ABSTRACT Objective The use of acetylsalicylic acid, even in low doses, may be associated with the onset of upper gastrointestinal bleeding as an idiosyncratic response. Considering the role of the genetic background in inter-individual responses to pharmacotherapy, we aimed to investigate the role of seven variants in the TNF-α, IL-β, and IL-1RN genes in association with the risk of upper gastrointestinal bleeding in users of low-dose acetylsalicylic acid for the prevention of cardiovascular events. Methods A case-control study was conducted in a Brazilian hospital complex. The Case Group comprised patients diagnosed with upper gastrointestinal bleeding who were administered a low dose of acetylsalicylic acid (n=50). Two Control Groups were recruited: 1) low-dose acetylsalicylic acid users without gastrointestinal complaints and under the supervision of a cardiologist (n=50) and 2) healthy controls (n=189). Sociodemographic, clinical, pharmacotherapeutic, and lifestyle data were recorded through face-to-face interviews. Genomic DNA from all participants was genotyped for rs16944 and rs1143634 (IL-β gene), rs4251961 (IL-1RN gene), and rs1799964, rs1799724, rs361525, and rs1800629 (TNF-α gene). Results No significant difference was noted in the genotypic frequencies of TNF-α, IL-β, and IL-1RN variants between the Case and Control Groups of low-dose acetylsalicylic acid users (p>0.05). The frequency of rs1800629 genotypes (TNF-α gene) differed significantly between the Case Group and healthy controls (p=0.003). None of the evaluated variants were associated with a risk of upper gastrointestinal bleeding. Conclusion This study aimed to explore pharmacogenomics biomarkers in low-dose acetylsalicylic acid users. Our data suggest that the presence of IL-1β, IL-1RN, and TNF-α variants was not associated with an increased risk of upper gastrointestinal bleeding. doses response interindividual inter individual pharmacotherapy TNFα, TNFα TNF α, α ILβ, ILβ IL β, β IL-β IL1RN ILRN 1RN RN lowdose events casecontrol case control complex n=50. n50 n n=50 . 50 recruited 1 (n=50 2 n=189. n189 n=189 189 (n=189) Sociodemographic clinical pharmacotherapeutic facetoface face interviews rs rs1694 rs114363 gene, gene , rs425196 rs1799964 rs1799724 rs361525 rs180062 gene. p>0.05. p005 p p>0.05 0 05 (p>0.05) p=0.003. p0003 p=0.003 003 (p=0.003) IL1β, IL1β 1β, 1β IL-1β IL1RN, 1RN, n5 n=5 5 (n=5 n18 n=18 18 (n=189 rs169 rs11436 rs42519 rs179996 rs179972 rs36152 rs18006 p00 p>0.0 (p>0.05 p000 p=0.00 00 (p=0.003 n= (n= n1 n=1 (n=18 rs16 rs1143 rs4251 rs17999 rs17997 rs3615 rs1800 p0 p>0. (p>0.0 p=0.0 (p=0.00 (n (n=1 rs1 rs114 rs425 rs1799 rs361 rs180 p>0 (p>0. p=0. (p=0.0 rs11 rs42 rs179 rs36 rs18 p> (p>0 p=0 (p=0. rs4 rs17 rs3 (p> p= (p=0 (p (p=

