Title: Analysis of pharmacotherapy and drug related problems in patients with arterial hypertension in Greece Student: Zisis Papadopoulos Tutor: Jiri Vlcek Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Kralove Background: Arterial hypertension or high blood pressure is a chronic medical condition which is characterized by elevated blood pressure in the arteries and is an important risk factor for future development of cardiovascular disease. Also belongs to asymptomatic diseases because it usually does not cause symptoms for years until a vital organ is damaged. Moreover is a major cause of morbidity and mortality, due to its association with some other serious diseases like coronary heart disease, cerebrovascular disease, atherosclerosis, renal disease, dyslipidemia, diabetes, obesity and metabolic syndrome. Arterial hypertension for adults, who don't suffer from any other kind of diseases, is defined by an elevation of blood pressure to 140 / 90 mm Hg or to higher values. Aim: In the theoretical part the main aim is to analyze information regarding etiopathogenesis, diagnostic methods and treatment strategies of arterial hypertension, as well as classification and causes of drug-related-problems to antihypertensive agents. In the...

Title of diploma thesis: Analysis of individual counselling in pharmacy I Author: Tereza Brandejská Tutor: PharmDr. Josef Malý, Ph.D. Consultant: PharmDr. Jana Šolínová Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and objective: Individual consultations are a relatively new and developing service provided for patients in community pharmacies within the pharmaceutical care. The aim of this paper was to analyse professional individual consultations in community pharmacy in period of 2009-2019. Methodology: Professional individual consultations were provided in the form of a discreet dialogue between a pharmacist and patient in a consulting room of a basic pharmacy with two dispensing places. Pharmacy is located in a municipality of up to 5000 inhabitants, where no other pharmacy is available. The content of every consultation was recorded into a consultation form, while its extent corresponded with the focus of the given consultation. Patient's medical history was obtained during the consultation: demographic data, personal history data, lifestyle, use of medicines and food supplements including dosage information. The data was transferred into an electronic form with the use of web application containing a structured template....

Analysis of pharmacoterapy hospice care patients Author: Jakub Sládek Tutor: doc. PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and purpose: The therapy of hospice care patients is accompanied by many changes and pitfalls that need to be balanced when choosing appropriate therapy. In the teoretic part we can find available information about paliative therapy of hospice care patients, with emhasis on pain therapy. The aim of this thesis is the analysis of pharmacotherapy hospice care patients. Methods: The data were collected in a hospice from September 2019 to November 2019. The farmacotherapy was revised every first day of the month. Informations from personal, drug, family and occupational social history of patients were noted into an electronic database and, after revision, were classified and evaluated by frequency analysis. In four randomly selected patients was described the management of drug-related problems (DRP). Results: In total we noted medical therapy in 40 patients, women were 75 % of this number. Average patient's age was 72.4 years for men and 74.6 for women. Patients most often used drugs from group N (drugs of the nervous system) according to the ATC classification. We indentified 115...

Analysis of the effect of pharmacotherapy on the risk of falls in inpatents III Author: Tereza Honsová Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction: Falls are frequent and unwanted events happening in healthcare facilities. The falls have a multifactorial character. The prevention is the best way how to improve a quality of healthcare and a quality of the patient's life. All of the doctors, clinical pharmacists and nurses can help to realize it by cooperating with each other, working with professional information and by individual attitude to each patient. Objective: The aim of this study was to analyze the effect of the fall risk-increasing drugs to falls in hospitalized patients and to recommend the right interventions to prevent the fall. Methodology: For the analysation, classification and quantification of the fall risk-increasing drugs, drug related problems and interventions a special online database was created. All of the doctors, clinical pharmacists and nurses were collecting details about the pacients and about how the fall happened. Fall risk-increasing drugs and drug-related problems were then analyzed by clinical pharmacists. Potential interventions were suggested. Also other...

