FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / INTRODUÃÃO: ReaÃÃes adversas a medicamentos - RAM constituem causa de morbi-mortalidade em pacientes hospitalizados, pÃem em risco a vida do paciente e representam aumento no tempo de internaÃÃo e nos custos hospitalares. OBJETIVOS: Determinar a incidÃncia de reaÃÃes adversas a medicamentos no Hospital UniversitÃrio Walter CantÃdio - HUWC, investigar quais os fatores que podem estar associados a esses eventos e propÃr medidas de prevenÃÃo ou reduÃÃo do impacto negativo dessas reaÃÃes. MÃTODOS: Estudo observacional, analÃtico, prospectivo, com monitorizaÃÃo intensiva de pacientes, determinaÃÃo da incidÃncia acumulada de RAM e avaliaÃÃo exploratÃria de seus determinantes. Eram incluÃdos no estudo, todos os pacientes internados nas clÃnicas mÃdicas do HUWC, de 01 de setembro de 2000 a 28 de fevereiro de 2001, os quais foram acompanhados desde o momento da internaÃÃo atà a alta hospitalar ou Ãbito, para a detecÃÃo e acompanhamento de reaÃÃes adversas. Foram realizadas visitas diÃrias Ãs clÃnicas mÃdicas do HUWC, registrando os medicamentos utilizados e investigaÃÃo sobre a ocorrÃncia de RAM. Os casos em que os pacientes apresentavam RAM eram avaliados seguindo a metodologia recomendada pela OrganizaÃÃo Mundial de SaÃde. As reaÃÃes eram classificadas conforme imputabilidade, gravidade e tipo. Os medicamentos foram classificados de acordo com o Anatomical-Therapeutical-Chemical â ATC, Classification Index e as reaÃÃes adversas atravÃs do WHO-ART tambÃm recomendado pela OrganizaÃÃo Mundial da SaÃde. RESULTADOS: Foram internados nas clÃnicas mÃdicas do HUWC um total de 970 pacientes destes, 54% eram mulheres e 46% homens, com idade variando de 9 meses a 97 anos. Todos os pacientes fizeram uso de medicamentos durante a internaÃÃo, variando de 1 a 20 medicamentos/paciente. Os grupos de medicamentos mais utilizados, (1 nÃvel ATC) foram medicamentos que atuam no sistema nervoso central (19,0%), medicamentos que atuam sobre o trato alimentar e metabolismo (17,0%), medicamentos que atuam no sistema cardiovascular (16,7%). Do total, oito (0,8%) tiveram como diagnÃstico de internaÃÃo alguma reaÃÃo adversa a medicamento. Durante o perÃodo do estudo foram verificadas 30 novas ocorrÃncias de RAM em pacientes hospitalizados. As manifestaÃÃes das reaÃÃes adversas compreendiam principalmente afecÃÃes da pele (65,0%) e distÃrbios do estado geral (25,0%). Quanto à gravidade, as reaÃÃes foram na sua maioria classificadas como moderadas (79,0%), seguidas das reaÃÃes leves (19,0%). A relaÃÃo de causalidade foi considerada provÃvel em 58,0% dos casos e definida em 24,5%. Os grupos farmacolÃgicos mais envolvidos foram antibiÃticos de uso sistÃmico (66,4%), seguido por medicamentos que atuam no sistema nervoso (7,7%), antineoplÃsicos e agentes imunomoduladores (7,7%). A incidÃncia de RAM entre os pacientes hospitalizados nÃo està associada ao sexo nem à idade. O nÃmero de dias de internaÃÃo interferiu na ocorrÃncia de RAM. CONCLUSÃO: Foram identificadas ocorrÃncias de reaÃÃes adversas como causa de internaÃÃo e durante a internaÃÃo hospitalar. Todos os pacientes admitidos com RAM apresentaram manifestaÃÃes dermatolÃgicas. Os antibiÃticos, principalmente a cefalotina, foram os medicamentos mais envolvidos com a ocorrÃncia de RAM em pacientes internados. / INTRODUCTION: Adverse drug reactions (ADR) constitute cause of morbidity in hospitalized patients, represent a risk for patients and an increase in the period patients stay in hospitals and the costs. OBJECTIVES: To determine the incidence of adverse drug reactions in the Walter CantÃdio University Hospital (WCUH), investigate what factors may be associated with these events and propose measures to prevent or reduce the negative impact of those reactions. METHODS: An observational, analytical, and prospective study, with intensive monitoring of patients, analysis of the cumulative incidence of ADR and an exploratory evaluation of its determinants. The study included all inpatients in the medical clinics of WCUH from September 1st, 2000 to February 28th 2001, which were assisted from admission until discharge or death, to detection and monitoring of adverse reaction. Daily calls were made to the clinics WCUH in order to register the use of drugs and the occurrence of ADR. Cases in which patients had ADRs were assessed according to the methodology proposed by the World Health Organization. The reactions were classified based on liability, severity and type. Drugs were classified according to the Anatomical-Therapeutical-Chemical (ATC), Classification Index and adverse reactions through the WHO-ART also recommended by the World Health Organization. RESULTS: 970 patients were admitted to the medical clinics of HUWC. Of those, 54% were women and 46% were men, ranging in age from 09 months to 97 years. All patients received medication during hospitalization, ranging from 1 to 20 drugs / patient. The most commonly used drug groups (1st level ATC) are drugs that act on central nervous system (19.0%), drugs that act on the digestive tract and metabolism (17.0%), and drugs that act on the cardiovascular system (16.7%). Of the total, in eight (8%) the diagnosis for admission was an adverse reaction to medication. During the study, 30 new cases of ADRs in inpatients were registered. The results of adverse reactions comprised mainly skin disorders (65.0%) and general disturbances (25.0%). About gravity, the reactions were mostly classified as moderate (79.0%), followed by mild reactions (19.0%). The relation of causality was considered probable in 58.0% of cases and set at 24.5%. Most involved pharmacological groups were antibiotics for systemic use (66.4%), followed by drugs that act on the nervous system (7.7%), antineoplastic and immunomodulating agents (7.7%). The incidence of ADR among inpatients is not associated with age or gender. The number of days of hospital admission interfered with the occurrence of RAM. CONCLUSION: Adverse reactions as cause of admission were identified. All inpatients with ADRs have skin manifestations. Antibiotics, especially cephalosporins, were drugs commonly involved with the occurrence of ADRs in inpatients.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:5871 |
| Date | 01 December 2004 |
| Creators | Adriana Parente Gomes |
| Contributors | Helena LutÃscia Luna Coelho, JoÃo MacÃdo Coelho Filho, Mirian Parente Monteiro |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em CiÃncias FarmacÃuticas, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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