Analiza uporabe neopioidnih analgetikov in z njimi povezanih dejavnikov tveganja za neželene učinke pri internističnih bolnikih pred sprejemom v bolnišnico

Torkar, Katarina (author), Kerec Kos, Mojca (mentor), Jošt, Maja (comentor)

Neopioidni analgetiki spadajo med najpogosteje uporabljana zdravila pri nas, a njihova uporaba vodi do številnih neželenih učinkov. Večje tveganje za neželene učinke predstavlja uporaba nesteroidnih protivnetnih in protirevmatičnih zdravil (NSAR). V raziskavi smo analizirali uporabo neopioidnih analgetikov pred sprejemom v bolnišnico pri hospitaliziranih internističnih bolnikih na Kliniki Golnik. Pri bolnikih z NSAR smo dodatno opredelili prisotnost dejavnikov tveganja za neželene učinke na prebavila, ledvice in srčno-žilni sistem in na podlagi tega ocenili varnost jemanja omenjenih zdravil. Glavna vira podatkov sta bila bolnišnični informacijski sistem BIRPIS ter informacije, pridobljene tekom pogovorov z bolniki. V raziskavo smo vključili 306 bolnikov in od tega jih je 209 (68 %) jemalo neopioidne analgetike, ki so jih imeli večinoma (62 %) predpisane na recept, a le 14 % jih je jemalo redno. Bolniki so najpogosteje jemali paracetamol (45 %), sledila sta mu metamizol (15 %) in naproksen (14 %). Večini bolnikov so neopioidni analgetiki uspešno lajšali bolečine. 92 bolnikov (30 %) je jemalo NSAR, večinoma po potrebi in predpisane na recept. Ocenili smo, da je imelo 62 % bolnikov zmerno, 29 % bolnikov pa visoko tveganje za neželene učinke NSAR na prebavila. 5 od 61 bolnikov z zmernim tveganjem je neselektivne NSAR jemalo redno, brez gastroprotektivnega sredstva, kar glede na smernice ni ustrezno. V skupini 29 bolnikov z visokim tveganjem za neželene učinke na prebavila nihče ni jemal NSAR v skladu s smernicami, vendar sta imela izmed njih le dva bolnika NSAR v redni terapiji. Pri dveh bolnikih, ki sta imela visoko tveganje za neželene učinke na prebavila in sta jemala naproksen, smo zabeležili aktivno razjedo prebavil, kar je glede na smernice kontraindicirano. Z vidika tveganja za neželene učinke na ledvice smo zabeležili dva bolnika, pri katerih je jemanje NSAR kontraindicirano. Omenjena bolnika sta kljub močno zmanjšani ledvični funkciji (v območjih kronične ledvične bolezni 4. ali 5. stopnje) in starosti nad 65 let jemala NSAR. Dodatno je enemu izmed njiju je grozila še nevarnost akutne ledvične odpovedi zaradi sočasnega jemanje NSAR, diuretika in zaviralca angiotenzinske konvertaze. 4/15 bolnikov (27 %) z diagnozo srčnega popuščanja je jemalo za srčno-žilne zaplete problematične NSAR. Visoko stopnjo tveganja za srčno-žilne zaplete ob jemanju NSAR smo ocenili tudi pri bolnikih z diagnozo srčno-žilne bolezni ali srčnim infarktom oz. možgansko kapjo v preteklosti (43 %) in bolnikih, ki so imeli prisotne tri ali več dejavnike tveganja za srčno-žilne zaplete (38 %). Zaključimo lahko, da je bila uporaba NSAR pri večjem deležu bolnikov ustrezna, a kljub temu bi bilo potrebno v prihodnosti pred uvedbo NSAR več pozornosti nameniti tudi dejavnikom tveganja za pojav neželenih učinkov pri posameznem bolniku.

• Language: Slovenian
• Keywords: Neopioidni analgetiki, nesteroidna protivnetna in protirevmatična zdravila, neželeni učinki, dejavniki tveganja, zgodovina zdravljena z zdravili.
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2020
• PID: 20.500.12556/RUL-121729
• Publication date in RUL: 24.10.2020

Secondary language

• Language: English
• Title: Analysis of non-opioid analgesics use and related risk factors for adverse drug effects in internistic patients before hospital admission

Abstract

Non-opioid analgesics are one of the most commonly used medicines, but their use can lead to several adverse effects. A higher risk for those may especially represent the use of non-steroid anti-inflammatory drugs (NSAIDs). In the study, we have analyzed the use of non-opioid analgesics in internistic patients of University Clinic Golnik before hospital admission. Additionally, we have investigated the risk for adverse effects on digestive organs, kidneys, and cardiovascular system in patients with NSAIDs. Based on that, the safety of treatment with NSAIDs was assessed. The main sources of information were the hospital information system BIRPIS and conversations with the patients. The study included 306 patients and 209 of them (68%) had been taking non-opioid analgesics. Most of the patients (62%) had prescription for non-opioid analgesics, but only 14% of them had been taking them regularly. The most often used drug was paracetamol (45%), followed by metamizole (15%) and naproxen (14%). In most cases, non-opioid analgesics have successfully relieved the pain. 92 patients (30%) had been taking NSAIDs, mainly obtained on prescription and taken as needed. We have estimated that 62% of patients in our study had moderate risk and 29% had high risk for the adverse effects of NSAIDs on digestive organs. Five patients with moderate risk had been using NSAIDs regularly without gastroprotective drug, which is not appropriate according to the guidelines. No one in the group of 29 patients with high risk for adverse effects on digestive organs had been taking NSAIDs appropriately, but only two of them had NSAIDs in regular therapy. Two patients with high risk for adverse effects on digestive organs and with naproxen in their therapy, had an active gastrointestinal tract ulcer, which is contraindicated to NSAIDs according to the guidelines. Regarding the risk for adverse effects on kidneys, we have noted only two patients with contradictions for NSAIDs. Both had been taking NSAIDs despite their age above 65 years and severely reduced kidney function (stage 4 or 5 of chronic kidney disease). Additionally, one of them was exposed to the risk of acute kidney failure due to the concurrent use of an angiotensin converting enzyme inhibitor with a diuretic and a NSAID. 4/15 patients (27%) with heart failure diagnosis had been taking problematic NSAIDs. High risk for cardiovascular adverse effects of NSAID has been determined in patients, who've had heart attack/stroke in the past or had been diagnosed with cardiovascular disease (43%), and patients, which had three or more risk factors for cardiovascular complications (38%). Based on the results of this study we can conclude that the use of NSAIDs was suitable in most cases. Nevertheless, before the prescription of NSAID we recommend more attention to the patient’s risk factors for adverse effects.

• Keywords: Non-opioid analgesics, nonsteroidal anti-inflammatory drugs, adverse effects, risk factors, medication history.