Sewage epidemiology is increasingly becoming an alternative method of estimating drug usage and consumption patterns for a given population. With the constant emergence of new psychoactive substances such as cathinones and piperazines, versatile, reliable, specific and sensitive analytical methods are needed for their detection in complex matrices such as waste water. This thesis reports the development of an analytical method based on solid phase extraction, derivatization with pentafluoropropionic anhydride and analysis by gas chromatography-mass spectrometry for the simultaneous analysis of 29 illicit and therapeutic drugs of abuse. All 29 drugs could be reliably identified in spiked waste water samples using selected ion monitoring and splitless injection. Recoveries for the majority of the drugs were above 70 %. Linearity varied based on the analyte but was assessed in the range 2.0 x 10-4 to 1.4 μg/mL. Intra-assay and intermediate precision of the instrument was determined at 0.005, 0.1 and 1.0 μg/mL, with the majority of relative standard deviations less than 10 %. Limits of detection and quantification for drugs such as amphetamine and methamphetamine were better than reported values for liquid chromatography-tandem mass spectrometry, a more commonly used technique. Untreated 72 h composite waste water samples from Cambridge, UK, were analysed using a six-point standard addition curve. Eleven drugs of abuse were detected, including amphetamine, methamphetamine, butylone and 4-fluoromethamphetamine. The latter two having been detected for the very first time in waste water. Using the validated method, the consumption of heroin, ketamine, cocaine, methamphetamine and amphetamine, in Cambridge, UK, was estimated to be 399.4 ± 90.8, 2463.5 ± 182.5, 195.5 ± 95.4, 84.3 ± 59.1 and 38.9 ± 24.8 mg/day per 1000 inhabitants. This is the first reported validated method for the detection of both classic drugs of abuse and new psychoactive substances in waste water using gas chromatography-mass spectrometry and derivatization with pentafluoropropionic anhydride.

Title: Analysis of self-medication with antibiotics in Kosovo Student: Ardita Veseli Supervisor: Prof. PharmDr. Jiří Vlček, Ph.D. Specialist Supervisor: Mgr. T. Belkina Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Background: Self-medication is described as a behavior during which someone utilizes drugs for the purpose of treating self-diagnosed symptoms or disorders or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms. When certain individuals self-medicate with antibiotics, they do it without any prior consultation with a physician. The antibiotics are bought from community pharmacies without a prescription, left-over antibiotics are used or they simply decide to follow the advice given from family members, neighbors or friends. Even though antibiotics are considered revolutionary therapeutic agents in order to eradicate microbes, the repeated and improper antibiotic consumption is contributing to the increased prevalence of antibiotic resistance which nowadays is one of the world's most pressing health problems. Aim: The main goal of the theoretical part is to describe self-medication with antibiotics, the patterns influencing it and some complications associated with this...

Charles University in Prague Faculty of Pharmacy in Hradec Kralove Department of Social and Clinical Pharmacy The analysis of pharmacotherapy in patients suffering from hyperlipidemia (Diploma Thesis) Mentor of Diploma Thesis Prof. PharmDr. Jiří Vlček, Ph.D. Mavrovouniotis Konstantinos- Parmenion Hradec Králové 2015 ABSTRACT ENGLISH The analysis of pharmacotherapy in patients suffering from hyperlipidemia Mavrovouniotis Konstantinos Mentor: Prof. Dr. Jiří Vlček, CSc. Introduction: Hyperlipidemia is a serious condition whereby the blood levels of lipids, cholesterol and triglycerides are abnormally elevated. This condition is generally asymptomatic but may lead to atherosclerotic heart disease and other types of cardiovascular pathology if not treated effectively. Various risk factors can affect the onset and severity of hyperlipidemia and those include genetic predisposition, hypertension, diabetes mellitus, obesity, poor diet, lack of regular exercise, smoking etc. Measurement and monitoring of blood levels of triglycerides, cholesterol and lipoproteins can be used as prevention method for assessing the risk for an individual to develop hyperlipidemia. Once a patient is diagnosed with the condition several approaches exist for the treatment. The main goal of the treatment is to reduce the risk of...

