As people age they are more likely to develop chronic conditions and will tend to be on multiple medications for long periods of time to manage those conditions. Some of these medications have side effects that are anticholinergic in nature. These side effects can impact different parts of the body including the central nervous system. As people enter their later years the permeability of the blood brain barrier increases, increasing their risk of these kinds of side effects. Sleep related disorders occur at a higher frequency in the older adults than in younger adults. This is a concern for older adults because poor sleep quality has been linked to chronic health conditions as well as declining function and quality of life. Although some medications are known to cause insomnia there has not been any work done to look at how an accumulative influence of anticholinergic burden may be influencing sleep despite their known influence on the central nervous system. The purpose of this research is to see if the anticholinergic burden of the medications is related to self-reported sleep quality. Fourteen outreach events targeting Medicare beneficiaries were conducted during the 2014 Medicare open enrollment window in northern/central California. Medication therapy management (MTM) services were provded by trained student pharmacists under the supervision of licensed pharmacists where demographic and medication information were collected. Beneficiaries who reported having trouble sleeping had higher anticholinergic burden than those who did not. Beneficiaries who only reported difficulty falling asleep had higher anticholinergic burden than those who did not. Correlations between anticholinergic burden and the number of nights with trouble sleeping was positive but this association only reached statistical significance with definite anticholinergic burden. Linear regression did not suggest that anticholinergic burden was a predictor of the number of nights with difficulty sleeping.

Improving medication management at transitions of care is a national and international priority. People with dementia, who transition between hospitals and care homes, can be at an increased risk of adverse events, harm and costly re-hospitalisation. There is limited research which examines factors which may influence the quality and continuity of medication management in this context, particularly in the UK. This research uses a systems approach to explore the factors which may influence the quality and continuity of medication management when people, with dementia, move between the care home and hospital setting. This multi method, multi-phase study included interviews with hospital staff, care home staff, residents with dementia and relatives and examination of policies and documents used to support medication management at transition. Overall, policy recommendations and implementation strategies to support medication management at transition were limited. Residents, staff and relatives emphasised the importance of administration routines and preferences, but there were no strategies to support the communication of this information. Procedures, tools and training to support care homes based medication reconciliation was also limited. Residents and relatives were rarely involved in medication management due to limited resources and decision making. This sustained, rather than challenged, the power imbalance between residents and staff. Better defined roles and integrated processes which take account of the needs of this transition may help residents, relatives and care home staff to feel valued and empowered to provide information which supports person-centred medication management and boost resilience by helping to identify medication errors or adverse events. / Alzheimer’s Society

No description available.

No description available.

No description available.

