Farmaceutska zdravstvena zaštita u terapiji astme

Asthma is a chronic inflammatory disease of the airways, characterized by symptoms such as wheezing, shortness of breath, cough, etc. A high level of disease control can be achieved, in most patients, using appropriate medication. However, a large number of asthma exacerbations is still present, due to inadequate treatment or poor compliance. Studies showed that the majority of patients do not use inhalers properly, which can consequently cause inadequate treatment efficacy. Therefore, the role of the pharmacist is to demonstrate and make sure that patients understand and use inhalers properly. Individualized asthma plans, created with mutal efforts of the pharmacist and the patient, were shown to effect treatment outcomes significantly. In order to improve the level of adherence, patients should be educated about the use and timing of use of medications, appropriate doses, evaluation of treatment response, adverse events and mode of action in case of treatment inefficacy. Investigations have, undoubtedly shown that patients appreciate the support of the pharmacist and that pharmacists improve treatment outcomes, in asthma patients, significantly.Astma je hronična inflamatorna bolest disajnih puteva koju karakterišu simptomi poput šištanja u grudima, kratkog daha, kašlja i sl. Primenom odgovarajućih lekova može se uspostaviti visok stepen kontrole nad bolešću kod većine pacijenata. Međutim, u praksi se i danas beleži veliki broj egzacerbacija astme, usled neodgovarajuće terapije ili nepridržavanja uputstva o pravilnoj primeni lekova od strane pacijenata. Istraživanja su pokazala da većina pacijenata nepravilno primenjuje lekove putem inhalacije, što može uzrokovati nedovoljan stepen efikasnosti terapije. Stoga je uloga farmaceuta da demonstrira i da se uveri da je pacijent razumeo pravilan način primene preparata za inhalaciju. Pokazano je da individualizovani, pisani astma plan u čijoj izradi učestvuju farmaceut i pacijent, značajno utiče na postizanje ishoda terapije. U cilju poboljšanja stepena adherence, pacijente je potrebno edukovati o načinu i vremenu primene lekova, odgovarajućim dozama, proceni odgovora na terapiju, ispoljavanju neželjenih dejstava i postupcima u slučaju neefikasnosti terapije. Studije su nedvosmisleno pokazale da pacijenti smatraju da im je pomoć farmaceuta potrebna i da farmaceuti značajno mogu poboljšati ishode terapije pacijenata sa astmom

Farmaceutska zdravstvena zaštita u terapiji dijabetesa

Diabetes mellitus is characterized by impairment of insulin secretion and/or impairment of tissue sensitivity for insulin. The disease is chronic and associated with microvascular and macrovascular complications and a decreased quality of life. Treatment goals are based on the achievement of predefined glucose, blood pressure and lipid levels, using pharmacotherapy and nonpharmacological measures. Studies reveal many treatment problems such as adverse drug reactions, the presence of untreated indications, use of inadequate drug doses, low adherence, drug interactions etc. which may result in treatment failure. In contrast, treatment success is associated with patient education about the disease and the quality of medical care which is reflected in an interdisciplinary health strategy that stimulates the active role of the patient in disease control. Pharmacists can and must contribute in solving treatment problems and improving patient outcomes. Key activities of pharmacists are the education of patients about adequate nutrition, drug use, prevention or mitigation of adverse drug reactions and interactions and improvement of adherence. Moreover, pharmacists should, periodically, evaluate treatment outcomes and search for new potential or actual treatment problems. Many studies showed that the aforementioned pharmacy activities contribute to improvement of patient outcomes in diabetes, increased productivity of patients and reduction of treatment costs.Dijabetes melitus se karakteriše poremećajem u sekreciji insulina i/ili poremećajem osetljivosti tkiva na insulin. Bolest je hronična, udružena sa mikrovaskularnim i makrovaskularnim komplikacijama i umanjenim kvalitetom života. Terapijski ciljevi se zasnivaju na postizanju ciljnih vrednosti glukoze, krvnog pritiska i lipida, pomoću farmakoterapije i nefarmakoloških mera. Istraživanja pokazuju da su problemi u terapiji mnogobrojni poput ispoljavanja neželjenih reakcija na lek, postojanja nelečenih indikacija, primene neodgovarajućih doza lekova, nedovoljnog stepena adherence, interakcija i sl., dok je posledica navedenih problema, neretko, neuspeh terapije. Nasuprot tome, uspeh terapije zavisi od edukovanosti samog pacijenta o bolesti i kvaliteta zdravstvene zaštite koji se ogleda u postojanju interdisciplinarne zdravstvene strategije koja stimuliše aktivnu ulogu pacijenta u kontroli bolesti. Farmaceuti mogu i moraju pružiti doprinos rešavanju terapijskih problema i poboljšanju ishoda pacijenata. Od ključnih aktivnosti farmaceuta izdvajaju se edukacija pacijenata o pravilnom načinu ishrane, pravilnoj primeni terapije i prevenciji ili ublažavanju neželjenih reakcija i interakcija i poboljšanju stepena adherence. Takođe, dužnost je farmaceuta da periodično prati ishode terapije i procenjuje pojavu novih potencijalnih ili aktuelnih terapijskih problema. Mnogobrojna istraživanja pokazuju da navedene aktivnosti farmaceuta u značajnoj meri doprinose poboljšanju ishoda pacijenata sa dijabetesom, njihovoj povećanoj produktivnosti i smanjenju troškova lečenja