Um aspecto marcante do mercado brasileiro de medicamentos benzodiazepínicos é o largo emprego das associações medicamentosas de venda livre conhecidas genericamente como \"antidistônicos\". Sua composição só difere daquela dos ansiolíticos e hipnóticos de venda controlada pelo acréscimo de pequenas doses anticolinárgico e/ou antiespasmódico; as razões da ausência de controle sobre suas vendas são essencialmente não-médicas. Assim, quando se discute o consumo de benzodiazepínicos no Brasil, deve-se fazer distinçã entre os ansiolíticos e hipnóticos de venda livre ou controlada. No período de 1970 a 1985 a tendência do consumo de benzodiazepinas no mercado brasileiro - medida através do número de doses médias diárias consumidas por 1000 habitantes de 15 ou mais anos de idade apresentou três fases. Entre 1970 e 1976 observou-se um crescimento da ordem de 22 por cento ao ano, devido, em sua maior parte, aos antidistônicos que cresceram a uma taxa média anual de 54 por cento . Entre 1976 e 1980 estas taxas de crescimento continuaram sendo positivas, mas seus valores cairam significativamente (4,4 por cento e 4,7 por cento respectivamente). A partir de 1980, inverte-se a tendência; até 1984 observaram-se taxas negativas (-2 por cento e -3,6 por cento , respectivamente). Popularizados a partir do fim da década de 60, os antidistônicos representam, hoje em dia, 47 por cento do consumo de todas as benzodiazepinas. Entre 1970 e 1985 o consumo de ansiolíticos variou de 4,1 a 7,9 DMD/1000hab/dia; o consumo de hipnóticos variou 1,7 a 2,1 DMD/10000hab/dia e o de antidistônicos de 1,5 a 9,7 DMD/1000hab/dia. Nesse período as preferências têm recaído sobre os derivados benzodiazepínicos que hoje em dia representam 97 por cento do consumo de tranquilizantes menores. Os baixos valores do consumo de hipnóticos devem-se, em grande parte, ao fato de, o fenobarbital, largamente empregado como hipnótico no Brasil, estar classificado no grupo de medicamentos anticonvulsivantes; o consumo dos demais barbitúricos é insignificante. Utilizando como parâmetro da expansão dos serviços de assistência a evolução do consumo de alguns grupos de medicamentos cujo emprego se faz sempre sob supervisão médica, verificamos que o crescimento do consumo de benzodiazepinas, entre 1970 e 1980, foi maior do que aquele que poderia ser esperado se eles acompanhassem as tendências gerais do setor saúde. As maiores restrições impostas, a partir de 1984, à prescrição de tranquilizantes menores resultou numa redução do consumo de benzodiazepinas controladas e um concomitante aumento das vendas de antidistônicos. No período de 1980 a 1983 todo o mercado brasileiro de medicamentos esteve retraído coincidindo com o período de recessão econômica. A retomada do crescimento de vendas começou a ocorrer a partir de 1984 na maioria dos grupos estudados. Não é possível concluir se a persistência da queda do consumo de benzodiazepinas foi primariamente devida às mudanças da legislaçio sanitária ou se ela indica uma tendência à redução mais definitiva do largo emprego dessas drogas. / One of the distinctive features in the brazilian market of benzodiazepines is the large use of hidden-psychotropics sold over-the counter (generally known as \"antidistonics\"). The only difference they have as related to the controlled preparations of benzodiazepines are the small doseS of anticholinergic agents; there are nonmedical reasons to explain why \"antidistonics\" have their use not controlled. Therefore, to discuss the consumption of benzodiazepines in Brazil, one should make a distinction between \"free\" and \"controlled\" minor tranquilizers. Between 1970 and 1985 the trends in the consumption of benzodiazepines in Brazil - as measured through the \"medium daily dosis\" per 1000 persons over 15 years - showed three phases. Between 1970 and 1976 a 22 per cent annual increase, greatly due to the \"antidistonics\" which increased at a 54 per cent annul rate. Between 1976 and 1980 those rates were still positives, but significantly smaller (4.4 per cent and 4.7 per cent ) As from 1980, until 1984 there was downward trend (-2.0 per cent and -3.6 per cent ). Very popular since the end of sixties, \"antidistonics\" nowadays represent 47 per cent of the whole use of benzodiazepines. Between 1970 and 1985 the consumption of controlled antianxiety drugs increased from 4.1 to 7.9 DMD/1000/day; consumption figures for hypnotics increased from 1.7 to 2.1 DMD/1000/day and for \"antidistonics\", from 1.5 to 9.7 DMD/100/day. In the last 15 years benzodiazepinas became the most widely used antianxiety and hypnotic agents; presently they represent 97 per cent of the consumption of minor tranquilizers. Low figures for consumption of hypnotics is largely due to the fact that fenobarbital, largely used as an hypnotic in Brazil, is classified among the antiepileptic drugs; the consumption of other barbiturates is not significant. When we take the consumption of drugs used on strict medical supervision as a parameter of the extent of medical care services, we conclude that the growth of the consumption of benzodiazepines between 1970 and 1980 was bigger than one might expect if they followed the general trends of the health sector. Increased restriction on minor tranquilizers\' prescriptions set in 1984, provoked a decrease in the consumption of \"controlled\" benzodiazepines and an increased in \"free\" diazepines sales. Between 1980 and 1983 the whole pharmaceutical market was inhibited by economic recession. Most of the groups included in this study had their sales recovered in 1984. Benzodiazepines sales continued to decline; it is impossible to conclude whether this decrease has due to the new regulations of if they represent a more definite trend.