<p>Several classes of psychotropic medications are known to produce neurological side effects. It has long been recognized that antipsychotic drugs classically block the D₂ subtype of DA receptors inducing a range of acute and subacute extrapyramidal syndromes (EPS), including parkinsonism and akathisia, as well as chronic syndromes such as tardive dyskinesia. More recently, SSRI-type drugs, which, as the name suggests, inhibit the serotonin transporter (SERT), and have been found to induce a similar profile of EPS. It is unclear how medications with such different pharmacological actions can produce similar neurological side effects. The goal of this thesis was to study the neurochemical alterations induced by antipsychotic and SSRI medications, with a specific focus on the nigrostriatal pathway, the causative location of parkinsonism.</p> <p>Environmental enrichment and exercise (EE) has been shown to have protective effects in various neurological settings. In the first experiment, we studied the changes induced by SERT inhibition compared to those induced by a non-pharmacological form of therapy, namely, environmental enrichment with exercise. The SSRI, fluoxetine (FLX) significantly reduced the levels of tyrosine hydroxylase (TH) and phosphorylated glycogen synthase kinase-3β (pGSK-3β-inactive), while increasing phosphorylated TH (pTH) in the striatum (STR). EE also reduced TH and increased pTH, but contrary to FLX, it significantly increased striatal pGSK-3β protein expression.</p> <p>Microglia, the brain’s primary immune cells, have been implicated in several neuroinflammatory conditions, including Parkinson’s disease. The purpose of the second experiment was to explore the modulatory effects of microglia on neuroleptic-induced changes in the nigrostriatal system. The typical antipsychotic, haloperidol (HAL), did not affect the overall levels of TH, though it did induce a robust increase in pTH. The microglial NADPH oxidase inhibitor, apocynin (APO), significantly attenuated this increase in pTH. HAL also induced a significant increase in striatal pGSK-3β, while apocynin, rather surprisingly, induced a stark decrease in pGSK-3β protein expression.</p> <p>The results of this thesis indicate that both pTH and pGSK-3β are intriguing markers to study in the context of dopamine neurotransmission. In addition, EE proved to be a valuable modality in which to compare the downstream effects of pharmacological treatment. It is also clear that microglia fulfill an undefined, but fascinating role as modulators of neural transmission.</p> / Master of Science in Medical Sciences (MSMS)

Estados e municípios puderam definir seu próprio elenco de medicamentos a ser ofertados aos seus cidadãos com a Política Nacional de Medicamentos (1998), e a consequente descentralização da Assistência Farmacêutica. Percebeu-se a oportunidade de realizar um estudo para analisar peculiaridades de um conjunto de Relações Municipais de Medicamentos Essenciais (Remumes) de municípios paulistas, visando a racionalidade das listas como instrumento norteador da aquisição, distribuição, prescrição e planejamento da AF municipal. Considerou-se as possibilidades de diferentes cenários, dependente da qualidade da gestão, organização e do perfil dos recursos humanos locais e que uma equipe farmacêutica competente e qualificada prove uma melhor gestão da AF. Além disso, considerando os impactos da transição demográfica e epidemiológica da população brasileira em que os idosos utilizam mais medicamentos, gestores e profissionais da saúde precisam selecionar medicamentos criteriosamente para atender necessidades dessa faixa etária. O emprego de medicamentos potencialmente inapropriados (MPI) para idosos requer cuidado e estudos tem procurado lista-los e criar instrumentos de seleção. Aqueles inclusos nos critérios Beers definidos com apoio da Sociedade Americana de Geriatria encontram-se associados a desfechos desfavoráveis de saúde e mortalidade. OBJETIVOS: Analisar Remumes disponibilizadas para este estudo visando alertar profissionais de saúde e gestores sobre MPIs que podem comprometer a segurança dos pacientes no processo de utilização de medicamentos. MÉTODOS: Trata-se de um estudo transversal de análise das Remumes dos municípios sedes dos 17 Departamentos Regionais de Saúde (DRSs) e das Remumes dos 27 municípios do Departamento Regional de Saúde (DRS) XIII enfatizando aqueles MPIs contidos nelas. Obtiveram-se 100% das 17 Remumes dos municípios sedes dos DRSs e 92,3% das 27 Remumes dos municípios do DRS XIII, formando um banco de dados com 9063 medicamentos, discriminados pela classificação ATC e pelos diversos critérios de Beers. RESULTADOS E DISCUSSÃO: Os municípios sedes apresentaram Remumes contendo de 128 (Piracicaba) a 396 (Santos) medicamentos, com média de 272,3 (DP=71,1) medicamentos. As Remume dos municípios da DRS XIII apresentaram entre 32 (Luiz Antônio) e 403 (Cássia dos Coqueiros) medicamentos, com média de 198 (DP=111,4). Predominaram os medicamentos que atuavam no sistema nervoso seguidos pelos