ABSTRACT Background: There is no gold-standard trigger for detecting drug-induced respiratory disorders, a type of Adverse Drug Event (ADE) with high morbimortality, particularly in older people. Objective: To propose and evaluate the performance of triggers for detecting hospitalizations related to drug-induced respiratory disorders in older people. Methods: A pilot cross-sectional study was conducted with older people (age ≥ 60) admitted to a Brazilian hospital. Electronic chart documentation was screened using ICD-10 codes; Global Trigger Tool (GTT); and drugs potentially associated with respiratory disorders. A chart and medication review were conducted to perform the causality assessment using the instrument developed by the World Health Organization. The performance of triggers was evaluated by the Positive Predictive Value (PPV), with values ≥ 0.20 indicating good performance. Results: Among 221 older people, 72 were eligible. Potential drug-induced dyspnea and/or cough were detected in six older people (6/72), corresponding to a prevalence of 8.3 %. The overall PPV of the triggers was 0.14, with abrupt medication stop (PPV = 1.00), codeine (PPV = 1.00), captopril (PPV = 0.33), and carvedilol (PPV = 0.33) showing good performance. Two triggers were proposed for detecting therapeutic ineffectiveness associated with respiratory disorders: furosemide (PPV = 0.23) and prednisone (PPV = 0.20). Conclusion: The triggers enabled the identification that one in 12 hospitalizations was related to drug-induced respiratory. Although good performance was observed in the application of triggers, additional investigations are needed to assess the feasibility of incorporating them into clinical practice for the screening, detection, management, and reporting of these ADEs, which are considered to be underreported and difficult to detect. Background goldstandard gold standard druginduced drug induced ADE (ADE morbimortality Objective Methods crosssectional cross sectional age 60 hospital ICD10 ICD 10 ICD-1 codes GTT (GTT) Organization PPV, , (PPV) 020 0 20 0.2 Results 22 7 eligible andor or 6/72, 672 6/72 6 (6/72) 83 8 3 8. % 014 14 0.14 1.00, 100 1.00 1 00 1.00) 0.33, 033 0.33 33 0.23 023 23 0.20. . 0.20) Conclusion screening detection management ADEs detect ICD1 ICD- (GTT 02 2 0. 67 6/7 (6/72 01 0.1 1.0 03 0.3 6/ (6/7 1. (6/ (6 (

Abstract Objective: To identify and assess the current evidence available about the costs of managing hospitalized pediatric patients diagnosed with Respiratory Syncytial Virus (RSV) and Parainfluenza Virus Type 3 (PIV3) in upper-middle-income countries. Methods: The authors conducted a systematic review across seven key databases from database inception to July 2022. Costs extracted were converted into 2022 International Dollars using the Purchasing Power Parity-adjusted. PROSPERO identifier: CRD42020225757. Results: No eligible study for PIV3 was recovered. For RSV, cost analysis and COI studies were performed for populations in Colombia, China, Malaysia, and Mexico. Comparing the total economic impact, the lowest cost per patient at the pediatric ward was observed in Malaysia ($ 347.60), while the highest was in Colombia ($ 709.66). On the other hand, at pediatric ICU, the lowest cost was observed in China ($ 1068.26), while the highest was in Mexico ($ 3815.56). Although there is no consensus on the major cost driver, all included studies described that the medications (treatment) consumed over 30% of the total cost. A high rate of inappropriate prescription drugs was observed. Conclusion: The present study highlighted how RSV infection represents a substantial economic burden to health care systems and to society. The findings of the included studies suggest a possible association between baseline risk status and expenditures. Moreover, it was observed that an important amount of the cost is destinated to treatments that have no evidence or support in most clinical practice guidelines. Objective (RSV PIV (PIV3 uppermiddleincome upper middle income countries Methods 202 Parityadjusted. Parityadjusted Parity adjusted. adjusted Parity-adjusted identifier CRD42020225757 CRD Results recovered impact $ ( 347.60, 34760 347.60 , 347 60 347.60) 709.66. 70966 709.66 . 709 66 709.66) hand ICU 1068.26, 106826 1068.26 1068 26 1068.26) 3815.56. 381556 3815.56 3815 56 3815.56) driver treatment (treatment 30 Conclusion society expenditures Moreover guidelines (PIV 20 CRD4202022575 3476 347.6 34 6 7096 709.6 70 10682 1068.2 106 2 38155 3815.5 381 5 CRD420202257 347. 709. 7 1068. 10 3815. 38 CRD42020225 1 CRD4202022 CRD420202 CRD42020 CRD4202 CRD420 CRD42 CRD4

Abstract To assess the therapy relative to indication, effectiveness, safety and adherence in patients with Alzheimer’s disease (AD). An interventional, prospective, non-randomized study was conducted in a single secondary care center in Brazil. The pharmacist-led medication therapy management (MTM) was conducted to detect drug-related problems (DRPs) at baseline and after six months of intervention. The health status outcomes (i.e. cognitive screening tests; levels of glucose; total cholesterol; triglycerides; thyroid stimulating hormone; serum free thyroxine and blood pressure) were measured. 66 patients with AD were included, of whom 55 patients completed the follow-up of six months. 36 patients (36/55) were non-adherent to AD drug therapy. Out of detected 166 DRPs, 116 were solved. Four patients were withdrawn from the AD protocol due to resolution of prodromal symptoms. On the conclusion of the study, the MTM improved and controlled blood pressure, glucose, total cholesterol, triglycerides levels (p<0.05). The pharmacist-led MTM was effective in solving 69.8% of DRPs, improving and controlling the clinical parameters evaluated.

