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Ocena možnosti zmanjšanja intenzivnosti zdravljenja z zaviralci protonske črpalke in ovrednotenje njihovih potencialnih interakcij pri bolnikih na Kliniki Golnik
ID Ravbar, Nina (Author), ID Knez, Lea (Mentor) More about this mentor... This link opens in a new window

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Abstract
Zaviralci protonske črpalke sodijo med najpogosteje uporabljena zdravila v Sloveniji. Zdravljenje pogosto ni skladno s smernicami, saj se velikokrat uporabljajo brez veljavne indikacije in dlje od priporočenega. Nepotrebna uporaba predstavlja stroškovno obremenitev, tveganje za dolgotrajne neželene učinke in potencialne interakcije z zdravili. Namen raziskave je bil, pri odraslih internističnih bolnikih, hospitaliziranih na Kliniki Golnik, opisati značilnosti zdravljenja z zaviralci protonske črpalke, oceniti možnosti zmanjšanja intenzivnosti tega zdravljenja in s strokovnim panelom ovrednotiti klinično pomembnost interakcij med zaviralci protonske črpalke in ostalimi zdravili. Podatke o bolnikih smo pridobili iz bolnišničnega informacijskega sistema ter iz zgodovine zdravljenja z zdravili. Interakcije med zdravili smo iskali s podatkovnimi zbirkami interakcij med zdravili (Drugs.com in Lexicomp), njihovo klinično pomembnost smo nato ocenili s strokovnim panelom kliničnih farmacevtov. Od 555 pregledanih bolnikov jih je 227 prejemalo zaviralce protonske črpalke (40,9 %). Od teh 227 bolnikov jih je 73,1 % prejemalo pantoprazol, najpogosteje v dvakratnem odmerku (52,9 %), večinoma so jih jemali redno (87,7 %) in dlje kot eno leto (74,4%). Najpogostejši indikaciji za zdravljenje sta bili gastroezofagealna refluksna bolezen (37,4 %) in preventivna uporaba ob jemanju nesteroidnih antirevmatikov (32,2%). Večina bolnikov (74,2 %) ni imela zdravljenja skladnega s smernicami in pri 60,0 % bolnikov bi lahko zmanjšali intenzivnost zdravljenja z zaviralci protonske črpalke bodisi z ukinitvijo (38,3 %) ali znižanjem odmerka (21,7 %). Pri 85,5 % bolnikov smo zaznali vsaj eno interakcijo, mediana števila zaznanih interakcij pri eni osebi je znašala 2. Skupno smo pri bolnikih odkrili 76 različnih interakcij, izmed katerih je strokovni panel ocenil 3 kot zelo pomembne. To so interakcije med klopidogrelom in esomeprazolom/omeprazolom ter rifampicinom in omeprazolom. Veliko bolnikov jemlje zaviralce protonske črpalke in pri več kot polovici bolnikov je možno zmanjšanje intenzivnosti zdravljenja. Interakcije z zaviralci protonske črpalke so pogoste, vendar le redko klinično pomembne.

Language:Slovenian
Keywords:zaviralci protonske črpalke, zmanjšanje intenzivnosti zdravljenja, nesteroidni antirevmatiki, gastroezofagealna refluksna bolezen, interakcije
Work type:Master's thesis/paper (mb22)
Organization:FFA - Faculty of Pharmacy
Year:2021
PID:20.500.12556/RUL-134131 This link opens in a new window
Publication date in RUL:24.12.2021
Views:493
Downloads:241
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Secondary language

Language:English
Title:Assesing the possibility of deprescribing proton pump inhibitors and evaluanting their potential interactions in patients at the University Clinic Golnik
Abstract:
Proton pump inhibitors are among the most commonly used medications in Slovenia. Their use is often outside treatment guidelines, being used without a valid indication and longer than recommended. Unnecessary use represents a financial burden, a risk of long-term side effects, and potential drug interactions. Our study aimed to describe the characteristics of treatment with proton pump inhibitors in adult medical patients, hospitalised at the University Clinic Golnik, assess the possibilities of deprescribing, and evaluate clinically important drug interactions with proton pump inhibitors. Patient data were obtained from the hospital information system and patients' medication history. Drug interactions were searched in drug interaction databases (Drugs.com and Lexicomp), and their clinical significance was assessed by an expert panel of clinical pharmacists. Of the 555 patients screened, 227 received proton pump inhibitors (40.9%). From these 227 patients, 73.1% received pantoprazole, often as a double dose (52.9%), used it regularly (87.7%) and for over one year (74.4%). The most common indications for proton pump inhibitors’ use were gastroesophageal reflux disease (37.4%) and prevention of gastrointestinal ulcers while on non-steroidal anti-inflammatory drugs (32.2%). In the majority of patients (74.2%) treatment was not in line with guidelines, allowing drug deprescribing in 60.0% of patients, by either discontinuation (38.3%) or dose reduction (21.7%). In total, 2102.01EUR could be saved every year if said changes were implemented. At least one interaction was detected in 85.5% of patients, with a median of 2 interaction per patient. Overall, 76 different interactions were detected, and 3 were identified by the expert panel as clinically very important. These were the interactions between clopidogrel and esomeprazole/omeprazole, and rifampicin and omeprazole. Many patients are prescribed proton pump inhibitors, and drug deprescribing is possible in over half of these patients. Drug interactions with proton pump inhibitors are common, however only rarely clinically important.

Keywords:proton pump inhibitors, deprescribing, nonsteroidal anti-inflammatory drugs, gastroesophageal reflux disease, interactions

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