Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 230-251).

Trata-se de estudo multicêntrico, com revisão retrospectiva de prontuário, que teve como objeto a associação entre o aprazamento de medicações intravenosas realizadas por enfermeiros e as potenciais interações medicamentosas (PIM) graves, encontradas em prescrições de pacientes críticos adultos hospitalizados. Os objetivos foram: a) apresentar os grupos medicamentosos e medicamentos prevalentes em cada Unidade de Tratamento Intensivo (UTI) pesquisada; b) descrever o perfil do aprazamento dos medicamentos intravenosos em cada UTI pesquisada; e, c) analisar a frequência das potenciais interações medicamentosas graves favorecidas pelo aprazamento feito por enfermeiros. Para coleta de dados foi utilizado um instrumento que contemplou o nome do medicamento, a dose, a via, a frequência de administração e os horários aprazados pelo enfermeiro, dando origem a um imenso banco de dados. Os dados foram coletados em 3 UTIs conveniadas ao SUS e pertencentes à Rede Sentinela. O levantamento das PIM foi feito de prescrição a prescrição, pareando-se todos os medicamentos intravenosos conforme critérios de inclusão, obtendo-se assim uma lista com as interações encontradas. As PIM foram identificadas nas bases Micromedex Drugs-Reax System.12 e Drugs.com. Foi encontrada uma chance quase três vezes maior (OR: 2,96) de PIM em prescrições com mais de 5 medicamentos. Às 6h foi encontrada nas UTIs A e B a maior chance de PIM. Na UTI C não foi encontrada prevalência nem OR significativa, assim como o número de doses comprometidas com PIM foi o menor entre todas as UTIs. Houve predomínio de medicamentos que atuam no sistema digestivo (31,99%), com destaque para ranitidina (44,08%). As UTI A e B seguem um mesmo padrão no que diz respeito a acumular o aprazamento, preferencialmente em quatro horários: 14h, 18h, 22h e 6h. A UTI C distribui seu aprazamento por nove horários, inclusive no horário de visitas (16h) e no início de plantão (08h e 20h). Na UTI A e B predominaram aprazamentos noturnos; na UTI C foram tarde e noite, sugerindo uma rotina organizada de acordo com o processo de trabalho de médicos, enfermagem e farmácia. Foram encontrados 47 PIM graves nos horários prevalentes. A UTI A apresentou o maior número de PIM graves (n=32). Destacam-se cinco medicamentos que, repetidamente, foram aprazados associados em PIM grave: haloperidol, metoclopramida, tramadol, furosemida e prometazina. Conclui-se que a rotina de atividades na UTI favorece o aprazamento padronizado e concentrado em poucos horários, logo a ocorrência de PIM graves, desconsiderando assim os aspectos farmacocinéticos e farmacodinâmicos dos medicamentos em uso concomitante. / This is a multicenter study, with retrospective review of medical records, which had as its object the association between the schedule of intravenous medications stated by nurses and potentially serious drug interactions (PDI) found in prescriptions of hospitalized critically ill adult patients. This work is aimed at presenting the drug groups and drug prevalent in each studied Intensive Care Unit (ICU), describe the schedule profile of intravenous drug in every researched ICU, and analyze the frequency of potentially serious drug interactions favored by the schedule stated by nurses. For data collection, an instrument was used which included the drug name, dose, via, administration frequency, and the schedule stated by the nurse, giving rise to a huge database. Data were collected in three ICUs belonging to Sentinel Network covenanted to Sistema Único de Saúde (SUS) (Health System). For PDIs survey, every prescription was analyzed, pairing up all intravenous medications according to inclusion criteria, and then listing all found interactions. PDIs were identified on Micromedex Drug-REAX system.12 and Drugs.com basis. A chance almost three times higher (OR: 2.96) of PDI was found in prescriptions with more than five medications. At 6 am, the greatest chance of PDI was found in ICU A and B. In the ICU C, significant prevalence nor OR was not found and the number of implicated doses with PDI was the lowest among all ICUs. There was a predominance of medications that act on the digestive system (31.99%) with emphasis on ranitidine (44.08%). ICU A and B follow the same pattern to accumulate the schedule preferentially at 2 pm, 6 pm, 10 pm, and 6 am. ICU C distributes its schedule for nine times, including during visiting hours (4 pm) and at starting the shift turn (8am and 8pm.). The nocturnal schedule dominated in ICU A and B; in ICU C, it was at afternoon and night, suggesting an organized routine according to the work scheme of doctors, nurses, and pharmacy. Forty-seven serious PDIs were found at prevalent times. ICU A had the highest number of serious PDIs (n=32). We highlight five drugs, haloperidol, metoclopramide, tramadol, furosemide, and promethazine that had repeatedly the schedule associated with serious PDI. It is concluded that ICU's routine activities favors the standardized and concentrated schedule in a few times, and hence the occurrence of serious PDIs, thus disregarding the pharmacokinetic and pharmacodynamic aspects of medications in concomitant use.

