Competições terapêuticas e fragilidade em idosos - Estudo SABE (Saúde, Bem-Estar e Envelhecimento) / Therapeutic competitions and frailty in elderly people - SABE Study (Health, Well-being and Aging)

Introdução: A população mundial demonstra uma transição epidemiológica e a aceleração do envelhecimento. Estes fenômenos induzem cada vez mais o uso inadequado de medicamentos por idosos, os quais podem expô-los a desfechos indesejáveis, assim como se associar a diversos problemas, dentre eles a fragilidade. A complexidade da farmacoterapia pode induzir a ocorrência de competição terapêutica. Esta ocorre quando um medicamento aplicado a uma determinada doença afeta negativamente outro problema de saúde também presente, podendo piorar ou induzir o surgimento de outros agravantes em idosos. Objetivo: Caracterizar a presença de competições terapêuticas e avaliar sua associação com a síndrome de fragilidade de idosos do município de São Paulo. Método: Estudo transversal, de base populacional, realizado pela base de dados do Estudo Saúde, Bem-Estar e Envelhecimento (SABE), estudo longitudinal de múltiplas coortes sobre as condições de vida e saúde dos idosos residentes no município de São Paulo. Foi utilizada a coorte entrevistada em 2015, com 1.224 idosos (pessoas com 60 anos ou mais). A análise descritiva foi apresentada pelas médias e desvios-padrão das variáveis quantitativas e frequências relativas das variáveis qualitativas. A presença de fragilidade foi estipulada com base nos componentes definidos por Fried (2001). A presença de competições terapêuticas foi determinada por meio de evidências já definidas em trabalhos anteriores. A análise de associação foi realizada por meio de regressão logística multinomial. Resultados: 11,2% dos idosos eram frágeis e 56,1% pré-frágeis. Idosos frágeis utilizavam mais medicamentos, sendo 46,7% em polifarmácia (uso de cinco ou mais medicamentos). As classes farmacológicas mais utilizadas foram estatinas (agentes modificadores lipídicos - 28,1%), inibidores da bomba de prótons (usados em distúrbios gástricos - 23,6%) e inibidores da enzima conversora de angiotensina (anti-hipertensivos - 23,1%). A prevalência de competições terapêuticas foi de 13,2% no total de idosos e maior no grupo de idosos frágeis (18,7%, valor-p: 0,0152). Competições terapêuticas envolvendo diabetes (5,1%), doença osteoarticular (3,5%) e hipertensão (3,2%) foram as mais identificadas. A competição terapêutica mais prevalente foi a que envolvia diabetes e doença cardiovascular (4,2% no total de idosos e 6,8% em idosos frágeis), principalmente com o uso de biguanidas e inibidores da enzima conversora de angiotensina. A presença de competição terapêutica foi associada à fragilidade na análise univariada odds ratio 1,84 (IC95% 1,07-3,16) em idosos pré-frágeis e 2,43 (IC95%: 1,22-4,84) em frágeis. A chance de pré-fragilidade foi 2,41 vezes maior (IC95%: 1,04-5,61) em idosos que apresentavam duas competições terapêuticas no modelo múltiplo. Conclusão: verificou-se um número significativo de competições terapêuticas em idosos, com percentual mais elevado entre idosos frágeis. A presença de duas competições terapêuticas foi associada à presença de pré-fragilidade em idosos.

Introduction: The world population demonstrates an epidemiological transition and the acceleration of aging. Associated with the increase in the prevalence of non-communicable chronic diseases and the advancement of health technologies, these phenomena increasingly induce the inappropriate use of drugs by the elderly, which can expose them to undesirable outcomes, as well as being associated with several problems, including frailty. The complexity of pharmacotherapy can induce the occurrence of therapeutic competition. This occurs when a drug applied to a certain disease negatively affects another health problem also present, which can worsen or induce the emergence of other aggravating factors in the elderly. Objective: To characterize the presence of therapeutic competitions and evaluate their association with the frailty syndrome of the elderly in the city of São Paulo. Method: Cross-sectional, population-based study, carried out using Health, Well-being and Aging Study (SABE) database, a longitudinal study of multiple cohorts on the living and health conditions of elderly people living in the city of São Paulo. The cohort interviewed in 2015 was used, with 1,224 elderly (people aged 60 and over). Descriptive analysis was presented by means and standard deviations of quantitative variables and relative frequencies of qualitative variables. The presence of frailty was stipulated based on the components defined by Fried (2001). The presence of therapeutic competitions was determined by means of evidence already defined in previous works. Association analysis was performed using multinomial logistic regression. Results: 11.2% of the elderly were frail and 56.1% were pre-frail. Frail elderly used more medications, with 46.7% in polypharmacy (use of five or more drugs). The most used pharmacological classes were statins (lipid modifying agents - 28.1%), proton pump inhibitors (used in gastric disorders - 23.6%) and angiotensin-converting enzyme inhibitors (antihypertensives - 23.1%). The prevalence of therapeutic competitions was 13.2% in the total number of elderly and higher in the frail elderly group (18.7%, p-value: 0.0152). Therapeutic competitions involving diabetes (5.1%), osteoarticular disease (3.5%) and hypertension (3.2%) were the most identified. The most prevalent therapeutic competition was that involving diabetes and cardiovascular disease (4.2% of the total elderly and 6.8% of frail elderly), mainly with the use of biguanides and angiotensin-converting enzyme inhibitors. The presence of therapeutic competition was associated with frailty in the univariate analysis - odds ratio 1.84 (CI95% 1.07-3.16) in pre-frail elderly and 2.43 (CI95%: 1.22-4.84) in frail individuals. The odd of pre-frailty was 2.41 higher (CI95%: 1.04-5.61) in elderly people who had two therapeutic competitions in the multiple model. Conclusion: there was a significant number of therapeutic competitions in the elderly, with a higher percentage among frail elderly people. The presence of two therapeutic competitions was associated with the presence of pre-frailty in the elderly.

