STUDIES, EXPERIENCE AND KNOWLEDGE OF FAMILY MEDICINE ON STATE IMPLEMENTATION OF PHARMACOTHERAPY CONTROL

Lijekovi, iako korisni, ponekad mogu imati štetne i neželjene učinke koje nazivamo nuspojavama. One se dijele na nuspojave tipa A - predvidljive, o dozi ovisne i preventabilne i tipa B - o dozi neovisne i nepredvidive. Najčešće se javljaju nuspojave tipa A. Interakcije su promjene učinka lijeka u prisutnosti drugog lijeka, biljnog pripravka ili hrane i vrlo često su štetne. Nuspojave su uzrok hitne hospitalizacije u 0,2 - 41,3%, a oko 50% tih nuspojava moguće je spriječiti. Klinički važne interakcije javljaju se u 3-5% slučajeva. Većina je nuspojava i interakcija predvidiva i moguće ih je spriječiti dobrim poznavanjem racionalne farmakoterapije. LOM se nalazi u središtu zdravstvenoga sustava, a propisivanje lijekova i nadzor nad terapijom svakodnevne su aktivnosti u radu LOM-a. Osobit izazov predstavljaju propisivanje i nadzor lijekova posebnih skupina bolesnika kao što su osobe starije životne dobi, osobe s multimorbiditetima, trudnice, djeca i žene za vrijeme laktacije. Cilj ovoga istraživanja bio je utvrditi znanje, stavove i praksu provođenja kontrole terapije od strane LOM-a te čimbenike koji na to utječu. Materijali i metode: Presječna je studija provedena internetskim anonimnim anketnim ispitivanjem 195 LOM-a u Republici Hrvatskoj. Za istraživanje znanja, stavova i prakse upotrijebljen je upitnik s 46 pitanja sastavljenih po uzoru na slična istraživanja. Validacijom prvotne verzije upitnika na trideset LOM-a utvrđena je niska pouzdanost (Chronbach's alpha = 0.61) jedne skupine pitanja te su u skladu s time učinjene odgovarajuće izmjene. Podaci su analizirani prikladnim statističkim metodama uz razinu značajnosti P<0.05. Rezultati: U skupini od 195 ispitanika najviše ih je bilo iz Osječko-baranjske županije i Grada Zagreba. Medijan dobi ispitanika je 51 godina, a broja osiguranika 1700. Prema broju točnih odgovora nema značajnih razlika prema spolu, mjestu rada ili duljini radnoga staža, ali značajno su veći broj točnih odgovora dali specijalisti obiteljske medicine. U potpunosti se slaže s tvrdnjom da mogu samostalno propisivati lijekove samo na osnovu svoga znanja osobama s većim brojem kroničnih bolesti (komorbiditeta) 26,7 % ispitanika, osobama starije životne dobi njih 32,3 %, djeci 18,5 % ispitanika, a trudnicama i ženama za vrijeme laktacije 15,9 % ispitanika. Većina ispitanika se niti slaže niti ne slaže s tvrdnjama da pacijente treba uputiti kliničkome farmakologu pri propisivanju lijekova. Više od 80 % ispitanika potrebu za edukacijom o racionalnoj farmakoterapiji ocijenilo je nužnom. Upravo zbog važnosti educiranosti LOM-a o nuspojavama i interakcijama lijekova kroz deset pitanja utvrđivano je njihovo znanje o najčešće propisivanim lijekovima. Najviše ispitanika, njih 93,8%, točno je odgovorilo da nije opravdana kombinacija antihipertenziva valsartan + ramipril. 84,1 % ispitanika zna da Izotretinoin ubrajamo u kategoriju X po FDA klasifikaciji, 63,1 % ispitanika tvrdi da bi Klaritromicin bio lijek izbora za atipičnu pneumoniju uzrokovanu Mycoplasmom pneumoniae-om kod sedmogodišnjega djeteta. Znanje LOM-a o mirtazapinu, kao odabranom antidepresivu koji vrlo rijetko izaziva seksualnu disfunkciju kao nuspojavu, navodi 32,8 % ispitanika. Samo 35% ispitanika složilo se s tvrdnjom da im je fakultet medicine pružio dovoljno znanja o nuspojavama lijekova. Zaključak: Gotovo polovina LOM-a pokazala je dobro znanje iz područja nuspojava i interakcija, a većina je svjesna potrebe za dodatnom edukacijom iz toga područja. Nedostatak informacija o održavanju edukacija smatraju najvećom zaprekom za njihovo pohađanje, a na drugome mjestu je nedostatak vremena. Kao prediktor lošijega znanja pokazala se dob ispitanika, te se mlađi ispitanici osjećaju manje sposobno samostalno propisivati lijekove.Objective: Although drugs are useful, sometimes harmful and unwanted effects can be induced, what is described