Prescribing for the Elderly Part I: Sensitivity of the Elderly to Adverse Drug Reactions*

Nolan, Lisa K.; O’Malley, K

doi:10.1111/j.1532-5415.1988.tb01785.x

Cited by 300 publications

(116 citation statements)

References 65 publications

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“…El número de medicamentos se ha informado constantemente como un factor fuertemente asociado al desarrollo de reacciones adversas a medicamentos (9,11,18,21,22).…”

Section: Discussionunclassified

Costos directos y aspectos clínicos de las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel de Bogotá.

et al. 2006

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Costos directos y aspectos clínicos de las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel de BogotáGabriel Tribiño, Carlos Maldonado, Omar Segura, Jorge Díaz Departamento de Farmacia, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.Introducción. Las reacciones adversas a medicamentos constituyen un problema clínico frecuente en el ámbito hospitalario y aumentan los costos de la atención en salud. En Colombia son pocos los estudios realizados para evaluarlas desde el punto de vista clínico y económico. Objetivo. Determinar los costos generados por las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel e identificar sus principales características clínicas. Materiales y métodos. Se hizo seguimiento intensivo de los pacientes del servicio de medicina interna durante un período de cinco meses para detectar reacciones adversas. La información se recolectó mediante un formulario basado en el formato de reporte del INVIMA. La probabilidad de causalidad se generó mediante el algoritmo de Naranjo. Se calcularon los costos directos desde la perspectiva del pagador teniendo en cuenta la estancia adicional, los medicamentos, los exámenes paraclínicos, los procedimientos, los traslados a la unidad de cuidado intermedio o intensivo y los insumos. Resultados. Se detectaron 268 reacciones adversas en 208 de los 836 pacientes que ingresaron en el servicio (proporción de incidencia, 25,1%; razón de presencia, 0,32). El 74,3% se clasificó como probable; el 92,5% fue tipo A; el 81,3% correspondió a reacciones moderadas. El sistema más frecuentemente afectado fue el hematológico (33,9%). Los medicamentos que actúan en sangre fueron los más frecuentemente relacionados (37,6%). El costo generado por la atención de las reacciones adversas fluctuó entre $93'633.422 y $122'155.406. Conclusiones. Dado el impacto negativo de las reacciones adversas en el bienestar de los pacientes, los recursos que se emplean en su atención y la proporción importante de reacciones adversas prevenibles, se requieren programas operativos de farmacovigilancia institucional.Palabras clave: farmacoepidemiología, efectos adversos, economía de la salud, hospitalización, medicina interna Direct costs and clinical aspects of adverse drug reactions in patients admitted to a level 3 hospital internal medicine ward.Introduction. Adverse drug reactions (ADRs) occur frequently in hospitals and increase costs of health care; however, few studies have quantified the clinical and economic impact of ADRs in Colombia. Objectives. These impacts were evaluated by calculating costs associated with ADRs in patients hospitalized in the internal medicine ward of a Level 3 hospital located in Bogotá, Colombia. In addition, salient clinical features of ADRs were identified and characterized. Material and methods. Intensive follow-ups for a cohort of patients were conducted for a five month period in order to ...

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“…El número de medicamentos se ha informado constantemente como un factor fuertemente asociado al desarrollo de reacciones adversas a medicamentos (9,11,18,21,22).…”

Section: Discussionunclassified

Costos directos y aspectos clínicos de las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel de Bogotá.

et al. 2006

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“…1 In the outpatient setting, rates of adverse drug reactions have ranged from 1.7% to 50.6%. 2 Costs associated with adverse drug events in a typical tertiary care hospital have been approximated to be $1.1-5.6 million per year, 3,4 and drug-related morbidity and mortality have been estimated to cost $76.6 billion annually in the ambulatory setting. 5 Therefore, clinicians, administrators, and policymakers have become interested in what system factors contribute to adverse drug reactions and how provider practices around medication prescribing can be improved.…”

mentioning

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Appropriateness of Medication Selection for Older Persons in an Urban Academic Emergency Department