Dosis de enoxaparina asociada a disminución de riesgo de muerte en COVID-19 / Enoxaparin dose associated with decreased risk of death in COVID-19

Introducción: en diciembre de 2019 se reportó por primera vez un brote de COVID-19. Esta enfermedad ha ocasionado millones de muertes a nivel mundial. A la fecha se han probado multiples fármacos, sin encontrar un tratamiento eficaz aún. Objetivo: describir la evolución y el tratamiento farmacológico utilizado en pacientes hospitalizados por COVID-19. Material y métodos: estudio observacional en 200 pacientes hospitalizados por COVID-19 en un hospital regional de Acapulco que ingresaron entre marzo y julio de 2020. Se identificaron las características, el tratamiento farmacológico y la evolución de los pacientes. Se realizó analisis univarido, bivariado y multivariado. Resultados: el 60% de los pacientes fueron del sexo masculino, 83% presentaron al menos una comorbilidad, 56% fallecieron. El fármaco más utilizado fue la enoxaparina, del cual recibir dosis de 60 mg se asoció a menor riesgo de fallecer comparado con recibir 40 mg. Haber recibido hidroxicloroquina, metilprednisolona, moxifloxacino y tener 60 años o más se asoció a un mayor riesgo de morir. Conclusiones: se presentó una elevada mortalidad. El fármaco más utilizado fue la enoxaparina, del cual utilizar dosis de 60 mg disminuyó el riesgo de fallecer

Background: In December 2019, an outbreak of COVID-19 was reported for the first time. This disease has caused millions of deaths worldwide. To date multiple drugs have been tried, without finding an effective treatment yet. Objective: To describe the evolution and the pharmacological treatment used in patients hospitalized due to COVID-19. Material and methods: Observational study in 200 patients hospitalized due to COVID-19 in a regional hospital of Acapulco who were admitted between March and July 2020. The characteristics, pharmacological treatment and evolution of the patients were identified. Univariate, bivariate and multivariate analyses were performed. Results: 60% of the patients were male, 83% had at least one comorbidity, 56% died. The most used drug was enoxaparin, of which receiving a 60 mg dose was associated with a lower risk of death, compared to receiving 40 mg. Having received hydroxychloroquine, methylprednisolone, moxifloxacin and being 60 years or older was associated with a higher risk of progressing to death. Conclusions: There was a high mortality. The most used drug was enoxaparin, of which using doses of 60 mg reduced the risk of death

Avaliação do risco de quedas entre pessoas com doença de Parkinson / Evaluación del riesgo de caídas en personas con enfermedad de Parkinson / Assessment of risk of falls in people with Parkinson's disease

RESUMO Objetivo identificar os fatores associados ao risco de quedas entre as pessoas com doença de Parkinson cadastradas na Associação Parkinson Santa Catarina. Método estudo transversal exploratório descritivo e de abordagem quantitativa, realizado com 53 pessoas cadastradas na Associação Parkinson Santa Catarina, no município de Florianópolis, Brasil, no período de junho a setembro de 2019. Foram aplicados questionário sociodemográfico, Escala de Hoehn e Yahr, Mini Exame do Estado Mental e Teste de Rastreio do Risco de Queda no Idoso. Os dados foram tabulados e analisados por meio do Sistema online de Ensino-Aprendizagem de Estatística SEstatNet®. Resultados foram identificados fatores de risco, como sexo, aumento da idade, redução da força muscular, instabilidade postural e diminuição da velocidade da marcha. Em relação aos estágios da doença, foi constatado que em todos houve piora da velocidade da marcha e o medo de cair é constante, aumentando com o agravamento da doença e o tempo de diagnóstico. Conclusão e implicações para a prática ao aprofundar o estudo do tema, o enfermeiro consegue compreender os acometimentos motores que levam à fragilização e à queda em pessoas com doença de Parkinson, elaborando estratégias para preveni-las.

RESUMEN Objetivo identificar los factores asociados al riesgo de caídas en personas con enfermedad de Parkinson registradas en la Asociación de Parkinson Santa Catarina. Método estudio descriptivo exploratorio transversal, con abordaje cuantitativo realizado con 53 personas registradas en la Asociación Parkinson Santa Catarina, en la ciudad de Florianópolis, Brasil, de junio a septiembre de 2019. Se aplicaron un cuestionario sociodemográfico, la Escala de Hoehn y Yahr, el Mini Examen del Estado Mental y la Prueba de Detección del Riesgo de Caídas en Ancianos. Los datos se tabularon y analizaron utilizando el Sistema en línea de enseñanza-aprendizaje de estadísticas SEstatNet®. Resultados se identificaron factores de riesgo como sexo, mayor edad, disminución de la fuerza muscular, inestabilidad postural y disminución de la velocidad de la marcha. En cuanto a las etapas de la enfermedad, se encontró que en todas ellas se produjo un empeoramiento de la velocidad de la marcha y el miedo a caer es constante, aumentando con el empeoramiento de la enfermedad y el momento del diagnóstico. Conclusión e implicaciones para la práctica al profundizar en el estudio del tema, el enfermero es capaz de comprender las deficiencias motoras que conducen a la fragilidad y caída en personas con enfermedad de Parkinson, ideando estrategias para prevenirlas.

ABSTRACT Objective to identify the factors associated with risk of falls among people with Parkinson's disease registered at the Parkinson Santa Catarina Association. Method this is a cross-sectional exploratory descriptive study with a quantitative approach, carried out with 53 people registered at the Parkinson Santa Catarina Association, in the city of Florianópolis, Brazil, from June to September 2019. Sociodemographic questionnaire, Hoehn and Yahr scale, Mini Mental State Examination and Simple Screening Test for Risk of Falls in the Elderly were applied. The data were tabulated and analyzed using the SEstatNet® Statistics Teaching-Learning Online System. Results risk factors were identified, such as sex, increased age, reduced muscle strength, postural instability and decreased gait speed. Regarding the stages of the disease, it was found that in all of them there was a worsening of gait speed and the fear of falling is constant, increasing with the worsening of the disease and diagnosis time. Conclusion and implications for practice by deepening the study of the topic, nurses are able to understand the motor impairments that lead to frailty and fall in people with Parkinson's disease, developing strategies to prevent them.

Direct-acting antivirals for chronic Hepatitis C are effective and safe: an observational study in Londrina/PR

Abstract This study aimed to evaluate the effectiveness and safety of direct-acting antivirals in a Unified Health System pharmacy of Londrina, Brazil. A descriptive observational study was performed from June 2017 to June 2018. Sociodemographic, clinical, and therapeutic variables of patients were collected from secondary data sources. Effectiveness was evaluated by sustained virologic response (SVR) and safety was evaluated by adverse events (AEs) and drug interactions (DIs). The mean population (N=30) was 56.6±11.3 years old and almost all patients had comorbidities (93.3%) and concomitant drugs (96.7%). Effectiveness evaluation was possible in 17 patients, and all of them (100.0%) achieved SVR. Eighteen patients (60.0%) reported 38 AEs, mostly mild, such as stomach symptoms and headache. No statistical relation was found between AE occurrence and treatment duration, Ribavirin use, number of comorbidities or number of concomitant drugs. A total of 48 DIs were reported, 18 being severe, and were managed by the pharmacist. The study indicates that the treatment was effective and safe.