Analysis of the effect of pharmacotherapy on the risk of fall in inpatients II Author: Nikola Szikorová Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and objectives: Falls are one of the most common problems of hospitalized patients. Their occurrence is associated with many problems and therefore should be avoided. Effective prevention involves analyzing risk factors and implementing interventions to minimize these risks. The aim of this work was to analyze the influence of drugs and other risk factors on the fall of hospitalized patients. Methods: Data was collected from April to December 2017 in 4 hospitals in South Bohemia. Only patients who had fallen during hospitalization participated in the study. An online database was created for the study to collect patient data (personal history, medications used, laboratory values and others). Population and individual fall risk-increasing drugs were analyzed. For each individual fall risk-increasing drug, the type of drug problem that could have been the cause of a fall was classified. Risk minimization interventions have been assigned to each drug problem. In addition to fall risk-increasing drug analysis, other risk factors that increased the risk...

Siauro terapinio indekso vaistų vartojimas ir farmakokinetikos tyrimų interpretavimas reikalauja specialių farmakokinetikos žinių. Mokslinės literatūros šaltiniuose teigiama, jog gydymo procese dalyvaujant klinikiniams vaistininkams vaistų vartojimas yra optimizuojamas. Lietuvoje panašios vaistininkų veiklos nėra, todėl tyrimo tikslas buvo įvertinti siauro terapinio indekso vaistų vartojimo racionalumą ir nustatyti klinikinės farmacijos paslaugos poreikį stacionarinio gydymo įstaigoje. Darbo uždaviniai: nustatyti ir įvertinti farmakoterapinių problemų, siejamų su siauro terapinio indekso vaistų (vankomicino, ciklosporino, digoksino, gentamicino) vartojimu, paplitimą tretinio lygio ligoninėje; kiekybiškai ir kokybiškai įvertinti nustatytų farmakoterapinių problemų rizikos veiksnius; įvertinti vankomicino farmakokinetikos stebėsenos praktiką ligoninės skyriuose; įvertinti farmacininko konsultacijos įtaką vankomicino farmakokinetikos stebėsenai. Tyrimui pasirinktų siauro terapinio indekso vaistų farmakokinetikos tyrimų analizė atskleidė klinikinės farmacijos paslaugos poreikį optimizuojant tokių vaistų vartojimą Lietuvos ligoninėse. Nustatytų farmakoterapinių problemų rizikos veiksnių analizė identifikavo praktikoje dar visuotinai nepripažintą padidintą inkstų klirensą ir jo reikšmingą įtaką vaistų veiksmingumui. / The prescription of narrow therapeutic index drugs (NTID) and interpretation of pharmacokinetic measurements require special pharmacokinetic knowledge. Scientific publications report that active participation of clinical pharmacists in the treatment process results in optimization of the drugs use. In Lithuania, there are no similar services provided by pharmacists up till now. Aim of the study: to evaluate the rationality of the use of NTIDs and to determine the demand for clinical pharmacy services in hospitals. Objectives of the study: to identify and evaluate the prevalence of drug-related problems associated with the use of NTIDs (vancomycin, cyclosporine, digoxin, and gentamicin) in the tertiary-level hospital; to perform quantitative and qualitative analysis of risk factors for the identified drug-related problems; to evaluate the practice of pharmacokinetic vancomycin monitoring in hospital departments; to evaluate the influence of pharmacist intervention on pharma¬cokinetic vancomycin monitoring. The analysis of pharmacokinetic measurements of NTIDs selected for this study revealed the demand for clinical pharmacy services while optimizing NTIDs use in the Lithuanian hospitals. The analysis of risk factors associated with the identified drug-related problems identified augmented renal clearance, which is not widely acknowledged in practice, and its significant impact on the effectiveness of drugs.