Trata-se de estudo multicêntrico, com revisão retrospectiva de prontuário, que teve como objeto a associação entre o aprazamento de medicações intravenosas realizadas por enfermeiros e as potenciais interações medicamentosas (PIM) graves, encontradas em prescrições de pacientes críticos adultos hospitalizados. Os objetivos foram: a) apresentar os grupos medicamentosos e medicamentos prevalentes em cada Unidade de Tratamento Intensivo (UTI) pesquisada; b) descrever o perfil do aprazamento dos medicamentos intravenosos em cada UTI pesquisada; e, c) analisar a frequência das potenciais interações medicamentosas graves favorecidas pelo aprazamento feito por enfermeiros. Para coleta de dados foi utilizado um instrumento que contemplou o nome do medicamento, a dose, a via, a frequência de administração e os horários aprazados pelo enfermeiro, dando origem a um imenso banco de dados. Os dados foram coletados em 3 UTIs conveniadas ao SUS e pertencentes à Rede Sentinela. O levantamento das PIM foi feito de prescrição a prescrição, pareando-se todos os medicamentos intravenosos conforme critérios de inclusão, obtendo-se assim uma lista com as interações encontradas. As PIM foram identificadas nas bases Micromedex Drugs-Reax System.12 e Drugs.com. Foi encontrada uma chance quase três vezes maior (OR: 2,96) de PIM em prescrições com mais de 5 medicamentos. Às 6h foi encontrada nas UTIs A e B a maior chance de PIM. Na UTI C não foi encontrada prevalência nem OR significativa, assim como o número de doses comprometidas com PIM foi o menor entre todas as UTIs. Houve predomínio de medicamentos que atuam no sistema digestivo (31,99%), com destaque para ranitidina (44,08%). As UTI A e B seguem um mesmo padrão no que diz respeito a acumular o aprazamento, preferencialmente em quatro horários: 14h, 18h, 22h e 6h. A UTI C distribui seu aprazamento por nove horários, inclusive no horário de visitas (16h) e no início de plantão (08h e 20h). Na UTI A e B predominaram aprazamentos noturnos; na UTI C foram tarde e noite, sugerindo uma rotina organizada de acordo com o processo de trabalho de médicos, enfermagem e farmácia. Foram encontrados 47 PIM graves nos horários prevalentes. A UTI A apresentou o maior número de PIM graves (n=32). Destacam-se cinco medicamentos que, repetidamente, foram aprazados associados em PIM grave: haloperidol, metoclopramida, tramadol, furosemida e prometazina. Conclui-se que a rotina de atividades na UTI favorece o aprazamento padronizado e concentrado em poucos horários, logo a ocorrência de PIM graves, desconsiderando assim os aspectos farmacocinéticos e farmacodinâmicos dos medicamentos em uso concomitante. / This is a multicenter study, with retrospective review of medical records, which had as its object the association between the schedule of intravenous medications stated by nurses and potentially serious drug interactions (PDI) found in prescriptions of hospitalized critically ill adult patients. This work is aimed at presenting the drug groups and drug prevalent in each studied Intensive Care Unit (ICU), describe the schedule profile of intravenous drug in every researched ICU, and analyze the frequency of potentially serious drug interactions favored by the schedule stated by nurses. For data collection, an instrument was used which included the drug name, dose, via, administration frequency, and the schedule stated by the nurse, giving rise to a huge database. Data were collected in three ICUs belonging to Sentinel Network covenanted to Sistema Único de Saúde (SUS) (Health System). For PDIs survey, every prescription was analyzed, pairing up all intravenous medications according to inclusion criteria, and then listing all found interactions. PDIs were identified on Micromedex Drug-REAX system.12 and Drugs.com basis. A chance almost three times higher (OR: 2.96) of PDI was found in prescriptions with more than five medications. At 6 am, the greatest chance of PDI was found in