Riesgo de sangrado en pacientes anticoagulados con antagonistas de la vitamina K que reciben antibióticos / Risk of bleeding in anticoagulated patients with vitamin K antagonists who receive antibiotics

Lograr un adecuado nivel de anticoagulación con antagonistas orales de la vitamina K suele ser un desafío frecuente en la práctica clínica, dado que su estrecho rango terapéutico suele verse afectado por diversas interacciones farmacológicas,alimentos y condiciones clínicas. A partir de un caso de un paciente anticoagulado que presenta una hemorragia gastro-intestinal posterior a realizar un tratamiento antibiótico, la autora de este artículo revisó la evidencia sobre el riesgo desangrado secundario a la interacción entre este tipo de anticoagulantes y antibióticos orales. Su conclusión tras realizar una búsqueda bibliográfica y seleccionar la mejor evidencia disponible, es que existe un aumento del riesgo relativo desangrado en pacientes anticoagulados que reciben antibióticos, por lo que deberían evitarse aquellos antibióticos con conocido potencial de interacción. Si ello no fuera posible, se recomienda monitorizar el estado de anticoagulación con dosaje de la razón internacional normatizada (RIN) posterior a la introducción del antibiótico. (AU)

Achieving an adequate level of anticoagulation with oral vitamin K antagonists is often a frequent challenge in clinical practice, given that their narrow therapeutic range is often affected by various drug interactions, food, and clinical conditions. Based on a case of an anticoagulated patient who presented gastrointestinal bleeding after antibiotic treatment, the authorof this article reviewed the evidence on the risk of secondary bleeding due to the interaction between this type of anticoagulants and oral antibiotics. Their conclusion, after performing a literature search and selecting the best available evidence, is that there is an increased relative risk of bleeding in anticoagulated patients receiving antibiotics, so antibiotics with known potential for interaction should be avoided. If it weren't possible, it is recommended to monitor the anticoagulation status with International Normalized Ratio (INR) dosing after the introduction of the antibiotic. (AU)

Evaluación de la prescripción de hipoglucemiantes orales en población adulta con Diabetes Mellitus Tipo 2 / Evaluation of the prescription of oral hypoglycemic agents in the adult population with type 2 diabetes mellitus

En el nivel primario de atención se detectan errores en la prescripción del tratamiento farmacológico de la diabetes tipo 2. El objetivo de este estudio fue evaluar la calidad de la prescripción de hipoglucemiantes orales en pacientes atendidos en consultorios del médico de la familia del Policlínico Universitario Hermanos Cruz, municipio Pinar del Río, Cuba. Se realizó un estudio de utilización de medicamentos de tipo descriptivo y transversal clasificado dentro de estos como de indicación-prescripción con elementos de esquema terapéutico y de factores que condicionan los hábitos de prescripción. El universo estuvo conformado por 1575 pacientes con diagnóstico de diabetes mellitus tipo 2 tratados con hipoglucemiantes orales que pertenecían a los 20 consultorios médicos de la familia.La muestra de estudio se obtuvo por el método de muestreo no probabilístico (por conveniencia) (n=846). La información se obtuvo de la historia clínica y tarjeta control de los pacientes para adquirir estos medicamentos. Predominó la edad de 40-49 años, el sexo femenino y entre 5-10 años de evolución de la enfermedad. No se usó la primera línea de tratamiento en el 43,6 % de los casos, ningún caso tenía estudios de laboratorio para el uso de la Metformina. La prescripción y dosis fue adecuada no así su uso racional. Las interacciones más frecuentes fueron las farmacocinéticas.El uso racional de hipoglucemiantes orales fue deficiente lo que hace necesario ampliar la divulgación de un protocolo de tratamiento para mejorar el uso de estos fármacos en el nivel primario de atención.

Errors in the prescription of drug treatment for type 2 diabetes are detected at the primary level of care. the purpose of this study was to evaluate the quality of the prescription of oral hypoglycemic agents in patients attended in the family doctor's offices of the Hermanos Cruz University Polyclinic, Pinar del Río distrit, Cuba. A descriptive and cross-sectional study of the use of medications was carried out, classified within these as indication-prescription with elements of the therapeutic scheme and factors that condition prescription habits. The universe was made up of 1575 patients diagnosed with type 2 diabetes mellitus treated with oral hypoglycemic agents who belonged to the 20 family medical offices. The study sample was carried out by the non-probabilistic sampling method (for convenience) (n = 846). The information was obtained from the clinical history and control card of the patients to acquire these medications. The age of 40-49 years, the female sex and between 5-10 years of evolution of the disease predominated. The first line of treatment was not used in 43.6% of the cases; no case had laboratory studies for the use of Metformin. The prescription and dose was adequate, but not its rational use. The most frequent interactions were pharmacokinetic ones.The rational use of oral hypoglycemic agents was deficient, which makes it necessary to expand the dissemination of a treatment protocol to improve the use of these drugs at the primary level of care.

Fatores associados para potenciais interações medicamentosas clinicamente significantes em terapia intensiva adulto / Associated factors for potential clinically significant drug-drug interactions in adult intensive care

RESUMO: Modelo do estudo: Estudo transversal. Objetivo: caracterizar as interações medicamentosas potenciais (IMp) maiores e contraindicadas em terapia intensiva adulto e determinar sua prevalência, medicamentos e fatores associados à exposição dessas interações. Métodos: a amostra foi composta por 309 pacientes internados em uma unidade de terapia intensiva adulto de um hospital da Região Centro-Oeste de Minas Gerais, Brasil. Os dados demográficos-clínicos e perfil medicamentoso foram coletados, prospectivamente. As IMp foram caracterizadas pela base Micromedex 2.0 quanto à gravidade, prevalência e implicação clínica. Realizaram-se análises descritivas para as variáveis qualitativas e contínuas. Modelos Lineares Generalizados com distribuição Gama e Poisson foram utilizados para avaliar a relação entre um conjunto de variáveis independentes e a prevalência de IMp maiores e contraindicadas (p<0.05). Resultados:Um total de 81,8% (n=251) foi exposto a, no mínimo, uma IMp maior ou contraindicada. Mais de um terço (37,4%) destes participantes foram expostos a seis ou mais IMp. Medicamentos com ação no sistema nervoso colaboraram para maior probabilidade de IMp maiores e/ou contraindicadas. Pessoas idosas (p=0,006), do sexo masculino (p=0,028) e polimedicadas (<0,001) tiveram maior probabilidade de serem expostas ao menos a uma IMp maior ou contraindicada. Conclusão: Interações medicamentosas potenciais maiores e contraindicadas apresentaram alta frequência. Pessoas idosas, do sexo masculino e polimedicadas foram mais expostas às IMp maiores e/ou contraindicadas. É importante que profissionais da saúde conheçam os riscos e potenciais eventos adversos relacionados às IMp maiores e contraindicadas, para que sejam implementadas medidas para promoção da segurança do paciente. (AU)