RESUMO CONTEXTO: A hemorragia digestiva alta não varicosa (HDANV) secundária à úlcera péptica é uma emergência médica digestiva e pode ser uma reação adversa a medicamento severa. OBJETIVO: Estimar a frequência de HDANV secundária à doença péptica. MÉTODOS: Estudo prospectivo e epidemiológico realizado em um hospital brasileiro terciário de referência, no período de julho de 2016 a dezembro de 2019. Os laudos de endoscopia gastrointestinal alta foram avaliados diariamente. O diagnóstico de HDANV secundária para úlcera péptica foi definido por achados endoscópicos de úlcera péptica e lesões gástricas erosivas e sintomas clínicos. A frequência de diagnóstico de HDANV secundária à úlcera péptica foi estimada por meio da razão entre o número de pacientes diagnosticados e o número de pacientes submetidos à endoscopia gastrointestinal alta no mesmo período. RESULTADOS: Um total de 2.779 laudos endoscópicos (2.503 pacientes) foram avaliados e 178 pacientes foram elegíveis. A frequência total de diagnóstico de HDANV secundária à úlcera péptica foi de 7,1%. A frequência anual de diagnósticos entre 2017 e 2019 variou de 9,3% a 5,7%. A maioria dos pacientes era do sexo masculino (72,8%); auto-declarado branco (71,8%); idoso (56,7%); e não possuía histórico familiar ou pessoal de doenças gastrointestinais (60,1%). 90% dos pacientes apresentaram úlcera péptica e melena (62,8%). Os pacientes faziam uso crônico de ácido acetilsalicílico como antiagregante plaquetário (29,3%), outros antiplaquetários (21,9%) e anticoagulantes orais (11,2%); e fizeram uso e uso de anti-inflamatórios não esteroidais na semana anterior ao início dos sintomas clínicos de HDANV (25,8%). CONCLUSÃO: Cerca de sete em cada 100 pacientes admitidos em um hospital terciário e submetidos à endoscopia gastrointestinal alta foram diagnosticados com HDANV secundária à úlcera péptica.

ABSTRACT BACKGROUND: Non-variceal upper gastrointestinal bleeding (NVUGIB) secondary to peptic ulcer disease is a medical digestive emergency and could be one of the most serious adverse drug reactions. OBJECTIVE: To identify the frequency of diagnosis of NVUGIB secondary to peptic ulcer disease. METHODS: Prospective and epidemiological study conducted in a tertiary referral Brazilian hospital, from July 2016 to December 2019. Upper gastrointestinal endoscopies (UGE) reports were evaluated daily. The diagnosis of NVUGIB secondary to peptic ulcer disease was defined through endoscopic findings of peptic ulcer and erosive gastric lesions, and clinical symptoms. The frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was estimated through the ratio between the number of patients diagnosed and the number of patients underwent UGE in the same period. RESULTS: A total of 2,779 endoscopic reports (2,503 patients) were evaluated, and 178 patients were eligible. The total frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was 7.1%. The annual frequency of diagnosis between 2017 and 2019 ranged from 9.3% to 5.7%. Most patients were men (72.8%); self-declared white (71.8%); older people (56.7%); and, had no familiar or personal history of gastrointestinal diseases (60.1%). 90% of the patients had a peptic ulcer and melena (62.8%). Patients made chronic use of low-dose aspirin (29.3%), other antiplatelet agents (21.9%) and, oral anticoagulants (11.2%); and non-steroidal anti-inflammatories use in the week a prior to the onset of clinical symptoms (25.8%). CONCLUSION: Seven in every 100 patients admitted and underwent UGE in a tertiary hospital were diagnosed with NVUGIB secondary to peptic ulcer disease.