as side effects. Side effects are divided into type A which are predictable, dose dependent and can be prevented, and type B which are dose independent and unpredictable. Type A side effects are the most common. Interactions are changes in the drug effect in the presence of another drug, herbal preparation or food and are very often harmful. Drug side effects participate in 0.2 - 41.3% of allemergency hospitalization, and about 50% of these side effects can be prevented. Clinically important interactions occur in 3-5% of cases. Most side effects and interactions are predictable and can be prevented by good knowledge of rational pharmacotherapy. Primary care providers (PCPs) is at the center of the healthcare system, and carefully prescribing medications and controlling the therapy are everyday activities in PCP's work. A rising challenge is prescribing and monitoring of medicines to particular groups of patients such as elderly people, people with multimorbidities, pregnant women, children and women during lactation. The aim of this study was to examine the knowledge, establish attitudes and practice of controlling the therapy by PCPs and the factors that influence it. Materials and Methods: An intermediate study conducted through anonymous survey of 195 PCPs in the Republic of Croatia. For the study of knowledge, attitudes and practices, a questionnaire was used with 46 questions based upon similar research. Validation of the initial version of the questionnaire on thirty PCPs revealed low reliability (Chronbach's alpha = 0.61) in one group of questions and corresponding changes were made accordingly. The data were analyzed and p <0.05 was considered as statistical significance difference. Results: In the group of 195 respondents, most are from the Osijek-Baranja County and the City of Zagreb. The median age of the respondentsis 51 and the number of insured persons per team of PCPs is 1700. According to the number of correct answers, there are no significant differences in gender, place of work or length of service, but a significant number of exact answers have been given by PCPs specialists. 26.7% of respondents fully agree with the claim that they can independently prescribe drugs only on the basis of their knowledge to people with a higher number of chronic diseases (comorbidity), 32.3% to the elderly, 18.5% tothe children and 15,9% of respondents to pregnant women and women during lactation. Mostrespondents nor agree nor disagree with the claims that patients should be referred to a clinical pharmacologist when prescribing medicines. More than 80% of respondents considered the need for rational pharmacotherapy education necessary. Just because of the importance of PCPs education on side effects and drug interactions, ten quick questions test reveal their knowledge of the most commonly prescribed drugs.93.8% questioners responded correctly that a combination of antihypertensive drug Valsartan and Ramipril is not justified, 84.1% of questioners know that Izotretinoin is included in category X by FDA (Food and Drug Administration) classification. 63.1% of questioners claim that Clarithromycin should be a medicine of choice for atypical pneumonia caused by Mycoplasma pneumoniae in a seven-year-old child. PCP’sdata of the mirtazapine, as the selected antidepressant, which very rarely causes sexual dysfunction as a side effect, suggests 32.8% of questioners. Only 35% of questioners agree with the statement that their faculty of medicine has provided enough knowledge about drug side effects. Conclusion: Almost half of PCPs has shown good knowledge of side effects and interactions, but most are aware that additional education is needed. Lack of information about education is considered the greatest barrier to not attending, and lack of time is a second greatest barrier. From the aspect of experience and age, beside inferior knowledge, younger questioners felt less able to independently prescribe drugs