ABSTRACT: Study Design: Cross-sectional. Objective: characterizing major and contraindicated potential drug-drug interactions (PDDI) in adult intensive care as well as determining their prevalence, risk factors, and potentially high-risk medications. Methods: The sample was composed of 309 patients hospitalized in an adult intensive care unit in the Midwest Region of Minas Gerais state, Brazil. Clinical data and drug profile were prospectively collected. The PDDI were characterized using the Micromedex 2.0 as to severity, prevalence, and clinical implications. Descriptive analyses were performed for qualitative and continuous variables. Generalized Linear Models with Gamma and Poisson distribution were used to assess the relationship between a set of independent variables and the prevalence of major and contraindicated PDDI (p<0.05). Results: A total of 81.8% (n = 251) were exposed to, at least, a major or contraindicated PDDI. More than a third (37.4%) of these participants were exposed to six or more IMp. Drugs with action on the nervous system contributed to a greater probability of major and/or contraindicated PDDI. Elderly (p = 0.006), male (p = 0.028), and polymedicated (<0.001) people were more likely to be exposed to at least a higher or contraindicated PDDI. Conclusion: Potentially major and contraindicated drug interactions showed high frequency. Elderly, male, and polymedicated people were more exposed to larger and/or contraindicated PDDI. It is important that health professionals are aware of the risks and potential adverse events related to major and contraindicated PDDI so that measures might be implemented to promote patient safety. (AU)

Drug safety among institutionalized elderly people: potential interactions / Seguridad medicamentosa en ajustes institucionalizados: potencial interacciones / Segurança medicamentosa em idosos institucionalizados: potenciais interações

ABSTRACT Objective: to identify the drug interactions among institutionalized elderly. Method: retrospective and documentary study with a quantitative approach developed in two Long Stay Institutions for Elderly, located in northeastern Brazil. Drug interactions were identified by using Drug-Reax® software from the Micromedex database, and they were classified by severity, start time, and documentation. Result: in the 286 analyzed prescriptions, 136 drug interactions were detected in both institutions, most of them classified as severe. The average number of drugs prescribed by the elderly was 4.5. In the analysis of Pearson's correlation, the number of drug interactions showed a statistically significant correlation with the time of institutionalization and with the amount of drugs administered on the day. Conclusion and implications for practice: the high consumption of drugs and serious drug interactions detected with significant clinical repercussions was evidenced in the study. Knowledge of these interactions is essential for the establishment of preventive safety measures in pharmacotherapy.

RESUMEN Objetivo: Identificar las posibles interacciones medicamentosas en ancianos institucionalizados. Metodo: Estudio documental, retrospectivo, con abordaje cuantitativo, desarrollado en dos Instituciones de Larga Permanencia para Ancianos, ubicada en el nordeste de Brasil. Las posibles interacciones medicamentosas, del tipo fármaco-fármaco, fueron identificadas utilizándose el software Drug-Reax® de la base de datos Micromedex, y clasificadas según la gravedad, el tiempo de inicio y la documentación. Resultados: En las 286 prescripciones, se detectaron 136 interacciones medicamentosas en las dos instituciones, siendo la mayoría clasificada como severidad grave. La media de medicamentos prescritos por los ancianos fue 4,5. El número de interacciones medicamentosas presentó correlación estadísticamente significativa con el tiempo de institucionalización y con la cantidad de medicamentos administrados en el día. Conclusión e implicaciones para la práctica: Se evidenció un alto consumo de fármacos y de potenciales interacciones medicamentosas graves con respuestas clínicas significativas. El conocimiento de estas interacciones es esencial para el establecimiento de medidas preventivas de seguridad en la farmacoterapia para esa población.

RESUMO Objetivo: Identificar as potenciais interações medicamentosas em idosos institucionalizados. Método: Estudo documental, retrospectivo, com abordagem quantitativa, desenvolvida em duas Instituições de Longa Permanência para Idosos, localizada no nordeste do Brasil. As potenciais interações medicamentosas, do tipo fármaco-fármaco, foram identificadas utilizando o software Drug-Reax® da base de dados Micromedex, e classificadas segundo a gravidade, ao tempo de início e a documentação. Resultados: Nas 286 prescrições, foram detectadas 136 interações medicamentosas nas duas instituições, sendo a maioria classificada como severidade grave. A média de medicamentos prescritos por idosos foi de 4,5. O número de interações medicamentosas apresentou correlação estatisticamente significativa com o tempo de institucionalização e com a quantidade de medicações administradas no dia. Conclusão e implicações para a prática: Foi evidenciado um alto consumo de fármacos e de potenciais interações medicamentosas graves com respostas clínicas significantes. O conhecimento dessas interações é essencial para o estabelecimento de medidas preventivas de segurança na farmacoterapia para essa população.

Prevalence, predictors and outcomes of potential drug-drug interactions in left ventricular failure: considerable factors for quality use of medicines

Hospitalized patients with left ventricular failure (LVF) are at high risk for potential drug-drug interactions (pDDIs) and its related adverse effects owing to multiple risk factors such as old age, comorbidities and polypharmacy. This cross-sectional study conducted in two tertiary care hospitals aim to identify frequency, levels and predictors of pDDIs in LVF patients. Data about patients' demographic, hospital stay, medication therapy, sign/symptoms and laboratory test results were collected for 385 patients with LVF. Micromedex Drug-Reax® was used to screen patients' medication profiles for pDDIs. Overall prevalence and severity-wise prevalence of pDDIs were identified. Chi-square test was performed for comparative analysis of various variables. Logistic regression was applied to determine the odds-ratios (OR) for predictors of pDDIs. The prevalence of pDDIs was 96.4% (n=371). Overall 335 drug-interacting pairs were detected, which were presented in a total of 2870 pDDIs. Majority of pDDIs were of major- (48.9%) and moderate-severity (47.5%). Logistic regression analysis shows significant association of >6 all types of pDDIs with >12 drugs as compared with <8 drugs (OR=16.5; p=<0.001). Likewise, there was a significant association of >4 major-pDDIs with men as compared with female (OR=1.9; p=0.007) and >12 drugs as compared with <8 drugs (OR=10.9; p=<0.001). Hypotension (n=57), impaired renal function (23) and increased blood pressure (22) were the most frequent adverse outcomes associated with pDDIs. This study shows high prevalence of pDDIs in LVF patients. Majority of pDDIs were of major- and moderate-severity. Male patients and those prescribed greater number of medicines were more exposed to major-pDDIs