ICU A and B. In the ICU C, significant prevalence nor OR was not found and the number of implicated doses with PDI was the lowest among all ICUs. There was a predominance of medications that act on the digestive system (31.99%) with emphasis on ranitidine (44.08%). ICU A and B follow the same pattern to accumulate the schedule preferentially at 2 pm, 6 pm, 10 pm, and 6 am. ICU C distributes its schedule for nine times, including during visiting hours (4 pm) and at starting the shift turn (8am and 8pm.). The nocturnal schedule dominated in ICU A and B; in ICU C, it was at afternoon and night, suggesting an organized routine according to the work scheme of doctors, nurses, and pharmacy. Forty-seven serious PDIs were found at prevalent times. ICU A had the highest number of serious PDIs (n=32). We highlight five drugs, haloperidol, metoclopramide, tramadol, furosemide, and promethazine that had repeatedly the schedule associated with serious PDI. It is concluded that ICU's routine activities favors the standardized and concentrated schedule in a few times, and hence the occurrence of serious PDIs, thus disregarding the pharmacokinetic and pharmacodynamic aspects of medications in concomitant use.

Orientadores: Francisco Carlos Groppo, Pedro Luiz Rosalen / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-05T23:21:41Z (GMT). No. of bitstreams: 1 Bergamaschi_CristianedeCassia_M.pdf: 674869 bytes, checksum: 9fc0d359f6d33ff4e69d0e5d57f6f092 (MD5) Previous issue date: 2006 / Resumo: O objetivo deste estudo foi avaliar o efeito do diclofenaco sódico sobre a biodisponibilidade da amoxicilina. Vinte voluntários do gênero masculino foram avaliados em um estudo aberto, randomizado, cruzado, com dois períodos e intervalo de uma semana entre as colheitas das amostras de sangue. Os voluntários receberam dose única de 2g amoxicilina (Amoxil®) - Grupo 1 ou 2g de amoxicilina (Amoxil®) juntamente com 100mg de diclofenaco sódico (Voltaren®) - Grupo 2. Imediatamente antes e após 15min, 30min, 1h, 1h30min, 2h, 2h30min, 4h, 6h, 8h, 12h e 24h da administração dos fármacos, foram obtidas amostras de plasma. A cromatografia líquida de alta eficiência (CLAE) com detecção UV foi usada para quantificar a concentração plasmática de amoxicilina. O método microbiológico, usando Micrococcus luteus ATCC 9341 como microorganismo teste, foi realizado para verificar a eficácia antimicrobiana da amoxicilina in vitro. Os parâmetros farmacocinéticos concentração máxima (Cmax), área sob a curva de 0 ao infinito (ASC0-inf), área sob a curva de 0 a t (ASC0-24) e clearence renal (CL) foram submetidos à ANOVA, enquanto os parâmetros tempo necessário para a máxima concentração (Tmax) e volume de distribuição (VD) foram analisados pelo teste de Wilcoxon (p<0.05). Os valores observados de ASC0-24, Cmax e Tmax para o Grupo 1 foram 3391,8µg.min/ml (±1186,7), 17,3µg/ml (±6,5) e 121,5min (±20,6), respectivamente e para o Grupo 2 foram 2918,4µg.min/ml (±1024,8), 15,5µg/ml (±5,8) e 136,5min (±30,0), respectivamente. O Grupo 2 demonstrou redução nos parâmetros de ASC and Cmax (p<0.05). O CL da amoxicilina aumentou (p<0.05) em 18,5% no Grupo 2 , sugerindo uma possível interferência do diclofenaco sódico na excreção renal da amoxicilina. O diclofenaco sódico afetou significativamente a farmacocinética da amoxicilina, reduzindo sua biodisponibilidade / Abstract: The aim of this study was to evaluate the effect of sodium diclofenac on the bioavailability of amoxicillin. Twenty volunteers were evaluated in an open, randomized, two-period, crossover study with one-week of washout period. The study was designed in two groups: a 2-g oral dose of amoxicillin (Amoxil®) ¿ Group 1; or a 2-g oral dose of amoxicillin with 100mg of sodium diclofenac (Voltaren®) ¿ Group 2. Blood samples were collected at 0, 15min, 30min, 1h, h30min, 2h, 2h30min, 4h, 6h, 8h, 12h and 24h after drug administration. High-performance liquid chromatography (HPLC) with UV detection