1,721,044 research outputs found
Bisoprolol pharmacokinetics and body composition in patients with chronic heart failure: a longitudinal study
No full textThe frequency of using herbs to relieve problems in pregnancy
Full text linkUvod: Nosečnice se za uporabo alternativnega zdravljenja večinoma odločajo v želji, da bi se izognile neželenim učinkom konvencionalnega zdravljenja in teratogenemu vplivu na plod. V nosečnosti je lajšanje zdravstvenih težav z zelišči pogosto pri jutranji slabosti in bruhanju, prebavnih motnjah, prehladu, nespečnosti, okužbah urinarnega trakta in pripravi na porod. Namen: Namen diplomskega dela je pridobiti podatke o pogostosti uporabe zelišč v nosečnosti in ugotoviti katera zelišča nosečnice najpogosteje uporabljajo in pri katerih zdravstvenih težavah. Metode dela: V teoretičnem delu diplomskega dela je uporabljena deskriptivna metoda dela s področja uporabe zelišč za lajšanje težav med nosečnostjo, ki jo je avtorica pridobila s kritičnim pregledom znanstvene in strokovne literature. V drugem delu diplomskega dela je bila izvedena kvantitativna raziskava. Podatki za raziskavo so pridobljeni s pomočjo anonimnega spletnega anketnega vprašalnika. Anketni vprašalnik ima 15 vprašanj odprtega in zaprtega tipa. Vprašalnik je objavljen na portalu EnKlik Anketa. Rezultati: Od 111 nosečnic, ki so sodelovale v raziskavi, jih 62% za lajšanje težav raje uporabljala zelišča kot klasična zdravila, od teh pa jih je 84% uporabljajo zelišča že pred nosečnostjo. Največkrat se odločijo za uporabo zelišč zaradi prehlada/gripe (61%), slabosti (46%) in zaprtosti (26%). Najpogosteje uporabljajo ingver (46%), liste maline (42%), brusnice (39%) in komarček (35%). 57% nosečnic, ki so uporabljale zelišča, je kot pripravo na porod uživalo liste maline. Največ nosečnic, ki uživa zelišča med nosečnostjo, biva na podeželju, so stare med 26 in 30 letom in imajo visokošolsko/višješolsko ali univerzitetno izobrazbo. Razprava: Rezultati naše raziskave in primerjalnih tujih študij so si enotni v tem, da se za uporabo zelišč med nosečnostjo največkrat odločijo nosečnice z višjo izobrazbo in tiste, ki bivajo na podeželju. Nosečnice v raziskavi so se največkrat odločile za uporabo ingverja, listov maline in brusnic. Večinoma se nosečnice odločijo za uporabo zelišč, ker se jim zdijo bolj varna in naravna kot klasična zdravila. Zaključek: Z raziskavo smo dobili vpogled o uporabi zelišč za lajšanje zdravstvenih težav v nosečnosti in ugotovili, da si nosečnice želijo bolj naravnega in alternativnega lajšanja zdravstvenih težav v nosečnosti, saj so mnenja da so le ta bolj varna in naravna.Introduction: During their pregnancies women mostly choose alternative treatment in order to avoid side effects, which can occur with conventional treatment, and to avoid teratogens. They use herbs mainly to avoid or treat morning sickness and vomiting, gastrointestinal disorders, colds, insomnia, urinal tract infections and to prepare themselves for childbirth. Purpose: The purpose of this work was to get information how frequent do women use herbs during pregnancy, which herbs do they use and for what purpose. Research method: At first, review of the literature about the use of herbs during pregnancy was made. The author uses descriptive method with critical review of the existing literature. In the second part quantitative research was carried out. Data for the research were obtained using anonymous online survey. The questionnaire had 15 closed-type questions and was published on “EnKlik” survey portal. Results: 62% of participating women preferred herbs over conventional medicine to relieve symptoms in pregnancy, 84% of them used herbs also prior to pregnancy. Mostly they started using herbs because of cold (61%), sickness (46%) and constipation (26%). Mostly they use ginger (46%), raspberry leaves (42%), cranberries (39%) and fennel (35%). More than half (57%) of the women, who preferred herbs over conventional medicine, used raspberry leaves as a preparation for a childbirth. Average pregnant woman using herbs is living in rural area, is between 26 and 30 years old and has university education or higher. Discussion: The results of this and other comparative studies are consistent in the fact that most women, using herbs during pregnancies, are living in rural areas and are highly educated. Mostly they use ginger, raspberry leaves and cranberries. Results show that the common reason that herbs are preferred over conventional drugs is the belief that herbs are more natural and safer. Conclusion: The study provided an insight into the use of herbs with the aim to relieve health problems during pregnancy. Women want more natural solutions, because they think that are more safe and natural
The association between prescribing potentially inapropriate drugs and falls among elderly residents of nursing homes
No full textDetermination of contrast media agent iohexol in human plasma for estimation of glomerular filtration rate
No full textEvaluation of adequacy of pharmacotherapy for insomnia and pain among elderly in the Metlika retirement home
Full text linkStarostniki pogosto jemljejo več različnih zdravil hkrati, zlasti pogosta je uporaba analgetikov in zdravil za zdravljenje nespec?nosti. Zaradi sočasnih obolenj in polifarmakoterapije je pri starostnikih zdravljenje bolečine in nespečnosti precej zahtevno.
