ASSESSMENT OF THE RISK OF ADVERSE DRUG REACTIONS IN ELDERLY PATIENTS WITH CARDIOVASCULAR DISEASE
Relevance: International research shows that polypharmacy is common among older people. Most older people take more than five drugs, some of which are not medically necessary. Research has clearly established a strong link between polypharmacy and negative clinical consequences. The result of polypharmacy is unwanted drug reactions, an increase in drug side effects and drug-drug interactions. To improve the pharmacotherapy of older people, it is important to use the tools for rationalizing drug treatment. One of them is Beers criteria.
Objective of the study: To optimize pharmacotherapy for patients of the older age group by identifying unwanted and potentially dangerous drugs using Beers criteria.
Materials and research methods. Retrospective analysis of medical records of inpatients of patients aged 65 years and older with cardiac profile for the period from January to December 2017.
Results of the study: As a result of the analysis of the case histories of the cardiological hospital, excessive polypharmacy was revealed - the appointment of 10 or more drugs in 43 (40.9%) patients. Of the unwanted drugs from Bierce's criteria, selective COX-2 inhibitors were used most of all - 18.1% of cases, ketorolac was prescribed least of all - 1.0%. Among the drugs that aggravate heart failure, NSAIDs and nondihydropyridine CCBs were prescribed. Medicines that are potentially dangerous for the elderly are vasodilators - 100.0% and diuretics - 93.4%, to a lesser extent - carbamazepine - 4.8% of cases. Undesirable drug combinations were noticed: warfarin + amiodarone - 1.0%, warfarin + meloxicam - 1.0%. Of the drugs to be avoided in renal failure, spironolactone was found in 1.0% of cases.
Conclusions: The results of this study indicate the need for careful monitoring of the efficacy and safety of drug therapy. It is necessary to apply various methods to combat polypharmacy and unwanted drug reactions, in particular, Beers criteria. Various trainings and master classes for training doctors will help to establish pharmacotherapy for patients.
Aizhan B. Musapirova1, https://orcid.org/0000-0002-6742-2182
Raikhan E. Tuleutaeva1, https://orcid.org/0000-0002-0462-5230
Asem R. Makhatova1, https://orcid.org/0000-0003-4127-7279
Zhanargul' K. Smailova1, https://orcid.org/0000-0002-4513-4614
Alibek Zh. Ukenov1, Dinara B. Ukenova1
NCJSC "Semey Medical University", Semey c., Republic of Kazakhstan
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20. Pariseault C.A. An Integrative Review of Methods of Measurement of Polypharmacy // J Nurs Meas. 2019. 27(3):554-574. doi: 10.1891/1061-3749.27.3.554.
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13. Halli-Tierney A.D., Scarbrough C., Carroll D. Polypharmacy: Evaluating Risks and Deprescribing. Am Fam Physician. 2019. 100(1):32-38.
14. Hudhra K., García-Caballos M., Casado-Fernandez E., Jucja B., Shabani D., Bueno-Cavanillas A. Polypharmacy and potentially inappropriate prescriptions identified by Beers and STOPP criteria in co-morbid older patients at hospital discharge. J Eval Clin Pract. 2016 Apr;22(2):189-93. doi: 10.1111/jep.12452
15. Kim J., Parish A.L. Polypharmacy and Medication Management in Older Adults. Nurs Clin North Am. 2017. 52(3):457-468. doi: 10.1016/j.cnur.2017.04.007.
16. Masnoon N., Shakib S., Kalisch-Ellett L., Caughey G.E. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017. 17(1):230. doi: 10.1186/s12877-017-0621-2.
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19. Olsson I.N., Rummamo R., Engfeldt P. Medication quality and quality of life in the elderly, a cohort study. Health Qual. Life Outcomes. 2011. 9. 95.
20. Pariseault C.A. An Integrative Review of Methods of Measurement of Polypharmacy // J Nurs Meas. 2019. 27(3):554-574. doi: 10.1891/1061-3749.27.3.554.
21. Payne R.A. The epidemiology of polypharmacy. Clin Med (Lond). 2016. 16(5):465-469. doi: 10.7861/clinmedicine.16-5-465.
22. Riedl M.A., Casillas A.M. Adverse Drug Reactions: Types and Treatment Options. Am. Fam. Physician. 2013. 68(9): 1781–1790.
23. United Nations. World Population Ageing, 2014. Dep. Econ. Soc. Aff. Popul. Div. 2014. С. 73.
24. Urzal J., Pedro A.B., Oliveira I.F., Romero I., Achega M., Correia I., Aldomiro F., Augusto J. Inappropriate prescribing to elderly patients in an internal medicine ward. Acta Med. Port. 2019. 32(2):141-148.
25. Wastesson J.W., Morin L., Laroche M.L., Johnell K. How Chronic Is Polypharmacy in Old Age? A Longitudinal Nationwide Cohort Study. J. Am. Geriatr. Soc. 2019. 67(3):455-462.
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Bibliography link
Musapirova A.B., Tuleutaeva R.E., Makhatova A.R., Smailova Zh.K., Ukenov A.Zh., Ukenova D.B. Assessment of the risk of adverse drug reactions in elderly patients with cardiovascular disease // Nauka i Zdravookhranenie [Science & Healthcare]. 2021, (Vol.23) 2, pp. 118-126. doi 10.34689/SH.2021.23.2.012Related publications:
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