cardiovasculares e anti-infecciosos sistêmicos. Quando os medicamentos contidos nas Remumes foram submetidos à aplicação dos critérios de Beers, foram identificados 59,9% de MPIs, sendo que do total de 77 classes terapêuticas 39 (53,6%) classes tinham pelo menos um representante na lista dos Critérios de Beers. Os achados foram discutidos comparando dados dos municípios, outros critérios para medicamentos inapropriados para idosos, à luz de evidências clíncas mais recentes. CONCLUSÃO: As Remumes mostraram elevada variação no número de medicamentos e grupos farmacológicos e elenco considerável de medicamentos dos critérios de Beers. Apontou para necessidade de qualificação da assistência farmacêutica municipal e a elaboração de um guia norteador que contribuam para o fortalecimento da Atenção Básica e da Assistência Farmacêutica. Este aprimoramento da utilização de medicamentos em geral e para idosos, envolvendo a prescrição, dispensação, administração e uso pelo paciente, reduzem morbimortalidade relacionada aos medicamentos. / States and municipalities were able to define their own list of medicines to be offered to their citizens with the National Drug Policy (1998) and the consequent decentralization of Pharmaceutical Assistance (PA). It was noticed the opportunity to carry out a study to analyze the peculiarities of a set of Municipal Lists of Essential Medicines (Remumes) of São Paulo state municipalities, aiming at the rationality of lists as a guiding instrument for the acquisition, distribution, prescription and planning of the municipal PA. Consideration was given to the possibilities of different scenarios, depending on the quality of management, organization and the profile of local human resources, and that a competent and qualified pharmaceutical team provides a better management of PA. In addition, considering the impact of the demographic and epidemiological transition of the Brazilian population in which the elderly use more drugs, managers and health professionals need to select medicines carefully to meet the needs of this age group. The employment of potentially inappropriate medications (PIM) for the elderly require care and studies have sought to list them and develop screening tools . Those included in the Beers criteria, defined with support from the American Society of Geriatrics, are associated with unfavorable health and mortality outcomes. OBJECTIVES: To analyze Remumes made available for this study in order to alert health professionals and managers about MPIs that may compromise patients\' safety in the medication use process. METHODS: This is a cross-sectional study of the Remumes of the municipalities of the 17 Regional Health Departments (DRSs) and of the Remumes of the 27 municipalities of the Regional Health Department (DRS) XIII emphasizing those MPIs contained in them. 100% of the 17 Remumes of the municipalities of the DRSs and 92.3% of the 27 Remumes of the municipalities of the DRS XIII were formed, forming a database with 9063 medicines, discriminated by the ATC classification and by the diverse criteria of Beers. RESULTS AND DISCUSSION: The municipal districts presented Remumes containing from 128 (Piracicaba) to 396 (Santos) medications, with an average of 272.3 (SD = 71.1) medications. Remume of DRS XIII municipalities presented medications between 32 (Luiz Antônio) and 403 (Cássia dos Coqueiros), with a mean of 198 (SD = 111.4). Predominant drugs that worked in the nervous system followed by cardiovascular and systemic anti-infectious. When medicinal products contained in Remumes were submitted to the Beers criteria, 59.9% of PIMs were identified. Of the total of 77 therapeutic classes, 39 (53.6%) classes had at least one representative in the list of Criteria of Beers. The findings were discussed comparing data from the municipalities, other criteria for PIMs for the elderly, in light of more recent clinical evidence. CONCLUSION: Remumes showed high variation in the number of drugs and pharmacological groups and considerable list of drugs of the Beers criteria. He pointed to the need for qualification of municipal pharmaceutical assistance and the elaboration of a guiding guide that contribute to the strengthening of Primary Care and Pharmaceutical Assistance. This improvement in the utilization of medications in general and for the elderly, involving prescription, dispensing, administration and use by the patient, reduces drug-related morbidity and mortality.

