 pacientes (19,5%)presentaron indicaciones y dosis correctas de IAG. Seencontró una relación de la prescripción con el ingreso aquirófano y con el uso concomitante de corticoides a dosisbajas. El consumo innecesario de IAG generó un gasto directomensual de US$ 470,42(AU)

Objectives: To evaluate prescription patterns of intravenous ranitidine and omeprazolein pediatric patients hospitalized in a childrenÆs hospital, the adequacy of said prescriptionsand the costs originated by incorrect prescriptions.Patients and Methods: A study of medication usage was designed to observe all patientshospitalized at Hospital de Niños (Córdoba- Argentina) during one month.Results: During the month of study 680 patients were hospitalized, 415 (61%) ofthem received acid-suppressive drugs (ASD). From these, 330 patients (79.5%) did notshow risk factors to develop stress ulcer and indications were considered incorrect in 293patients (70.6%). Only 81 patients (19.5%) showed correct indications and doses of ASD.A relationship was found between prescription and access to the operating room alongwith the concomitant use of corticoid in low doses. The unnecessary consumption of ASDgenerated a direct monthly expenditure of USD 470.42(AU)

Describen el nivel de conocimiento acerca del sistema de farmacovigilancia / Description of levels of knowledge on the pharmacovigilance system

Se demuestra la necesidad de continuar con el fomento de la comprensión y la enseñanza de la farmacovigilancia, así como la formación clínica en la materia y una comunicación eficaz dirigida a los profesionales de la salud y a la opinión pública en general.

Farmacoepidemiología aplicada a programas públicos para pacientes diabéticos em Altaracia (Córdoba, Argentina) / Pharmacoepidemiology applied to public programs for diabetic patients in Alta Gracia (Córdoba, Argentina)

La Diabetes Mellitus es una enfermedad crónicarelacionada con hiperglucemia y la finalidad del tratamientoes prevenir y reducir las complicaciones, responsables de másdel 70% de muertes. Se analizaron programas de salud con provisión de medicamentos en instituciones públicas de la ciudad de Alta Gracia: Hospital Arturo Umberto Illia (HAUI),dependiente del Ministerio de Salud (Provincia de Córdoba) y 12 dispensarios dependientes de la Dirección de Salud Pública (DSP), Municipalidad de Alta Gracia.Se identificaron 540 pacientes en la base de datos unificada y 49 se hallaron en ambas instituciones. Losconsumos de medicamentos, en DDD por cada 100 pacientes bajo programa/día, fueron: para Glibenclamida 25,2 en HAUIy 24,6 en DSP; para Metformina 17,6 en HAUI y 13,1 en DSP; para Insulina 59,0 en HAUI. La información obtenida desde Farmacia permitiódesarrollar una base de datos de pacientes diabéticos y unestudio de utilización de medicamentos.

Diabetes Mellitus is a chronic disease related to hyperglycaemia, and its treatment purposes are preventing and reducing the complications which cause more than 70% of deaths. Health programs with drug supply at public health facilities in Alta Gracia Citywere analized: Hospital Arturo Umberto Illia (HAUI), depending on the Health Ministry of the Province of Córdoba, and 12 dispensaries, depending on the Dirección de SaludPública (DSP) of the Municipality of Alta Gracia. A total of 540 patients were identified in the merged data base and 49 were found inboth settings. Drug consumptions, expressed in DDD per 100 patient under program by day, were: 25.2 in HAUI and 24.6 in DSP for glibenclamide; 17.6 in HAUI and 13.1 in DSP for Metformin; 59.0 in HAUI for Insulin. The information obtained from the Pharmacy Services let the development of a diabetic patient data base and a consumption drug utilization study.