ABSTRACT BACKGROUND: Improving knowledge and establishing strategies and policies for better patient safety are worldwide priorities. OBJECTIVE: To evaluate drug safety among elderly people with Alzheimer’s disease (AD). DESIGN AND SETTING: Cross-sectional study among elderly people within the National AD Assistance Protocol (PCDTDA/MS) who were living in the municipality of Araraquara, Brazil, in 2017. METHODS: Through interviews conducted with relatives/caregivers of elderly people with diagnoses of AD, the following variables were evaluated: comorbidities, drug therapy used, use of potentially inappropriate medications for the elderly (PIMs), presence of potentially inappropriate interactions (PIIs) and medication regimen complexity index. Factors associated with AD severity were also evaluated. Multivariate and simple logistic regressions were applied. RESULTS: 143 elderly people enrolled in PCDTDA/MS were analyzed. The majority were women (67.1%); assisted only through the public healthcare system (75.5%); polymedicated (57.4%); using at least one PIM (63.6%); presenting at least one PII (63.6%); and under drug therapy of low to medium complexity (92.2%). No semi-annual monitoring of the effectiveness of PCDTDA/MS drugs was identified. The proportion using AD drug therapy at daily doses differing from those recommended by the World Health Organization was 75.6%. However, these doses were not associated with drug risk. CONCLUSION: The data from this study raise the hypothesis that use of polypharmacy might show a correlation with severity of AD. The drug safety risk may be associated with comorbidities of the metabolic syndrome, anxiety and off-label use of PIMs, such as risperidone and quetiapine, and benzodiazepines (i.e. clonazepam and flunitrazepam).

RESUMO A demência é uma doença crônica e neurodegenerativa, e a doença de Alzheimer (DA) é a mais prevalente. Objetivo: Descrever o monitoramento da farmacoterapia de pacientes inseridos no Protocolo Clínico e Diretrizes Terapêuticas da Doença de Alzheimer (PCDTDA), Brasil. Métodos: Estudo descritivo, conduzido por meio de entrevistas em 2017. Foram incluídos pacientes com diagnóstico da doença de Alzheimer (DA) inseridos no PCDTDA. As variáveis foram idade; sexo; tempo de diagnóstico e farmacoterapia da DA; os parâmetros clínicos Mini-exame do estado mental (MEEM) e Clinical Dementia Rating (CDR); e farmacoterapia em uso. Resultados: O monitoramento de 143 pacientes foi avaliado. Considerando a exigência dos testes de rastreio para a inserção do paciente no PCDTDA, observou-se que todos os pacientes tinham pelo menos um escore no MEEM e no CDR na admissão no protocolo. Nenhum paciente foi submetido à primeira reavaliação da efetividade da farmacoterapia da DA e nem à reavaliação semestral. Conclusão: Apesar do PCDTDA ser a maior evidência do tratamento da DA, dados evidenciam falhas no monitoramento da efetividade da farmacoterapia da DA na dispensação.

ABSTRACT Dementia is a chronic neurodegenerative disease and Alzheimer’s disease (AD) is the most prevalent type. Objective: To describe the drug monitoring of patients enrolled in a Clinical Protocol and Therapeutic Guidelines of Alzheimer’s Disease (PCDTDA) in Brazil. Methods: A descriptive study based on interviews conducted in 2017 was performed. Patients diagnosed with Alzheimer’s disease (AD) enrolled on the PCDTDA were included. The variables assessed were age, sex, time since diagnosis, clinical parameters of Mini-Mental State Exam (MMSE) and Clinical Dementia Rating (CDR), drug therapy used and AD drug collection. Results: The drug monitoring of 143 patients was evaluated. Observing the requirements of the screening tests for patient enrolment on the PCDTDA, all patients had scores for at least one MMSE and CDR assessment at protocol admission. None of the patients underwent the first reassessment of the effectiveness of AD drug therapy or the semiannual reassessment. Conclusion: Although PCDTDA provides the best evidence of AD treatment, the data showed failures in the monitoring of the effectiveness of AD drug therapy at dispensing.

