Prevalência de interações medicamentosas em unidades de terapia intensiva no Brasil

Abstract

Objective: To determine the prevalence of drug interactions in intensive care units and to analyze the clinical significance of interactions identified. Methods: A multicenter, retrospective and cross sectional study conducted with 1124 patients in the seven intensive care units of teaching hospitals in Brazil. Information on drugs administered at 24 hours and 120 hours of hospitalization was obtained from the prescriptions. Results: Within 24 hours, 70.6% of patients had at least one drug interaction; the number at 24h was 2299, at 120 h it was 2619. Midazolam, fentanyl, phenytoin and omeprazole were the drugs with higher frequency of drug interactions. Conclusion: In this sample, moderate and severe drug interactions were more prevalent. In light of these findings, all actions of health professionals who provide care to these patients must be integrated in order to identify and prevent possible drug events. ResumoObjetivo: Determinar a prevalência de interações medicamentosas em Unidades de Terapia Intensiva-UTI brasileiras e analisar seu significado clínico. Métodos: Estudo multicêntrico, retrospectivo, desenvolvido com 1.124 prontuários em sete UTI de hospitais de ensino brasileiros. As informações sobre os medicamentos prescritos e administrados em pacientes com 24 horas e 120 horas de internação foram obtidas baseadas nas prescrições. Resultados: Em 24 horas, 70,6% dos pacientes de UTI tinham, pelo menos uma interação medicamentosa. O número total de interações detectadas foi de 2.299 em 24 horas, e 2.619 em 120 horas. Midazolam, Fentanyl, Phenytoin e Omeprazole foram os medicamentos que apresentaram maior frequência de interação medicamentosa. Conclusão: Na amostra estudada, as interações medicamentosas graves e moderadas foram mais prevalentes. Neste sentido, todas as ações dos profissionais de saúde que prestam cuidados a esses pacientes devem ser integradas no intuito de identificar e prevenir possíveis eventos com medicamentos.

Interações medicamentosas potenciais em prescrições, contendo antimicrobianos de uso restrito, de pacientes internados em um hospital no interior da Bahia

“…Contudo, existem tratamentos que necessitam da associação de mais de um medicamento. 1,2,3 Os principais objetivos da associação medicamentosa são os de potencializar os efeitos terapêuticos, diminuir efeitos colaterais, diminuir doses terapêuticas, prevenir resistência, obter ações múltiplas e amplas, e proporcionar maior comodidade para o paciente. Porém, a maioria das associações ocorre inadvertidamente, em situação de politerapia, sendo danosa ao organismo.…”

Drug-nutrient interaction in prescriptions for enteral feeding at the intensive care unit of a general hospital

“…A study by Carvalho et al, 2013, found at least one drug interaction in 793 of the 1124 patients studied. Given that only 320 (28.5%) patients were using enteral nutrition, that study revealed only 3 drug-enteral nutrition cases and 2 drug-drug interactions classified as contraindicated among 2299 interactions found in the first 24 h of hospitalization.…”

Drug Therapy Scheduling by Nurses and Resulting Potential Drug Interactions in the Hospital Care Of Adolescents: A Cross-Sectional Study

“…Potential drug interactions (PDIs) are defined as those in which the effect of the drugs involved could change, which may lead to undesirable results and increase the incidence of the adverse effects of therapy without increasing the therapeutic benefit (Bachmann, Lewis, Fuller, & Bonfliglio, 2006). Given the complexity of drug therapy, especially with regard to DIs and potential adverse effects, it is recommended that nurses schedule medications because scheduling is characterized as the planning of the daily administration of drugs (Carvalho et al, 2013). To properly implement drug therapy, nurses must reflect on the routinely used schedules, the conditions of the prescribed drug, the patient's clinical condition, and the PDIs and adverse effects of therapy (Secoli, 2001).…”

“…In addition, studies indicate that scheduling concentrated at pre-established times favors DIs and interferes with the efficacy of treatment, even in cases when up to five drugs are prescribed (Silva, Matos, Barreto & Albuquerque, 2013;Okuno, Cintra, Vancini-Campanharo& Batista, 2013) the prevalence of DIs is 70.6%, with a predominance of severe and moderate ones (Carvalho et al, 2013).…”

“…Regarding the clinical management of PDIs, a study identified the main care actions through which health professionals can intervene: observing signs and symptoms (211-47.9%), monitoring the therapeutic response (95-20.6%), adjusting the drug dose (85-18.4%), adjusting the drug administration time (38-8.2%), avoiding combining drugs (15-3.3%), changing the drug (4-0.9%) and changing the drug administration route (3-0.7%) (Lima &Cassiani, 2009). Researchers reinforce the need for integrated actions among the health team and knowledge of pharmacological mechanisms to avoid DIs (Carvalho et al, 2013) Additionally, equipping nurses to rationally use drugs can increase the safety of patient care (Okuno, Cintra, Vancini-Campanharo& Batista, 2013).…”