Direct-Acting Antivirals (DAAs): Drug-Drug Interactions (DDIs) in the Treatment of Hepatitis C Virus (HCV)

Hepatitis C virus (HCV)-infected patients often use multiple medications to treat infection, adverse events related to HCV therapy, or to manage other comorbidities. Drug-drug interactions (DDIs) associated with this polypharmacy are important in HCV pharmacotherapy, especially after introduction of direct-acting antivirals (DAAs). Knowledge about pharmacokinetics, metabolism, and disposition of drugs used in the treatment of HCV and comorbidities is crucial in the interpretation of these data and management of these interactions (e.g. dose adjustments, therapeutic drug monitoring, or safe alternatives). Web-based DDIs interactive tools like http://www.hep-druginteractions.org represent the most feasible and comprehensive way for an assessment of potential DDIs before, during, and after treatment. Additional helpful resources are data from clinical drug interaction studies as well as recent real-life data. This chapter is practical overview of DDIs in the treatment of HCV with the last update

The most important characteristics of coronarographed patients treated in the Coronary Intensive Care of the University Hospital Center Osijek.

Coronary artery disease (CAD), along with other diseases from the group of cardiovascular disea- ses holds a significant share in the morbidity and mortality of the population, especially among developed countries. The aim of this study was to determine the preva- lence of cardiovascular risk factors in hospitalized patients undergoing coronary angiography thereby placing a special emphasis on gender. The analysis includes 196 patients (106 men and 90 women) from the Coronary intensive Care, University Hospital Center Osijek that during 2010 underwent coronary angiography. In addition to demographic data and body mass index, the analysis encompassed the data on coronary angiography procedure, type of CAD and characteristics of narrowing of coronary arteries and the data obtained by aortography and left ventriculography. We have found that coronarographed patients are usually men, older, obese persons and diabetics. In most cases, the right coronary artery was dominant, while the greatest number of patients had a one-vessel coronary artery disease. Some 40.7% of patients underwent percutaneous coronary interven- tion, while coronary artery bypass graft was recommended to 27.3% of patients. Female patients were usually older, with the presence of multiple risk factors. More frequent and more extensive left anterior descending artery stenosis was recorded in women. This study confirms previous insights, because persons with multiple risk factors were more vulnerable to the occurrence of CAD

Učinak hipertireoze i antitiroidne terapije na koštanu gustoću - patofiziološki mehanizmi te kliničko značenje

Graves’ disease is an autoimmune disease characterized by excessive thyroid hormone production. One of the consequences of that state can be a decrease in bone mineral density (BMD). Graves’ disease is often treated with antithyroid drugs (ATD) as first line therapy, which can lead to disease remission. Moreover, recent data show that improvement in BMD can be expected. However, vitamin D deficiency can coexist along with Graves’ disease, which is also involved in the process of bone remodeling. It is still not known whether lower values of vitamin D can contribute to onset of Graves’ disease and if its supplementation might be helpful in therapy for hyperthyroidism. In the past couple of decades, osteopenia and osteoporosis have become a major health burden not only in post-menopausal women but also as a result of other diseases, leading to extensive research into various pathophysiological mechanisms responsible for bone remodeling. The Wnt (wingless integrated) signaling pathway is a very important factor in bone homeostasis, especially the canonical pathway. Present data indicate that stimulation of the Wnt pathway leads to bone mass increase and, in contrast, its inhibition leads to bone mass decrease. Hence, inhibitors of the canonical Wnt pathway became the focus of interest, in particular sclerostin and dickkopf 1 (DKK1). Hyperthyroidism and osteopenia/osteoporosis are quite common today and can coexist together or as separate entities. In this article, we aimed to give an overview of possible associations and potential mutual pathophysiological mechanisms.Gravesova bolest je autoimuna bolest karakterizirana prevelikom proizvodnjom hormona štitnjače. Jedna od posljedica toga stanja može biti sniženje mineralne gustoće kosti. Liječi se antitireoidnim lijekovima kao prvim izborom čime se može postići remisija bolesti. Postizanjem remisije, može se očekivati i poboljšanje mineralne gustoće kosti. No, uz Gravesovu bolest, može postojati i snižena vrijednost vitamina D koji je također važana za procese pregradnje kosti. Još je uvijek otvoreno pitanje mou li snižene vrijednosti vitamina D pridonijeti nastanku Gravesove bolesti i da li bi njegova supstitucija mogla pomoći u liječenju hipertireoze. Kako je smanjena mineralna gustoća kosti danas rasprostranjena širom svijeta, u prošlim desetljećima počeo se istraživati Wnt put. Ovaj put vrlo je važan za homeostazu kosti, osobito njegov dio koji se naziva kanonički put u kojem sudjeluju i sklerostin i dickkopf 1 kao inhibitori. Svi spomenuti čimbenici, odnosno stanja, danas su učestala i mogu postojati zajedno i odvojeno. Ovim člankom pokušali smo dati pregled moguće veze između njih

