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Uporaba nesteroidnih antirevmatikov pri starostnikih na kirurškem oddelku Splošne bolnišnice Novo mesto : diplomska naloga
Brkopec, Mateja (Author), Kerec Kos, Mojca (Mentor) More about this mentor... This link opens in a new window, Tomšič, Tanja (Co-mentor)

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Abstract
Nesteroidni antirevmatiki sodijo med najpogosteje uporabljena zdravila na svetu. Po sestavi so raznolika skupina zdravil, ki jih uporabljamo za zdravljenje bolečine, vnetja in zvišane telesne temperature. Najpogostejši neželeni učinki nesteroidnih antirevmatikov so vezani na prebavila, lahko pa se pojavi tudi poslabšanja ledvične bolezni, arterijska hipertenzija, srčno popuščanje in jetrna ciroza. Namen naloge je bil retrospektivno pregledati uporabo sistemsko apliciranih nesteroidnih antirevmatikov pri bolnikih, starih 65 let in več, ki so se v novembru 2015 zdravili na Kirurškem oddelku Splošne bolnišnice Novo mesto. Opredelili smo ustreznost predpisanega antirevmatika glede na indikacijo, stopnjo bolečine, ledvično funkcijo, sočasne bolezni in sočasno terapijo. Pri ustreznosti predpisovanja zdravil za starostnike smo upoštevali Beersove kriterije, START/STOP kriterije in Priscus listo. Podatke o bolnikih, vključenih v raziskavo, smo pridobili iz temperaturnih listov, programa Birpis in programa K22, ki je program za analizo podatkov v Splošni bolnišnici Novo mesto. V raziskavo je bilo zajetih 109 bolnikov, s povprečno starostjo 76 let. Peroralno je bil najpogosteje predpisan ibuprofen, intravensko pa ketoprofen. Poleg nesteroidnih antirevmatikov je 86,2 % bolnikov dobivalo še dodatno protibolečinsko terapijo, najpogosteje kombinacijo paracetamola in tramadola ter Na-metamizolat. Glede na ocenjeno hitrost glomerulne filtracije so bili pri treh bolnikih nesteroidni antirevmatiki kontraindicirani, pri 17 bolnikih pa je bila potrebna previdnost pri predpisovanju NSAR. Glede na ocenjeno stopnjo bolečine z vizualno analogno skalo je bila protibolečinska terapija pri bolnikih v večini primerov ustrezna. Pri sočasni terapiji smo se osredotočili na antihipertenzive in zdravila, ki vplivajo na strjevanje krvi. Prevladovali so antihipertenzivi, kar je pričakovano glede na to, da je 68 bolnikov imelo arterijsko hipertenzijo. Primernost sočasnega zdravljenja z antihipertenzivi in nesteroidnimi antirevmatiki nismo mogli določiti, ker iz medicinske dokumentacije nismo mogli ugotoviti ali je hipertenzija pri bolnikih urejena ali ne. Pogosta so bila tudi zdravila z vplivom na strjevanje krvi, med antitrombotiki je prevladovala ASK (18 bolnikov), med antikoagulanti pa dalteparin (40 bolnikov). Ti bolniki so nesteroidni antirevmatik dobivali najkrajši možni čas in v najnižjem odmerku. Glede na Priscus listo so bili vsi nesteroidni antirevmatiki predpisani ustrezno. Glede na Beersove kriterije je bilo predpisovanje neustrezno pri 15 bolnikih, glede na Start/Stop kriterije pa pri 52 bolnikih. Glavni problem je bila nezaščita želodca ob jemanju nesteroidnih antirevmatikov.

Language:Slovenian
Keywords:farmacija zdravila vnetja antirevmatiki nesteroidni antirevmatiki
Work type:Undergraduate thesis (m5)
Tipology:2.11 - Undergraduate Thesis
Organization:FFA - Faculty of Pharmacy
Year:2016
Publisher:[M. Brkopec]
Number of pages:IX, 52 f.
UDC:615.275-053.9(043.2):616-009.7
COBISS.SI-ID:2048269061 Link is opened in a new window
Views:68
Downloads:23
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Secondary language

Language:English
Title:The use of nonsteroidal anti-inflammatory drugs in elderly patients at the surgical ward of General Hospital Novo mesto
Abstract:
Nonsteroidal anti-inflammatory drugs are one of the most commonly used drugs in the world. According to the composition, they are a diverse group of medicines, which are used for pain treatment, inflammation and fever. The most common side effects of nonsteroidal anti-inflammatory drugs manifest itself in the digestive system, but clinically very important and often overlooked are the deterioration of kidney disease, arterial hypertension, heart failure and liver cirrhosis. The thesis purpose was to retrospectively check the use of systematically applied nonsteroidal anti-inflammatory drugs with patients, aged 65 and older, who were treated in November 2015 in the surgical department of the General Hospital Novo mesto. We defined the prescribed anti-inflammatory drug’s suitability according to the indication, the level of disease, kidney function, simultaneous disease and simultaneous therapy. At suitability of prescribing medicine for elderly, we considered the Beers criteria, the START/STOP criteria and the Priscus list. Patients’ data, included in the research, will be acquired from their temperature’s lists, the Birpis programme and K22 programme for data’s analysis in the General Hospital Novo mesto. The study included 109 patients with an average age of 76 years. Ibuprofen was the most commonly prescribed drug, which is used orally and ketoprofen was applied intravenously. Beside nonsteroidal anti-inflammatory drugs, 86,2% of patients received an additional painkiller therapy, which was often a combination of paracetamol, tramadol and Na-metamizole. Nonsteroidal anti-inflammatory drugs were contraindicated with three patients according to the estimated speed of glomerular filtration. An extra caution with prescribing NSAID was needed with 17 patients according to the glomerular filtration’s speed. Regarding the estimated level of pain with visual analogue’s scale, the patients’ painkiller therapy was suitable in most cases. We focused on the simultaneous therapy which encompasses anti-hypertensives and drugs that affect blood coagulation. Anti-hypertensives prevailed, which is expected according to the fact that 68 patients had an arterial hypertension. Patients with anti-hypertensives in the therapy received different nonsteroidal anti-inflammatory drugs. We were not able to accurately assess whether this was appropriate or not, because we were unable to determine from the data whether hypertension is regulated or not. Medicines with an effect on blood coagulation were also very common, among antithrombotics, ASK prevailed (18 patients) and among anticoagulant, dalteparin prevailed (40 patients). These patients received a nonsteroidal anti-inflammatory drug the shortest time possible and in the lowest dose. According to the Priscus list, all nonsteroidal anti-inflammatory drugs were suitably prescribed. Prescribing was unsuitable with 15 patients according to the Beers criteria and with 52 patients according to the Start/Stop criteria.


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