COMDORA-SBN recommendations for patients with rare kidney diseases in relation to the Covid-19 pandemic / Recomendações do COMDORA-SBN a pacientes portadores de doenças renais raras em relação à pandemia de Covid-19

ABSTRACT During the Covid-19 pandemic, the issue is how to maintain adequate care for people with other diseases. In this document, the SBN Rare Diseases Committee (COMDORA) gives some guidelines on the care of patients with rare kidney diseases. These patients should follow the recommendations for the general population, bearing in mind that, as they have chronic kidney disease, they are included in the risk group for more serious outcomes if they develop Covid-19. Non-essential decision-making procedures should be postponed. In stable cases under appropriate treatment, we must choose to contact our patients remotely, using teleconsultations and home exam collections (if possible). In the presence of a symptom or sign of decompensation of the underlying disease, or infection with Sars-cov-2, advise the patient to seek medical assistance. The patient should not be waiting to get worse. Changes to the prescription should only be made on a scientific basis. Dosage suspension or change is not recommended, even in cases in which the patient needs to go to a center to receive his medication; in this case, the infusion center must follow the recommendations of the Ministry of Health. If the patient develops Covid-19 and uses any drugs, check the need for dose adjustment of the routine medications. Avoid the use of antimetabolics and anti-CD20 in patients with Covid-19, as they reduce viral clearance and predispose to bacterial infections. Contact between the patient and the medical team is essential; changes are recommended only with specialized medical guidance.

RESUMO Durante a pandemia da Covid-19, fica a questão de como manter o atendimento adequado aos portadores de outras doenças. O Comitê de Doenças Raras (COMDORA) da SBN neste documento dá algumas orientações ao atendimento de pacientes com doenças renais raras. Estes pacientes devem seguir as recomendações destinadas à população geral tendo em mente que, por serem portadores de doença renal crônica, estão incluídos no grupo de risco para desfechos mais graves, caso venham a desenvolver a Covid-19. Procedimentos não essenciais para tomada de decisão devem ser adiados. Deve-se optar por contatos a distância, como teleconsultas, e coletas de exames domiciliares (se possível) nos casos estáveis sob tratamento adequado. Na presença de sintoma ou sinal de descompensação da doença de base ou infecção pelo Sars-cov-2, orientar o paciente a procurar a equipe médica. O paciente não deve ficar esperando o quadro agravar-se. Alterações na prescrição só devem ser feitas com embasamento científico. Não se recomenda a suspensão ou alteração posológica, mesmo nos casos em que o paciente necessita ir a um centro para receber sua medicação; neste caso o centro de infusão deve seguir as recomendações do Ministério da Saúde. Caso o paciente desenvolva a Covid-19 e faça uso de alguma droga, verificar a necessidade de ajuste nas doses dos medicamentos rotineiros. Evitar o uso de antimetabólicos e antiCD20 nos pacientes com a Covid-9, por reduzirem o clareamento viral e predisporem a infecções bacterianas. O contato entre paciente e equipe médica é essencial; alterações são recomendadas apenas com orientação médica especializada.

The interference of polypharmacy and the importance of clinical pharmacy advice in the treatment of leprosy: a case-control study

Abstract INTRODUCTION: Although supervised doses are essential for reducing leprosy treatment failure, the impact of specific drug interactions has rarely been assessed. This study aimed to estimate the risk of leprosy treatment suspension in patients receiving polypharmacy. METHODS We performed this case-control study in which the primary outcome was defined as the need to discontinue multibacillary leprosy treatment for at least one supervised dose, and the main risk factor was the detection of polypharmacy. Multivariate analysis by logistic regression was used for calculating odds ratio (OR). RESULTS: This study included 103 patients, of whom 43 needed to discontinue leprosy treatment (hemolysis = 26, hepatitis = 2, hemolysis associated with hepatitis = 6, and suspected treatment resistance = 9) and the rest did not. The severity of drug interactions had no effect on treatment discontinuation. Patients who used five or more drugs in addition to leprosy treatment had almost a 4-fold greater risk of treatment suspension (OR, 3.88; 95% confidence interval: 1.79-9.12; p < 0.001). The number of drugs used also positively influenced the occurrence of hemolysis (p < 0.001). No patient presented evidence of molecular resistance to rifampicin, dapsone, or ofloxacin treatment, as evidenced by genetic sequencing detection of rpoB, folp1, and gyrA mutations. CONCLUSIONS: Polypharmacy has deleterious effects on the already difficult-to-adhere-to treatment of leprosy and polypharmacy induces hemolysis. Additional measures must be taken to avoid the undesirable effects of inadequate polypharmacy.

Diabetes as a risk factor of acute kidney injury in vancomycin users: an observational and prospective study

Diabetes was investigated as a risk factor for nephrotoxicity induced by vancomycin. In the present study, the drug's nephrotoxic effect was indirectly evaluated by Glomerular Filtration Rate, albuminuria and serum levels of creatinine and urea on the 1st, 7th and 14th days of vancomicyn therapy in a group of diabetic and non-diabetic patients, with and without previous nephropathy. The correlations between investigated variables (including the population's epidemiological profile and hospital care) were measured by the Spearman test. The sample consisted of 132 patients, predominantly male diabetic patients with previous nephropathy, over 40 years, receiving ≥ 10 grams of vancomycin for the treatment of infectious diseases and showing satisfactory clinical outcomes. A risk of vancomycin drug interaction with potential nephrotoxic outcome was observed in 36.4% of patients who used multiple drugs. Furthermore, 80% of patients had an increase of at least 0.5 mg.dL-1 in baseline serum levels of creatinine and urea at the end of the study. This was more common among the diabetic patients with previous nephropathy, showing higher albuminuria and a reduction in the Glomerular Filtration Rate. Therefore, it has been recommended that the use of vancomycin in diabetic patients should be in careful dosages and that kidney functioning be monitored.

Comorbidities among adults living with hiv from two healthcare centers in Colombia / Comorbilidad entre adultos viviendo con VIH en dos centros de atención en Colombia

Objective: To determine the prevalence of comorbidities among adults living with HIV from two healthcare centers in Colombia, and to identify factors associated with comorbidity-free years. Methods: Observational, retrospective medical chart review study. Summary statistics for demographic and clinical characteristics were developed and relationship between comorbidity-free years were analyzed through Kaplan-Meier analysis and Cox regression. Results: 669 clinical charts were included, 71.7% were male and 16.1% were 50 years or older, 69.96% had at least one comorbidity. The most frequent comorbidities were dislipidemia(15.06%), hypertension(5.67%), risk factors were tobacco use(15.33%), alcohol intake(24.36%) and drugs abuse (14.66%). Discussion: These findings are consistent with previous reports showing the underlying processes of patients, producing multiple comorbidities. Conclusions: Significant proportion of patients have comorbidities that may increase risk of other complications or reduced comorbidity-free years. Poly-pharmacy among HIV+ adults need to be addressed to ensure adherence and minimize drug-drug interactions.