OBJECTIVES: Evaluate adherence to the therapeutic prophylaxis protocol for venous thromboembolism (VTE) as well as the costs of this practice. METHODS: A descriptive and cross-sectional study was conducted at a State General Hospital in Brazil through reports of drug dispensions, prescriptions and risk stratification of patients. Adherence to the VTE prophylaxis protocol was monitored. The tests for VTE diagnosis measured the adherence to therapeutic prophylaxis treatment, and the purchase prices of the drugs went into the calculation of drug therapy costs. The level of adherence to prescriptions for VTE prophylaxis in the hospital was classified as “adherence”, “non-adherence” and “justified non-adherence” when compared with the protocol. RESULTS: Protocol adherence was observed for 50 (30.9%) patients, and non-adherence was observed for 63 (38.9%) patients, generating an additional cost of $180.40/month. Justified non-adherence in 49 (30.2%) patients generated $514.71/month in savings due to a reduction in the number of daily administrations of unfractionated heparin while still providing an effective method for preventing VTE. Twenty-six patients stratified as having medium to high risk of VTE who did not receive prophylaxis were identified, generating $154.41 in savings. However, these data should be evaluated with caution since the risks and outcomes associated with not preventing VTE outweigh the economy achieved from not prescribing a drug when a patient needs it. The only case of VTE identified during the study period was related to justified non-adherence to the protocol. CONCLUSION: The protocol is based on scientific evidence that describes an effective therapy to prevent VTE. However, the protocol should be updated because the justifications for non-adherence are based on scientific evidence, and this justified non-adherence generates savings and yields effective disease prevention.

ABSTRACT BACKGROUND: Risks regarding hospital admission due to adverse drug reactions and drug interactions from use of omeprazole have been reported. The question guiding the present review was “Which adverse events occur in patients using omeprazole in a Food and Drug Administration-approved and/or off-label manner?” It was also proposed to evaluate the safety of use of omeprazole. DESIGN AND SETTING: Qualitative narrative review with critical evaluation, in a public university. METHODS: The PubMed, SCOPUS, LILACS, SciELO, EMBASE and EBSCO databases were searched on July 31, 2018. Studies evaluating adverse events were screened. RESULTS: 72 articles were included, among which 58 reported on adverse drug events (47, adverse drug reactions; 5, drug interactions; and 6, situations of ineffectiveness). 28 adverse drug reactions not described in compendia and drug leaflets were described in these studies: myocardial infarction (6); stroke (2); spontaneous abortion (1); proliferative changes (1); chills (1); heart failure (1); thrombosis (2); and dementia (1), among others. Severe adverse reactions, for instance cardiac problems, Steven-Johnson syndrome and proliferative changes, were identified. The antiplatelet effects of drugs such as clopidogrel, in patients who underwent heart-related surgery, increased the risk of developing cardiac problems, such as cardiovascular death, myocardial infarction and stroke. In newly transplanted patients, decreased absorption of mycophenolate mofetil occurred, thus leading to rejection of transplanted organs. CONCLUSION: Use of omeprazole should be monitored primarily in patients with heart disorders using antiplatelet agents concomitantly, and in newly transplanted patients using mycophenolic acid, in order to avoid serious adverse reactions.

RESUMO Paciente idosa, 76 anos, diagnosticada com disfagia, depressão, hipotireoidismo, doença de Alzheimer e déficit cognitivo leve, foram identificados problemas relacionados com a sertralina e levotiroxina. O Gerenciamento da Terapia Medicamentosa foi usado para ajustar a terapia às necessidades da paciente, macerando comprimidos de sertralina e solubilizando-os em 10-30 mL de suco de laranja. Foi recomendado a paciente tomar levotiroxina após o jejum. Seis meses depois, o seguimento farmacêutico identificou um aumento no score da escala Mini-Mental de 22 para 26 e Avaliação Clínica da Demência (CDR) de 1,0 para 0,5 em conjunto com melhorias físicas e de humor, bem como uma diminuição significativa na agressividade e agitação. O déficit cognitivo pode ser o resultado de procedimentos de administração inadequada de fármacos, levando à ineficácia do fármaco. A otimização da administração de levotiroxina e sertralina, com conhecimento de suas propriedades físico-químicas, melhora sua efetividade clínica, incluindo a cognição do paciente com a doença de Alzheimer e disfagia.