Effects of Pelargonium sidoides extract vs roxithromycin on chemokine levels in nasal secretions of patients with uncomplicated acute rhinosinusitis

Background: Previous investigations suggest the use of extract from the roots of Pelargonium sidoides (EPs 7630) for the therapy of uncomplicated rhinosinusitis. The aim of this prospective study was to compare the effects of herbal drug EPs 7630 and antibiotic roxithromycin on chemokine production in nasal mucosa and clinical parameters in patients with uncomplicated acute bacterial rhinosinusitis (ABRS). Methods: Seventy-eight ABRS patients were divided into 26 patients receiving EPs 7630 tablets, 3 × 20 mg/day per os (group 1), 26 patients receiving roxithromycin tablets, 2 × 150 mg/day per os (group 2), both for 10 days, and 26 patients who received no therapy (Control group). We measured chemokine levels in nasal secretions by flow cytometry and assessed clinical parameters on day 0 and day 10 of investigation. Results: EPs 7630 increased concentrations of MCP-1 (P =.001) and IP-10 (P =.049) and decreased levels of MIP-1α (P <.001), ENA-78 (P <.001), and IL-8 (P <.001). Roxithromycin increased levels of IP-10 (P =.049) and decreased levels of MCP-1 (P <.001), MIP-1α (P <.016), ENA-78 (P <.001), and IL-8 (P <.001). Comparison of the non-treated patients' group with groups 1 and 2 revealed significant improvement of all clinical parameters in treated patients (P <.001), but therapy with roxithromycin resulted in better improvement in nasal symptoms and endoscopic findings than therapy with EPs 7630. Conclusion: Our results suggest the presence of similar modulatory effects of both therapies on production of chemokines that regulate the function of neutrophils and monocytes in nasal mucosa. Roxithromycin shows better clinical efficacy than EPs 7630 in patients with uncomplicated ABRS. Level of Evidence: 1b