O autor faz uma análise crítica do consumo de medicamentos psicotrópicos e apresenta os resultados de um inquérito epidemiológico realizado no Distrito de São Paulo com vistas a determinar os níveis de prevalência e incidência do consumo destes medicamentos, os padrões de consumo, os tipos de medicamentos mais frequentemente utilizados e a associação do uso de psicotrópicos a algumas variáveis sócio-demográficas. Inicialmente discute os aspectos psico-sociais da ansiedade chamando a atenção para o risco da utilização de ansiolíticos, hipnóticos e sedativos para o alívio da ansiedade objetiva, a qual representa uma resposta de defesa do indivíduo frente ao seu meio ambiente; defende a idéia de que esta forma de ansiedade é útil e necessária ao Homem e que a utilização indiscriminada de medicamentos psicotrópicos para o seu alívio representa um prejuízo para o desenvolvimento emocional individual e para a progressão teleológica da sociedade. Discute aspectos do mercado destes medicamentos apontando os papéis desempenhados pelos principais envolvidos em uma complexa relação de interesses: a indústria farmacêutica, a classe médica, os pacientes e os proprietários de farmácias. Em relação ao mercado brasileiro, discute o importante segmento ocupado pelos produtos classificados como \"antidistônicos\" que, a seu ver, representam uma forma disfarçada de colocação no mercado de produtos psicotrópicos cuja venda escapa aos rigores da legislação que regula a prescrição e aquisição de medicamentos contendo substâncias psicotrópicas. O inquérito epidemiológico realizado em 1976-1978 indica que entre 3690 indivíduos de 16 ou mais anos de idade pertencentes a 1345 famílias a prevalência de consumo no último ano foi de 122,2/1000 habitantes (75,7/1000 para o sexo masculino e 163,2/1000 para o sexo feminino). A incidência de novos consumidores nos últimos 30 dias foi 7,6/1000 habitantes (5,8/1000 para o sexo masculino e 9,2/1000 para o sexo feminino). Observou-se uma tendência ao crescimento dos níveis de consumo com a idade e valores de prevalência de consumo sempre maiores entre as mulheres do que entre os homens (produto cruzado igual a 2,38). A idade média dos consumidores de psicotrópicos é 5,13 anos superior a dos não consumidores. A prevalência de consumo nas áreas geográficas de melhor qualidade de vida é 62 por cento superior àquela das áreas de menor qualidade de vida. Foram observados três padrões característicos de consumo: o uso regular (56,1 por cento dos consumidores), o uso esporádico (38,1 por cento dos consumidores) e o uso episódico (4,4 por cento dos consumidores). Os consumidores esporádicos tendem a ser mais constantes no seu comportamento do que os consumidores regulares e episódicos. Os medicamentos ansiolíticos, hipnóticos e sedativos são os mais frequentemente usados (86,5 por cento cos casos) e, pelo menos, 62,6 por cento deles podem ser adquiridos sem a apresentação de receita médica. Somente os derivados da benzodiazepina (ansiolíticos e hipnóticos) representam\' 72,8 por cento de todos os produtos consumidos. Em 81,6 por cento dos casos o uso se deu por indicação médica, em 2,7 por cento dos casos a indicação foi do \"farmacêutico\", em 4,4 por cento dos casos a indicação foi de um parente ou conhecido e em 10,2 por cento dos casos foi o próprio usuário que decidiu a indicação. Dentre os médicos, são os clínicos gerais os que mais prescrevem psicotrópicos (57,4 por cento do total) e eles têm clara preferência pelos produtos livres de controle de receituário. Há indícios de que possa haver maiores níveis de consumo entre mulheres com vínculo matrimonial rompido (viúvas, separadas e desquitadas) na faixa etária de 30 a 50 anos. Outrossim, foram observados maiores níveis de consumo em pessoas com menor grau de instrução. Não foi encontrada qualquer relação entre consumo de medicamentos e as condições