Prevalencia de hipertensión arterial y factores biopsicosociales asociados, en población adulta de Villa Allende, Córdoba / Prevalence of hypertension and associated biopsychosocial factors, in adult population in Villa Allende, Córdoba

Objetivo: Determinar prevalencia de HTA y su asociación con factores biopsicosociales, en adultos de Villa Allende, Córdoba. Método: Estudio descriptivo, transversal y correlacional. Visitas domiciliarias con empleo de encuesta estructurada, cuestionarios autoadministrados, medición de Presión Arterial y Perímetro Abdominal. Muestra de 354 personasadultas. Resultados: La prevalencia de HTA fue 30,5%. El 77% de los hipertensos tenía diagnóstico previo y 45% estaba tratado y controlado. Además se observó: Tabaquismo 40 %, Sedentarismo 82% y Obesidad Central 38%. Hubo asociación estadísticamente significativa entreHTA y antecedentes familiares, obesidad central, consumo de sal normal, nivel instructivo bajo y ausencia de hábito de fumar. No hubo asociación de HTA con sedentarismo, apoyo social, estrategias de afrontamiento y consumo de alimentos con alto contenido de sodio. Conclusiones: Prevalencia de HTA similar a otros estudios reportados. Alta prevalencia de otros Factores de Riesgo Cardiovasculares. Es necesario implementar medidas quepromocionen el autocuidado de la salud.

Objective: To determine the prevalence of Hypertension and its association with biopsychosocial factors, in adults in Villa Allende, Cordoba. Method: Descriptive, cross-sectional and correlational study. Home visits using structured surveys and self-administered questionnaires. Measurement of Blood Pressure and Waist Circumference. Sample: 354 adult people. Results: The prevalence of Hypertension was 30.5%. seventy-seven percent of thehypertensive subjects had previous diagnosis and 45% were already treated and controlled. In addition it was observed: Tobacco Consumption 40%, Sedentary Lifestyle 82% andCentral Obesity 38%. There was statistically significant association between Hypertension and family history of the disease, central obesity, normal consumption of salt, low level of education and nosmoking habit. Hypertension was not associated with sedentary lifestyle, social support, coping strategies or food consumption with high sodium content. Conclusions: Prevalence of Hypertension was similar to other reported studies. High prevalence of other Cardiovascular Risk Factors. It is necessary to implement measuresto promote self-care.

Comportamiento de las reacciones adversas reportadas por productos naturales: Matanzas 2003-2008 / Behavior of adverse reactions caused by natural products: Matanzas 2003-2008

El uso de medicamentos naturales es fundamental dentro del procedimiento médico-farmacológico de la sociedad actual. Nuestro objetivo es evaluar el comportamiento del reporte de reacciones adversas a medicamentos naturales en la provincia Matanzas durante el período 2003-2008. Se realizó un estudio longitudinal, retrospectivo, observacional. Se consideró como elegible para el estudio el universo conformado por el conjunto de los reportes de sospecha de reacciones adversas a fitofármacos recogidos durante el período referido. Hubo un predominio en la frecuencia de aparición de las reacciones adversas a los medicamentos derivados de Ajo ( Allium sativum L. ), Eucalipto ( Eucalyptus sp. div. ) y Naranja Agria ( Citrus aurantium L. ), siendo estas reacciones de tipo leves y moderadas con afectación fundamental del sistema digestivo y la piel. Se reportaron reacciones adversas con el empleo de productos naturales en el período estudiado, siendo más frecuentes las reacciones clasificadas como moderadas según su gravedad y como probables según su relación de causalidad, con una mayor afectación del sistema digestivo y piel.

The usage of natural medicines is essential in the medico-pharmacological treatment nowadays. Our objective was evaluating behavior of the adverse reactions reports to natural medicines at the province of Matanzas during the period between 2003 and 2008. We carried out a longitudinal, retrospective, observational study. We considered as eligible to this study a universe formed by all the reports of suspected adverse reactions to phytomedicines recorded during the referred period. There was predominance in the frequency of adverse reactions to medicines prepared with Garlic ( Allium sativum L. ), Eucalyptus ( Eucalyptus sp. div. ) and Sour Orange ( Citrus aurantium L.); being these reactions light or moderated, and affecting mainly digestive system and skin. There were reported adverse reactions with the usage of natural products in the studied period, being more frequent the reactions classified as light according to their seriousness, and as probable according to the causality relation, highly affecting the digestive system and skin.

