Frequency and nature of drug-drug interactions in a Swiss primary and secondary acute care hospital

Oertle, Marc

doi:10.4414/smw.2012.13522

Cited by 21 publications

(21 citation statements)

References 25 publications

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“…The fact that internists found more DDIs per check than surgeons is in line with other studies [18], presenting higher numbers of prescribed drugs per patient in wards of internal medicine, similar to our findings. Internists predominantly screened for DDIs while reviewing the patient chart (mode 2) in order to overview the concurrent drug therapies frequently administered to multimorbid patients.…”

Section: Discussionsupporting

confidence: 93%

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Use of an On-demand Drug–Drug Interaction Checker by Prescribers and Consultants: A Retrospective Analysis in a Swiss Teaching Hospital

Beeler

Eschmann

Rosen³

et al. 2013

Drug Saf

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BACKGROUND: Offering a drug-drug interaction (DDI) checker on-demand instead of computertriggered alerts is a strategy to avoid alert fatigue. OBJECTIVE: The purpose was to determine the use of such an on-demand tool, implemented in the clinical information system for inpatients. METH-ODS: The study was conducted at the University Hospital Zurich, an 850-bed teaching hospital. The hospital-wide use of the on-demand DDI checker was measured for prescribers and consulting pharmacologists. The number of DDIs identified on-demand was compared to the number that would have resulted by computer-triggering and this was compared to patient-specific recommendations by a consulting pharmacist. RESULTS: The on-demand use was analyzed during treatment of 64,259 inpatients with 1,316,884 prescriptions. The DDI checker was popular with nine consulting pharmacologists (648 checks/consultant). A total of 644 prescribing physicians used it infrequently (eight checks/prescriber). Among prescribers, internists used the tool most frequently and obtained higher numbers of DDIs per check (1.7) compared to surgeons (0.4). A total of 16,553 DDIs were identified on-demand, i.e., <10 % of the number the computer would have triggered (169,192). A pharmacist visiting 922 patients on a medical ward recommended 128 adjustments to prevent DDIs (0.14 recommendations/patient), and 76 % of them were applied by prescribers. In contrast, computer-triggering the DDI checker would have resulted in 45 times more alerts on this ward (6.3 alerts/patient). CONCLUSIONS: The on-demand DDI checker was popular with the consultants only. However, prescribers accepted 76 % of patient-specific recommendations by a pharmacist. The prescribers' limited on-demand use indicates the necessity for developing improved safety concepts, tailored to suit these consumers. Thus, different approaches have to satisfy different target groups. Running TitleUse of an On-demand DDI Checker Keywords (MeSH terms)

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Section: Discussionsupporting

confidence: 93%

“…table V), generating a DDI report warning against the risk of hyperkalemia. [18] Thus, before reporting a DDI, the condition of the patient should be taken into account. Such concepts may offer promising strategies to improve the specificity of computer-triggered alerts.…”

Section: Discussionmentioning

confidence: 99%

Use of an On-demand Drug–Drug Interaction Checker by Prescribers and Consultants: A Retrospective Analysis in a Swiss Teaching Hospital

Beeler

Eschmann

Rosen³

et al. 2013

Drug Saf

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“…Так, в наиболее «опасные» ЛП по количеству major-взаимодействий входят тиоридазин (24 потенциальных взаимодействия), калия хлорид (14), моксифлоксацин (11), галоперидол (9), кветиапин (8), клозапин (7), имипрамин (7), сертралин (7), трифлуоперазин (7), верапамил (6).…”

Section: журнал неврологии и психиатрии 5 2017unclassified

“…На-пример, такая фармакологическая группа ЛП, как анти-депрессанты, занимает третье место по частоте комбина-ций, способных вызвать потенциально опасные межле-карственные взаимодействия [12]. Более т ого, по данным некоторых авторов [13,14], в условиях оказания психиа-трической помощи опасные межлекарственные взаимо-действия могут приводить к снижению качества жизни, возрастанию риска возникновения коморбидных рас-стройств, а также являться одним из факторов, приводя-щих к сокращению продолжительности жизни.…”

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The drug-drug interactions in a psychiatric hospital