Z raziskavo smo ovrednotili ustreznost na recept predpisanih zdravil za zdravljenje nespečnosti in bolečine pri oskrbovancih Doma starejših občanov Metlika. Znotraj teh terapevtskih skupin zdravil smo preverili tudi potencialno neprimerna zdravila za starostnike ter potencialne interakcije z drugimi sočasno predpisanimi zdravili.
V raziskavo smo vključili vse oskrbovance Doma starejših občanov Metlika, stare 65 let ali več, ki so redno ali po potrebi prejemali zdravila za sistemsko zdravljenje bolečine in/ali nespečnosti. Vse potrebne podatke smo na izbrani dan v letu 2018 pridobili iz medicinske domske dokumentacije. Primernost posameznih zdravil smo ovrednotili s pomočjo smernic za zdravljenje nespečnosti oziroma bolečine in liste PRISCUS, ustreznost odmerkov s pomočjo Povzetkov glavnih značilnosti zdravila, potencialne interakcije med zdravili pa s podatkovno bazo Lexicomp.
Izmed vseh oskrbovancev, ki so bili nastanjeni v domu, jih je 98 prejemalo zdravila za zdravljenje nespečnosti in/ali bolečine. Od tega je bilo 62 (63,3 %) žensk, s povprečno starostjo 84,9 let, in 36 (36,7 %) moških, pri katerih je povprečna starost znašala 77,9 let. Zdravila za zdravljenje nespečnosti je imelo predpisanih 77 (78,6 %) oskrbovancev. Skupno so prejemali 8 različnih zdravilnih učinkovin, najpogosteje zolpidem (47 predpisov), sledili so mu benzodiazepini (alprazolam, bromazepam diazepam in lorazepam) in kvetiapin. Navedene zdravilne učinkovine po evropskih smernicah niso primerne za dolgotrajno zdravljenje nespečnosti. Med zdravili za zdravljenje nespečnosti ne sodijo med potencialno neprimerna za starostnike le kvetiapin, trazodon in klometiazol. Zdravila za zdravljenje bolečine je prejemalo 87 (88,8 %) oskrbovancev, ki so imeli predpisanih 12 različnih zdravilnih učinkovin. 58 (66,7 %) oskrbovancev je imelo predpisano kombinacijo tramadola in paracetamola, ki sta ji sledila paracetamol ter metamizol. Strokovna priporočila odsvetujejo zdravljenje bolečine pri starostnikih z nesteroidnimi antirevmatiki z dolgotrajnim delovanjem, v našem primeru sta bila to etorikoksib in indometacin. Med zdravili za zdravljenje bolečine sodita med potencialno neprimerna za starostnike le indometacin in etorikoksib. Pri pregledu odmerkov zdravil za zdravljenje nespečnosti oz. bolečine so bili pri 5 oskrbovancih prekoračeni dnevni maksimalni odmerki. Pri 77 (78,5 %) starostnikih smo identificirali potencialne interakcije, in sicer 212 primerov interakcij D in 9 primerov interakcij X. Največ interakcij tipa D je bilo s tramadolom, zolpidemom in kvetapinom, največ X interakcij pa s kvetiapinom.Elderly people take several different drugs at the same time, common is use of analgesics and drugs for treatment of insomnia. Due to concomitant diseases and polypharmacotherapy treatment of pain and insomnia represents a great challenge in elderly.
