Prevalência e fatores associados a medicamentos potencialmente inapropriados e interações medicamentosas em pessoas idosas de uma assistência primária à saúde
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2024.211366Palavras-chave:
Saúde do idoso, Prescrições de medicamentos, Lista de medicamentos potencialmente inapropriados, Interações medicamentosas, Atenção primária à saúdeResumo
Objetivo: Verificar a prevalência e os fatores associados às interações medicamentosas e aos medicamentos potencialmente inapropriados utilizados por idosos assistidos por uma Unidade Básica de Saúde. Métodos: Estudo transversal, realizado com 236 idosos com idade ≥ 60 anos, assistidos pela Estratégia de Saúde da Família. As variáveis dependentes foram a presença de medicamentos potencialmente inapropriados e as interações medicamentosas, valendo-se dos critérios de Beers e da organização sistemática Anatomical Therapeutic Chemical. As variáveis independentes foram idade, sexo, cor, estado civil, escolaridade, contribuição para renda familiar, presença de tabagismo, presença de etilismo, mora sozinho, sair de casa sozinho, prática de atividade física, prática de atividade de lazer, prática de atividades ofertadas pela UBS, autopercepção de saúde, multimorbidade e presença de polifarmácia. Realizou-se análises descritivas e as análises associativas foram feitas pelo teste Qui-quadrado de Pearson. Resultados: 27,5% dos idosos utilizavam ao menos 1 medicamento potencialmente inapropriado, sendo associado a idade maior ou igual a 75 anos (38,5%), sexo feminino (32,4%), cor branca (40,3%), ausência de tabagismo (44,4%), ausência da prática de atividades lazer (31,8%), presença de multimorbidades (34,4%) e prática de polifarmácia (43,8%). Já as interações medicamentosas estiveram presente em 18,2% da amostra e associação com sexo feminino (22,7%), prática de atividades na UBS (31,4%), autopercepção da saúde como negativa (23,9%), presença de multimorbidade (25,3%) e presença da polifarmácia (42,7%). O principal medicamento potencialmente inapropriado foi o omeprazol e a principal interação medicamentosa foi sinvastatina com anlodipino. Conclusão: A presença de medicamentos inapropriados e interações medicamentosas indevidas podem provocar perda funcional significativa nos idosos, com efeitos adversos, novas doenças ou declínio cognitivo, dando origem à cascata de prescrições. A coordenação do cuidado da pessoa idosa é necessária para otimizar a farmacoterapia e evitar desfechos desfavoráveis.
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Martinez R, Morsch P, Soliz P, Hommes C, Ordunez P, Vega E. Life expectancy, healthy life expectancy, and burden of disease in older people in the Americas, 1990–2019: a population-based study. Rev Panam Salud Publica. 2021; 45:e114.
Farias NAS, Rodrigues RV. The influence of polypharmacy on elderly people attending a family health unit in Porto Velho – RO. BJD. 2022; 8(4):27459-88.
Johnston MC, Crilly M, Black C, Prescott GJ, Mercer SW. Defining and measuring multimorbidity: a systematic review of systematic reviews. Eur J Public Health. 2019; 29(1):182-9.
Sousa CR, Coutinho JFV, Freire Neto JB, Barbosa RGB, Marques MB, Diniz JL. Factors associated with vulnerability and frailty in the elderly: a cross-sectional study. rev Bras Sick . 2022; 75(2):e20200399.
World Health Organization (WHO). Medication Safety in Polypharmacy: Technical Report. Geneva: WHO; 2019.
Oliveira PC, Silveira MR, Ceccato MGB, Reis AMM, Pinto IVL, Reis EA. Prevalence and Factors Associated with Polypharmacy in Elderly People Assisted in Primary Health Care in Belo Horizonte-MG , Brazil. Collective health science. 2021; 26(4):1553-64.
Brazil. Ministry of Health. National Health Surveillance Agency. Resolution - RDC nº 60, of December 17, 2010. Brasília (DF): Ministry of Health; 2010.
Balaram K, Balachandran S. Psychopharmacology in the Elderly: Why Does Age Matter? Psychiatrist Clin North Am. 2022; 45(4):735-44.
American Geriatrics Society. The 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019; 67(4):674-94.
Kimura H, Yoshida S, Takeuchi M, Kawakami K. Impact of Potentially Inappropriate Medications on Kidney Function in Chronic Kidney Disease: Retrospective Cohort Study. Nephron . 2022; 16:1-8.
Buckley E, Jonsson A, Flood Z, Lavelle M, O'Sullivan N, Nurdin N, et al. Potentially inappropriate medication use and mortality in patients with cognitive impairment. Eur J Clin Pharmacol. 2022; 78(12):2013-20.
Oliveira GPL, Dias LL, Sogame LCM, Pampolim G. Analysis of the medication profile and factors associated with polypharmacy in elderly people assisted by a Health Unit in Vitória – ES. Rev. Colomb. Science. Chem. Farm. 2022; 51(2):1005-24.
Brazil. Ministry of Health. Secretariat of Science, Technology, Innovation and Strategic Inputs in Health. Department of Pharmaceutical Assistance and Strategic Inputs. National List of Essential Medicines Rename 2022. Brasília: Ministry of Health; 2022.