was used to quantify plasmatic amoxicillin concentrations. Bioassay (Micrococcus luteus ATCC9341) was performed to verify the antimicrobial efficacy of amoxicillin in vitro. The pharmacokinetic parameters AUC, Cmax and CL were analyzed by ANOVA and Tmax and VD by Wilcoxon test (p<0.05). For group 1, AUC0-24, Cmax and Tmax values were 3391.8µgmin/ ml (±1186.7), 17.3µg/ml (±6.5) and 121.5min (±20.6), respectively, and for Group 2, 2918.4µg-min/ml (± 1024.8), 15.5µg/ml (± 5.8) and 136.5min (± 30.0). Lower values of AUC and Cmax were obtained for Group 2 (p<0.05). The clearance of amoxicillin increased (p<0.05) 18.5% in Group 2, suggesting that sodium diclofenac might interfere with amoxicillin renal excretion. In conclusion, sodium diclofenac can reduce the bioavailability of amoxicillin significantly / Mestrado / Farmacologia, Anestesiologia e Terapeutica / Mestre em Odontologia

No description available.

Magister Pharmaceuticae - MPharm / The objectives of the present study were to describe the type and frequency of prescribing errors and error frequency, to determine the error frequency for different drug classes, to identify potential drug interactions and drug-disease interactions to point out off-label prescribing and to evaluate risk factors of prescribing errors. Methods: This prospective cross sectional study was conducted over a period of 6 months from July 2012 to December 2012 in 2 specialist wards and 2 general medical wards at Red Cross War Memorial Children’s Hospital in Cape Town in South Africa. Only prescriptions generated by doctors in the above mentioned wards were assessed. Convenience sampling was used to select 200 prescription charts for analysis. Information relating to prescribing error, potential drug interaction, potential drug-disease interactions, off-label prescribing and potential risk factors of prescribing error were entered into excel spreadsheet and analysed using STATA versions 11&12. The mass of the patients was converted into weight-for-age z-score (WAZ) using WHO 2006 child growth standards. Univariate analysis and multiple logistic regression were used to identify risk factors of prescribing errors. Results: Of the 200 children on whom prescribing information was analysed, 40 (20%) were severely underweight and a further 25(12.5%) were moderately underweight. A total of 1402 prescribing errors were documented in 1282 drug items prescribed, a rate of 1.09 errors per drug item prescribed. Incomplete prescription information was the most common type of prescribing error, present in 65.6% of all drug items prescribed. The error frequency was high for all drug classes ranging from 57.9% of all respiratory drug items prescribed to 86.4% of all gastro intestinal system drug items prescribed. The number of potential drug-drug interactions was low i.e. 20 potential pharmacodynamics and 49 potential pharmacokinetic drug interactions were identified. The number of potential drug-disease interactions was also low i.e. 39 or 0.03% per drug item prescribed. Furthermore 57 off-label prescribing incidences were recorded. Senior doctors posed a significant risk factor for prescribing errors, an OR 1.95, 95% CI 1.46 – 2.61. Conversely, prescriptions written up in the general wards compared to the specialty wards (an OR 0.65. 95% CI 0.47-0.90) and prescribing during weekends compared to weekdays (an OR 0.71, 95% CI 0.53-0.96) were associated with lower prescribing error risk. Conclusion: This study provided valuable information about prescribing practices in children at RCWMCH. There is a need to improve prescribers’ practice at RCWMCH considering the type of errors observed viz. missing information, use of wrong drug name, abbreviations, legibility concerns and lack of clarity of the prescriptions, among others. Based on this study results further intervention studies are recommended to investigate the level of medical student’s training w.r.t prescribing practice.