The study evaluated the adequacy of pharmacotherapy for insomnia and pain among elderly in the retirement home in Metlika. Among these drugs we checked whether they were potentially inappropriate for the elderly and if there was a risk for potential drug-drug interactions with other concomitant drugs.
In the study we included residents of the retirement home Metlika, who were at least 65 years old and received prescription drugs for systemic treatment of insomnia and/or pain, either for regular use or when needed. All the necessary data was obtained in the retirement home from a doctor’s medical documentation on the selected day in the year 2018. Adequacy of individual drugs was evaluated using guidelines for pharmacotherapy of insomnia or pain and PRISCUS list, dose adequacy was checked using the Summary of Product Characteristics and potential drug-drug interactions were identified by Lexicomp datebase.
Among all the residents of the retirement home, 98 of them received drugs for the treatment of insomnia and/or pain. 62 (63.3%) of them were women, with an average age of 84,9 years, and 36 (36.7%) were men, with an average age of 77.9 years. Drugs for insomnia were prescribed to 77 (78.6%) residents. Altogether they received 8 different drugs, the most commonly zolpidem (47 prescriptions), followed by benzodiazepines (alprazolam, bromazepam, diazepam and lorazepam) and quetiapine. According to the European guidelines these drugs are not recommended for long-term use. Among all prescribed drugs for insomnia, only quetiapine, trazodone and clomethiazole are not potentially inappropriate drugs for elderly.
Drugs for treatment of pain were prescribed to 87 (88.8%) residents and altogether they received 12 different drugs. Most of the residents (66.7%) were taking a combination of tramadol and paracetamol, followed by paracetamol and metamizole. According to the guidelines the use of long-acting non-steroidal anti-inflammatory drugs (in our case indomethacin and etoricoxib) are not recommended for the treatment of pain in elderly. Among the prescribed drugs for treatment of pain only indomethacin and etorocoxib belong to potentially inappropriate drugs for elderly. Maximum daily doses of drugs for treatment of insomnia or pain were exceeded in 5 residents. We identified potential drug interactions in 77 (78.5%) residents. All together we identified 212 interactions of type D and 9 interactions of type X. Most interactions of type D were caused by tramadol, zolpidem and quetiapine and most interactions of type X were caused by quetiapine
Retrospective analysis of infusion-related reactions following parenteral administration of chemotherapeutics at the Institute of Oncology Ljubljana from 2019 to 2023
No full textRakava obolenja so v zadnjih letih drugi najpogostejši vzrok smrti v Sloveniji, saj oboleva vedno večje število ljudi. Večje število bolnikov pomeni tudi vedno večjo potrebo po uporabi parenteralne kemoterapije, ki lahko ob aplikaciji povzroči infuzijsko reakcijo (IR).
Namen retrospektivne raziskave je analizirati incidenco in lastnosti IR, ki so bile zabeležene pri bolnikih, ki so se na Onkološkem inštitutu Ljubljana med leti 2019 in 2023 zdravili s kemoterapijo. Zanimalo nas je, v katerem ciklu terapije se IR pojavijo, kako pogosto bolniki nadaljujejo z aplikacijo učinkovine še isti dan po umiritvi simptomov oziroma v prihodnjih ciklih ter kako pogosta in uspešna je desenzibilizacija.
