Seguridad del paciente
Análisis de la prescripción en adultos mayores de una policlínica de salud mental del Hospital Vilardebó, Uruguay
DOI:
https://doi.org/10.29193/RMU.38.4.3Palabras clave:
PSICOTRÓPICOS, FARMACOLOGÍA, PRESCRIPCIONES DE MEDICAMENTOS, CARGA ANTICOLINÉRGICAResumen
Introducción: los pacientes con 65 años o más, por su condición fisiológica, tienen mayor probabilidad de estar expuestos a reacciones adversas a medicamentos. Algunos riesgos están asociados a la carga anticolinérgica de la medicación, y otros al perfil de seguridad de cada uno de los fármacos.
Objetivo: realizar un análisis de los tratamientos farmacológicos para los pacientes ≥65 años y su posible implicancia en la clínica, por los riesgos potenciales debido a reacciones adversas.
Método: se realizó un estudio descriptivo, transversal, observacional, naturalístico, del tratamiento farmacológico de los pacientes ≥65 años de la policlínica del Hospital Vilardebó, entre mayo y agosto de 2021. Se calculó la carga anticolinérgica de los tratamientos y se efectuó una comparación de dicha carga con la de una muestra de pacientes menores de 65 años.
Resultados: 356 pacientes (83,0%) ≥65 años tenían un riesgo alto de tener algún efecto por su carga anticolinérgica y este riesgo fue similar a los pacientes menores de 65 años. Un total de 344 pacientes estaban en tratamiento con alguna benzodiazepina, destacándose el uso de flunitrazepam (47,6%) y clonazepam (32,6%). A 289 pacientes (67,4%) se le prescribió algún antipsicótico y nueve pacientes estaban con más de dos antipsicóticos. Dos pacientes estaban en tratamiento con imipramina y 49 pacientes recibían algún antiparkisoniano.
Conclusiones: los pacientes mayores de 65 años están expuestos a riesgos altos de padecer reacciones adversas a medicamentos como consecuencia de una alta carga anticolinérgica (similar a la de la población más joven estudiada) y de una acentuada polifarmacia. Además, se deberían evitar algunas prácticas, como la prescripción de ciertos tipos de benzodiacepinas, así como minimizar el uso de imipramina y antiparkisonianos.
Es necesario buscar estrategias de formación que disminuyan o minimicen este potencial riesgo que repercute adversamente en la salud de los pacientes.
Citas
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4) Anathhanam S, Powis RA, Cracknell AL, Robson J. Impact of prescribed medications on patient safety in older people. Ther Adv Drug Saf 2012; 3(4):165-74. doi: 10.1177/2042098612443848.
5) Bates DW, Singh H. Two decades since to err is human: an assessment of progress and emerging priorities in patient safety. Health Affairs (Millwood) 2018; 37(11):1736-43. doi: 10.1377/hlthaff.2018.0738.
6) Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Mahmoud RA, et al. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc 2008; 56(7):1333-41. doi: 10.1111/j.1532-5415.2008.01737.x.
7) Toto S, Hefner G, Hahn M, Hiemke C, Roll SC, Wolff J, et al. Current use of anticholinergic medications in a large naturalistic sample of psychiatric patients. J Neural Transm (Vienna) 2021; 128(2):263-72. doi: 10.1007/s00702-020-02298-5.
8) Back C, Wittmann M, Haen E. [Delirium induced by drug treatment]. Ther Umsch 2011; 68(1):27-33. doi: 10.1024/0040-5930/a000116.
9) Flacker JM, Cummings V, Mach JR, Bettin K, Kiely DK, Wei J. The association of serum anticholinergic activity with delirium in elderly medical patients. Am J Geriatr Psychiatry 1998; 6(1):31-41.
10) McEvoy JP. The clinical use of anticholinergic drugs as treatment for extrapyramidal side effects of neuroleptic drugs. J Clin Psychopharmacol 1983; 3(5):288-302.
11) Mintzer J, Burns A. Anticholinergic side-effects of drugs in elderly people. J R Soc Med 2000; 93(9):457-62. doi: 10.1177/014107680009300903.
12) Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr 2015; 15:31. doi: 10.1186/s12877-015-0029-9.
13) Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med 2007; 167(8):781-7. doi: 10.1001/archinte.167.8.781.
14) Villalba-Moreno AM, Alfaro-Lara ER, Santos-Ramos B. Anticholinergic risk: use and limitations of anticholinergic scales. Eur J Intern Med 2015; 26(10):e65-6. doi: 10.1016/j.ejim.2015.08.014.
15) Kouladjian O’Donnell L, Gnjidic D, Nahas R, Bell JS, Hilmer SN. Anticholinergic burden: considerations for older adults. J Pharm Prac Res 2017; 47(1):67-77. doi: org/10.1002/jppr.1303.
16) Speranza N, Domínguez V, Pagano E, Artagaveytia P, Olmos I, Toledo M, et al. Consumo de benzodiazepinas en la población uruguaya: un posible problema de salud pública. Rev Méd Urug 2015; 31(2):112-9. Disponible en: https://revista.rmu.org.uy/index.php/rmu/article/view/213 [Consulta: 24 marzo 2022].