STUDIES, EXPERIENCE AND KNOWLEDGE OF FAMILY MEDICINE ON STATE IMPLEMENTATION OF PHARMACOTHERAPY CONTROL

Lijekovi, iako korisni, ponekad mogu imati štetne i neželjene učinke koje nazivamo nuspojavama. One se dijele na nuspojave tipa A - predvidljive, o dozi ovisne i preventabilne i tipa B - o dozi neovisne i nepredvidive. Najčešće se javljaju nuspojave tipa A. Interakcije su promjene učinka lijeka u prisutnosti drugog lijeka, biljnog pripravka ili hrane i vrlo često su štetne. Nuspojave su uzrok hitne hospitalizacije u 0,2 - 41,3%, a oko 50% tih nuspojava moguće je spriječiti. Klinički važne interakcije javljaju se u 3-5% slučajeva. Većina je nuspojava i interakcija predvidiva i moguće ih je spriječiti dobrim poznavanjem racionalne farmakoterapije. LOM se nalazi u središtu zdravstvenoga sustava, a propisivanje lijekova i nadzor nad terapijom svakodnevne su aktivnosti u radu LOM-a. Osobit izazov predstavljaju propisivanje i nadzor lijekova posebnih skupina bolesnika kao što su osobe starije životne dobi, osobe s multimorbiditetima, trudnice, djeca i žene za vrijeme laktacije. Cilj ovoga istraživanja bio je utvrditi znanje, stavove i praksu provođenja kontrole terapije od strane LOM-a te čimbenike koji na to utječu. Materijali i metode: Presječna je studija provedena internetskim anonimnim anketnim ispitivanjem 195 LOM-a u Republici Hrvatskoj. Za istraživanje znanja, stavova i prakse upotrijebljen je upitnik s 46 pitanja sastavljenih po uzoru na slična istraživanja. Validacijom prvotne verzije upitnika na trideset LOM-a utvrđena je niska pouzdanost (Chronbach's alpha = 0.61) jedne skupine pitanja te su u skladu s time učinjene odgovarajuće izmjene. Podaci su analizirani prikladnim statističkim metodama uz razinu značajnosti P<0.05. Rezultati: U skupini od 195 ispitanika najviše ih je bilo iz Osječko-baranjske županije i Grada Zagreba. Medijan dobi ispitanika je 51 godina, a broja osiguranika 1700. Prema broju točnih odgovora nema značajnih razlika prema spolu, mjestu rada ili duljini radnoga staža, ali značajno su veći broj točnih odgovora dali specijalisti obiteljske medicine. U potpunosti se slaže s tvrdnjom da mogu samostalno propisivati lijekove samo na osnovu svoga znanja osobama s većim brojem kroničnih bolesti (komorbiditeta) 26,7 % ispitanika, osobama starije životne dobi njih 32,3 %, djeci 18,5 % ispitanika, a trudnicama i ženama za vrijeme laktacije 15,9 % ispitanika. Većina ispitanika se niti slaže niti ne slaže s tvrdnjama da pacijente treba uputiti kliničkome farmakologu pri propisivanju lijekova. Više od 80 % ispitanika potrebu za edukacijom o racionalnoj farmakoterapiji ocijenilo je nužnom. Upravo zbog važnosti educiranosti LOM-a o nuspojavama i interakcijama lijekova kroz deset pitanja utvrđivano je njihovo znanje o najčešće propisivanim lijekovima. Najviše ispitanika, njih 93,8%, točno je odgovorilo da nije opravdana kombinacija antihipertenziva valsartan + ramipril. 84,1 % ispitanika zna da Izotretinoin ubrajamo u kategoriju X po FDA klasifikaciji, 63,1 % ispitanika tvrdi da bi Klaritromicin bio lijek izbora za atipičnu pneumoniju uzrokovanu Mycoplasmom pneumoniae-om kod sedmogodišnjega djeteta. Znanje LOM-a o mirtazapinu, kao odabranom antidepresivu koji vrlo rijetko izaziva seksualnu disfunkciju kao nuspojavu, navodi 32,8 % ispitanika. Samo 35% ispitanika složilo se s tvrdnjom da im je fakultet medicine pružio dovoljno znanja o nuspojavama lijekova. Zaključak: Gotovo polovina LOM-a pokazala je dobro znanje iz područja nuspojava i interakcija, a većina je svjesna potrebe za dodatnom edukacijom iz toga područja. Nedostatak informacija o održavanju edukacija smatraju najvećom zaprekom za njihovo pohađanje, a na drugome mjestu je nedostatak vremena. Kao prediktor lošijega znanja pokazala se dob ispitanika, te se mlađi ispitanici osjećaju manje sposobno samostalno propisivati lijekove.Objective: Although drugs are useful, sometimes harmful and unwanted effects can be induced, what is described