Na Onkološkem inštitutu Ljubljana so v obdobju raziskave aplicirali 13 različnih citostatičnih učinkovin in do IR je prišlo v 403 primerih. Najvišjo incidenco IR smo zabeležili pri bolnikih, ki so prejeli pegilirano liposomalno obliko doksorubicina (7,42 %), sledila sta oksaliplatin (6,91 %) ter paklitaksel (3,10 %), nekoliko nižjo pojavnost IR pa smo opazili pri bolnikih, ki so prejemali karboplatin (1,95 %). Pri ostalih učinkovinah so bile incidence IR nižje (manj kot 1 %). Antraciklinski antibiotiki ter taksani so IR povzročali pretežno ob prvem ali drugem ciklu terapije, medtem ko je bil ob aplikaciji platinovih spojin pojav preobčutljivosti kasnejši, z mediano v 7 ciklu terapije. Po pojavu IR so po umiritvi simptomov še isti dan nadaljevali z aplikacijo učinkovine pri pegiliranem liposomalnem doksorubicinu (95 %), docetakselu (93 %) ter paklitakselu (73 %). Pri ostalih učinkovinah je bil odstotek nadaljevanja terapije bistveno nižji in sicer je bil najnižji pri karboplatinu in oksaliplatinu, kjer je v istem dnevu s terapijo nadaljevalo zgolj 6 oziroma 7 % bolnikov. Tudi ob prihodnjih ciklih terapije je trend podoben, saj je s terapijo nadaljevalo največ bolnikov, ki so prejemali docetaksel (86 %), pegilirani liposomalni doksorubicin (84 %) in paklitaksel (81 %). Tudi tukaj so najnižji odstotek nadaljevanja s terapijo imele platinove spojine (okoli 25 %). Ob izpostavitvi učinkovini, ki je enkrat že privedla do IR, je do ponovne IR v večini primerov prišlo pri nizkem številu bolnikov (okoli 20 %). Kadar je bila ob ponovni izpostavitvi učinkovini uporabljena desenzibilizacija, je le-ta še dodatno zmanjšala ponoven pojav IR za vsaj 50 %.
V raziskavi zbrani podatki prispevajo k boljšemu razumevanju IR, kar je ob čedalje višji incidenci rakavih obolenj ter posledično večji uporabi citostatičnih učinkovin bistvenega pomena.Cancer has become the second most common cause of death in Slovenia in recent years, with an increasing number of people being affected. The growing number of patients also means a rising need for the use of parenteral chemotherapy, which can cause the occurence of infusion reactions (IR) during administration.
The purpose of this retrospective study is to analyze the incidence and characteristics of IRs recorded in patients treated with chemotherapy at the Oncology Institute Ljubljana between 2019 and 2023. We determined during which cycle of therapy IRs occurred, how often patients continued with the administration of the drug on the same day after symptom resolution, and the frequency and success of desensitization.
Our study revealed that among 13 different cytotoxic agents administered at the Institute of Oncology, IRs occurred in 403 cases. The highest incidence of IR was recorded for pegylated liposomal doxorubicin (7,42%), followed by oxaliplatin (6,91%) and paclitaxel (3,10%), with a slightly lower incidence for carboplatin (1,95%). Other agents had significantly lower IR incidence (below 1%). Anthracycline antibiotics and taxanes mostly caused IRs during the first or second therapy cycle, whereas IRs to platinum compounds appeared later, with a median around the 7th therapy cycle. After an IR, patients continued the drug administration on the same day after symptoms subsided for pegylated liposomal doxorubicin (95%), docetaxel (93%), and paclitaxel (73%). For other agents, the percentage was significantly lower, with the lowest being for carboplatin and oxaliplatin, where only 6% and 7% of patients, respectively, continued therapy on the same day. The trend was similar in subsequent therapy cycles, with the highest continuation rates for docetaxel (86%), pegylated liposomal doxorubicin (84%), and paclitaxel (81%). The lowest continuation rates were again observed with platinum compounds (around 25%). Upon re-exposure to the drug that initially caused an IR, the recurrence of IR was low, occurring in approximately 20% of patients. When desensitization was used, the recurrence of IR was further reduced by at least 50%.
