Investigación de técnicas de preparación de medicamentos administrados vía catéteres por enfermeros en terapia intensiva

Se apuntó a identificar la forma farmacéutica de los medicamentos preparados para ser administrados vía catéter y el perfil de errores cometidos durante la preparación. Estudio epidemiológico transversal, de tipo observacional, desarrollado en unidad de terapia intensiva sobre muestra de 350 dosis de medicamentos preparados por 56 técnicos de enfermería. Datos recolectados en marzo de 2010. Los resultados expresan que 92% de los medicamentos eran sólidos. Los errores se agruparon en las categorías: dilución y mezcla para formas líquidas, agregados de trituración para sólidos. Las tasas de errores superaron el 40% en todas las categorías. Se concluye en que: la trituración inapropiada pudo comprometer el resultado terapéutico con comprimidos revestidos y de liberación controlada; no diluir jarabes pudo haber ayudado a obstruir catéteres, y mezclar medicamentos al triturarlos puede aumentar el riesgo de interacciones medicamentosas.The goals of the research were to assess the pharmaceutical form of medicinal preparations administered through catheters and identify the profile of errors that occur during their preparation. This is a cross-sectional study of an observational nature, conducted in an intensive care unit with a sample of 350 doses of medication prepared by 56 nursing technicians. Data collection occurred in March 2010. The results showed that 92% of the drugs were in the solid form. The errors were divided into two categories for liquid forms: dilution and mixing, and grinding was added as an error possibility for a solid form. The error rates were greater than 40% in all categories. The conclusions are that grinding can compromise the therapeutic effect of coated controlled-release tablets, not diluting syrups may contribute to the obstruction of catheters, and mixing medication during grinding may increase the risk of drug interactions.Esta pesquisa teve como objetivo identificar a forma farmacêutica dos medicamentos preparados para serem administrados por cateteres e o perfil dos erros cometidos durante o preparo. Trata-se de estudo epidemiológico transversal, de natureza observacional, conduzido em uma unidade de terapia intensiva com amostra de 350 doses de medicamentos preparados por 56 técnicos de enfermagem. A coleta de dados ocorreu no mês de março de 2010. Os resultados mostram que 92% dos medicamentos eram sólidos. Os erros foram agrupados nas categorias diluição e mistura para formas líquidas, acrescidos de trituração para sólidos. As taxas de erro foram superiores a 40% em todas as categorias. Concluiu-se que: a trituração indevida pode ter comprometido o resultado terapêutico em comprimidos revestidos e de liberação controlada; não diluir xaropes pode ter contribuído para a obstrução de cateteres; misturar medicações ao triturá-las pode aumentar o risco de interações farmacêuticas

Comparative evaluation of the applicability of fixed-dose combined drugs in HIV therapy / Avaliação comparativa da aplicabilidade de drogas combinadas em dose fixa na terapia do HIV

The principal global pandemic is Acquired Immunodeficiency Syndrome (AIDS), the early diagnosis and the premature treatment is the main current strategies in combating the development and spread of the disease. Antiretroviral therapy is effective and safe, what is sought nowadays is compliance and convenience for the patient. Different countries adopt different combinations of antiretroviral drugs when using the fixed-dose combination (FDC). The study design was a meta-analysis with clinical trials, patients experienced and naïve of treatment. The Pubmed, Scopus, Embase, Web of Science and Cochrane databases were searched for studies reporting AIDS treatment. The primary outcome was viral load and another outcome is adverse events. The results of the main analysis included 5224 patients. Since there was significant heterogeneity between studies, random effects were selected, and they showed an event rate of 0.67 (95%CI from 0.57 to 0.77). The exploratory analysis showed the general drug effects are not consistently significant along time, and treatments of longer times are more efficient. Specifically, the random analyses of 6 months and 1 year did not show significant drug effects on viral load, while a significant effect of 71% (95% CI from 0.61 to 0.80) in a very heterogeneous analyses (I2>96%). First, d4T-3TC-NVP showed a mean rate of only 21% efficacy and the second, EFV-TDF-FTC did not reach statistical significance (p=0.07). This meta-analysis shows that fixed-dose combination therapy is tolerability, safety and effective, occurred viral load suppression between patients on FDC

Suspected adverse drug reactions reported for Brazilian children: cross‐sectional study

To assess spontaneous reports of suspected adverse drug reactions in children aged 0-12 years from the Brazilian Health Regulatory Agency between 2008 and 2013.A cross-sectional study on suspected adverse drug reactions reports related to medicines and health products in children was carried out for a six-year period (2008-2013). Year of report, origin of report by Brazilian state, gender, age, suspected drug, adverse reaction description and seriousness were included in the analysis. The data obtained was compared to the number of pediatric beds in health services and to global data from the VigiBase (World Health Organization).A total of 3330 adverse drug reactions were reported in children in Brazil in the investigated period (54% were in boys). About 28% of suspected adverse drug reactions reports involved 0 to 1-year-old children. Almost 40% of reports came from the Southeast region. Approximately 60% were classified as serious events. There was death in 75 cases. Nearly 30% of deaths involved off-label use; 3875 medicines (465 active substances) were considered suspected drugs. Anti-infective (vancomycin, ceftriaxone, oxacillin, and amphotericin), nervous system (metamizole) and alimentary tract and metabolism medicines were more frequent in reports.The distribution of suspected adverse drug reactions reports by sex and age group corresponded to the profile of children hospitalized in Brazil. Data about seriousness and medicines reported may be useful to encourage regulatory actions and improve the safe use of medicines in children