de habitação (medidas pelo índice de aglomeração). / The author critically analyzes the consumption of psychotropic drugs and also presents the results of an epidemiological survey taken within the District of São Paulo, which was performed in order to determine the prevalence and incidence of the consumption of such drugs, the consumption patterns, the types of medications most frequently taken, and to determine a relation between the use of psychotropics and social demographic variables. First, some psycho-social aspects of anxiety are presented, emphasizing the risks involved when minor tranquilizers, hypnotics, and sedatives are used to relieve objective anxiety, which is the normal individual\'s defense reaction against the agressions of his environment. It sunports the idea that such anxiety is constructive and necessary for man and that the carefree utilization of psychotropic medications will thus harm, both the individual\'s emotional development and the teleological progress of society. The psychopharmaceutical rnarket is then discussed, pointing out the complex relationships among those involved and their various interests: the pharmaceutical industry, the medical class, the patients, and the pharmacy proprietors. In respect to the Brazilian market, those products classified as \"antidistônicos\", (hidden psychotropics), are discussed as a disguised way to legally sell psychotropic drugs over the counter and escape laws applying to their purchase and prescription. The epidemiological survey taken during the years 1976-1978 indicates that 3690 participants, 16 years or older ano distributed among 1345 families, showed a consumption prevalence in the last year of 122.2/1000 inhabitants, (75.7/ 1000 for males ano 163.2/1000 for females). In the last 30 days the incidence of new consumers was 7.6/1000 inhabitants. There is an increasing tendency observed in correspondence to the consumption level and age. Furthermore, the prevalence values are always higher for females than for males, (cross product is equivalent to 2.38); the mean age of psychotropic consumers is 5.13 years higher than nonconsumers. In the geoqraphic areas with a higher standard of living, the consumption prevalence is 62 per cent greater than in those areas with a lower standard of living. Three consumption patterns are characterized: the regular use (56.1 per cent of the consumers), the sporadic use (38.l per cent of the consumers), and the episodic use (4.4 per cent of the consumers). The sporadic consumers tend to have a more consistent behavior compared to those considered regular or episodic consumers. Minor tranquilizers, hypnotics, and secatives are found as being the medications most frequently used, (86.5 per cent of the cases), with at least 62.6 per cent of them purchasable over the counter. Those drugs derived from benzodiazepine, (i.e., minor tranquilizers and hypnotics), alone represent 72.8 per cent of all the medications consumed. In 81.6 per cent of the cases, the medications were taken under a doctor\'s prescription, 2.7 per cent of the cases occurred due to a pharmacist\'s indication, in 4.4 per cent of the cases a relative or friend had suggested the use of the medication, and in 10.2 per cent of the cases the user himself had prescribed the medication. Among physicians, psychotropics are more ofter prescribed by general practitioners, (57.4 per cent of the total cases), whose preference is clearly given to those products freely sold over the counter. There is indication given that women with broken marriages, (widowed, seperated, or divorced), within the age group of 30 to 50 years, have a higher consumption level. High levels of consumption are also observed among less educated persons. No association was found between the consumption of psychotropics and habitation conditions, (measured by the conglomeration index).