Estados e municípios puderam definir seu próprio elenco de medicamentos a ser ofertados aos seus cidadãos com a Política Nacional de Medicamentos (1998), e a consequente descentralização da Assistência Farmacêutica. Percebeu-se a oportunidade de realizar um estudo para analisar peculiaridades de um conjunto de Relações Municipais de Medicamentos Essenciais (Remumes) de municípios paulistas, visando a racionalidade das listas como instrumento norteador da aquisição, distribuição, prescrição e planejamento da AF municipal. Considerou-se as possibilidades de diferentes cenários, dependente da qualidade da gestão, organização e do perfil dos recursos humanos locais e que uma equipe farmacêutica competente e qualificada prove uma melhor gestão da AF. Além disso, considerando os impactos da transição demográfica e epidemiológica da população brasileira em que os idosos utilizam mais medicamentos, gestores e profissionais da saúde precisam selecionar medicamentos criteriosamente para atender necessidades dessa faixa etária. O emprego de medicamentos potencialmente inapropriados (MPI) para idosos requer cuidado e estudos tem procurado lista-los e criar instrumentos de seleção. Aqueles inclusos nos critérios Beers definidos com apoio da Sociedade Americana de Geriatria encontram-se associados a desfechos desfavoráveis de saúde e mortalidade. OBJETIVOS: Analisar Remumes disponibilizadas para este estudo visando alertar profissionais de saúde e gestores sobre MPIs que podem comprometer a segurança dos pacientes no processo de utilização de medicamentos. MÉTODOS: Trata-se de um estudo transversal de análise das Remumes dos municípios sedes dos 17 Departamentos Regionais de Saúde (DRSs) e das Remumes dos 27 municípios do Departamento Regional de Saúde (DRS) XIII enfatizando aqueles MPIs contidos nelas. Obtiveram-se 100% das 17 Remumes dos municípios sedes dos DRSs e 92,3% das 27 Remumes dos municípios do DRS XIII, formando um banco de dados com 9063 medicamentos, discriminados pela classificação ATC e pelos diversos critérios de Beers. RESULTADOS E DISCUSSÃO: Os municípios sedes apresentaram Remumes contendo de 128 (Piracicaba) a 396 (Santos) medicamentos, com média de 272,3 (DP=71,1) medicamentos. As Remume dos municípios da DRS XIII apresentaram entre 32 (Luiz Antônio) e 403 (Cássia dos Coqueiros) medicamentos, com média de 198 (DP=111,4). Predominaram os medicamentos que atuavam no sistema nervoso seguidos pelos cardiovasculares e anti-infecciosos sistêmicos. Quando os medicamentos contidos nas Remumes foram submetidos à aplicação dos critérios de Beers, foram identificados 59,9% de MPIs, sendo que do total de 77 classes terapêuticas 39 (53,6%) classes tinham pelo menos um representante na lista dos Critérios de Beers. Os achados foram discutidos comparando dados dos municípios, outros critérios para medicamentos inapropriados para idosos, à luz de evidências clíncas mais recentes. CONCLUSÃO: As Remumes mostraram elevada variação no número de medicamentos e grupos farmacológicos e elenco considerável de medicamentos dos critérios de Beers. Apontou para necessidade de qualificação da assistência farmacêutica municipal e a elaboração de um guia norteador que contribuam para o fortalecimento da Atenção Básica e da Assistência Farmacêutica. Este aprimoramento da utilização de medicamentos em geral e para idosos, envolvendo a prescrição, dispensação, administração e uso pelo paciente, reduzem morbimortalidade relacionada aos medicamentos. / States and municipalities were able to define their own list of medicines to be offered to their citizens with the National Drug Policy (1998) and the consequent decentralization of Pharmaceutical Assistance (PA). It was noticed the opportunity to carry out a study to analyze the peculiarities of a set of Municipal Lists of Essential Medicines (Remumes) of São Paulo state municipalities, aiming at the rationality of lists as a guiding instrument for the acquisition, distribution, prescription and planning of the municipal PA. Consideration was given to the possibilities of different scenarios, depending on the quality of management, organization and the profile of local human resources, and that a competent and qualified pharmaceutical team provides a better management of PA. In addition, considering the impact of the demographic and epidemiological transition of the Brazilian population in which the elderly use more drugs, managers and health professionals need to select medicines carefully to meet the needs of this age group. The employment of potentially inappropriate medications (PIM) for the elderly require care and studies have sought to list them and develop screening tools . Those included in the Beers criteria, defined with support from the American Society of Geriatrics, are associated with unfavorable health and mortality outcomes. OBJECTIVES: To analyze Remumes made available for this study in order to alert health professionals and managers about MPIs that may compromise patients\' safety in the medication use process. METHODS: This is a cross-sectional study of the Remumes of the municipalities of the 17 Regional Health Departments (DRSs) and of the Remumes of the 27 municipalities of the Regional Health Department (DRS) XIII emphasizing those MPIs contained in them. 100% of the 17 Remumes of the municipalities of the DRSs and 92.3% of the 27 Remumes of the municipalities of the DRS XIII were formed, forming a database with 9063 medicines, discriminated by the ATC classification and by the diverse criteria of Beers. RESULTS AND DISCUSSION: The municipal districts presented Remumes containing from 128 (Piracicaba) to 396 (Santos) medications, with an average of 272.3 (SD = 71.1) medications. Remume of DRS XIII municipalities presented medications between 32 (Luiz Antônio) and 403 (Cássia dos Coqueiros), with a mean of 198 (SD = 111.4). Predominant drugs that worked in the nervous system followed by cardiovascular and systemic anti-infectious. When medicinal products contained in Remumes were submitted to the Beers criteria, 59.9% of PIMs were identified. Of the total of 77 therapeutic classes, 39 (53.6%) classes had at least one representative in the list of Criteria of Beers. The findings were discussed comparing data from the municipalities, other criteria for PIMs for the elderly, in light of more recent clinical evidence. CONCLUSION: Remumes showed high variation in the number of drugs and pharmacological groups and considerable list of drugs of the Beers criteria. He pointed to the need for qualification of municipal pharmaceutical assistance and the elaboration of a guiding guide that contribute to the strengthening of Primary Care and Pharmaceutical Assistance. This improvement in the utilization of medications in general and for the elderly, involving prescription, dispensing, administration and use by the patient, reduces drug-related morbidity and mortality.

