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
1. Гржибовский А.М., Унгуряну Т.Н. Анализ биомедицинских данных с использованием пакета статистических программ SPSS. Учебное пособие. — Архангельск: Изд-во Северного государственного медицинского университета, 2017. — 293 с. 2. Демографический прогноз Республики Казахстан: основные тренды, вызовы, практические рекомендации. Аналитический доклад. Министерство экономики и бюджетного планирования РК. Астана, 2014. 66 с. 3. Королева М.В., Ильницкий А.Н., Кудашкина Е.В., Коршун Е.И., Шарова А.А. Современные направления фармакотерапии гериатрических пациентов: полиморбидность - полипрагмазия - депрескрайбинг // Современные проблемы здравоохранения и медицинской статистики. 2019. Т. 3. № 1. С. 150–171. 4. Кузденбаева Р. Фармаконадзор в лечении пожилых пациентов. Фармаконадзор лекарственных средств и мониторинг безопасности медицинских изделий. Регистрация и экспертиза лекарственных средств и медицинских изделий в рамках ЕАЭС. Алматы, 2017. 156с. 5. Сычев Д.А. Полипрагмазия в клинической практике: проблема и решения Учебное пособие для врачей. Спб: «Профессия», 2016. 94с. 6. Сычев Д.А., Отделёнов В.А., Краснова Н.М., Ильина Е.С. Полипрагмазия: взгляд клинического фармаколога // Терапевтический архив. 2016;88(12):94-102. https://doi.org/10.17116/terarkh2016881294-102. (Дата обращения: 12.05.2020г.) 7. Сычев Д.А., Данилина К.С., Головина О.В. Частота назначения потенциально не рекомендованных препаратов (по критериям Бирса) пожилым пациентам, находящимся в терапевтических отделениях многопрофильного стационара // Тер. архив. 2015. Т. 87. № 1. С. 27–30. 8. Третьякова С.Н., Калмаханов С.Б., Тулебаев К.А., Жантуриев Б.М., Кошимбеков М.К., Игисенова А.И. Резервы увеличения продолжительности жизни населения 45 лет и старше в республике Казахстан // J. Chem. Inf. Model. 2008. Т. 53. № 9. С. 287. 9. Antimisiaris D., Cutler T. Managing Polypharmacy in the 15-Minute Office Visit // Prim Care. 2017. 44(3):413-428. doi: 10.1016/j.pop.2017.04.003. 10. By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults // J Am Geriatr Soc. 2015. 63(11):2227-46. doi: 10.1111/jgs.13702. 11. Cooper J.A., Cadogan C.A., Patterson S.M., Kerse N., Bradley M.C., Ryan C., Hughes C.M. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane sys-tematic review // BMJ Open. 2015. 5(12):e009235. doi: 10.1136/bmjopen-2015-009235. 12. Grina D., Briedis V. The use of potentially inappropriate medications among the Lithuanian elderly according to Beers and EU(7)-PIM list – a nationwide cross-sectional study on reimbursement claims data // J. Clin. Pharm. Ther. 2017. 42. 2: 195–200. 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. 17. Molnar A.O., Bota S., Jeyakumar N., McArthur E., Battistella M., Garg A.X., Sood M.M., Brimble K.S. Potentially inappropriate prescribing in older adults with advanced chronic kidney disease // PLoS One. 2020. 15(8):e0237868. doi: 10.1371/journal.pone.0237868. 18. Mortazavi S.S., Shati M., Keshtkar A., Malakouti S.K., Bazargan M., Assari S. Defining polypharmacy in the elderly: a systematic review protocol // BMJ Open. 2016. 6(3):e010989. doi: 10.1136/bmjopen-2015-010989. 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. References: 1. Grzhibovskiy A.M., Unguryanu T.N. Analiz biomeditsinskikh dannykh s ispol'zovaniem paketa statisticheskikh programm SPSS [Analysis of biomedical data using the SPSS statistical software package]. Uchebnoe posobie. — Izd-vo Severnogo gosudarstvennogo meditsinskogo universiteta [Tutorial. - Arkhangelsk: Publishing house of the Northern State Medical University], 2017. - 293 p. [in Russian] 2. Demograficheskii prognoz Respubliki Kazakhstan: osnovnye trendy, vyzovy, prakticheskie rekomendatsii. Analiticheskii doklad. Ministerstvo ekonomiki i byudzhetnogo planirovaniya RK. [Demographic forecast of the Republic of Kazakhstan: main trends, challenges, practical recommendations. Analytical report. Ministry of Economy and Budget Planning of the Republic of Kazakhstan]. Astana, 2014. - 66 p. [in Russian] 3. Koroleva M.V., Ilnitskiy A.N., Kudashkina E.V., Korshun E.I., Sharova A.A. Sovremennye napravleniya farmakoterapii geriatricheskikh patsientov: polimorbidnost' - polipragmaziya - depreskraibing [Modern directions of pharmacotherapy of geriatric patients: polymorbidity - polypharmacy – deprescribing]. Sovremennye problemy zdravookhraneniya i meditsinskoi statistiki [Modern problems of health care and medical statistics]. 