Study of utilization of the human albumin in hospitals of the Rio de Janeiro, Brazil

Made available in DSpace on 2012-09-05T18:23:53Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 273.pdf: 735803 bytes, checksum: f3b584790347827b7b8e5f85f723595f (MD5) Previous issue date: 2006Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.As controvérsias em torno da indicação terapêutica da albumina humana (AH) e o impacto nos custos hospitalares pelo uso irracional do produto, motivaram nas três últimas décadas, a realização de estudos a respeito do problema em diversos países. No Brasil, as iniciativas de racionalização de uso da AH são escassas e pouco difundidas. Esta tese é apresentada em três artigos que abordam os aspectos clínicos e epidemiológicos do uso da AH em hospitais do Rio de Janeiro, utilizando dados primários e secundários. (...

Drug intoxication among children under five years old

Made available in DSpace on 2010-08-23T16:41:10Z (GMT). No. of bitstreams: 3 license.txt: 1842 bytes, checksum: 48bf538711ef67a6b83f563f13ffdca6 (MD5) Bortoletto_Intoxicacoes medicamentosa_2002.pdf: 91671 bytes, checksum: 2ebc65f2c74cecad98ff081bfc98b7f6 (MD5) Bortoletto_Intoxicacoes medicamentosa_2002.pdf.txt: 43018 bytes, checksum: a0e54d5c4be1c3a17c4d49594728facf (MD5) Previous issue date: 2002Made available in DSpace on 2010-11-04T14:18:05Z (GMT). No. of bitstreams: 3 Bortoletto_Intoxicacoes medicamentosa_2002.pdf.txt: 43018 bytes, checksum: a0e54d5c4be1c3a17c4d49594728facf (MD5) Bortoletto_Intoxicacoes medicamentosa_2002.pdf: 91671 bytes, checksum: 2ebc65f2c74cecad98ff081bfc98b7f6 (MD5) license.txt: 1842 bytes, checksum: 48bf538711ef67a6b83f563f13ffdca6 (MD5) Previous issue date: 2002Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnologia em Saúde. Sistema Nacional de Informações Tóxico-farmacológicas. Rio de Janeiro, RJ, Brasil.Objetivos: conhecer a magnitude das ocorrências de intoxicações em crianças menores de cinco anos, no Brasil. Métodos: a partir de dados secundários do Sistema Nacional de Informações Tóxico-Farmacológicas (SINITOX) foram analisadas as freqüências por classe terapêutica, seguimento e circunstâncias, dos casos de intoxicação em menores de cinco anos, nos anos de 1997 e 1998 em São Paulo e Rio Grande do Sul. Resultados: no Brasil, foram registrados no período, 151.000 casos de intoxicações humanas. Quase um terço pôde ser associado a medicamentos, sendo que cerca de 40.000 casos ocorreram entre crianças menores de cinco anos. O maior número de casos correspondeu aos descongestionantes nasais, analgésicos, broncodilatadores, anticonvulsivantes, anti-histamínicos e contraceptivos orais. Os descongestionantes nasais, anticonvulsivantes, anti-histamínicos e expectorantes foram responsabilizados pelos óbitos. Conforme o SINITOX as principais circunstâncias dos eventos foram o acidente individual, o erro de administração e o uso terapêutico. Conclusões: as intoxicações medicamentosas representam um grave problema de saúde pública, que necessita intervenções no campo da prevenção e da promoção. Isto demonstra a necessidade de ações educativas, junto à população para reduzir o número de acidentes e injurias. As principais lacunas do SINITOX são o sub-registro, a articulação insuficiente com os serviços de saúde e a falta de padronização dos dados.Objectives: to describe drug intoxication among children under five years old in Brazil. Methods: the source of information is a database from an intoxication surveillance system, SINITOX (National System of Toxicological Information), located in the city of São Paulo and Rio Grande do Sul. All cases of drug intoxication, among children under five years old, in 1997 and 1998, were examined. We analyzed event frequency, therapeutic class, followup and circumstances. Results: in Brazil, there were 151.000 intoxication cases in the focused period. Almost one third was associated to medication, and about forty thousand occurred among children less than five years old. Analgesics, the decongestants, the bronchodilators, the antiepileptics and oral contraceptives were the therapeutic classes involved, and the decongestants, the antiepileptics, the antihistamines and the expectorants were associated to cause of death. The surveillance system pointed out that individual accidents, medication errors and therapeutic misuse were the main circumstances involved. Conclusions: drug intoxication is a major public health problem, for which intervention measures are necessary. Educational and regulatory actions could decrease the number of accidents and injuries. The main inadequacies of SINITOX are under-registration, lack of integration with health services and poor data uniformity