O autor faz uma análise crítica do consumo de medicamentos psicotrópicos e apresenta os resultados de um inquérito epidemiológico realizado no Distrito de São Paulo com vistas a determinar os níveis de prevalência e incidência do consumo destes medicamentos, os padrões de consumo, os tipos de medicamentos mais frequentemente utilizados e a associação do uso de psicotrópicos a algumas variáveis sócio-demográficas. Inicialmente discute os aspectos psico-sociais da ansiedade chamando a atenção para o risco da utilização de ansiolíticos, hipnóticos e sedativos para o alívio da ansiedade objetiva, a qual representa uma resposta de defesa do indivíduo frente ao seu meio ambiente; defende a idéia de que esta forma de ansiedade é útil e necessária ao Homem e que a utilização indiscriminada de medicamentos psicotrópicos para o seu alívio representa um prejuízo para o desenvolvimento emocional individual e para a progressão teleológica da sociedade. Discute aspectos do mercado destes medicamentos apontando os papéis desempenhados pelos principais envolvidos em uma complexa relação de interesses: a indústria farmacêutica, a classe médica, os pacientes e os proprietários de farmácias. Em relação ao mercado brasileiro, discute o importante segmento ocupado pelos produtos classificados como \"antidistônicos\" que, a seu ver, representam uma forma disfarçada de colocação no mercado de produtos psicotrópicos cuja venda escapa aos rigores da legislação que regula a prescrição e aquisição de medicamentos contendo substâncias psicotrópicas. O inquérito epidemiológico realizado em 1976-1978 indica que entre 3690 indivíduos de 16 ou mais anos de idade pertencentes a 1345 famílias a prevalência de consumo no último ano foi de 122,2/1000 habitantes (75,7/1000 para o sexo masculino e 163,2/1000 para o sexo feminino). A incidência de novos consumidores nos últimos 30 dias foi 7,6/1000 habitantes (5,8/1000 para o sexo masculino e 9,2/1000 para o sexo feminino). Observou-se uma tendência ao crescimento dos níveis de consumo com a idade e valores de prevalência de consumo sempre maiores entre as mulheres do que entre os homens (produto cruzado igual a 2,38). A idade média dos consumidores de psicotrópicos é 5,13 anos superior a dos não consumidores. A prevalência de consumo nas áreas geográficas de melhor qualidade de vida é 62 por cento superior àquela das áreas de menor qualidade de vida. Foram observados três padrões característicos de consumo: o uso regular (56,1 por cento dos consumidores), o uso esporádico (38,1 por cento dos consumidores) e o uso episódico (4,4 por cento dos consumidores). Os consumidores esporádicos tendem a ser mais constantes no seu comportamento do que os consumidores regulares e episódicos. Os medicamentos ansiolíticos, hipnóticos e sedativos são os mais frequentemente usados (86,5 por cento cos casos) e, pelo menos, 62,6 por cento deles podem ser adquiridos sem a apresentação de receita médica. Somente os derivados da benzodiazepina (ansiolíticos e hipnóticos) representam\' 72,8 por cento de todos os produtos consumidos. Em 81,6 por cento dos casos o uso se deu por indicação médica, em 2,7 por cento dos casos a indicação foi do \"farmacêutico\", em 4,4 por cento dos casos a indicação foi de um parente ou conhecido e em 10,2 por cento dos casos foi o próprio usuário que decidiu a indicação. Dentre os médicos, são os clínicos gerais os que mais prescrevem psicotrópicos (57,4 por cento do total) e eles têm clara preferência pelos produtos livres de controle de receituário. Há indícios de que possa haver maiores níveis de consumo entre mulheres com vínculo matrimonial rompido (viúvas, separadas e desquitadas) na faixa etária de 30 a 50 anos. Outrossim, foram observados maiores níveis de consumo em pessoas com menor grau de instrução. Não foi encontrada qualquer relação entre consumo de medicamentos e as condições de habitação (medidas pelo índice de aglomeração). / The author critically analyzes the consumption of psychotropic drugs and also presents the results of an epidemiological survey taken within the District of São Paulo, which was performed in order to determine the prevalence and incidence of the consumption of such drugs, the consumption patterns, the types of medications most frequently taken, and to determine a relation between the use of psychotropics and social demographic variables. First, some psycho-social aspects of anxiety are presented, emphasizing the risks involved when minor tranquilizers, hypnotics, and