En 2003, un groupe de travail de la Société Française de Pharmacie Clinique (SFPC) a mis au point un outil codifiant les interventions relatives aux problèmes médicamenteux détectés au cours de l'analyse de prescription par les pharmaciens ainsi qu'une base de données (ACT-IP©) destinée à la collecte de ces interventions. Notre recherche a eu pour objectifs de préciser les conditions et le potentiel d'analyse du contenu d'ACT-IP© et de fixer les limites de cette analyse. Le travail se décline en quatre séquences : 1. quantifier le savoir nécessaire pour prescrire et dispenser des médicaments 2. déconstruire ce contenu afin de rapporter de quoi une intervention pharmaceutique est le résultat 3. rechercher ce qui normalement aurait dû y être présent et qui est absent 4. dessiner les sujets de recherche à venir. Notre travail démontre que le contenu d'ACT-IP© constitue avant tout une base solide d'analyse des pratiques des pharmaciens. / In 2003, a working group of the French Society of Clinical Pharmacy (SFPC) validated an instrument for documentation of pharmacist's interventions in French speaking hospitals. To extend the documentation of these interventions to every pharmacist, a Web site database (ACT-IP©) was created. The aim of our research was to explore the potential and conditions for analyzing the ACT-IP© content and define the limits of this analysis. The work is divided into four sequences: 1. quantifying the necessary knowledge to prescribe and dispense drugs 2. deconstruction of this content in order to capture the elements that lead to pharmacist interventions 3. identifying interventions types that are absent whereas they normally should be present 4. define areas for future research as a connection of ACT-IP content with a fully structured drug information database in order to extend the field of hospital pharmacist practice studies. Our work demonstrates that the content of ACT-IP© primarily constitutes a basis for the analysis pharmacist professional practices instead of a database of prescribing errors.

Candidate: Zuzana Očovská1 Supervisor: prof. RNDr. Jiří Vlček, CSc.1 Consultant: PharmDr. Martina Maříková2 1 Department Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University 2 University Hospital Hradec Králové, Hospital Pharmacy, Head of the Division of Clinical Pharmacy Title of the master thesis: The analysis of drug-related problems potentially leading to hospitalization among geriatric patients Hospital admissions due to drug-related problems (DRPs) represent a relevant clinical issue with significant economic consequences. Polypharmacy and age-related pharmacokinetic and pharmacodynamic changes make elderly patients particularly prone to develop DRP. The aim of the theoretical part of this thesis was to introduce the issue of drug-related problems and to outline the results of previous studies concerning drug-related hospitalizations among geriatric patients. The aim of the practical part was to determine the prevalence of DRP potentially leading to hospitalization and to identify the most common medication classes involved in these DRPs. Over the period of six months 200 admissions to geriatric ward of III. Internal Gerontometabolic Clinic of University Hospital Hradec Králové have been retrospectively evaluated in order to determine whether the...

Background: In paediatrics, the limited documentation to guide medication, the lack of suitable dosage forms, and the continuous development in childhood present a scenario where safety of medication is a particular challenge. Aim: To explore reported adverse drug reactions (ADRs) and the challenges in prescribing and administering medicines in paediatrics, in order to identify and suggest areas needing international surveillance within medication safety and improvement in the clinical setting. Methods: Four exploratory studies were conducted. Worldwide reporting of suspected ADRs (individual case safety reports, ICSR) with ages 0-17 years were examined overall. Twenty published case reports and ICSRs for adolescents, who developed a rare and incompletely documented ADR (rhabdomyolysis) during antipsychotic medicine use, were analysed in-depth. Prescribed doses of anti-inflammatory medicines were studied in a UK electronic health record database. Transcribed focus group interviews with 20 registered nurses from four paediatric wards in Sweden were analysed for factors that may promote or hinder safe medication practices. Descriptive statistics, multiple regression, and content analyses were used. Results: Although, skin reactions and anti-infective medicines were most frequently reported, and more reported in paediatric patients than in adults, medication errors and adverse reactions related to psychostimulant medicines were reported with increased frequency during 2005 to February 2010. The in-depth case analysis emphasised the need for increased vigilance following changes in patients’ medicine regimens, and indicated that ICSRs could contribute with clinically valuable information. Prescribed dose variations were associated with type of dosage form. Tablets and capsules were prescribed with a higher dose than liquid dosage forms. Six themes emerged from the interviews: preparation and administration was complex; medication errors caused considerable psychological burden; support from nurse colleagues was highly valued; unfamiliar medication was challenging; clear dose instructions were important; nurses handling medications needed to be accorded higher priority. Conclusions: Age-specific screening of ICSRs and the use of ICSRs to enhance knowledge of ADRs and medication errors need to be developed. Access to age-appropriate dosage forms is important when prescribing medicines to children. To improve medication safety practices in paediatric care, interdisciplinary collaborations across hospitals on national or even global levels are needed.