ABSTRACT An elderly patient, aged 76 years, diagnosed with dysphagia, depression, hypothyroidism, Alzheimer's disease and mild cognitive deficit, was identified with sertraline and levothyroxine- drug-related problems. Medication Therapy Management (MTM) was used to adjust therapy to the patient's needs by macerating sertraline tablets and solubilizing them in 10-30 mL of orange juice. The patient was advised to take levothyroxine after fasting. Six months later, pharmaceutical follow-up identified an increase in the Mini-Mental State Exam score from 22 to 26 and a decrease in the Clinical Dementia Rating (CDR) scale score from 1.0 to 0.5 in conjunction with mood and physical improvements, as well as a significant decrease in aggressiveness and agitation. Cognitive deficit may be a result of poor drug administration procedures, leading to drug ineffectiveness. Optimizing levothyroxine and sertraline administration, based on knowledge of their physicochemical properties, improves their clinical effectiveness, including the cognition of patients with Alzheimer's disease and dysphagia.

ABSTRACT The objective of this study was to identify drugs that received dose adjustments (DA) and pharmaceutical alternatives (PA) that avoid DA, and calculate the economic percentage of this replacement. A descriptive, observational and cross-sectional study was performed in a second level hospital. The pharmacy and nursing services was accompanied to identify the drugs that received DA and the compounding techniques. After identifying all the drugs that received DA, was identified in the Brazilian market the corresponding pharmaceutical alternative, with the Drugs Price List of Brazilian Health Regulatory Agency. For those drugs that was not available any PA, was performed a research of studies that describe compounding techniques in international scientific databases. Was identify 88 drugs that received DA, and these, 50 do not have any PA. Were identified compounding techniques to 40 drugs. Although any drug has your own particularity of compounding, the compounding techniques can be grouped in five categories. The standardization of 29 drugs can reduce in 28% the DA procedure and cost saving of 34,85%/month. We can conclude that every three drugs prescribed, one received DA and every three DA, one can be avoided by the selection of 29 PA, saving cost as well. The use and standardization of five techniques would attend the pharmaceutics recommendations for better dissolution, bioavailability and patient safety.

RESUMO O objetivo foi descrever e avaliar um modelo de serviço de dispensação de medicamentos desenvolvido e implantado em uma Farmácia Comunitária no Brasil. Trata-se de restudo descritivo, observacional e quase-experimental, realizado no período de 21 de janeiro a 20 de abril de 2013. A descrição e avaliação do modelo foi realizada segundo os parâmetros: estrutura, processo e resultado.Os aspectos descritos e avaliados foram: 1. Estrutura: perfil dos pacientes, perfil profissiográfico dos farmacêuticos, estrutura física, material de informação; 2. Processo: problemas relacionados ao medicamento detectados, intervenções farmacêuticas realizadas, resultados das intervenções farmacêuticas; 3. Resultado: conhecimento do pacientes sobre os medicamentos utilizados. A dispensação proporcionou melhora do conhecimento do paciente sobre os medicamentos (p < 0,05), que demonstrou-se associada à complexidade da farmacoterapia (p < 0,05). Foram identificados majoritariamente problemas relacionados à falta de condições do paciente em utilizar o medicamento (52,94%). As intervenções farmacêuticas foram realizadas predominantemente junto ao paciente (86,27%) através do fornecimento de informações verbais (95,4%) e escritas (68,2%) e, em sua maioria, o problema que originou a intervenção foi totalmente resolvido (62,75%).O serviço foi capaz de identificar e resolver os problemas relacionados ao medicamento e contribuiu para a melhoria do conhecimento dos pacientes relativo aos medicamentos utilizados.

