A senescência é um processo natural do envelhecimento que altera a farmacocinética e a farmacodinâmica dos medicamentos, sendo particularmente importante quando se trata de um país de idosos como o Brasil. Associado à idade, há um aumento das doenças crônicas não transmissíveis (DCNTs) e consequentemente do uso de diversos medicamentos. A polifarmácia aumenta o risco de reações adversas, especialmente quando associado à prescrição de medicamentos potencialmente inapropriados (MPIs) para idosos. O presente estudo tem como objetivo avaliar a prescrição de MPIs por meio dos critérios de Beers de 2015 em um grupo de idosos portadores de doenças crônicas vinculados a um plano de saúde em São Paulo, Brasil. Trata-se de um estudo exploratório e descritivo, realizado mediante a análise de 5.995 prescrições médicas, de setembro a dezembro de 2015. Os medicamentos foram examinados segundo os critérios de Beers revisados em 2015. Observou-se que, das 5.995 prescrições médicas feitas a 1.428 idosos, 20,3% foram consideradas inapropriadas. Os MPIs mais prescritos foram: inibidores de bomba de prótons (IBP), 39,4% (481); antidiabéticos, 13,3% (162); benzodiazepínicos (BZP) de ação curta, intermediária e longa, 10,8% (132); anti-inflamatórios não hormonais (AINEs), 10,3% (127); e anti-histamínicos de primeira geração, 6,8% (83). O grupo estudado apresentou um alto índice de prescrição inadequada de medicamentos em uso contínuo. Trata-se de um grupo populacional de risco, devido às suas próprias particularidades clínicas, predispondo a desfechos biopsicossociais desfavoráveis.Palavras-chave: Assistência à saúde do idoso. Lista de medicamentos potencialmente inapropriados. Planos de saúde. Prescrições de medicamentos.
The yellow fever is a systemic disease that was under control due to the effective campaigns against the vector and promotion of vaccines programs. However, since 1999, outbreaks appeared because of inefficient control of the vector, and led to the need of amplifying the immunization in large scale against the yellow fever virus, and consequently, raising the risk of adverse reactions to the vaccine. We report a case of previously healthy infant, who was referred to our care service, after 3 days with fever, chills, nausea and vomits, he received support therapy and was discharged from the hospital. After 24 hours of supportive measures, he was discharge. The patient returned to our service with general condition decline, strabismus, inability to control of cervical musculature and reduced force of the legs. The patient vaccine had received all vaccines from the calendar, and he was vaccinated for yellow fever 20 days before symptoms. During the hospitalization, liquor was collected, and ceftriaxone and aciclovir were administered. After negative cultures from the liquor, the antibiotics were suspended. The computed tomography of patient's brain showed no alterations. Research for antibodies against yellow fever was requested, being positive for IgM in the liquor, and confirming the neurotropic disease associated with the yellow fever vaccine. On the fifth day of hospitalization, the patient showed improvement on the strabismus, cervical tonus, and musculature force. On the tenth day of hospitalization, patient showed complete improvement, and his laboratory exams no alterations. Subsequently, patient was discharged. The vaccine against yellow fever is safe, efficient and highly recommended, however it is not completely free from serious adverse reactions, including death.
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