Farmaceutska zdravstvena zaštita u terapiji duboke venske tromboze

Anticoagulation therapy is commonly used in deep vein thrombosis (DVT) prophylaxis associated with surgical interventions and in treatment of patients with DVT, atrial fibrillation and prosthetic heart valves. Long-term treatment is usually initiated with parenteral heparin (unfractionated or low molecular weight) or fondaparinux followed by concomitant warfarin use (5-10 mg). Oral anticoagulants such as warfarin and coumarin derivatives are efficient in treatment and prevention of thromboembolic events but are also associated with increased risk of potentially fatal hemorrhages. Drug doses are adjusted to achieve international normalized ratio (INR) of 2.5 (2-3) in patients with DVT, atrial fibrillation and prosthetic heart valves, or 3.5 (3-4) in patients with recurrent DVT or pulmonary embolism. INR is influenced by warfarin/acenocoumarol interactions with other conventional and herbal medicines dietary supplements, consumption of vitamin K rich food, presence of comorbidities such as heart failure, hepatic insufficiency, hypo- and hyperthyrodism, older age, alcohol consumption and adherence. Moreover, caution is needed in surgical events and dental interventions. Due to the small INR window and the risk of hemorrhage, patient counseling is of great importance. The role of the pharmacist is to counsel about regular and appropriate drug use, food consumption and possibilities of decreasing the hemorrhage risk. Counseling can be performed as part of the standard service offered to patients in primary or secondary care or, as in case of developed health-care systems, in anticoagulation clinics, where pharmacists play an important role due to their competences.Antikoagulantna terapija se najčešće primenjuje u profilaksi duboke venske tromboze (DVT) kod hirurških zahvata i u terapiji pacijenata sa DVT, atrijalnom fibrilacijom i veštačkim srčanim zaliscima. U bolničkim uslovima, dugotrajna terapija počinje parenteralnom primenom heparina (nefrakcionisanog ili niskomolekularnog) ili fondaparinuksa uz istovremenu oralnu primenu varfarina (5-10 mg). Oralni antikoagulansi poput varfarina i kumarinskih derivata efikasni su u lečenju i prevenciji tromboembolijskih događaja ali sa sobom nose povišen rizik od pojave potencijalno fatalnih krvarenja. Doziranje lekova se prilagođava sa ciljem postizanja vrednosti internacionalnog normalizovanog odnosa (INR) 2,5 (2-3) kod DVT, veštačkih srčanih zalistaka i atrijalne fibrilacije odnosno 3,5 (3-4) kod pacijenata sa rekurentnom DVT ili plućnom embolijom. Na vrednost INR mogu uticati: interakcije lekova, biljnih i dijetetskih suplemenata sa varfarinom/acenokumarolom, konzumiranje hrane bogate vitaminom K, prisustvo komorbiditeta poput srčane i hepatičke insuficijencije, hipo- i hipertiroidizma, starost pacijenta, konzumacija alkohola i stepen adherence. Takođe, oprez je potreban pri hirurškim zahvatima i posetama stomatologu. Zbog uskog terapijskog opsega INR vrednosti i potencijalnog rizika od hemoragije, potrebno je posvetiti posebnu pažnju savetovanju pacijenata na terapiji varfarinom/acenokumarolom. Uloga farmaceuta ogleda se u savetovanju o redovnoj i pravilnoj primeni leka, pravilnom načinu ishrane i mogućnostima minimiziranja rizika od pojave krvarenja. Savetovanje se može vršiti u okviru usluge koja se pacijentima pruža u primarnoj i sekundarnoj zdravstvenoj zaštiti ili, kao što je slučaj u razvijenim zdravstvenim sistemima, u antikoagulantnim ambulantama u čijem radu, zbog svoje kompetentnosti, značajna uloga pripada farmaceutima

Adverse drug reactions caused by drug–drug interactions in cardiovascular disease patients: introduction of a simple prediction tool using electronic screening database items

Objective: Cardiovascular disease (CVD) drugs have been frequently implicated in adverse drug reaction (ADR)-related hospitalizations. Drug-drug interactions (DDIs) are common preventable cause of ADRs, but the impact of DDIs in the CVD population has not been investigated. Hence, the primary aim of the study was to identify DDIs associated with ADRs in CVD patients at hospital admission. The second aim was to develop a simple tool to identify high-risk patients for DDI-related adverse events. Methods: An observational study was conducted on the Cardiology Ward of University Clinical Hospital Center. Data were obtained from medical charts. A clinical panel identified DDIs implicated in ADRs, using LexiInteract database and Drug Interaction Probability Scale. Statistics were performed using PASW 22 (SPSS Inc.). Results: DDIs contributed to hospital admission with a total prevalence of 9.69%. DDI-related ADRs affected mainly cardiac function (heart rate or rhythm, 41.07%); bleeding and effect on blood pressure were equally distributed (17.86%). Non-cardiovascular ADRs were found in 23.21% of DDIs. After admission, 73% of the identified DDIs led to changes in prescription. Prediction ability of calculated DDI adverse event probability scores was rated as good (AUC = 0.80, p < .001). Conclusions: CVD patients are highly exposed to adverse DDIs; about one in ten patients hospitalized with CVD might have a DDI contributing to the hospitalization. Given the high prevalence of CVD, DDI-related harm might be a significant burden worldwide. Identification of patients with high DDI adverse event risk might ease the recognition of DDI-related harm and improve the use of electronic databases in clinical practice.This is peer-rewiewed version of the following article: Kovačević, M.; Vezmar Kovačević, S.; Radovanović, S.; Stevanović, P.; Miljković, B. Adverse Drug Reactions Caused by Drug–Drug Interactions in Cardiovascular Disease Patients: Introduction of a Simple Prediction Tool Using Electronic Screening Database Items. Curr. Med. Res. Opin. 2019, 35 (11), 1873–1883. [https://doi.org/10.1080/03007995.2019.1647021