ABSTRACT The objective was to describe and evaluate a model of drug dispensing developed and implemented in a community pharmacy in Brazil. This was a descriptive, observational, quasi-experimental study performed in the period between 21 January 2013 and 20 April 2013. The model was evaluated and described in terms of three parameters: structure, process and outcome. The description and assessment of each parameter was performed as follows: (I) Structure: profile of patients, pharmacist's professional profile, physical facility, informational material; (II) Process: drug-related problems, pharmaceutical interventions performed, results of pharmaceutical interventions; (III) Outcome: patient knowledge of medications. Dispensing service improved patient knowledge of medications (p < 0.05), which was associated with pharmacotherapy complexity (p < 0.05). The main problems identified were related to lack of patient knowledge regarding their medication (52.9%). Pharmaceutical interventions were mostly performed directly to the patients (86.3%) by verbal (95.4%) and written (68.2%) information, and most of the problems were completely solved (62.7%). The medicine dispensing model was able to identify and solve drug-related problems and promote an improvement in patient knowledge about medication.

O objetivo do presente estudo foi avaliar o conhecimento de farmacêuticos e verificar suas condutas em relação à dispensação de medicamentos. Trata-se de um estudo transversal realizado em quatro municípios das regiões sul e sudeste do Brasil, que são referência no cenário nacional de saúde e concentram 73,6% da atividade econômica nacional. Farmacêuticos que trabalham em farmácias comunitárias foram convidados a responder um questionário elaborado pelos autores do presente estudo e validado. Os principais desfechos medidos foram o conhecimento farmacêutico, avaliado segundo o número de acertos em um questionário elaborado pelos pesquisadores, e a conduta dos profissionais durante a dispensação de medicamentos. Os dados foram coletados de setembro a dezembro de 2012 e as informações obtidas foram tabuladas em duplicata por dois pesquisadores para posterior análise. 486 farmácias comunitárias foram visitadas, mas apenas 112 profissionais participaram do estudo. Entre os participantes, 78,6% (n = 88) não tinham conhecimento satisfatório para realizar a dispensação de medicamentos, apesar de este mesmo número de farmacêuticos terem afirmado participar de congressos e cursos após a graduação. As principais fontes de informação sobre medicamentos utilizados pelos participantes possuem um baixo nível de evidência científica. A realização de tarefas não diretamente relacionadas à profissão reduz o tempo disponível para o atendimento aos usuários de medicamentos. Além disso, a venda indiscriminada de antibióticos e a comercialização de produtos alheios à saúde descaracterizam o papel do farmacêutico na farmácia comunitária. Existem lacunas no conhecimento dos profissionais, o que limita a realização satisfatória de dispensação de medicamentos. Além disso, o excesso de atribuições e a conduta profissional inadequada comprometem a promoção do uso racional de medicamentos.

The objective of the study was to evaluate the knowledge of pharmacists and check their conduct in relation to dispensing of drugs. This is a cross-sectional study performed in four municipalities from South and Southeast of Brazil, which are reference in health national scenario and concentrate 73.6% of national economic activity. Pharmacists who works in community pharmacies were invited to answer a questionnaire prepared by the authors of this study and validated. The main outcome measured was the pharmaceutical knowledge, rated according to the number of correct answers on that questionnaire prepared by the researchers, and professional conduct in relation to dispensing of drugs. The data collection occurred from September to December 2012 and the information obtained were tabulated in duplicate by two independent researchers for later analysis. 486 community pharmacies were visited but only 112 professionals participated in the study. Among the participants, 78.6% (n = 88) did not have adequate knowledge to perform the dispensing of drugs, despite this same number of pharmacists claiming to have participated in conferences and courses after graduation. The main sources of information on drugs used by participants have a low level of scientific evidence. The performance of non-employment related tasks reduces the time available for the care of medication users. In addition, the indiscriminate sale of antimicrobials and the sale of products other than health, mischaracterize the role of the pharmacist in the community pharmacy. There are gaps in the knowledge of professionals, limiting the satisfactory completion of dispensing of drugs. In addition, the excess of other duties and inadequate professional conduct compromise the promotion of the rational use of drugs.