Objetivo: Determinar la prevalencia de comorbilidades entre adultos viviendo con VIH en dos centros de atención en Colombia e identificar los factores asociados con años libres de comorbilidad . Metodos: Revisión observacional retrospectiva de historias clínicas. Resumen de estadísticas de características demográficas y clínicas y análisis de correlación entre características clínicas a través de pruebas de Kaplan-Meier y regresión de Cox. Resultados: Se analizaron 669 historias clínicas, 71.7% fueron hombres y 16.1% tuvieron 50 años o más, 69.96% tuvieron al menos una comorbilidad. Las comorbilidades más frecuentes fueron dislipidemia(15.06%), hipertensión (5.67%), los factores de riesgo fueron el uso de tabaco (15.33%), ingesta de alcohol (24.36%) y abuso de drogas (14.66%). Discusión: Estos hallazgos son consistentes con reportes previos que evidencian los procesos subyacentes que llevan a múltiples comorbilidades. Conclusiones: Una proporción significativa de pacientes tiene comorbilidades que pueden aumentar el riesgo de otras condiciones o los años libres de comorbilidad. La polifarmacia en pacientes HIV+ debe hacerse de manera que se asegure la adherencia y se minimicen las interacciones entre medicamentos.

Interações medicamentosas potenciais em adultos e idosos na atenção primária / Potential drug interactions in adults and the elderly in primary health care

Resumo O objetivo do presente estudo foi caracterizar as interações medicamentosas potenciais (IMP) e avaliar os fatores associados à sua ocorrência em adultos e idosos assistidos pelo Programa Médico de Família de Niterói, Rio de Janeiro. Trata-se de um subestudo do ESTUDO DIGITALIS, que incluiu indivíduos cadastrados no Programa Médico de Família de Niterói (45-99 anos). Foram analisados 341 indivíduos com prescrição de dois ou mais medicamentos. A classificação das IMP seguiu o MICROMEDEX®. Houve 113 interações diferentes. Do total de indivíduos, 63,6% apresentaram pelo menos uma IMP. As variáveis com maior chance de IMP foram: menor escolaridade; renda inferior a R$800,00; ausência de plano de saúde; diagnóstico de hipertensão, diabetes, infarto agudo do miocárdio; e uso de 5 ou mais medicamentos prescritos. Após ajuste, as variáveis diagnóstico anterior de hipertensão e diabetes e uso de 5 ou mais medicamentos prescritos permaneceram significativas estatisticamente. É importante uma gestão cautelosa do tratamento na atenção básica com monitoramento das IMP, especialmente em pacientes mais susceptíveis.

Abstract The objective of the present study was to characterize the potential drug interactions (PDI), estimating the factors associated to their occurrence in adults and the elderly assisted by the Programa Médico de Família de Niterói, Rio de Janeiro. This is a sub-study of STUDY DIGITALIS, which included individuals enrolled in the Niteroi Family Medical Program (45-99 years). In this study, 341 individuals with a prescription of two or more drugs were analyzed. The classification of PDI followed MICROMEDEX. There were 113 different interactions. Of the total number of individuals, 63.6% had at least one PDI. The variables with higher probability of PDI were: lower level of schooling; income less than R$800.00; absence of health plan; previous diagnosis of hypertension and diabetes; use of 5 or more medications prescribed. After adjustment, the variables previous diagnosis of hypertension and diabetes and use of 5 or more prescription drugs remained statistically significant. Careful management of primary care treatment with monitoring is important in patients with PDI, especially in patients who are more susceptible.

Interações medicamentosas nos idosos em uso de anticoagulantes orais internados num hospital cardiológico / Drug interactions in elderly people making use of oral anticoagulants and hospitalized in a cardiology hospital / Interacciones medicamentosas en los ancianos en uso de anticoagulantes orales internados en un hospital cardiológico

Objective: The study's purpose has been to relate the drug interactions of oral anticoagulants with other medications used by elderly people hospitalized in a cardiology hospital. Methods: It is a prospective exploratory study with 16 elderly people taking oral anticoagulant, who were hospitalized at a governmental cardiology institution in São Paulo State over the period from November to December 2017. Results: Among 73 medicines prescribed and analyzed in the Micromedex 2.0, 24 (33.3%) interacted with Warfarin, the only prescribed oral anticoagulant. There were found Omeprazole (70; 97.2%); Dipyrone (68; 94.4%); Simvastatin (43; 59.72%); Enoxaparin (42; 58.33%); Amiodarone (29; 40.27%); Sertraline (28; 38.88%); Spironolactone (21; 29.16%); and Atenolol (11; 15.27%), whose interactions could either potentialize or inhibit the anticoagulant action. Considering the interactions, 14 (58.33%) were of moderate severity, 10 (41.66%) of high severity and 14 (58.33%) of fast effect. Conclusion: Polypharmacy and the use of oral anticoagulants in elderly patients bearing heart diseases are common events. Moreover, a better understanding about drug interactions is also required, bearing in mind that they can either potentialize or decrease the anticoagulant effect, with high or moderate severity

Objetivo: Relacionar as interações medicamentosas dos anticoagulantes orais com os medicamentos utilizados por idosos internados em hospital cardiológico. Método: Estudo exploratório, prospectivo, com 16 idosos em uso de anticoagulantes orais, internados numa instituição cardiológica governamental de São Paulo entre novembro e dezembro de 2017. Resultados: Dentre 73 medicamentos prescritos e analisados no Micromedex 2.0, 24 (33,3%) interagiam com a Varfarina, único anticoagulante oral prescrito. Encontrou-se Omeprazol (70;97,2%); Dipirona (68;94,4%); Sinvastatina (43;59,72%); Enoxaparina (42;58,33%); Amiodarona (29;40,27%); Sertralina (28;38,88%); Espironolactona (21;29,16%); e Atenolol (11;15,27%), cujas interações poderiam potencializar ou inibir a ação anticoagulante. Das interações, 14 (58,33%) eram de gravidade moderada, 10 (41,66%) maior e 14 (58,33%) de efeito rápido. Conclusão: A polifarmácia e o uso de anticoagulante oral em idosos cardiopatas é comum e, conhecer as interações medicamentosas, é imperativa, considerando que potencializam ou diminuem a ação anticoagulante, com gravidade maior ou moderada