Anticholinergic and sedative drug burden in elderly patients with cardiovascular diseases (oral presentation)

Background Exposure to anticholinergic and sedative drugs have been associated with adverse health outcomes in the elderly population, which can be measured in an individual patient using Drug Burden Index (DBI). Higher DBI values were associated with poorer cognitive and physical performance, which may negatively influence cardiovascular disease (CVD) therapy outcomes. Purpose The aim was to assess the anticholinergic and sedative drug prevalence and burden in CVD patients. Method A retrospective observational study was conducted on the Cardiology ward of University Hospital Medical Center. Data were collected from medical records. DBI was used to calculate the exposure, based on the therapy used before the hospital admission. Descriptive and statistical analysis was performed using IBM SPSS® Statistics ver. 22. Findings A total of 254 patients aged ≥65 were included in the analysis. Patients were comorbid (Charlson Comorbidity Index, mean ± S.D., 3.18 ± 1.63), with the average number of drugs above 6 (6.21 ± 2.78). Anticholinergic or sedative drugs were used by 23 (9.1%) patients, with identified 19 different drugs. The highest frequency was observed for doxazosin (6; 2.4%), sertraline (6; 2.4%), memantine (4; 1.6%), clonazepam (3; 1.2%) and diazepam (3; 1.2%). The majority of patients had only one drug (15; 5.9%), 2 patients (0.8%) used 2, 4 patients (1.6%) used 3, and 2 patients (0.8%) used 4 different drugs with anticholinergic or sedative effects. Patients who were exposed to those drugs had longer length of hospital stay (15.74 vs 9.41 days, p<0.05), and higher total number of drugs (7.61 vs 6.07, p<0.05). The average DBI value equalled 1.11 ± 0.74 (total range 0.33-2.60). DBI <1 was present in 13 (5.1%) patients, and higher DBI≥1 in 10 (4%) patients. Conclusion The study revealed lower than expected exposure to anticholinergic or sedative drugs. The results could be seen as beneficial, as the minimization of anticholinergic burden in CVD patients is highly recommended

The prevalence and preventability of potentially relevant drug-drug interactions in patients admitted for cardiovascular diseases: A cross-sectional study

Aim: The aim was to describe the type and prevalence of potentially relevant drug-drug interactions (pDDIs) in a population of patients admitted for cardiovascular diseases (CVD), and management strategies for reducing the occurrence of pDDIs. Methods: A retrospective cross-sectional study was performed on Cardiology ward of University Clinical Hospital Center in Belgrade, Serbia. A total of 527 patients, with more than one prescription during hospital stay, were enrolled in this study. Data were obtained from medical records. LexiInteract was used as the screening tool. Results: At least one potentially relevant pDDI was identified in 83.9% of patients. Occurrence was significantly more prevalent in patients with higher number of drugs, multimorbidity, longer length of stay, arrhythmia, heart failure, infectious and respiratory disease. About 13% of pDDIs exposures were accompanied with concurrent renal or liver disease, as an additional risk for DDI manifestation. Among CVD, patients with a history of myocardial infarction possessed the highest additional risk. The most common potential clinical outcome was the effect on cardiovascular system 48.5%, renal function and/or potassium 22.3%, bleeding 9.5%, impaired glucose control 6.8% and digoxin toxicity 4.6%. Main management strategies to avoid X or D class included using paracetamol instead of NSAID or alternative NSAID (38%), alternative antibiotic or antifungal (20.4%), H-2 receptor antagonist instead of PPI (8.3%), avoiding therapeutic duplication (7.3%), and alternative HMG-CoA reductase inhibitor (7%). Heart rate, blood pressure, electrolytes/potassium and blood glucose could have been employed in monitoring for potential consequence of 72.2% C class pDDIs. Conclusions: Use of drug interaction screening tools can be beneficial risk mitigation strategy for potentially relevant pDDIs in CVD patients. DDI screening software could be linked to the patient's laboratory results or clinical data regarding renal or liver function, as an approach to reinforce DDIs alert quality