The data collected in this study will contribute to a better understanding of IRs, which is crucial given the increasing incidence of cancer and the consequent greater use of cytotoxic agents
Prevalence of potential drug-drug interactions and potentially inappropriate medicines in elderly at Cardiology department of Pulj General Hospital
Full text linkS staranjem začnejo pri starostnikih upadati fiziološke funkcije, kar lahko pripelje do pogostejše obolevnosti ter s tem tudi do uporabe več zdravil hkrati. Fiziološke spremembe pri njih vplivajo na spremenjeno farmakokinetiko in farmakodinamiko zdravil. Med farmakokinetičnimi procesi so pri starostnikih zaznane spremembe na nivoju absorpcije, porazdelitve, metabolizma in izločanja zdravil, medtem ko se farmakodinamčne spremembe lahko pokažejo na nivoju receptorjev, prevajanja signalov ali homeostatskih mehanizmov. Posledično pride pogosteje do pojava neželenih učinkov zdravil. Več sočasnih obolenj pri starostnikih vodi v polifarmakoterapijo, ki lahko ima za posledico veliko neželenih izidov, kot so neželeni učinki zdravil, slabo sodelovanje pacientov pri zdravljenju z zdravili, veliki stroški zdravljenja ter pogostejši pojav klinično pomembnih interakcij med zdravili ali celo uporabo potencialno neprimernih zdravil za starostnike. Danes je na voljo precej informacijskih sistemov, ki omogočajo varnejše in bolj racionalno predpisovanje zdravil pri starostnikih. Vendar je vedno potrebno upoštevati, da so vsa opozorila in priporočila za varno predpisovanje samo potencialna. Vsak pacient je individualen in njegovo zdravljenje je močno odvisno od obstoječih bolezni, njegovega splošnega zdravstvenega stanja, življenskih navad ter sočasne uporabe zdravil brez recepta in prehranskih dopolnil. Pri starostnikih, ki so se zdravili na kardiološkem oddelku Splošne bolnišnice Pulj, smo želeli retrospektivno določiti pogostost potencialnih interakcij med sistemsko kronično terapijo, ki so jo prejemali ob sprejemu v bolnišnico ter ustreznost predpisanih zdravil glede na Beersove kriterije. Z vključevanjem bolnikov smo začeli 1. septembra 2016 in vključili prvih 100 bolnikov starih 65 in več let, ki so se zdravili na kardiološkem oddelku ter so ob sprejemu v bolnišnico imeli predpisani vsaj dve kronični sistemski zdravili. Podatke o bolnikih in njihovi farmakoterapiji smo pridobili s pomočjo bolnišnično informacijskega sistema BIS, ki je namenjen shranjevanju in avtomatizaciji vseh kliničnih podatkov o pacientih. Potencialne interakcije med zdravili smo preverjali s pomočjo Lexi-InteractTM Online. To je podatkovna baza namenjena identifikaciji neprimernih kombinacij zdravil in zdravilnih rastlin, ki je ustvarjena na podlagi različnih znanstevnih virov in strokovne literature. V tej bazi so interakcije med zdravili razdeljene v 5 kategorij glede klinične pomembnosti. Za potrebe naše raziskave smo se osredotočili samo na klinično pomembne interakcije tipa D (priporoča se zamenjava terapije) in X (kombinacija je kontraindicirana). Za identifikacijo potencialno neprimernih zdravil pri starostnikih smo uporabljali Beersove kriterije, ki so jih prvič objavili leta 1991. Njihov namen je bil zmanjšati incidenco neželenih učinkov zdravil pri starostnikih v Združenih Državah Amerike, danes pa se ti kriteriji uporabljajo povsod po svetu. V raziskavi smo uporabili zadnjo posodobljeno verzijo iz leta 2015 in sicer predvsem tabeli 2 in 3. Tabela 2 je sestavljena iz zdravilnih učinkovin ali njihovih skupin, ki naj bi bile neprimerne za uporabo pri starostnikih, v tabeli 3 pa so zdravilne učinkovine, ki so neprimerne za uporabo pri starostnikih le pri določenih bolezenskih stanjih. Pri vsaki posamezni zdravilni učinkovini oz. skupini zdravilnih učinkovin, ki niso primerne za uporabo pri starostnikih, je tudi razlaga in priporočilo za obravnavo, podprto z medicinskimi dokazi. V raziskavo smo vključili 100 pacientov, z mediano starosti 78 let. Največ pacientov (53 %) je bilo starih med 75 in 84 let. Več kot polovico (57 %) so bile ženske. Bolečina v prsih in dispneja sta bila dva najpogostejša razloga za hospitalizacijo, medtem ko je bila arterijska hipertenzija najpogostejše kronično obolenje. Mediana kroničnih bolezni na pacienta je bila 4. Izkazalo se je, da so najstarejši med našimi pacienti imeli najmanjše število kroničnih bolezni. Mediana kroničnih sistemskih zdravil na recept je bila 7 na pacienta. Pacient z največjim številom zdravil je imel predpisanih celo 19 kroničnih zdravil. Ugotovili smo tudi to, da je najmlajša skupina pacientov (65-74 let) jemala največ zdravil. 