Objetivo: Relacionar las interacciones medicamentosas de los anticoagulantes orales con los medicamentos utilizados por ancianos internados em um hospital cardiológico. Método:Estudio exploratorio, prospectivo, con 16 ancianos en uso de anticoagulantes orales, internados en una institución cardiológica gubernamental de São Paulo entre noviembre y diciembre de 2017. Resultados:Entre 73 medicamentos prescritos y analizados en el Micromedex 2.0, 24 (33,3%) interactuaban con la Varfarina, único anticoagulante oral prescrito. Se encontró Omeprazol (70, 97,2%); Dipirona (68, 94,4%); Sinvastatina (43, 59,72%); Enoxaparina (42, 58,33%); Amiodarona (29, 40,27%); Sertralina (28, 38,88%); Espironolactona (21, 29,16%); y Atenolol (11, 15,27%), cuyas interacciones podrían potenciar o inhibir la acción anticoagulante. De las interacciones, 14 (58,33%) eran de gravedad moderada, 10 (41,66%) mayor y 14 (58,33%) de efecto rápido. Conclusión: La polifarmacia y el uso de anticoagulante oral en ancianos cardiopatas es común y, conocer las interacciones medicamentosas, es imperativa, considerando que potencian o disminuyen la acción anticoagulante, con gravedad mayor o moderada

Perfil sociodemográfico e clínico de idosos usuários crônicos de omeprazol na rede básica de saúde / Sociodemographic and clinical profile of elderly people chronic users of omeprazole attending the basic health network / Perfil sociodemográfico y clínico de los ancianos usuarios crônicos de omeprazol em la red básica de salud

Objetivo: Descrever o perfil sociodemográfico e clínico de idosos usuários crônicos de omeprazol. Método: Trata-se de um estudo transversal com usuários com idade superior a 60 anos, que retiraram o omeprazol na Farmácia Pública de Panambi/RS. Resultados: Participaram da pesquisa sessenta idosos, com idade média de 67,90 ±5,6 anos. Duas interações graves foram identificadas envolvendo citalopram e clopidogrel. Observou-se a presença nas prescrições de medicamentos que tem a sua absorção alterada pelo uso concomitante com o omeprazol como captopril (25%) e enalapril (16,7%). Conclusão: Dessa forma, evidenciou-se uma população suscetível a riscos que necessita de acompanhamento farmacêutico

Objective: To describe the sociodemographic and clinical profile of elderly chronic omeprazole users. Method: This is a cross-sectional study. Patients aged 60, from the Public Pharmacy of the city of Panambi / RS. Results: A total of 60 elderly chronic omeprazole users participated in the study with an average of 67.90 ± 5.6 years of age. Two serious interactions were identified involving citalopram and clopidogrel. There was the presence in the prescription of drugs that have their absorption altered by concomitant use of omeprazole as captopril (25%) and enalapril (16.7%). Conclusion: Thus, we highlight that there is a population susceptible to risks that needs pharmaceutical monitoring

Objetivo: Describir el perfil sociodemográfico y clínico de los ancianos usuarios crónicos de omeprazol. Método: Es un estudio transversal descriptivo cuantitativo. Participaron en el estudio pacientes con edad igual o mayor de 60 años, usuarios crónicos de omeprazol, y que acudieron al medicamento en la Farmacia Publica de la cuidad de Panambi/RS. Resultados: Participaron de la investigación 60 ancianos 51,7% del sexo femenino, con edad media de 67,90 ±5,6 años, 81,7% relataran alguna comorbilidad, siendo la más prevalente la hipertensión arterial sistémica (61,7%). Los medicamentos que actúan en el tracto alimentar y metabólico fueron los más frecuentes. Se identificaron dos graves interacciones relacionado al citalopram (8,4%) y clopidogrel (1,7%). Se observó en las prescripciones la presencia de medicamentos cuya absorción es alterada por el uso concomitante con el omeprazol, como el captopril (25%) y enalapril (16,7%). Conclusión: De esta forma, se ha evidenciado una populación susceptible a los riesgos y que necesita de acompañamiento farmacéutico

Cardiac Disorder in Chronic Hepatitis C

Chronic hepatitis C (CHC) has a high prevalence in the world. In addition to hepatic complications with cirrhosis in about 20% of patients and high risk for hepatocarcinoma, extrahepatic manifestations may also occur. Cardiac involvement in patients with CHC is associated with several factors, such as increased risk for coronary artery disease, primary cardiomyopathies, or hemodynamic and electrophysiological changes observed in liver cirrhosis. Furthermore, antiviral treatment may, in rare cases, causes cardiovascular adverse effects. Cardiac arrhythmias are the main form of clinical presentation, and, often, markers of poor prognosis in individuals with advanced liver disease. Although some mechanisms that justify these changes have already been reported, many questions remain unanswered, especially about the true involvement of the hepatitis C virus in the genesis of primary cardiac abnormalities, and the risk factors for cardiac-related complications of antiviral treatment

Evaluation of the systemic and therapeutic repercussions caused by drug interactions in oncology patients

SUMMARY INTRODUCTION: Drug interaction is an important cause of global morbidity. It is of particular importance in cancer patients since they are often in use of polypharmacy, related to interactions between the drugs and the chemotherapeutics used. OBJECTIVE: To evaluate the drug interaction between chemotherapy and other drugs in cancer patients. METHODS: a cross-sectional study carried out in the outpatient oncology department of a public tertiary hospital. Two hundred thirty-five patients were included, and the drugs they were using were identified. Using the MedScape and Epocrates database, we evaluated the interactions between medications and chemotherapy by defining their frequency and dividing their severity from interaction into mild, close monitoring necessity and severe. RESULTS: 161 patients had some drug interaction. We identified 9 types of mild interactions, 23 types of interactions with close monitoring necessity, and 2 types of serious interactions. The most frequent interactions were between fluorouracil and leucovorin (32 cases) and cyclophosphamide and doxorubicin (19 cases). Serious interactions were between aspirin and pemetrexed; and leucovorin and Bactrim. CONCLUSION: In the present study, drug interactions were frequent, including serious interactions with a potential increase in morbidity and mortality. Thus, it is necessary for oncologists to draw up a therapeutic plan considering potential interactions between prescribed chemotherapy and current medications in use by patients.