sedatives are used to relieve objective anxiety, which is the normal individual\'s defense reaction against the agressions of his environment. It sunports the idea that such anxiety is constructive and necessary for man and that the carefree utilization of psychotropic medications will thus harm, both the individual\'s emotional development and the teleological progress of society. The psychopharmaceutical rnarket is then discussed, pointing out the complex relationships among those involved and their various interests: the pharmaceutical industry, the medical class, the patients, and the pharmacy proprietors. In respect to the Brazilian market, those products classified as \"antidistônicos\", (hidden psychotropics), are discussed as a disguised way to legally sell psychotropic drugs over the counter and escape laws applying to their purchase and prescription. The epidemiological survey taken during the years 1976-1978 indicates that 3690 participants, 16 years or older ano distributed among 1345 families, showed a consumption prevalence in the last year of 122.2/1000 inhabitants, (75.7/ 1000 for males ano 163.2/1000 for females). In the last 30 days the incidence of new consumers was 7.6/1000 inhabitants. There is an increasing tendency observed in correspondence to the consumption level and age. Furthermore, the prevalence values are always higher for females than for males, (cross product is equivalent to 2.38); the mean age of psychotropic consumers is 5.13 years higher than nonconsumers. In the geoqraphic areas with a higher standard of living, the consumption prevalence is 62 per cent greater than in those areas with a lower standard of living. Three consumption patterns are characterized: the regular use (56.1 per cent of the consumers), the sporadic use (38.l per cent of the consumers), and the episodic use (4.4 per cent of the consumers). The sporadic consumers tend to have a more consistent behavior compared to those considered regular or episodic consumers. Minor tranquilizers, hypnotics, and secatives are found as being the medications most frequently used, (86.5 per cent of the cases), with at least 62.6 per cent of them purchasable over the counter. Those drugs derived from benzodiazepine, (i.e., minor tranquilizers and hypnotics), alone represent 72.8 per cent of all the medications consumed. In 81.6 per cent of the cases, the medications were taken under a doctor\'s prescription, 2.7 per cent of the cases occurred due to a pharmacist\'s indication, in 4.4 per cent of the cases a relative or friend had suggested the use of the medication, and in 10.2 per cent of the cases the user himself had prescribed the medication. Among physicians, psychotropics are more ofter prescribed by general practitioners, (57.4 per cent of the total cases), whose preference is clearly given to those products freely sold over the counter. There is indication given that women with broken marriages, (widowed, seperated, or divorced), within the age group of 30 to 50 years, have a higher consumption level. High levels of consumption are also observed among less educated persons. No association was found between the consumption of psychotropics and habitation conditions, (measured by the conglomeration index).

Um aspecto marcante do mercado brasileiro de medicamentos benzodiazepínicos é o largo emprego das associações medicamentosas de venda livre conhecidas genericamente como \"antidistônicos\". Sua composição só difere daquela dos ansiolíticos e hipnóticos de venda controlada pelo acréscimo de pequenas doses anticolinárgico e/ou antiespasmódico; as razões da ausência de controle sobre suas vendas são essencialmente não-médicas. Assim, quando se discute o consumo de benzodiazepínicos no Brasil, deve-se fazer distinçã entre os ansiolíticos e hipnóticos de venda livre ou controlada. No período de 1970 a 1985 a tendência do consumo de benzodiazepinas no mercado brasileiro - medida através do número de doses médias diárias consumidas por 1000 habitantes de 15 ou mais anos de idade apresentou três fases. Entre 1970 e 1976 observou-se um crescimento da ordem de 22 por cento ao ano, devido, em sua maior parte, aos antidistônicos que cresceram a uma taxa média anual de 54 por cento . Entre 1976 e 1980 estas taxas de crescimento continuaram sendo positivas, mas seus valores cairam significativamente (4,4 por cento e 4,7 por cento respectivamente). A partir de 1980, inverte-se a tendência; até 1984 observaram-se taxas negativas (-2 por cento e -3,6 por