The work presented in this dissertation focuses on the association between sleep medication use, poor sleep, and falls in community-dwelling adults 65 years or older. Sleep complaints and the consumption of medications to aid sleep are common in older adults. Psychotropic medications, such as sedative hypnotics, are associated with risk of falls in older adults. However, very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls in community-dwelling older adults. In the first project, a cross-sectional analysis of the Health and Retirement Study (HRS) 2010 data was conducted to determine the prevalence of sleep problems, sleep medication use and falls; and to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. A multiple logistic model adjusted for covariates was used. In the sample of community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the older adults. Older adults who had sleep problems and took sleep medications had a significantly higher risk of falls compared with older adults who did not have sleep problems and did not take sleep medications. The other two groups, older adults who had sleep problems and did not take sleep medications, and those who did not have sleep problems and took sleep medications also had a significantly greater risk for falls. The second project was a prospective cohort study of independently-living older adults from senior congregate housing. The effect of combined poor sleep quality and sleep medication use on risk of falls was assessed using logistic regression modeling. In this study of 113 community-dwelling older adults, 46.9% had at least one fall, and 62.8% had poor sleep quality. Sleep medication use was reported by 44.2% of the older adults. Older adults with poor sleep quality and sleep medication use had a significantly increased risk of falls compared with older adults with good sleep quality and no sleep medication use. Older adults with good sleep quality and sleep medication use, and those with poor sleep quality and no sleep medication use did not have a significantly greater risk for falls. In conclusion, poor sleep added to sleep medication use significantly increased the risk of falls in community-dwelling older adults. The research undertaken in this dissertation was the first to evaluate the associations between poor sleep, use of sleep medications, and falls in community-dwelling older adults.

Made available in DSpace on 2016-08-10T10:57:44Z (GMT). No. of bitstreams: 1 Tassio Fontes Moreira Camara.pdf: 4274892 bytes, checksum: d87bfb8717ef6c568ba858ef5dfd418c (MD5) Previous issue date: 2015-12-01 / Hypertension is a disease difficult to control, responsible for a lot of deaths worldwide and an important risk factor in the development of cardiovascular disease. It can be treated with lifestyle changes (no drug treatment) or with the use of one or more drugs (drug treatment). The objective of this study was to evaluate the pharmacological treatment of hypertension in patients with a reference health care and blood pressure control achieved. This was a retrospective study conducted at the Hypertension League of the Federal University of Goiás (HL-FUG). Medical records of 1,129 active register patients who were in regular antihypertensive drug therapy were evaluated. Were collected socioeconomic and clinical variables related to the first and last visit and the drugs used in the last query before the collection that have been identified according to the pharmacological class. Descriptive analysis was performed and used the Wilcoxon test to compare the means of the initial and final blood pressure, the comparison between the prevalence of controlled and uncontrolled pressure was established with the Chi-Square test and Pearson correlations between age and the monitoring time with the values of systolic and diastolic blood pressure were obtained using the test Spearman (p <0.05). Among the active patients HL-FUG, 96.8% were in drug treatment. The mean age was 62.7 ± 12.4 years, 854 (75.6%) were female and 890 (78.8%) with companion. Most