Candidate: Kateřina Kukrálová1 Supervisor: prof. RNDr. Jiří Vlček, CSc.1 Consultant: PharmDr. Zuzana Očovská1 1 Department Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Title of the master thesis: The analysis of drug-drug interactions in patients admitted to hospital (I.) The presence of potential drug-drug interactions (DDIs) is common in daily practice and only a small proportion of potential DDIs results in hospitalization of the patients. Nevertheless, DDIs represent a significant cause of hospital admissions. This study aims to identify DDIs in the medication history of the patients admitted to University Hospital Hradec Králové via the emergency department in August-November 2018. The objectives of this study are a) to determine the prevalence of potential DDIs; b) to categorize identified potential DDIs with respect to their mechanism, severity, risk rating, level of documentation and potential outcomes and c) to determine the prevalence of manifest DDIs. This study has a cross-sectional design. The following data were obtained retrospectively from electronic medical records: demographic data, medication history, past medical history, laboratory and clinical findings, and information about hospital admission. The identification of potential DDI was...

No description available.

Naturläkemedel är ett område som väcker stort intresse idag och allt fler individer väljer att ta hand om sina åkommor på egen hand. Modern forskning visar på interaktioner mellan naturläkemedel och konventionella läkemedel. Eftersom naturläkemedel under lång tid uteslutande har använts i egenvårdssyfte har patienters användning av dessa produkter skett i stor utsträckning utan medverkan från den vanliga hälso- och sjukvården. Syftet med denna studie var att undersöka sjuksköterskors inställning till och kunskaper om naturläkemedel. Studien är av kvalitativ design och är baserad på sex intervjuer med sjuksköterskor verksamma vid två ortopediska vårdavdelningar i Södra Sverige. Resultatet visade att behovet av ökade kunskaper om naturläkemedel hos sjuksköterskor är stort och att naturläkemedel är något som diskuteras i mycket liten omfattning inom sjukvården. / Herbal remedies is an area that arouses great interest today and more individuals choose to take care of their symptoms on their own. Modern research shows interactions between herbal remedies and conventional medicines. Since herbal remedies for a long time been used exclusively in self-care purposes, the patients use of these products are made largely without the participation of the ordinary health care. The purpose of this study was to investigate nurses attitudes towards and knowledge of herbal remedies. The design of this study is qualitative and is based on six interviews with nurses working in two orthopedic departments in southern Sweden. The results showed that the need for increased knowledge of herbal remedies among nurses is high and that herbal remedies are discussed in a very small scale in health care.