60 % pacientov je imelo več kot 5 predpisanih kroničnih zdravil, kar pomeni, da so bili podvrženi polifarmakoterapiji. Najpogosteje predpisana zdravila so bila iz terapevtskih skupin C, A in N po ATC klasifikacijskem sistemu, medtem ko so bile najpogosteje predpisane zdravilne učinkovine furosemid, pantoprazol in bisoprolol. Pri 49 % pacientov smo detektirali vsaj eno potencialno interakcijo med zdravili. Rezultati so pokazali, da je incidenca potencialnih interakcij naraščala z naraščujočim številom predpisanih zdravil, saj je le-ta bila 61,5 % pri bolnikom, ki so jemali od 6 do 10 zdravil, ter skoraj 100 % pri tistih ki so imeli več kot 10 sočasno predpisanih zdravil. Med pacienti z interakcijami je bila mediana interakcij na bolnika 2. Samo interakcije tipa D so bile detektirane pri 38 % bolnikov, medtem ko smo samo X interakcije zasledili pri 3 % pacientov. D in X interakcije je imelo sočasno v svoji kronični terapiji 8 % pacientov. Zdravila, ki so bila najpogosteje vključena v interakcije tipa D so iz terapevtskih skupin C, N in A, medtem ko so v X interakcije največkrat vstopala zdravila iz skupin N in R. V interakcijah tipa D so bile najpogosteje identificirane učinkovine varfarin, klopidogrel in alopurinol, v interakcije tipa X pa so bile pogosto vključene kalijeve soli. 61 % pacientov je redno jemalo vsaj eno neprimerno zdravilo za starostnike, kar se je v primerjavi s podobnimi raziskavami izkazalo kot precej visok rezultat. Mediana potencialno neprimernih zdravil na pacienta je znašala 1. Ena pacientka v raziskavi je sočasno jemala celo 4 potencialno neprimerna zdravila. Pacienti, ki so imeli več predpisanih zdravil, so imeli tudi večjo mediano potencialno neprimernih zdravil za starostnike. Najpogostejša predpisana neprimerna zdravila za starostnike so bila pantoprazol, diazepam in amiodaron. Pogostost potencialnih interakcij med zdravili kot tudi potencialno neprimernih zdravil za starostnike se je pri naših pacientih izkazala za zelo visoko. Moramo pa poudariti, da so vse interakcije in neprimerna zdravila samo potencialna in da ni nujno, da se negativni izidi le-teh vedno klinično izrazijo. Za pridobitev natančnejših rezultatov bi bilo bolj primerno narediti prospektivno študijo, saj bi na ta način lahko pridobili bolj zanesljivo zgodovino zdravljenja z zdravili ter hkrati ugotavljali, ali so se posledice neprimernega predpisovanja zdravil dejansko izrazile pri pacientih. Pri optimizaciji farmakoterapije pri starostnikih in tudi na splošno imajo ključno vlogo klinični farmacevti, ki žal še niso popolnoma integrirani v zdravstvene inštitucije na Hrvaškem. Z uvajanjem farmacevtskih kognitivnih storitev, kot so pregled uporabe zdravil in farmakoterapijski pregled, bi se optimizacija in racionalizacija zdravljenja z zdravili lahko izboljšala. S tem bi lahko zmanjšali neželene učinke zdravil, polifarmakoterapijo, interakcije med zdravili ter tudi breme zdravstvenega zavarovanja. Zaenkrat imajo velik pomen farmacevti v javnih lekarnah, saj lahko detektirajo in ukrepajo pri težavah povezanih z zdravili, ter na ta način izboljšajo uporabo zdravil, še posebej pri starostnikih.The definition of the elderly usually comprises of chronological ages of 65 years or older. Due to a higher life standards and advances in medicine, societies are now faced with a large aging population. Aging is also defined as a series of anatomical and physiological changes that consider reduced physiological functions and weakened homeostatic reserve, which is why the elderly have an increased risk of diseases. More diseases at the same time also means consuming more concomitant medications. Age-related physiological changes occur in all organ systems and affect the pharmacokinetics and pharmacodynamics of drugs. Thus, consequent results of polypharmacy are not just greater health care costs and medication non-adherence, but also an increased risk of adverse drug reactions, potential drug-drug interactions and potentially inappropriate medications` use. Polypharmacy in the elderly is very common and it is therefore nowadays considered as a great public health concern. Our goal was to determine the prevalence of potential drug-drug interactions and potentially inappropriate medications among geriatric patients who were treated at the Department of Cardiology in Pula General Hospital. In the retrospective study we included the first 100 patients 65 years old and above who were admitted to cardiology department from September 1st 2016 onwards and who had at least 2 chronic systemic medications prescribed at the moment of their admission. All the data were obtained from the Hospital Information System program. For detecting potential drug-drug interactions we used Lexi-Interact OnlineTM (only interactions of types D and X) and potentially inappropriate medications in the elderly were identified using the last updated version of Beers criteria. In our group of patients (average age 78.2 years, 57 % women) chest pain and dyspnea were most commonly encountered reasons for hospitalization. Most of the patients (67 %) suffered from arterial hypertension and diabetes mellitus type 2 (46 %). 