Determinados medicamentos são considerados potencialmente inapropriados (MPI) para idosos, por aumentarem o risco de ocorrência de eventos adversos a medicamentos (EAM) e por existirem alternativas terapêuticas mais seguras. Neste contexto, com o intuito de identificar os instrumentos que avaliam a qualidade das prescrições médicas para idosos e verificar quais medicamentos são considerados MPI, levantamento bibliográfico foi realizado nas bases de dados PUBMED, LILACS e PAHO em fevereiro e março de 2010. Para a seleção dos manuscritos utilizaram-se descritores em saúde e busca manual nas referências bibliográficas dos artigos identificados. No período da coleta de dados, foram identificados 15 instrumentos. Em 2012, com a publicação da atualização da lista de Beers, este instrumento foi incluído no estudo. Foram identificados 163 MPI de 25 classes terapêuticas, dos quais 125 (76,7%) são comercializados no Brasil. Destes, 31 (24,8%) são medicamentos essenciais (RENAME 2012), sendo que para 13 deles há equivalentes terapêuticos mais seguros e 19 (15,2%) são medicamentos isentos de prescrição. Os dados sugerem a necessidade de inclusão de medicamentos mais seguros para idosos na lista nacional de medicamentos essenciais e do monitoramento farmacoterapêutico para a detecção precoce de EAM nesta faixa etária para contribuir com o uso seguro de medicamentos.

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines.

As Reações Adversas a Medicamentos (RAM) podem ser responsáveis por 2,4% a 11,5% das admissões hospitalares. O estudo objetivou conhecer o perfil demográfico dos pacientes internados por possíveis RAM, identificar os medicamentos e as queixas mais freqüentemente relacionadas e estimar a incidência de admissão hospitalar pelo uso de medicamentos. Durante um mês, os pacientes internados em um hospital geral foram entrevistados quanto ao uso de medicamentos antes da internação e as queixas que o levaram ao hospital; as informações foram analisadas, usando-se a base de dados MICROMEDEX® e outras bases oficiais. Observou-se que as admissões por uso de medicamentos ocorreram predominantemente em idosos [47,5% (66/139)] e mulheres [62% (87/139)]. Os medicamentos mais freqüentes foram: omeprazol (16), analgésicos (31), antihipertensivos (31), sinvastatina (7) e formoterol (6); e normalmente os sintomas associados foram do sistema digestório (20,5%), circulatório (20,2%), respiratório (18,2%) e SNC (13,9%). Estima-se que em 15,5% (139/897) das internações, possivelmente, a razão foi o uso de medicamentos. Os dados sugerem medidas de prevenção, como o acompanhamento farmacoterapêutico dos pacientes no âmbito da assistência primária à saúde, principalmente aos idosos, aos portadores de doenças crônicas e aos polimedicados, além da orientação farmacêutica na compra e dispensação de medicamentos, principalmente os isentos de prescrição.

According to the Word Health Organization, adverse drug reactions (ADR) are any harmful and non intentional answer which occurred in doses normally used in human beings. The ADR can be responsible for 2.4% to 11.5% of hospital admissions. Therefore, this study aimed at knowing the admitted patient´s demographic profile due to possible ADR, identifying the most frequent drugs and complaints, and evaluating the incidence of hospital admission related to drug use. Patients who were 18 years old or more and were admitted during a period of one month to a medical clinical of a general hospital were interviewed for one month about drug use before being admitted, as well as regarding to the complaint which led them to hospital. These information were analyzed according to official data, like MICROMEDEX® and WHO criteria as well. It was observed that the admission due to drug use occurred in most part of the cases in elderly [47.5% (66/139)] and women [62% (87/139)]. The most frequent drugs used were: omeprazole (16), analgesics (31), antihypertensive (31), simvastatin (7) and formoterol fumarate (6), and the symptoms were normally associated to the digestive (20.5%), circulatory (20.2%), respiratory (18.2%) and central nervous systems (13.9%). It was estimated that 15.5% (139/897) of the hospital admission occurred possibly due to the drug use. The data found by present study suggests some strategies in order to prevent ADR in the context of primary health care services, such as monitoring drug therapy, manly for patients with chronic diseases, elderly and polimedicated people; and pharmaceutical care including dispensation and purchasing of the drugs, a lot of them dispensed over the counter (OTC).