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Retrospektivna analiza drobljenja trdnih farmacevtskih oblik za aplikacijo po nazogastrični sondi pri postoperativnih bolnikih
ID Lisac, Jan (Author), ID Vovk, Tomaž (Mentor) More about this mentor... This link opens in a new window, ID Grošelj, Aleš (Comentor)

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Abstract
Enteralna sonda (ES) pogosto predstavlja edini način za prejem predpisane terapije bolnikom z oteženim požiranjem. Namen magistrske naloge je bil pri bolnikih, ki so bili v letu 2020 hospitalizirani na Kliniki za otorinolaringologijo in cervikofacialno kirurgijo (ORL), identificirati potencialne interakcije (PI) med zdravili s pomočjo programa Lexi-comp® in v Povzetkih glavnih značilnosti zdravila (SmPC) in literaturnem viru preveriti ustreznost terapije z vidika drobljenja trdnih farmacevtskih oblik (FO) za aplikacijo po ES. Dodatno smo želeli preveriti razumevanje pravilnega ravnanja pri aplikaciji zdravil po ES, kar smo izvedli z izdelavo vprašalnika za medicinsko osebje na ORL. Klinično pomembne interakcije (tipa D in X) smo zabeležili pri 58 bolnikih, ki so lahko požirali (per os), ter pri 122 bolnikih z vstavljeno ES. Pri obeh skupinah bolnikov skupaj se je interakcij tipa D pojavilo 284, interakcij tipa X pa 131. Pri obeh tipih interakcij smo najpogosteje identificirali kombinacije učinkovin z nesteroidnimi antirevmatiki (NSAR). Pri D tipu so to bile interakcije NSAR z aspirinom, escitalopramom in furosemidom, pogoste so bile tudi interakcije med učinkovinami z delovanjem na centralni živčni sistem kot so klometiazol, nitrazepam, tramadol in skopolamin. Pri interakcijah tipa X je bila najpogostejša interakcija med ibuprofenom in metamizolom (61,1 % vseh X-interakcij). Bolnikom z vstavljeno ES smo preverili ustreznost terapije (skupno 167 različnih trdnih FO) z vidika drobljenja zdravil za raztapljanje in aplikacijo po ES. Po SmPC je drobljenje tablet ali odpiranje kapsul dovoljeno pri 10 zdravilih (6,0 %), nedovoljeno ali nepriporočljivo pri 44 zdravilih (26,3 %), pri preostalih (67,6 %) pa ni navedeno. Po literaturnem viru je drobljenje tablet ali odpiranje kapsul dovoljeno pri 37 zdravilih (22,2 %) in nedovoljeno pri 20 zdravilih (12,0 %). Po vzoru francoske raziskave smo med medicinsko osebje na ORL razdelili 38 vprašalnikov, s katerimi smo preverili, kako v praksi poteka aplikacija zdravil po ES. Izpolnjenih vprašalnikov smo prejeli 31 (81,6 %). Zaposleni povečini vedo, da se tablet z oblogo ne sme drobiti, ustrezno je tudi raztapljanje v različnih medijih. Problematično je njihovo znanje o dajanju zdravil v povezavi s hrano, vprašljivi so tudi določeni higienski standardi. V prihodnje lahko izboljšanje aplikacije zdravil bolnikom z oteženim požiranjem dosežemo z oblikovanjem natančnejših navodil za drobljenje zdravil, z izogibanjem aplikacije kombinacij zdravil, ki vstopajo v klinično pomembne interakcije, in z vključitvijo (kliničnega) farmacevta v zdravstveni tim.

Language:Slovenian
Keywords:retrospektivna analiza, drobljenje, interakcije med zdravili, nazogastrična sonda
Work type:Master's thesis/paper
Organization:FFA - Faculty of Pharmacy
Year:2022
PID:20.500.12556/RUL-134880 This link opens in a new window
Publication date in RUL:10.02.2022
Views:1370
Downloads:193
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Secondary language

Language:English
Title:Retrospective analysis of crushing solid dosage forms for administration via nasoenteric tubes in postoperative patients
Abstract:
Enteral feeding tubes (EFTs) are often the only way for a patient with swallowing difficulties to receive prescribed therapy. The purpose of this master's thesis was to identify potential drug interactions (PIs) using the online Lexi-comp® program, and in the Summary of Product Characteristics (SmPC) and in the literature source to verify the adequacy of therapy in terms of crushing solid dosage forms (DF) for administration via EFT in patients admitted to the Clinic for Otorhinolaryngology and Cervicofacial Surgery (ORL) in 2020. In addition, the understanding of the correct preparation and administration of drugs via EFT was evaluated using a specially developed questionnaire for medical staff at the ORL. Clinically significant interactions (types D and X) were observed in 58 patients who were able to swallow (per os) and in 122 patients with inserted EFT. In both groups of patients, a total of 284 D-type interactions and 131 X-type interactions occurred. Combinations with non-steroidal anti-inflammatory drugs (NSAIDs) were most commonly identified in both types of interactions. In D-type interactions, these were NSAID interactions with aspirin, escitalopram, and furosemide, also common were interactions of NSAID with agents which affect the central nervous system such as clomethiazole, nitrazepam, tramadol, and scopolamine. In X-type interactions, the most common interaction was between ibuprofen and metamizole (61.1 % of all X- type interactions). Patients with inserted EFT were inspected if their therapy (167 different solid DFs) had been appropriate in terms of crushing drugs for dissolution and administration via EFT. According to the SmPC, crushing tablets or opening capsules is allowed for 10 drugs (6.0 %), forbidden or not recommended for 44 drugs (26.3 %), and not listed for the rest (67.6 %). According to the literature source, crushing tablets or opening capsules is allowed for 37 drugs (22.2 %) and not allowed for 20 drugs (12.0 %). Following the example of the French research, we distributed 38 questionnaires among the medical staff at the ORL, with which we checked how the application of drugs via EFT takes place in practice. We received 31 filled out questionnaires (81.6 %). Employees mostly know that coated tablets should not be crushed, and they are also aware of the proper way of dissolving them in different solutions. However, their knowledge of administration of drugs together with food is problematic, and certain hygiene standards are also questionable. In the future, the application of drugs to patients with difficulty swallowing can be improved by developing more detailed instructions for crushing drugs, by avoiding the use of combinations of drugs that are involved in clinically important interactions, and by including a (clinical) pharmacist in the medical team.

Keywords:retrospective analysis, crushing, drug interactions, nasoenteric tube

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