Aspectos farmacológicos do idoso: uma revisão integrativa de literatura

Abstract

RESUMO:Os idosos constituem o grupo populacional que mais cresce de forma acelerada e descontrolada no Brasil, representando 14,3% da população geral. Associado a isto e ao aumento da expectativa de vida, mudança do padrão de adoecimento do pais e a medicalização no idoso, temas como a farmacologia do indivíduo idoso tornam-se essenciais na formação de um profissional da área da saúde. O processo normal do envelhecimento possui particularidades capazes de modificar as etapas da farmacocinética e a farmacodinâmica de um medicamento, predispondo o idoso às Reações Adversas a Medicamentos (RAM), cascata iatrogênica, uso de Medicamentos Potencialmente Inapropriados (MPI) e polifarmácia, processo do adoecimento, quedas e fraturas, delirium, hospitalização, institucionalização e até à morte. Baseado nisso, instrumentos ou listas de medicamentos considerados inadequados para uso em idosos foram criadas, cada uma com particularidades da comercialização de seu país. Visto isso, entende-se que o assunto é de extrema relevância na pratica clínica, e, quando utilizado de forma interdisciplinar, melhora a qualidade de serviços, formação de profissionais da área da saúde e permite a prevenção de eventos iatrogênicos.Descritores: Idoso; Farmacologia. Envelhecimento; Lista de medicamentos potencialmente inapropriados/utilização; Efeitos colataterais e reações adversas à medicamentos; Serviços de saúde para idosos. ABSTRACT:The elderly are the fastest growing population group in Brazil, accounting for 14.3% of the population. Associated with this and with the increase in life expectancy, changes in the country's pattern of illness and the medicalization of aging, issues such as pharmacology in elderly have become essential topics in the health professionals' training. The normal aging process has particularities that can modify the pharmacokinetic and pharmacodynamic properties of drugs, predisposing elderly to Adverse Drug Reactions (ADRs), iatrogenesis, use of Potentially Inappropriate Medications (PIM), polypharmacy, illness processes, falls and fractures, delirium, hospitalization, institutionalization and even death. Based on this, instruments or lists of medications considered inappropriate for elderly were created, each with particularities of the medication market of each country. Therefore, this subject is extremely relevant in clinical practice and when it is used in an interdisciplinary way, it improves the quality of services and the training of health professionals and allows the prevention of iatrogenic events.

The iatrogenic triad in a group of elderly women contracted to a health plan

“…This determines the greater clinical and therapeutic vulnerability of the group, highlighting the importance of avoiding the irrational use of medications, especially those considered potentially inappropriate. Thus, the risk of the occurrence of ADR, illness, decompensation of the underlying disease(s), profiles of confusion (delirium), dependence, hospitalization and institutionalization increases significantly 5,23 .…”

“…The prescriptions were classified as polypharmacy or otherwise through the number of drugs prescribed, based on a minimum of five or more drugs in continuous use by the elderly. It should be noted that despite the presence of several definitions of polypharmacy, both qualitative and quantitative, and the lack of consensus, the present study opted for the definition of prevalence applied in literature and commonly used in clinical practice 1,2,4,5 .…”

“…ADR are considered to be a harmful and nonintentional response to the use of a drug whose dosage is normally used for prophylaxis or the diagnosis or treatment of diseases. Diuretics, antilipidemics, betablockers, anti-inflammatories, digitalis, inhibitors (omeprazole, cimetidine and captopril) and enzyme inducers (phenytoin and carbamazepine) are some of the medicines that frequently cause ADR and are responsible for approximately 25% of resulting hospital admissions, which are mostly caused by an acute reaction 4,5 .…”

“…PIM are medications prescribed by physicians which present a risk of causing adverse effects which exceed their benefits, and where there effective alternatives to their use exist. The increased risk of adverse reactions, the use of medications that aggravate the underlying disease or the lack of scientific evidence about the therapeutic efficacy of the medication can also be considered PIM 1,4,5,6 .…”

Interação ensino-serviço e o estágio curricular em atenção primária à saúde: um relato de experiência

“…Os desfechos negativos do uso de medicamentos por idosos são frequentemente apontados e discutidos na literatura, e a incidência de eventos adversos relacionados aos medicamentos é maior nesta faixa etária, aumentando expressivamente de acordo com a complexidade terapêutica (Locquet et al, 2017;Oliveira & Corradi, 2018).…”