Danshen, the dried root of Salvia miltiorrhiza Bunge, is a herb listed in the Chinese Pharmacopoeia for the treatment of cardiovascular and cerebrovascular diseases. Danshen has been reported to have antiplatelet, cardioprotective, anti-inflammatory, hepatoprotective, and anti-HIV effects in preclinical studies. However, exaggerated anticoagulation and bleeding complications have also been observed during concurrent use of Danshen and warfarin in patients, although the mechanism(s) of the herb-drug interaction, pharmacodynamic and/or pharmacokinetic interactions, remained uncertain. Characterization of the cytochrome P450 isoforms responsible for the metabolism(s) of drugs and herbal constituents is important for the identification of potential drug-drug or drug-herb interactions. The present study investigated the effects of Danshen on the metabolism of probe substrates of specific CYP isoforms including CYP1A2, CYP3A and CYP2C9, the isoforms that are responsible for the metabolism of warfarin to assess the potential interactions of Danshen with drugs that utilize these isoforms for their biotransformation. / Firstly, the effects of Danshen and its tanshinone components on CYP1A2 activity were investigated in vitro and in vivo in the rat. Formulated Danshen extract, the ethanolic extract and the aqueous extract from Danshen root, and individual tanshinones inhibited phenacetin O-deethylation (CYP1A2) activity in vitro. Enzyme kinetic studies showed that tanshinone I, tanshinone IIA, cryptotanshinone, and dihydrotanshinone were competitive CYP1A2 inhibitors. Acute, sub-chronic and chronic pretreatments of formulated Danshen extract decreased the clearance (CL) of caffeine, with a concomitant increase in the area under concentration-time curve (AUC), and prolongation of the plasma half-life (T 1/2). These results suggested that Danshen inhibited rat CYP1A2 activity and altered the pharmacokinetics of the CYP1A2 probe substrates in vivo. / In conclusion, these results confirmed that Danshen-inhibited CYP activity, especially CYP1A2, then CYP2C9/11 (CYP2C9 in human, CYP2C11 in rats) in vitro. In vivo studies confirmed the clearance of the probe substrates was also decreased when co-administered with Danshen. Given that CYP1A2, CYP2C9 and CYP3A4 are responsible for the metabolism and disposition of a large number of drugs currently used in man, the concomitant use of Danshen with drugs which are substrates of CYP1A2, 2C9 and 3A4, especially CYP1A2, must be met with great caution. / Secondly, the effects of Danshen and its tanshinone components on CYP3A activity were investigated in vitro and in vivo in the rat. Formulated Danshen extract, the ethanolic extract from Danshen root, and tanshinones inhibited testosterone 6beta-hydroxylation (CYP3A) activity in vitro. Enzyme kinetic studies showed that tanshinone I, tanshinone IIA, and cryptotanshinone were competitive CYP3A inhibitors, whereas dihydrotanshinone was a noncompetitive CYP3A inhibitor. In vivo studies showed the pretreatments of formulated Danshen extract did not significantly change the pharmacokinetics of midazolam. / The effects of Danshen and its tanshinones on human CYP1A2 (phenacetin O-deethylation), CYP3A4 (testosterone 6beta-hydroxylation), and CYP2C9 (tolbutamide 4-hydroxylation) activities were also investigated in vitro using pooled human liver microsomes and human CYP isoforms. The ethanolic fraction of Danshen root was more effective than water-soluble fraction in inhibiting human CYP1A2, CYP3A4 and CYP2C9 activities. Enzyme kinetic studies showed that tanshinone I, tanshinone IIA, and cryptotanshinone were competitive inhibitors of CYP1A2, CYP3A4 and CYP2C9 with varying effectiveness. Dihydrotanshinone was not a competitive inhibitor of CYP1A2 and CYP2C9, but a noncompetitive CYP3A4 inhibitor. CYP1A2 was most affected and CYP3A4 was least affected by Danshen and tanshinones. Compared with the results obtained from rat and human, rat is a good animal model for predicting Danshen-drug interactions in humans, especially drugs which are substrates of CYP1A2. / Thirdly, the effects of Danshen and its tanshinone components on CYP2C11 activity were investigated in vitro and in vivo in the rat. Formulated Danshen extract, the ethanolic extract from Danshen root, and tanshinones inhibited testosterone 2alpha-hydroxylation (CYP2C11) activity in vitro. Enzyme kinetic studies showed that tanshinone I, tanshinone IIA, cryptotanshinone, and dihydrotanshinone were competitive CYP2C11 inhibitors. Sub-chronic pretreatment of formulated Danshen extract increased the AUC, T1/2 but decreased CL of tolbutamide. These results suggested that Danshen inhibited the CYP2C activity in the rat. In conclusion, these results confirmed the possible mechanism is enzyme inhibition, involved in the interaction of Danshen and warfarin previously observed in rats. / Wang, Xin. / "September 2007." / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4699. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 284-302). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.