20.500.12556/RUL-167061 Vloga kliničnega farmacevta pri optimizaciji farmakoterapije bolnikov s težavami pri požiranju v Splošni bolnišnici Jesenice Clinical pharmacist’s role in optimizing pharmacotherapy of patients with swallowing difficulties at the Jesenice General Hospital Pri bolnikih s težavami pri požiranju in/ali vstavljeno sondo za enteralno hranjenje je pogosto potrebno prilagoditi velikost ali konsistenco trdnih peroralnih farmacevtskih oblik. Zdravstveni delavci smejo poseči v zdravilo z drobljenjem (odpiranjem) in/ali dispergiranjem skladno s Povzetkom glavnih značilnosti zdravila. S tem namreč vplivajo na farmakokinetiko zdravila in posledično na doseganje želenih terapevtskih izidov zdravljenja. Namen magistrske naloge je bil retrospektivno ovrednotiti ustreznost predpisanih zdravil za peroralno uporabo pri bolnikih s težavami pri požiranju, ki so bili v letih od 2021 do 2023 hospitalizirani na internem oddelku v Splošni bolnišnici Jesenice. V raziskavo smo vključili polnoletne bolnike z vsaj enim predpisanim zdravilom v trdni peroralni farmacevtski obliki. Potrebne podatke smo pridobili iz bolnišnične zdravstvene dokumentacije. V raziskavo smo vključili 151 bolnikov (mediana starosti 75 let, 54,3 % moških). Skoraj polovica bolnikov (47,0 %; 71/151) je imela vstavljeno perkutano endoskopsko gastrostomo. Nekaj več kot polovica trdnih peroralnih farmacevtskih oblik, ki so bile bolnikom predpisane med hospitalizacijo (53,7 %; 564/1050), je bila primernih za drobljenje (odpiranje) in dispergiranje. V zdravilih, primernih za drobljenje (odpiranje) in dispergiranje, je bil najpogosteje predpisan esomeprazol, v neprimernih zdravilih pa acetilsalicilna kislina. V farmakoterapiji bolnikov smo zaznali potencialne interakcije med zdravili, in sicer 17,0 % (26/153) tipa X in 83,0 % (127/153) tipa D. Zaradi pomanjkanja kadra v bolnišnici je klinični farmacevt opravil farmakoterapijski pregled le pri 25,2 % hospitaliziranih bolnikov (38/151). Skupno je podal 251 navodil za pravilno aplikacijo zdravil po sondi za enteralno hranjenje in 161 predlogov intervencij za optimizacijo farmakoterapije. Med intervencijami so bili najpogostejši predlogi za zamenjavo farmacevtske oblike (48,4 %; 78/161) in zamenjavo zdravilne učinkovine (32,3 %; 52/161). Zdravniki so sprejeli vse predlagane intervencije za uvedbo zdravila, znižanje odmerka in zamenjavo poti aplikacije zdravila ter več kot polovico predlogov za ukinitev zdravila. Ostale predlagane intervencije so upoštevali v manj kot polovici primerov. Bolniki, pri katerih so zdravniki upoštevali večino priporočil kliničnega farmacevta, so ob odpustu iz bolnišnice prejemali značilno večje število trdnih peroralnih farmacevtskih oblik, primernih za drobljenje (odpiranje) in dispergiranje, kot tisti, pri katerih klinični farmacevt ni opravil farmakoterapijskega pregleda (Mann-Whitney U-test, p < 0.05). In patients with swallowing difficulties and/or enteral feeding tubes, it is often necessary to adjust the size or consistency of solid oral dosage forms. Healthcare professionals can modify the medicine by crushing (opening) and/or dispersing it in accordance with the Summary of Product Characteristics. Namely, this can affect the drug pharmacokinetics and treatment outcomes. The purpose of the master's thesis was to retrospectively evaluate the accuracy of prescribed oral medicines for patients with swallowing difficulties who were hospitalized in the internal department at the General Hospital Jesenice between 2021 and 2023. We included adult patients with at least one prescribed medicine in solid oral dosage form. The data were obtained from hospital medical documentation. 151 patients were included in the study (median age 75 years, 54.3% male). Almost half of the patients (47.0%; 71/151) had a percutaneous endoscopic gastrostomy. Slightly more than half of the solid oral dosage forms prescribed to patients during hospitalization (53.7%; 564/1050) were suitable for crushing (opening) and dispersing. The most frequently prescribed drug in medicines suitable for crushing (opening) and dispersing was esomeprazole, while acetylsalicylic acid was the most frequently prescribed unsuitable medicine. We detected potential drug interactions in the pharmacotherapy: 17.0% (26/153) of type X and 83.0% (127/153) of type D. Due to lack of staff in the hospital, the clinical pharmacist conducted a pharmacotherapy review in only 25.2% of hospitalized patients (38/151). The pharmacist provided 251 instructions for the correct administration of medicines via enteral feeding tube and suggested 161 interventions for pharmacotherapy optimization. The most common interventions were changes of the dosage form (48.4%; 78/161) and changes of the drug substance (32.3%; 52/161). Physicians accepted all suggested interventions for the addition of a new medicine, dosage reduction, change of administration route, and more than half of the proposals for discontinuation of the medicine. Less than half of other suggested interventions were accepted. Patients whose physicians accepted the majority of the clinical pharmacist’s recommendations were discharged with a significantly higher number of solid oral pharmaceutical forms suitable for crushing (opening) and dispersing compared to patients without pharmacotherapy review by the clinical pharmacist (Mann-Whitney U-test, p < 0.05). disfagija nazogastrična sonda perkutana endoskopska gastrostoma farmacevtska oblika farmakoterapijski pregled klinični farmacevt dysphagia nasogastric tube percutaneous endoscopic gastrostomy pharmaceutical form pharmacotherapy review clinical pharmacist true false false Slovenski jezik Angleški jezik Magistrsko delo/naloga 2025-02-06 07:45:05 2025-02-06 07:45:12 2025-02-07 03:59:56 0000-00-00 00:00:00 2025 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1970-01-01 114567 26830.pdf 26830.pdf 1 033CC6D739EEC201968BDFAE9AB9D962 dd6102735bb2b28111112fde80175619b8d05ea7cfb8df58448ee181a9243119 1200423e-e455-11ef-b232-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=199207 Fakulteta za farmacijo 0 0 0