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Doctoral Thesis
DOI
Document
Author
Full name
Fabiana Angelo Marques Carizio
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Pereira, Leonardo Régis Leira (President)
Andrade, Regina Célia Garcia de
Freitas, Osvaldo de
Martins, Maria Auxiliadora
Reis, Adriano Max Moreira
Varallo, Fabiana Rossi
Title in Portuguese
Reações adversas a medicamentos: incidência e fatores de risco em idosos internados em um centro de terapia intensiva
Keywords in Portuguese
Farmacêutico.
Idoso
Reação Adversa a Medicamento
Unidade de Terapia Intensiva
Abstract in Portuguese
De acordo com a Organização Mundial de Saúde a reação adversa a medicamento (RAM) é definida como "uma resposta nociva e não intencional ao uso de um medicamento que ocorre em doses normalmente utilizadas em seres humanos para profilaxia, diagnóstico ou tratamento de doenças ou para modificação da função fisiológica". O potencial de RAM é aumentado na população idosa e em Unidade de Terapia Intensiva (UTI). Diante disto, o objetivo do presente estudo foi avaliar a incidência de RAM, por meio de trigger tools, e identificar os fatores de risco para a ocorrência das mesmas, em idosos internados no UTI adulto do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Para isso um estudo caso controle aninhado a uma coorte foi desenvolvido com pacientes de idade igual ou superior a 60 anos. Os exames laboratoriais, as prescrições médicas e o prontuário dos pacientes incluídos no estudo foram monitorados diariamente. Nos casos sugestivos de RAM foi realizada a análise de causalidade, os pacientes que durante a internação na UTI não tiveram identificado nenhum trigger tools ou este foi próprio do processo de doença do paciente ou não levou a uma RAM foram alocados no grupo controle. Os pacientes que possuíram a RAM classificada na categoria de causalidade como: definida, provável ou possível, foram alocados no grupo caso. As demais variáveis de interesse no estudo dividiram-se em características clínicas e farmacoterapêuticas, além disso, foi calculado o escore de risco para RAM (The GerontoNet Adverse Drug Reactions Risk Score e Brighton Adverse Drug Reactions Risk-BADRI) e avaliado o uso de medicamentos potencialmente inapropriados para idosos (MPI) (critérios AGS Beers e STOPP). Foram incluídos no estudo 41 pacientes com a média idade de 66,8 anos (DP 5,2), variando entre 60 e 78 anos, a principal razão de admissão no CTI ocorreu por comprometimentos cardiovasculares sendo 86,2% devido a choque séptico. Os pacientes permaneceram internados em média por 15,1 dias (DP 7,8) e utilizaram durante o período de internação na UTI uma média de 24,7 medicamentos/paciente (DP 7,4), sendo as classes mais prescritas de antibacterianos para uso sistêmico, analgésicos e terapia cardíaca. Apenas um dos pacientes incluídos no estudo não utilizou nenhum MPI. Foram identificados 1295 trigger tools, uma mediana de 30/paciente (IIQ 28), sendo que 3,0% tratou-se de um indicativo para RAM. Foram identificadas 15 RAM que ocorreram em 11 pacientes, alocados para o grupo caso, o coeficiente de incidência detectado foi de 36,6 RAM/100 pacientes. Os instrumentos The GerontoNet ADR Risk Score e BADRI mostraram-se efetivos para estimar os idosos com maior risco de desenvolver RAM na UTI, cerca de 50% das reações ocorreram pelo uso de MPI e metade dos medicamentos suspeitos de RAM foram antimicrobianos e opióides. Em conclusão aproximadamente um terço dos pacientes apresentou pelo menos uma RAM; os trigger tools mostraram-se efetivos na busca ativa de RAM, pois 66,7% das reações foram identificadas devido o uso desta ferramenta; e o tempo de internação no CTI e o número de medicamentos utilizados durante o período de internação foram as variáveis associadas com a ocorrência de RAM em idosos internados em UTI.
Title in English
Adverse drug reactions: incidence and risk factors in hospitalized elderly of an intensive care unit
Keywords in English
Adverse Drug Reactions
Elderly
Intensive Care Unit
Pharmacist
Abstract in English
According to the World Health Organization (WHO) adverse drug reaction (ADR) is defined as -a response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or for the modifications of physiological function?. The potential of ADR is increased in the elderly population due to the number of diagnoses, number of medications used and the complexity of pharmacotherapy. In the Intensive Care Unit (ICU), pharmacotherapy is extremely important for the patient, and is used to minimize morbidity and mortality and frequently the patients requires the administration of drugs with a high risk of adverse reactions.Therefore, the aim of this study was to evaluate the incidence of ADR using trigger tools and to identify risk factors for their occurrence in elderly patients admitted to the ICU of the General Hospital of the Ribeirão Preto Medical School, University of São Paulo. Thus a nested case-control study was developed with patients aged equal or higher than 60 years. The laboratory exams, electronic prescriptions and medical records of the patients included in the study were monitored daily. In cases suggestive of ADR analysis of the causality was carried out, the patients that during hospitalization in the ICU had not identified any trigger tools or this is itself the patient's disease process were allocated in the control group. Patients who had a ADR classified in the category of causality as certain, probable or possible were allocated in the case group. The other variables of interest in the study were divided into clinical and pharmacotherapeutic characteristics, the risk score for ADR was calculated (The GerontoNet Adverse Drug Reactions Risk Score and Brighton Adverse Drug Reactions Risk-BADRI), and the use of potentially inappropriate drugs (PID) for the elderly was evaluated (AGS Beers criteria and STOPP criteria). The study included 41 patients with a mean age of 66.8 years (SD 5.2), ranging from 60 to 78 years, the main reason for ICU admission was cardiovascular impairment, being 86.2% due to septic shock. Patients were hospitalized for a mean of 15.1 days (SD 7.8) and used a mean of 24.7 medication/ patient (SD 7.4) during the ICU stay, with the most prescribed classes being antiinfectives for systemic use, analgesics and cardiac therapy. Only one patient included in the study did not use any PID. A total of 1295 trigger tools were identified, a median of 30 / patient (IR 28), and 3.0% was an indication for ADR. We identified 15 ADRs that occurred in 11 patients, allocated to the case group, the incidence coefficient detected was 36.6 ADR / 100 patients. The GerontoNet ADR Risk Score and BADRI instruments were effective in estimating the elderly with a higher risk of developing ADR in ICU, about 50.0% of the reactions occurred using PID and half of the drugs suspected of ADR were antiinfectives and opioids. In conclusion, approximately one third of the patients presented at least one ADR; the trigger tools were effective in the active search for ADR, since 66.7% of the reactions were identified due to the use of this tool; and the length of ICU stay and the number of medications used during the hospitalization period were the variables associated with the occurrence of ADR in elderly patients admitted to the ICU.
 
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Release Date
2021-09-03
Publishing Date
2019-11-13
 
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