as side effects. Side effects are divided into type A which are predictable, dose dependent and can be prevented, and type B which are dose independent and unpredictable. Type A side effects are the most common. Interactions are changes in the drug effect in the presence of another drug, herbal preparation or food and are very often harmful. Drug side effects participate in 0.2 - 41.3% of allemergency hospitalization, and about 50% of these side effects can be prevented. Clinically important interactions occur in 3-5% of cases. Most side effects and interactions are predictable and can be prevented by good knowledge of rational pharmacotherapy. Primary care providers (PCPs) is at the center of the healthcare system, and carefully prescribing medications and controlling the therapy are everyday activities in PCP's work. A rising challenge is prescribing and monitoring of medicines to particular groups of patients such as elderly people, people with multimorbidities, pregnant women, children and women during lactation. The aim of this study was to examine the knowledge, establish attitudes and practice of controlling the therapy by PCPs and the factors that influence it. Materials and Methods: An intermediate study conducted through anonymous survey of 195 PCPs in the Republic of Croatia. For the study of knowledge, attitudes and practices, a questionnaire was used with 46 questions based upon similar research. Validation of the initial version of the questionnaire on thirty PCPs revealed low reliability (Chronbach's alpha = 0.61) in one group of questions and corresponding changes were made accordingly. The data were analyzed and p <0.05 was considered as statistical significance difference. Results: In the group of 195 respondents, most are from the Osijek-Baranja County and the City of Zagreb. The median age of the respondentsis 51 and the number of insured persons per team of PCPs is 1700. According to the number of correct answers, there are no significant differences in gender, place of work or length of service, but a significant number of exact answers have been given by PCPs specialists. 26.7% of respondents fully agree with the claim that they can independently prescribe drugs only on the basis of their knowledge to people with a higher number of chronic diseases (comorbidity), 32.3% to the elderly, 18.5% tothe children and 15,9% of respondents to pregnant women and women during lactation. Mostrespondents nor agree nor disagree with the claims that patients should be referred to a clinical pharmacologist when prescribing medicines. More than 80% of respondents considered the need for rational pharmacotherapy education necessary. Just because of the importance of PCPs education on side effects and drug interactions, ten quick questions test reveal their knowledge of the most commonly prescribed drugs.93.8% questioners responded correctly that a combination of antihypertensive drug Valsartan and Ramipril is not justified, 84.1% of questioners know that Izotretinoin is included in category X by FDA (Food and Drug Administration) classification. 63.1% of questioners claim that Clarithromycin should be a medicine of choice for atypical pneumonia caused by Mycoplasma pneumoniae in a seven-year-old child. PCP’sdata of the mirtazapine, as the selected antidepressant, which very rarely causes sexual dysfunction as a side effect, suggests 32.8% of questioners. Only 35% of questioners agree with the statement that their faculty of medicine has provided enough knowledge about drug side effects. Conclusion: Almost half of PCPs has shown good knowledge of side effects and interactions, but most are aware that additional education is needed. Lack of information about education is considered the greatest barrier to not attending, and lack of time is a second greatest barrier. From the aspect of experience and age, beside inferior knowledge, younger questioners felt less able to independently prescribe drugs