cento , respectivamente). Popularizados a partir do fim da década de 60, os antidistônicos representam, hoje em dia, 47 por cento do consumo de todas as benzodiazepinas. Entre 1970 e 1985 o consumo de ansiolíticos variou de 4,1 a 7,9 DMD/1000hab/dia; o consumo de hipnóticos variou 1,7 a 2,1 DMD/10000hab/dia e o de antidistônicos de 1,5 a 9,7 DMD/1000hab/dia. Nesse período as preferências têm recaído sobre os derivados benzodiazepínicos que hoje em dia representam 97 por cento do consumo de tranquilizantes menores. Os baixos valores do consumo de hipnóticos devem-se, em grande parte, ao fato de, o fenobarbital, largamente empregado como hipnótico no Brasil, estar classificado no grupo de medicamentos anticonvulsivantes; o consumo dos demais barbitúricos é insignificante. Utilizando como parâmetro da expansão dos serviços de assistência a evolução do consumo de alguns grupos de medicamentos cujo emprego se faz sempre sob supervisão médica, verificamos que o crescimento do consumo de benzodiazepinas, entre 1970 e 1980, foi maior do que aquele que poderia ser esperado se eles acompanhassem as tendências gerais do setor saúde. As maiores restrições impostas, a partir de 1984, à prescrição de tranquilizantes menores resultou numa redução do consumo de benzodiazepinas controladas e um concomitante aumento das vendas de antidistônicos. No período de 1980 a 1983 todo o mercado brasileiro de medicamentos esteve retraído coincidindo com o período de recessão econômica. A retomada do crescimento de vendas começou a ocorrer a partir de 1984 na maioria dos grupos estudados. Não é possível concluir se a persistência da queda do consumo de benzodiazepinas foi primariamente devida às mudanças da legislaçio sanitária ou se ela indica uma tendência à redução mais definitiva do largo emprego dessas drogas. / One of the distinctive features in the brazilian market of benzodiazepines is the large use of hidden-psychotropics sold over-the counter (generally known as \"antidistonics\"). The only difference they have as related to the controlled preparations of benzodiazepines are the small doseS of anticholinergic agents; there are nonmedical reasons to explain why \"antidistonics\" have their use not controlled. Therefore, to discuss the consumption of benzodiazepines in Brazil, one should make a distinction between \"free\" and \"controlled\" minor tranquilizers. Between 1970 and 1985 the trends in the consumption of benzodiazepines in Brazil - as measured through the \"medium daily dosis\" per 1000 persons over 15 years - showed three phases. Between 1970 and 1976 a 22 per cent annual increase, greatly due to the \"antidistonics\" which increased at a 54 per cent annul rate. Between 1976 and 1980 those rates were still positives, but significantly smaller (4.4 per cent and 4.7 per cent ) As from 1980, until 1984 there was downward trend (-2.0 per cent and -3.6 per cent ). Very popular since the end of sixties, \"antidistonics\" nowadays represent 47 per cent of the whole use of benzodiazepines. Between 1970 and 1985 the consumption of controlled antianxiety drugs increased from 4.1 to 7.9 DMD/1000/day; consumption figures for hypnotics increased from 1.7 to 2.1 DMD/1000/day and for \"antidistonics\", from 1.5 to 9.7 DMD/100/day. In the last 15 years benzodiazepinas became the most widely used antianxiety and hypnotic agents; presently they represent 97 per cent of the consumption of minor tranquilizers. Low figures for consumption of hypnotics is largely due to the fact that fenobarbital, largely used as an hypnotic in Brazil, is classified among the antiepileptic drugs; the consumption of other barbiturates is not significant. When we take the consumption of drugs used on strict medical supervision as a parameter of the extent of medical care services, we conclude that the growth of the consumption of benzodiazepines between 1970 and 1980 was bigger than one might expect if they followed the general trends of the health sector. Increased restriction on minor tranquilizers\' prescriptions set in 1984, provoked a decrease in the consumption of \"controlled\" benzodiazepines and an increased in \"free\" diazepines sales. Between 1980 and 1983 the whole pharmaceutical market was inhibited by economic recession. Most of the groups included in this study had their sales recovered in 1984. Benzodiazepines sales continued to decline; it is impossible to conclude whether this decrease has due to the new regulations of if they represent a more definite trend.