2019. Vol. 3. №1. P. 150–171. [in Russian] 4. Kuzdenbaeva R. Farmakonadzor v lechenii pozhilykh patsientov. Farmakonadzor lekarstvennykh sredstv i monitoring bezopasnosti meditsinskikh izdelii. Registratsiya i ekspertiza lekarstvennykh sredstv i meditsinskikh izdelii v ramkakh EAES [Pharmacovigilance in the treatment of elderly patients. Pharmacovigilance of drugs and monitoring the safety of medical devices. Registration and examination of medicines and medical devices within the EAEU]. Almaty, 2017. 156 p. [in Russian] 5. Sychev D.A. Polipragmaziya v klinicheskoi praktike: problema i resheniya [Polypharmacy in Clinical Practice: Problem and Solutions]. Uchebnoe posobie dlya vrachei [Textbook for Physicians]. SPb: "Profession", 2016. 94 p. [in Russian] 6. Sychev DA, Otdelenov VA, Krasnova NM, Ilyina ES Polipragmaziya: vzglyad klinicheskogo farmakologa [Polypharmacy: a view of a clinical pharmacologist]. Terapevticheskii arkhiv [Therapeutic archive]. 2016. 88(12). pp. 94-102. https://doi.org/10.17116/terarkh2016881294-102. (accessed: 12.05.2020.) [in Russian] 7. Sychev D.A., Danilina K.S., Golovina O.V. Chastota naznacheniya potentsial'no ne rekomendovannykh preparatov (po kriteriyam Birsa) pozhilym patsientam, nakhodyashchimsya v terapevticheskikh otdeleniyakh mnogoprofil'nogo statsionara [The frequency of prescribing potentially not recommended drugs (according to Beers criteria) to elderly patients in the therapeutic departments of a multidisciplinary hospital] Terapevticheskii arkhiv [Therapeutic archive]. 2015. V.87. №1. pp. 27–30. [in Russian] 8. Tretyakova S.N., Kalmakhanov S.B., Tulebaev K.A., Zhanturiev B.M., Koshimbekov M.K., Igisenova A.I. Rezervy uvelicheniya prodolzhitel'nosti zhizni naseleniya 45 let i starshe v respublike Kazakhstan [Reserves for increasing life expectancy of the population 45 years and older in the Republic of Kazakhstan]. J. Chem. Inf. Model. 2008. V. 53. №9. P. 287. [in Russian] 9. Antimisiaris D., Cutler T. Managing Polypharmacy in the 15-Minute Office Visit. Prim Care. 2017. 44(3):413-428. doi: 10.1016/j.pop.2017.04.003. 10. By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015. 63(11):2227-46. doi: 10.1111/jgs.13702. 11. Cooper J.A., Cadogan C.A., Patterson S.M., Kerse N., Bradley M.C., Ryan C., Hughes C.M. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane sys-tematic review. BMJ Open. 2015. 5(12):e009235. doi: 10.1136/bmjopen-2015-009235. 12. Grina D., Briedis V. The use of potentially inappropriate medications among the Lithuanian elderly according to Beers and EU(7)-PIM list – a nationwide cross-sectional study on reimbursement claims data. J. Clin. Pharm. Ther. 2017. 42. 2: 195–200. 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. 17. Molnar A.O., Bota S., Jeyakumar N., McArthur E., Battistella M., Garg A.X., Sood M.M., Brimble K.S. Potentially inappropriate prescribing in older adults with advanced chronic kidney disease. PLoS One. 2020. 15(8):e0237868. doi: 10.1371/journal.pone.0237868. 18. Mortazavi S.S., Shati M., Keshtkar A., Malakouti S.K., Bazargan M., Assari S. Defining polypharmacy in the elderly: a systematic review protocol. BMJ Open. 2016. 6(3):e010989. doi: 10.1136/bmjopen-2015-010989. 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.
: 23

:

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.2021.23.2.012