Kirilochev

Умерова

Дорфман

et al. 2017

Z. nevrol. psikhiatr. im. S.S. Korsakova

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Проблема безопасности комбинированной фармако-терапии актуальна во всех сферах медицины, поскольку практикующий врач любой специальности сталкивается с назначением нескольких препаратов одному больному. Однако клиническое мышление врача, как правило, в большей степени направлено на выбор наиболее эффек-тивной комбинации лекарственных средств для усиления терапевтического эффекта или воздействия сразу на не-сколько клинических проявлений, нежели оценку без-опасности такой комбинации. Во многих случаях комби-нированная фармакотерапия приводит к возникновению лекарственного взаимодействия, которое способно вы-звать неблагоприятные лекарственные реакции.Межлекарственное взаимодействие -это изменение эффективности и безопасности одного лекарственного средства при одновременном или последовательном при-менении с другим лекарственным средством [1]. Проведен анализ 132 лекарственных препаратов, используемых в условиях психиатрического стационара, на предмет возможности развития их взаимодействия. Установлено, что каждая пятая потенциальная комбинация вступает в лекарственное взаимодействие, среди которых преобладают клинически значимые сочетания препаратов. Психотропные лекарственные препараты занимают лидирующие позиции по количеству таких взаимодействий. Учет приведенных в статье данных способен повысить безопасность комбинированной фармакотерапии путем выбора альтернативного лекарственного препарата, коррекции дозового режима или активного мониторирования клинического состояния пациента, включая лабораторные и инструментальные данные. An analysis of 132 drugs used in a psychiatric hospital for the estimation of the possibility of drug-drug interactions has been carried out. It has been established that one in five potential combination has a drug-drug interaction with clinically significant interactions being more frequent. Psychotropic drugs occupy a leading position in the number of such interactions. This analysis is able to improve the safety of the combined pharmacotherapies by choosing an alternative drug, correction of dose or active monitoring of the clinical condition of the patient, including laboratory and instrumental data. Keywords: combined pharmacotherapies, drug-drug interactions, adverse drug reactions.К видам взаимодействия лекарственных средств от-носят: а) фармацевтическое -обусловлено физическими и химическими свойствами лекарств, происходит до по-ступления лекарственных препаратов (ЛП) в организм че-ловека (например, смешивание препаратов в одной инфу-зионной системе); б) фармакокинетическое -происхо-дит на уровнях всасывания, распределения, метаболизма и выведения ЛП и приводит к изменению концентрации ЛП в плазме крови, а следовательно, изменению воздей-ствия на молекулы-мишени; в) фармакодинамическое -связано с изменением фармакологического эффекта од-ного ЛП под действием другого, как правило, происходит на уровне механизма действия препарата. Наибольшее клиническое значение имеют последние два типа взаимо-действия, которые могут привести как к изменению тера-певтического ответа, так и увели...

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“…Computerized physician order entry (CPOE) in combination with clinical 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 decision support systems (CDSS) may help to detect DDIs and to alert the prescribing physicians. However, they are often based on DDI knowledge bases which do not take patient characteristics into account, resulting in a low specificity of alerts, overalerting and alert fatigue [7][8][9][10]. In order to avoid alert fatigue on-demand DDI checks have been implemented into the electronic health record of the University Hospital Zurich [11].…”

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confidence: 99%

Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug–drug interactions

Eschmann

Beeler

Kaplan

et al. 2013

Eur J Clin Pharmacol

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PURPOSE: Hyperkalaemia due to potassium-increasing drug-drug interactions (DDIs) is a clinically important adverse drug event. The purpose of this study was to identify patient-and physicianrelated risk factors for the development of hyperkalaemia. METHODS: The risk for adult patients hospitalised in the University Hospital Zurich between 1 December 2009 and 31 December 2011 of developing hyperkalaemia was correlated with patient characteristics, number, type and duration of potassiumincreasing DDIs and frequency of serum potassium monitoring. RESULTS: The 76,467 patients included in this study were prescribed 8,413 potentially severe potassium-increasing DDIs. Patient-related characteristics associated with the development of hyperkalaemia were pulmonary allograft [relative risk (RR) 5.1; p < 0.0001), impaired renal function (RR 2.7; p < 0.0001), diabetes mellitus (RR 1.6; p = 0.002) and female gender (RR 1.5; p = 0.007). Risk factors associated with medication were number of concurrently administered potassium-increasing drugs (RR 3.3 per additional drug; p < 0.0001) and longer duration of the DDI (RR 4.9 for duration 6 days; p < 0.0001). Physician-related factors associated with the development of hyperkalaemia were undetermined or elevated serum potassium level before treatment initiation (RR 2.2; p < 0.001) and infrequent monitoring of serum potassium during a DDI (interval >48 h: RR 1.6; p < 0.01). CONCLUSION: Strategies for reducing the risk of hyperkalaemia during potassium-increasing DDIs should consider both patient-and physician-related risk factors. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 AbstractPurpose Hyperkalaemia due to potassium-increasing drug-drug interactions (DDIs) is a clinically important adverse drug event. The purpose of this study was to identify patient-and physician-related risk factors for the development of hyperkalaemia. MethodsThe risk for adult patients hospitalised in the University Hospital Zurich of developing hyperkalaemia was correlated with (i) patient characteristics, (ii) number, type and duration of potassium-increasing DDIs, and (iii) the frequency of serum potassium monitoring. (iii) Physician-related factors associated with development of hyperkalaemia were: undetermined or elevated serum potassium level before starting treatment (RR 2.2; p < 0.001) and infrequent monitoring of serum potassium during DDI (intervals > 48 h; RR 1.6; p < 0.01). ConclusionStrategies for hyperkalaemia risk reduction during potassium-increasing DDIs should consider patient-as well as physician-related risk factors.

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Frequency and nature of drug-drug interactions in a Swiss primary and secondary acute care hospital

Cited by 21 publications

References 25 publications

Use of an On-demand Drug–Drug Interaction Checker by Prescribers and Consultants: A Retrospective Analysis in a Swiss Teaching Hospital

Use of an On-demand Drug–Drug Interaction Checker by Prescribers and Consultants: A Retrospective Analysis in a Swiss Teaching Hospital

The drug-drug interactions in a psychiatric hospital

Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug–drug interactions

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