Ticyclic Antidepressants Consumption In Czech Republic Charles University Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Author: Zuzana Květenská Supervisor: PharmDr. Pavel Horký, Ph.D. Tricyclic antidepressants are one of the oldest groups of antidepressants. Except for indication for depression, they are used in the therapy of chronic pain or enuresis nocturna in children. Nowadays, tricyclic antidepressants are drug of the first choice only in some types of neuropathic pain, and in other indications they have been replaced by newer substances with a lower occurrence of side effects. The aim of this works is to find out how consumption of tricyclic antidepressants has developed and what share in utilization of antidepressants they represent. Data for this work were obtained from the State Institute for Drug Control of the Czech Republic; namely from distributors' report about supplies of medicinal products to pharmacies and healthcare facilities, sellers of selected medicinal products, other distributors and veterinary doctors. Utilization was evaluated for the period from 1 January 2008 to 31 December 2018 with DUR (drug utilization review). For evaluation, a defined daily dose per 1000 inhabitants per day and methods of descriptive statistics was selected. A...

Magdaléna Moravcová Diplomová práce Ne/zavedení aplikačních místností v České republice Abstract The thesis titled Non/introduction of drug consumption rooms in the Czech Republic is devoted to the controversy that surrounds the debate on the possible introduction of drug consumption rooms in the Czech Republic. It focuses on understanding the attitudes of actors of czech drug policy towards this tool by examinig discourse through analysis of language and speech they use. The analysis of discourse identifies two discoursive groups . The first group are advocates of introduction of drug consumption rooms who adopt the discourse that is marked as a humanist and a second group are the opponents, who adopt the discourse I named as represionistic. The thesis reveals the value contest behind these discourses and also points to the associated discoursive conflict on how to make policy. Such a discourse significantly affects the form of the discourse on the possible introduction of drug consumption rooms in Czech Republic. By using the theory of social construction of target populations the text is looking for an answer on how the target population of problem drug users is socially constructed, and how the character of such a construction is related to the attitudes towards the introduction of drug consumption...

In 1981, no representative study of the medical and social conditions among elderly persons in northern Scandinavia was performed. Nor was there such a study in a smaller Swedish town than Gothenburg. This study was initiated to fill that knowledge gap. The aim of the study was to evaluate gender and age differences in medical and social conditions among elderly people, including the reference intervals of clinical chemistry parameters and characteristic features of the 24-hour electrocardiogram (ECG) in healthy elderly. By way of longitudinal design with birth cohorts stratified by gender, it was assumed that the effects could be demonstrated. Also, the death risk of various social and medical variables was to be assessed. During the study period 1981 to 1990, the subjects were between 70 and 88 years of age. The proportion of persons living in private housing decreased from almost all at the age of 70 to slightly more than half at 88 years of age. The number of socially active persons decreased considerably during the period. The need of help increased from almost none to 60 % of the persons. The proportions of persons with normal sight and hearing decreased from two thirds to around one tenth The most frequent symptoms were general tiredness, pains, dyspnoea, constipation and dryness of the mouth. Cardiovascular diseases were the most frequent. Hypertensive disease became less, and congestive heart failure more frequent with age. The frequency of dementia increased steeply among the oldest persons; at 88 years of age, 40 % were demented. Drug consumption increased; the oldest persons in both age cohorts used 5 different drugs or more per person regularly. The consumption increase was mainly due to the increasing morbidity accompanying age. The most common drugs taken were cardiovascular preparations, psychoactive agents, drugs to alleviate gastrointestinal symptoms, and analgesics. Drug intake and symptom prevalence were generally higher in women, despite the fact that there was no gender difference in the number of diseases. The reference intervals of many blood components in healthy elderly were shown to be broader than those of younger persons. The intervals of P(lasma)-folate and P- potassium were on a lower and those of the erythrocyte sedimentation rate, P-creati- nine and, in women, S(erum)-cholesterol, were on a higher level than among younger persons. Several features of the 24-hour ECG, e.g. the number of episodes of supraventricular tachycardia as well as supraventricular and ventricular premature beats in healthy elderly were more frequent than among younger persons. Between 80 and 88 years of age, many functions crucial to the chances of living a rich and vital life were found deteriorating in the elderly persons. High age, male sex, dementia, congestive heart failure, and low values of S-creatinine were shown to be independent factors connected with an increased death risk. / <p>S. 1-112: sammanfattning, s. 115-177: 5 uppsatser</p> / digitalisering@umu.se