Chin

Wang

Jin

et al. 1999

Academic Emergency Medicine

172

130

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Abstract. Objectives:To determine the frequency of potentially inappropriate medication selection for older persons presenting to the ED, the most common problematic drugs, risk factors for suboptimal medication selection, and whether use of these medications is associated with worse outcomes. Methods: The authors performed a prospective cohort study of 898 patients 65 years or older who presented to an urban academic ED in 1995 and 1996. Seventy-nine percent of the patients were African-American and 43% did not graduate from high school. Potentially inappropriate medications and adverse drug-disease interactions were identified using the 1997 Beers explicit criteria for elders. During the three months after the initial visit, revisits to the ED or hospital, death, and changes in health-related quality of life were analyzed as measured by validated questions adapted from the Medical Outcomes Study. Results: Upon presentation, 10.6% of the patients were taking a potentially inappropriate medication, 3.6% were given one in the ED, and 5.6% were prescribed one upon discharge from the ED. The most frequently prescribed potentially inappropriate medications in the ED were diphenhydramine, indomethacin, meperidine, and cyclobenzaprine. Emergency physicians added potentially inappropriate medications most often to patients with discharge diagnoses of musculoskeletal disorder, back pain, gout, and allergy or urticaria. Potentially adverse drug-disease interactions were relatively uncommon at presentation (5.2%), in the ED (0.6%), and on discharge from the ED (1.2%). Potentially inappropriate medications and adverse drug-disease interactions prescribed in the ED were not associated with higher rates of revisit to the ED, hospitalization, or death, but were correlated with worse physical function and pain. However, confidence intervals were wide for analyses of revisits and death. Conclusions: Suboptimal medication selection was fairly common and was associated with worse patient-reported health-related quality of life. Key words: emergency services; aging; drugs; pharmacology; outcomes; quality of care. ACADEMIC EMER-GENCY MEDICINE 1999; 6:1232-1242 A DVERSE drug reactions are common and expensive. For example, a recent meta-analysis estimated that 6.7% of hospitalized patients have serious adverse drug reactions.1 In the outpatient setting, rates of adverse drug reactions have ranged from 1.7% to 50.6%.2 Costs associated with adverse drug events in a typical tertiary care hospital have been approximated to be $1.1-5.6 million per year, 3,4 and drug-related morbidity and mortality have been estimated to cost $76.6 billion annually in the ambulatory setting.5 Therefore, clinicians, administrators, and policymakers have become interested in what system factors contribute to adverse drug reactions and how provider practices around medication prescribing can be improved. 6,7 Several factors place older persons at especially high risk for iatrogenic complications of medication use. The normal aging process is associated with ...

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“…Es de destacar que el número de medicamentos concomitantes es un factor fuertemente relacionado con el desarrollo de efectos secundarios a los medicamentos (22)(23)(24). En este estudio, el promedio de medicamentos administrados a cada paciente fue de siete, con un porcentaje mayor a 24% en el caso de la dipirona y de 46% en el caso del tramadol para más de ocho medicamentos por paciente.…”

Section: Discussionunclassified

Detección de efectos secundarios asociados a la administración de tramadol y dipirona en un hospital de alta complejidad

2009

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Introducción. Un objetivo prioritario después de la comercialización de medicamentos, como la dipirona y el tramadol, en grupos particulares de población, como el colombiano, es garantizar la eficacia y la seguridad. Objetivo. Describir y estimar la frecuencia de efectos secundarios, incluida la falla terapéutica, asociados al uso de tramadol y a la dipirona en el Hospital Universitario Palabras clave: dipirona/efectos secundarios, tramadol/efectos secundarios, costos en medicamentos, farmacoepidemiología. Adverse events associated with tramadol and dipirona administration in a level III hospitalIntroduction. The efficacy and safety of pharmaceutical drugs such as dipirone and tramadol must be a primary objective in the post-marketing period and as they are used in specific population groups.Objectives. The frequency of adverse effects (including therapeutic failure) with the medications tramadol and dipirona were described and estimated. Material and methods. At the Hospital Universitario de la Samaritana, Bogotá, D.C., Colombia, adverse events associated with dipirone and tramadol were rigorously tracked in patients hospitalized in the internal medicine, as well as the orthopedics and surgery departments. For a period of six months, data were collected by means of the Instituto Nacional de Vigilancia Médica y Alimentos (INVIMA) standard report form. Direct costs of adverse event treatment to the patient were calculated. Results. Adverse reactions were detected 213 times in 171 (8.4%) of the 2,547 patients admitted to the services (incidence rate. Of these instances, 53.4% were rated as possible for dipirone and 46.82% for tramadol. Of the total, 0.6% (16 cases) were classes as serious adverse events. The gastrointestinal system was the most affected, with the incidences of adverse events for dipirone Boston, demostró grandes diferencias en la variación de riesgo en diferentes países, que podría explicarse por diferentes factores, como consumo y frecuencia del uso de dipirona, susceptibilidad genética de la población a la agranulocitosis y otros factores propios, y reportó una incidencia de agranulocitosis inducida de uno por cada 1'100.000 usuarios por semana. La dipirona claramente causa agranulocitosis, pero existe información insuficiente para cuantificar adecuadamente el riesgo (4). Es por esto que el determinar el balance riesgo/beneficio y los costos que se generan por los efectos secundarios asociados al uso de dipirona, es importante para los países en los que aún se comercializa, incluyendo Colombia.Existen varias proyecciones, estudios observacionales y retrospectivos a partir de consumo del medicamento, que muestran que la incidencia de agranulocitosis asociada con la dipirona en América Latina es realmente baja y significativamente menor que la reportada en países como Suecia. Por ejemplo, el estudio de Sollero et al. realizado en Brasil, abarcó un período de 20 años, de 1954 a 1974 pacientes. Se registraron 15 casos de agranulocitosis por pirazolonas (incidencia<0,002%) y un caso por dipirona (i...

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Prescribing for the Elderly Part I: Sensitivity of the Elderly to Adverse Drug Reactions*

Cited by 300 publications

References 65 publications

Costos directos y aspectos clínicos de las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel de Bogotá.

Costos directos y aspectos clínicos de las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel de Bogotá.

Appropriateness of Medication Selection for Older Persons in an Urban Academic Emergency Department

Detección de efectos secundarios asociados a la administración de tramadol y dipirona en un hospital de alta complejidad

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