RESUMO INTRODUÇÃO: Interação medicamentosa é uma importante causa de morbidade mundial. Apresenta especial importância em pacientes oncológicos, pois esses frequentemente estão em uso de polifarmácia, podendo haver interações entre os medicamentos e os quimioterápicos utilizados. OBJETIVO: Avaliar a interação medicamentosa entre a quimioterapia e outros medicamentos em pacientes oncológicos. MÉTODOS: Estudo transversal realizado em serviço ambulatorial de oncologia de um hospital público terciário. Foram incluídos 235 pacientes, identificando-se quais medicamentos eram utilizados por eles. Por meio do auxílio do banco de dados do MedScape e Epocrates, avaliaram-se as interações entre as medicações e os quimioterápicos, definindo sua frequência e dividindo sua gravidade da interação em leve, monitorização próxima e grave. RESULTADOS: Do total estudado, 161 pacientes apresentavam alguma interação medicamentosa, sendo nove tipos de interações leves, 23 tipos de interações com necessidade de monitorização próxima e dois tipos de interações graves. As interações mais frequentes foram entre fluoracil e leucovorin (32 casos) e ciclofosfamida e doxorrubicina (19 casos). As interações sérias foram entre aspirina e pemetrexed; e leucovorim e bactrim. CONCLUSÃO: No presente trabalho, interações medicamentosas foram frequentes, incluindo interações graves com potencial aumento de morbimortalidade. Assim, faz-se necessário que oncologistas tracem um plano terapêutico levando em consideração as possíveis interações medicamentosas entre a quimioterapia prescrita e demais medicações em uso pelos pacientes.

Potential and clinical relevant drug-drug interactions among elderly from nursing homes: a multicentre study in Murcia, Spain / Interações medicamentosas potenciais e clinicamente relevantes em instituições de longa permanência para idosos: um estudo multicêntrico em Murcia, Espanha

Abstract This study purposes to determine the prevalence of potential and clinical relevant Drug-Drug-Interactions (pDDIs) in institutionalized older adults and to identify the pertinent factors associated. We conduct an observational, multicenter and cross-sectional study during the last quarter of 2010. We selected a sample of 275 subjects (aged ≥ 65 years) from 10 nursing homes of Murcia (Spain) by a two-stage complex sampling. pDDIs were identified using the College of Pharmacists Database. We only considered pDDIs of clinical relevance, and thereafter the relevant factors were identified through uni-level and multi-level regression analyses. A total of 210 pDDIs were identified, 120 of which were considered clinically relevant (57.1%), affecting a total of 70 elderly (25.8%). Eight pharmacological groups made up 70.2% of the clinically relevant pDDIs. More clinically relevant DDIs were found in people suffering several pathologies (OR = 2.3; 95%CI = 1.4-4.5), and also in people who take ten or more drugs daily (OR = 9.6; 95%CI = 4.8-19.1), and people who take anti-inflammatory drugs (OR = 3.9; 95%CI = 1.4-10.4). This study reveals that clinically relevant pDDIs are very common in institutionalized elderly people, and that caregivers should aim at improving their practice in order to reduce the prevalence of this phenomenon.

Resumo Este estudo pretende identificar a prevalência de interações medicamentosas potenciais (IMP) em idosos institucionalizados e seus fatores associados. Realizamos um estudo observacional, multicêntrico e transversal, durante o último trimestre de 2010. Selecionamos uma amostra de 275 sujeitos (≥ 65 anos) de 10 instituições para idosos de Murcia (Espanha) mediante amostragem aleatória complexa em duas etapas. As IMP foram identificadas usando a base de dados do College of Pharmacists. Estimamos a prevalência de IMP de relevância clínica e analisamos os fatores associados com análise de regressão uni e multinível. Identificamos 210 IMP, das quais 120 foram consideradas clinicamente relevantes (57,1%) e afetaram 70 idosos (25,8%). Oito grupos farmacológicos constituíram 70,2% das IMP clinicamente relevantes. A prevalência de IMP esteve associada à multimorbidade (OR = 2,3; IC 95% = 1,4-4,5) e tomar dez ou mais medicamentos diariamente (OR = 9,6; IC95% = 4,8-19,1) e uso de medicamentos anti-inflamatórios (OR = 3,9; IC 95% = 1,4-10,4). Este estudo revela que as IMP clinicamente relevantes são muito comuns em idosos institucionalizados e que os serviços devem melhorar seus processos para reduzir a prevalência deste fenômeno.

Fatores associados às interações medicamentosas em idosos internados em hospital de alta complexidade / Factors associated with drug interactions in elderly hospitalized in high complexity hospital

Resumo O estudo tem por objetivo determinar a frequência de interações medicamentosas potenciais (IMP) entre idosos hospitalizados e os fatores associados. Estudo transversal realizado em um hospital de ensino. A variável dependente do estudo foi a ocorrência de IMP identificadas utilizando o software DrugReax. Também foram identificados os pacientes que desenvolveram reações adversas a medicamentos (RAM) relacionadas à manifestação clínica de IMP. Realizou-se regressão logística para analisar a associação da ocorrência de IMP e variáveis independentes. No estudo foram incluídos 237 idosos, a prevalência de IMP foi de 87,8 %, e de RAM relacionadas às interações foi de 6,8%. Identificou-se associação positiva entre a detecção de IMP (OR 8,6; IC95% 2,5-30,0), internação por diagnóstico de doença do aparelho circulatório e número de medicamentos superior que 14 (OR 9,8; IC95% 2,8-34,3). O estudo evidenciou uma elevada prevalência de IMP na farmacoterapia dos idosos, mas reduzida prevalência de RAM. Além disso, detectou associação positiva entre IMP e internação por diagnóstico de doença do aparelho circulatório e número de medicamentos superior a 14. A identificação de fatores associados às IMP permite direcionar medidas de prevenção para populações mais expostas à ocorrência de eventos adversos.

Abstract This study aims to determine the frequency of potential drug-drug interactions (PDI) in hospitalized elderly and associated factors. This is a cross-sectional study in a teaching hospital. The dependent variable was the occurrence of potential drug interactions identified using DrugReax software. Patients with adverse drug reactions (ADR) related to clinical manifestations of PDIs were also identified. Multivariate logistic regressions was performed to analyze the association between the occurrence of PDIs and independent variables. In total, 237 older adults were included in the study. The prevalence of PDIs and interaction-related ADRs was 87.8% and 6.8%, respectively. The multivariate analysis showed a positive association between the detection of PDIs (OR 8.6; 95% CI, 2.5-30.0), and hospitalization due to a diagnosed circulatory system disease and number of medications > 14 (OR 9.8; 95% CI, 2.8-34.3%). The study showed a high prevalence of PDIs in the drug treatment of the elderly, but a lower prevalence of ADRs, as well as a positive association between PDIs and hospitalization due to a diagnosed circulatory system disease and number of medications > 14. The identification of factors associated with PDIs guides prevention measures for people that are more exposed to adverse events.