Implementação de um programa para evitar possíveis interações fármaco-alimento em pacientes adultos internados em unidades clínicas e cirúrgicas de um hospital universitário / Implementation of a program to prevent possible drug-food interactions in adult patients hospitalized in the clinical and surgical units of a university hospital

Introdução: As interações fármaco-alimento (IFA) são definidas como alterações produzidas nos efeitos terapêuticos de um medicamento em razão da ingestão concomitante de alimento. Objetivo: Identificar prescrições médicas com possíveis IFA dos pacientes internados no Hospital de Clínicas de Porto Alegre (HCPA) e orientar o corpo clínico quanto aos horários adequados de administração dos medicamentos. Métodos: O estudo analisou, entre fevereiro e julho de 2006, 2.645 prescrições de pacientes adultos internados nas unidades clínicas e cirúrgicas do HCPA e que recebiam dieta oral. Resultados: Observou-se que 54,5% (1.442) das prescrições apresentavam potenciais IFA. Nesses casos, as equipes assistenciais recebiam, através de notificação em prontuário médico, informações sobre os medicamentos que necessitavam de intervalo de jejum para garantir sua máxima biodisponibilidade. Conclusão: A alta incidência de prescrições contendo medicamentos possíveis de interagir com os alimentos demonstra a necessidade de um sistema que disponibilize, sistematicamente, as orientações relacionadas à correta administração dos medicamentos.

Background: Drug-food interactions (DFI) are defined as alterations produced in the therapeutic effects of a drug due to concomitant food ingestion. Objective: To identify medical prescriptions with possible DFI in patients hospitalized at Hospital de Clínicas de Porto Alegre (HCPA) and to provide guidance to the clinical staff about the appropriate time for drug administration. Methods: Between February and July 2006, we analyzed 2,645 prescriptions of adult inpatients receiving oral diet. Results: We found that 54.5% (1,442) of the prescriptions had potential DFI. In such cases, the medical staff was receiving information about the drugs that needed a fasting interval to ensure maximum bioavailability by means of notifications in medical records. Conclusions: The high incidence of prescriptions with possible DFI shows the need for a system that provides systematic guidance regarding the adequate administration of drugs.

Antiemetic medications in children with presumed infectious gastroenteritis--pharmacoepidemiology in Europe and Northern America.

OBJECTIVE: To investigate the prescription pattern of antiemetic medications in 0- to 9-year-old children with infectious gastroenteritis in several industrialized countries during 2005. STUDY DESIGN: We retrospectively retrieved data from 4 national and international databases (IMS MIDAS, IMS disease analyzer, WIdO databases). RESULTS: Between 2% and 23% of children with gastroenteritis (International Classification of Diseases code A08.X or A09) received prescriptions for antiemetic medications (United States, 23%; 95% CI, 15-31; Germany, 17%; 95% CI, 15-20; France, 17%; 95% CI, 14-19; Spain, 15%; 95% CI, 10-19; Italy, 11%; 95% CI, 7-16; Canada, 3%; 95% CI, 0-16; United Kingdom, 2%; 95% CI, 1-2). The antihistamines dimenhydrinate and diphenhydramine were most frequently used in Germany and Canada, whereas promethazine was prescribed preferentially in the United States. In France, Spain, and Italy, the dopamine receptor antagonist domperidone was preferred as antiemetic treatment. Ondansetron was used in a minor proportion of antiemetic prescriptions (Germany, Canada, Spain, and Italy, 0%; United States, 3%; United Kingdom, 6%). CONCLUSION: Antiemetic drugs are frequently used in children with gastroenteritis. In different industrialized countries, prescription of antiemetic medication varies considerably. Ondansetron, the only drug with evidence-based antiemetic efficacy, plays a minor role among antiemetic prescriptions.

Pharmacovigilance and pharmacoepidemiology of drugs in a Mexican pediatric hospital. A proposed guide.

We describe the procedures of pharmacovigilance (PV) and pharmacoepidemiology (PE) of drugs in a pediatric hospital. These activities contribute to the detection and registration of adverse drug reactions and to determine the patterns of drug prescription among children attended at the hospital. The PV activities show that there is a relation between an increase in incidence of adverse drug reactions and the prescription of a larger number of drugs. The PE activities reveal that antibiotics are the most frequently prescribed drugs and next are drugs used for gastrointestinal diseases. Since PV and PE activities were initiated at our hospital, they have contributed to a more adequate use of drugs in children. As a conclusion of these activities, it could be that if the PE of a hospital is known, drug consumption can be optimally planned. PV and PE demonstrate that, if polytherapy is not necessary, it must be avoided. Finally, the present guide can be adopted to initiate PV and PE at a hospital.