60 % of patients were under high polypharmacy, considering they were prescribed with more than 5 concomitant chronic medications. The median number of medications used per patient was 7. The most frequently prescribed medications were the ones to treat cardiovascular diseases from the ATC classification group C (47.3 %). The number of prescription medications was decreasing with the increasing age of the patients. Three most often used chronic systemic prescription medications were furosemide, pantoprazole and bisoprolol. In 49 % of patients, which is almost a half, we have detected at least one potential drug-drug interaction. The number of drug-drug interactions was growing with the rising number of used medications. The incidence was 61.5 % in those who were taking from 6 to 10 medications, and almost a 100 % in those who had more than 10 prescribed chronic medications. Considering only the 49 patients with detected potential interactions, the median number of potential drug-drug interactions per patient was 2. Potential drug-drug interactions of only type D were detected in 38 % of patients. Drug combinations triggering drug-drug interactions of type X, on the other hand, were found only in 3 % of patients. The combination of both categories of drug-drug interactions was present at 8 % of patients. All together we have detected 125 potential drug-drug interactions (83.2 % of type D, 16.8 % of type X). Considering the occurrence of potential drug-drug interactions based on the sex of the patients, the results have shown that the prevalence of both types of drug-drug interactions was greater in female patients. Most of the drugs that were involved in detected potential drug-drug interactions classifiable as D was part of the ATC classification group C. Most of the drugs involved in interactions of type X were from the ATC classification groups N and R. Drugs most often involved in potential drug-drug interactions of type D were clopidogrel, warfarin and allopurinol, while the interactions of type X mostly included potassium salts, anticholinergics and antipsychotics. 61 % of patients were on at least one potentially inappropriate medication at admission to hospital, according to Beers criteria. Female patients accounted 65.6 % of the sample. Most of the patients among those with identified potentially inappropriate medications had only one prescription medication considered potentially inappropriate. 4 potentially inappropriate medications per patient, which was the maximum in our research, were identified in only one patient. We encountered a total of 98 potentially inappropriate prescription medications with the median number of 1 potentially inappropriate medication per patient. Overall, 13.4 % of all chronic medications prescribed were detected as inappropriate according to Beers criteria. The number of potentially inappropriate medications was growing with the increasing number of prescribed medications. Most frequently prescribed potentially inappropriate medications were pantoprazole, diazepam and amiodarone. Comparing our results with other studies suggests that the prevalence of both drug-drug interactions and potentially inappropriate medications in our patients was high. However, all the results are only potential and not necessarily actually harmful. That also leaded us to conclusion that prospective study would probably be better alternative for giving us more precise results. With such type of study we could obtain better insight into the each patient`s medication history since the patient per se would be reliable source of information. To improve safe prescribing and optimization of therapy in Croatia, introduction of new cognitive services, t.i. medicine use review and pharmacotherapy review is needed. Clinical pharmacists would certainly help reducing the risk of potential adverse drug reactions, as well as of drug-drug interactions and potentially inappropriate medications in the elderly
Review of the treatment of advanced non-small-cell lung cancer patients with mutation in the epidermal growth factor during the years of 2010 and 2014 at the University Clinic Golnik
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