Primary Care Provider Counseling Practices about Adverse Drug Reactions and Interactions in Croatia

BACKGROUND: Prescribing medications is one of the most common medical decisions that is made by primary care providers (PCPs). In the Republic of Croatia, PCPs hold a key position in prescribing and evaluating the medications that are provided for patients. Accordingly, providing advice for patients regarding the potential adverse drug reactions (ADRs) and drug-drug interactions (DDIs) is frequently the responsibility of the PCPs. The aim of the current study was to assess the knowledge, attitudes, and counseling practices of PCPs regarding drug interactions and adverse effects. METHODS: After enrolling 195 PCPs that were selected at random, a survey was conducted while using an anonymous questionnaire that was created based on previously published studies, adjusted in a way that includes the most commonly prescribed medications in Croatia. RESULTS: Of the 10 questions on knowledge about DDIs and ADRs, the median number of correct responses by PCPs was 5 (interquartile range 4 to 7). More than half of respondents (56%) agreed with the claim that knowledge of drug side effects facilitated their work in family medicine. Almost all of the respondents (92.8%) explained side effects and drug interactions to special groups of patients (pregnant women, elderly patients etc.). CONCLUSION: The results show a need for additional education in the field of drug prescribing. However, PCPs were aware of the importance of counseling practices about adverse drug reactions and interactions and counseling practices among special patients populations are satisfactory

Association of Wnt Inhibitors, Bone Mineral Density and Lifestyle Parameters in Women with Breast Cancer Treated with Anastrozole Therapy

Aim: To determine the levels of Wnt inhibitors in patients treated with aromatase inhibitors (AIs) prior to therapy and to investigate their association with bone mineral density (BMD) and lifestyle parameters. Methods: 137 breast cancer patients were divided into a group treated with 1 mg of anastrozole and a group w/o anastrozole therapy. Serum concentrations of sclerostin and dickkopf1 (DKK1) were measured by ELISA. BMD was measured by dual-energy X-ray absorptiometry (DXA). Lifestyle factors were investigated by a self-reported questionnaire. Results: Sclerostin was significantly higher in the AI-treated group (31.8 pmol/L vs. 24.1 pmol/L; p &lt; 0.001), whereas DKK1 was significantly lower in the AI-treated group (24.3 pmol/L vs. 26.02 pmol/L; p &lt; 0.001). Total hip and femoral neck BMD were significantly lower in the AI-treated group. Conclusion: AI treatment was associated with increased levels of sclerostin and decreased levels of DKK1