World Health Organization (WHO). Collaborating center for drug statistics methodology [Internet]. Geneva: WHO; 2023 [accessed 23 March 2023]. Available at: http://www.whocc.no/atc_ddd_index/.
Malaquias BSS, Buso ALZ, Silvano CM, Nardelli GG, Martins GT, Santos Álvaro S. Evaluation of medication prescriptions for elderly people in a geriatric outpatient clinic. Medicine (Ribeirão Preto) [Internet]. 2016; 49(5):440-5.
Gomes MS, Amorim WW, Morais RS, Gama RS, Graia LT, Queiroga HM, et al. Polypharmacy in older patients at primary care units in Brazil. Int J Clin Pharm. 2019; 41(2):516-24.
Farias AD, Lima KC, Oliveira YMC, Leal AAF, Martins RR, Freitas CHSM. Prescription of potentially inappropriate medications for the elderly: a study in Primary Health Care. Collective health science. 2021; 26(5):1781-92.
Fernández A, Gómez F, Curcio CL, Pineda E, Souza JF. Prevalence and impact of potentially inappropriate medication on community-dwelling older adults. Biomedicine . 2021; 41(1):111-22.
Aires JMP, Silva LT, Frota DL, Dewulf NLS, Lopes FM. Potentially inappropriate medications prescribed to patients at a Reference Center for Health Care for the Elderly. Rev. bras. geriatr . gerontol . 2020; 23(4):e200144.
Carneiro JA, Ramos GCF, Barbosa ATF, Medeiros SM, Lima CA, Costa FM, et al. Prevalence and factors associated with polypharmacy in community-dwelling elderly people: a population-based epidemiological study. Medicine (Ribeirão Preto) [Internet]. 2018; 51(4):254-64.
Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol . 2018; 10:289-98.
Praxedes MFS, Pereira GCS, Lima CFM, Santos DB, Berhends JS. Prescription of potentially inappropriate medications for the elderly according to the Beers Criteria: systematic review. Collective health science. 2021; 26(8):3209-19.
Harrison S, O'Donnell LK, Miltre R, Dyer SM, Gnanamanickam ES, Bradley CE, et al. Costs of potentially inappropriate medication use in residential aged care facilities. BMC Geriatr. 2018; 18:9.
Seto SL, Barra ME, Hamidi A, Sin JH, Devine LT. Efficacy and Safety of Immediate-Release Nifedipine in Critically Ill Patients. J Pharm Practice . 2022; 14:8971900221074953.
Schwan J, Sclafani J, Tawfik VL. Chronic Pain Management in the Elderly Anesthesiol Clinic. 2019; 37(3):547–60.
Kshesek GB, Souza LGH, Leandro LA. Prevalence of chronic pain in the elderly: integrative literature review. Braz. J. Hea . Rev. 2021; 4(5):21367-81.
Barroso WKS, Rodrigues CIS, Bortolotto LA, Mota-Gomes MA, Brandão AA, Feitosa ADM, et al. Brazilian Arterial Hypertension Guidelines - 2020. Arq. Bras. Cardiol . 2021; 116(3):516-658.
Fuhrmanna S, Koppena A, Seeling A, Knoth H, Schröder J. Analysis of secondary care data to evaluate the clinical relevance of the drug-drug interaction between amlodipine and simvastatin. ZEvid _ Fortbild Qual Gesundhwes . 2019; 146:21-7.
Wang YC, Hsieh TC, Chou CL, Wu JL, Fang TC. Risks of Adverse Events Following Coprescription of Statins and Calcium Channel Blockers: A Nationwide Population-Based Study. Medicine (Baltimore). 2016; 95(2):e2487.
Wiggins BS, Saseen JJ, Page RL, Reed BN, Sneed K, Kostis JB, et al. On behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology; Council on Hypertension; Council on Quality of Care and Outcomes Research; and Council on Functional Genomics and Translational Biology. Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation . 2016; 134(21):e468-95.
Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. JAMA. 2000; 283(21):2822-5.
Zamfirescu I, Carlson HE. Absorption of levothyroxine when coadministered with various calcium formulations. Thyroid . 2011; 21(5):483-6.
Morini E, Catalano A, Lasco A, Morabito N, Benvenga S. In thyroxine-replaced hypothyroid postmenopausal women under simultaneous calcium supplementation, switch to oral liquid or softgel capsule L-thyroxine ensures lower serum TSH levels and favorable effects on blood pressure, total cholesterolemia and glycemia. Endocrine . 2019; 65:569–79.
Meid AD, von Medem A, Heider D, Adler JB, Günster C, Seidling HM, et al. Investigating the Additive Interaction of QT-Prolonging Drugs in Older People Using Claims Data. Drug Saf. 2017; 40(2):133-144.
O'Mahony D. STOPP/START criteria for potentially inappropriate medications/potential prescribing omissions in older people: origin and progress, Expert Rev Clin Pharmacol. 2020; 13(1):15-22.
Oliveira MG, Amorim WW, Oliveira CRB, Coqueiro HL, Gusmão LC, Passos LC. Brazilian Consensus on Potentially Inappropriate Medications for the Elderly. Geriatr Gerontol Aging . 2017; 10(4):168-84.
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Copyright (c) 2024 Glenda Pereira Lima Oliveira, Aldren Thomazini Falçoni Júnior, Gracielle Pampolim, Luciana Carrupt Machado Sogame
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