17) 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.
18) Danza Á, Rodríguez Branco M, López Pampín M, Agorio D, Caleri A, Patiño I, et al. Benzodiazepinas y fractura de cadera: estudio de casos y controles. Rev Méd Urug 2015; 31(2):120-7. Disponible en: https://revista.rmu.org.uy/index.php/rmu/article/view/214 [Consulta: 24 marzo 2022].
19) Bogunovic OJ, Greenfield SF. Practical geriatrics: use of benzodiazepines among elderly patients. Psychiatr Serv 2004; 55(3):233-5. doi: 10.1176/appi.ps.55.3.233.
20) Maletta GJ. Use of benzodiazepines in elderly patients. May Clin Proc 1996; 71(11):1124. doi: 10.4065/71.11.1124.
21) Mato M, Toledo M, Olmos I, Frontini M, Nan F, Parpal L, et al. Estudio de consumo de benzodiacepinas en la policlínica del Hospital Vilardebó. Rev Psiquiatr Urug 2012; 76(1):25-34.
22) Uruguay. Universidad de la República. Facultad de Medicina. Recomendaciones para el uso de benzodiazepinas en Uruguay. Julio 2016. Disponible en: www.farmacologia.hc.edu.uy/images/Recomendaciones_uso_benzodiazepinas.pdf [Consulta: 31 mayo 2002].
23) Pratt N, Roughead EE, Ramsay E, Salter A, Ryan P. Risk of hospitalization for hip fracture and pneumonia associated with antipsychotic prescribing in the elderly: a self-controlled case-series analysis in an Australian health care claims database. Drug Saf 2011; 34(7):567-75. doi: 10.2165/11588470-000000000-00000.
24) Pringsheim T, Gardner DM. Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study. CMAJ Open 2014; 2(4):E225-32. doi: 10.9778/cmajo.20140009. eCollection 2014 Oct.
25) Tveito M, Handal M, Engedal K, Smith RL, Høiseth G, Skurtveit S. Prescribing of antipsychotic drugs to older patients living at home 2006–18. Tidsskr Nor Laegeforen 2019; 139(16). doi: 10.4045/tidsskr.19.0233.
26) Mato M, Olmos I, Toledo. Evolución del consumo de antipsicóticos en la Policlínica Psiquiátrica del Hospital Vilardebó. Rev Psiquiatr Urug 2017; 81(2):106-12.
27) Waal H, Vold JH, Skurtveit SO. Quetiapine abuse – myth or reality? Tidsskrift Nor Legeforen 2020; 140(12). doi: 0.4045/tidsskr.20.0059.
28) Tariot I, Ismail MS. Use of quetiapine in elderly patients. J Clin Psychiatry 2002; 63 Suppl 13:21-6.
29) El-Saifi N, Moyle W, Jones C, Tuffaha H. Quetiapine safety in older adults: a systematic literature review. J Clin Pharm Therap 2016; 41(1):7-18. doi: 10.1111/jcpt.12357.
30) Bernardo M, Rico-Villademoros F, García-Rizo C, Rojo R, Gómez-Huelgas R. Real-world data on the adverse metabolic effects of second-generation antipsychotics and their potential determinants in adult patients: a systematic review of population-based studies. Adv Ther 2021; 38(5):2491-2512. doi: 10.1007/s12325-021-01689-8.
31) Gallego JA, Nielsen J, De Hert M, Kane JM, Correll CU. Safety and tolerability of antipsychotic polypharmacy. Expert Opin Drug Saf 2012; 11(4):527-42. doi: 10.1517/14740338.2012.683523.
32) Correll CU, Rubio JM, Kane JM. What is the risk-benefit ratio of long-term antipsychotic treatment in people with schizophrenia? World Psychiatr 2018;17(2):149-60. doi: 10.1002/wps.20516.
33) Roose SP, Schatzberg AF. The efficacy of antidepressants in the treatment of late-life depression. J Clin Psychopharmacol 2005; 25(4 Suppl 1):S1-7. doi: 10.1097/01.jcp.0000162807.84570.6b.
34) Pagano E, Domínguez V, Speranza N, Barboza L, Tamosiunas G. Evaluación del consumo en antidepresivos en la población uruguaya entre 2010 y 2014. Rev Méd Urug 2021; 37(3):e203. doi: 10.29193/RMU.37.3.3.
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2022-12-12
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Olmos I, Angulo D, Mato M, Ricciardi C, Toledo M, Vázquez M. Seguridad del paciente: Análisis de la prescripción en adultos mayores de una policlínica de salud mental del Hospital Vilardebó, Uruguay. Rev. Méd. Urug. [Internet]. 12 de diciembre de 2022 [citado 21 de diciembre de 2024];38(4):e38404. Disponible en: https://revista.rmu.org.uy/index.php/rmu/article/view/980
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