Pregled interakcija lekova kod pacijenata sa afektivnim bipolarnim poremećajem

Drug interactions are classified as quantitative and/or qualitative alterations in the effects of one drug in the presence of another one. Bipolar disorder is an affective disorder characterized by manic and depressive episodes and often requires more than one drug in its treatment. In patients with comorbidities higher prevalence of clinically significant interactions could be expected. The aim was to evaluate clinically significant drug interactions in patients with bipolar disorder and determine whether patients’ characteristics such as age, number of comorbidities and polypharmacy are related with their appearance. A retrospective study included 50 patients treated at the Institute of mental health in Belgrade. Data were obtained from patients’ medical documentation. Epocrates® database was used to identify potential drug interactions. SPSS® software was used for statistical analysis. Patients’ average age was 46.19 ± 11.49. The average number of drugs in therapy was 6.46±2.58 per patient. Total of 549 interactions were detected, approximately 10.98±5.97 per patient. Most interactions (59.2%) demanded monitoring/modification of therapy. Caution was advised in 28.78% of interactions while 11.66% of them suggested use of an alternative treatment. Only 0.36% drug interactions were classified as contraindicated. A positive correlation between the total number of used drugs and number of drug interactions is shown (p<0.001), as well as the patients’ age and number of drug interactions (p<0.05). The results show a high prevalence of interactions in the examined population which implies the importance of monitoring in order to secure patients’ safety and avoid adverse effects.Interakcije lekova predstavljaju kvalitativne i/ili kvantitativne promene delovanja jednog leka u prisustvu drugog. Bipolarni poremećaj je afektivni poremećaj koji karakterišu manične i depresivne epizode pa se u terapiji često primenjuje više od jednog leka. U prisustvu pridruženih bolesti ukupan broj lekova u terapiji znatno raste, pa se može očekivati visoka prevalenca klinički značajnih interakcija. Cilj istraživanja je procena potencijalno klinički značajnih interakcija lekova kod pacijenata sa afektivnim bipolarnim poremećajima. Takođe je ispitano da li karakteristike poput starosti, broja komorbiditeta, polifarmacije utiču na ispoljavanje interakcija. Sprovedeno je retrospektivno istraživanje na populaciji od 50 pacijenata lečenih na Institutu za mentalno zdravlje u Beogradu. Podaci su prikupljeni iz medicinske dokumentacije pacijenata. Za analizu potencijalnih interakcije korišćena je Epocrates ® baza podataka. Dobijeni rezultati obrađeni su pomoću SPSS® programa. Prosečna starost pacijenta bila je 46,19 ± 11,49 godina, a prosečan broj lekova u terapiji iznosio je 6,46 ± 2,58. Detektovano je 549 interakcija, dok je prosek po pacijentu bio 10,98 ± 5,97. U većini slučajeva je bilo potrebno praćenje/modifikacija terapije (59,2%), oprez je bio potreban kod 28,78% interakcija dok je u 11,66% slučajeva bilo potrebno izbeći kombinaciju ispitivanih lekova i uvesti alternativnu terapiju. Udeo interakcija lekova čija je primena kontraindikovana iznosio je 0,36%. Analiza je pokazala statistički uticaj broja lekova u terapiji na broj interakcija (p<0,001), kao i starosti pacijenta na broj interakcija (p<0,05). Dobijeni rezultati ukazuju na postojanje velikog broja klinički značajnih interakcija u ispitivanoj populaciji i na značaj procene interakcija u prisustvu komorbiditeta kako bi se osigurala bezbednost pacijenta i izbegli neželjeni efekti.VIII Kongres farmaceuta Srbije sa međunarodnim učešćem, 12-15.10.2022. Beogra