patients 796 (70.5%) were overweight and when started the treatment at the HL-FUG, 932 (82.6%) used two or more drugs. Where as monotherapy patients, the pharmacologic class most prescribed was AT1 receptor blockers of Angiotensine II (RBA II): 61 (31.0%). The most common combination of two drugs was found RBA II with diuretic, 161 (35.9%), followed inhibitor of angiotensine-converting enzyme (ACE-I) with diuretic, 150 (33.5%). The initial systolic blood pressure (SBP) was 148mmHg (CI: 148.21-153.09) and final 135mmHg (CI: 135.99-138.40) (p <0.001). The initial diastolic (DBP) was 91mmHg (CI: 92,49-94,43), and the final was 82mmHg (CI: 81,79-83,27) (p <0.001). There was an increase in the number of patients with controlled pressure from 24.4% to 36.7%. In conclusion, most patients from HL-FUG was in pharmacological treatment with two drugs or more drugs. The AT1 receptor blockers of Angiotensine II is the pharmacological class most used as monotherapy and also associated with diuretic. There was a reduction on blood pressure as systolic as diastolic compared to the initial consultation and final consultation assessed. There was moderate correlation SBP with the age. / A hipertensão arterial é uma doença de difícil controle, responsável por milhares de mortes em todo o mundo e fator de risco importante no desenvolvimento de doenças cardiovasculares. Pode ser tratada com mudanças de estilo de vida (tratamento não farmacológico) ou com a utilização de um ou mais medicamentos (tratamento farmacológico). O objetivo deste trabalho foi avaliar o tratamento farmacológico da hipertensão arterial sistêmica em pacientes de um serviço de saúde de referência e o controle pressórico alcançado. Tratou-se de um estudo retrospectivo, realizado na Liga de Hipertensão Arterial da Universidade Federal de Goiás (LHA-UFG). Foram avaliados prontuários de 1.129 pacientes do cadastro ativo, que estavam em tratamento farmacológico anti-hipertensivo regular. Foram coletadas variáveis socioeconômicas e clínicas referentes à primeira e à última consulta e os medicamentos utilizados na última consulta antes da coleta que foram identificados segundo a classe farmacológica. Foi realizada análise descritiva dos dados e utilizado o teste de Wilcoxon para a comparação entre médias da pressão arterial inicial e final, a comparação entre a prevalência de pressão controlada e não controlada foi estabelecida com o teste qui-quadrado de Pearson e as correlações entre a idade e o tempo de acompanhamento com os valores de pressão arterial sistólica e diastólica foram obtidas com a utilização do teste de Spearman (p<0,05). Dentre os pacientes ativos da LHA-UFG, 96,8% estavam em tratamento farmacológico. A idade média foi de 62,7±12,4 anos, 854 (75,6%) eram do sexo feminino e 890 (78,8%) com companheiro. A maioria dos pacientes 796 (70,5%) estava com excesso de peso e, quando iniciaram o tratamento na LHA-UFG, 932 (82,6%) utilizavam dois ou mais medicamentos. Considerando os pacientes em monoterapia, a classe farmacológica mais prescrita foi bloqueadores do receptor AT1 da angiotensina II (BRA II): 61 (31,0%). A associação de duas medicações mais comuns encontradas foi BRA II com diurético, 161 (35,9%), seguido do inibidor da enzima conversora de angiotensina (I-ECA) com diurético, 150 (33,5%). A pressão arterial sistólica (PAS) inicial foi 148mmHg (IC: 148,21-153,09) e a final 135mmHg (IC: 135,99-138,40) (p<0,001). A pressão arterial diastólica (PAD) inicial foi 91mmHg (IC: 92,49-94,43) e a final 82mmHg (IC: 81,79-83,27) (p<0,001). Houve aumento do número de pacientes com pressão controlada, de 24,4% para 36,7%. Conclui-se que, a maioria dos pacientes da LHA-UFG estava em tratamento farmacológico com duas os mais medicações. Os bloqueadores do receptor AT1 da angiotensina II é a classe farmacológica mais utilizada como monoterapia e também associado com diurético. Houve redução da pressão arterial tanto sistólica quanto diastólica em relação à consulta inicial e a última consulta avaliada. Houve correlação moderada PAS com a idade.