Investigação de interações farmacocinéticas potenciais em pacientes internados em um hospital universitário

Abstract

Introduction: In clinical practice, the prescription and concomitant use of several drugs has become common. Despite the beneficial effects of polypharmacy, certain drug combinations are detrimental and may lead to increased risk of drug interactions (DI) and, consequently, are associated with adverse drug reactions (ADR), difficulties in adherence to treatment, and increased costs of health care. Objective: to investigate potential pharmacokinetic interactions (PPkI) in patients hospitalized in adult intensive care unit (ICUa) and medical clinic (MC) in a university hospital. Methods: a cross-sectional, analytical and quantitative study conducted at Hospital Universitário Alcides Carneiro in Campina Grande/PB. A pilot study was conducted between March and May 2017 to test and adjust the collection instruments and the database and to know the most prevalent IMPc. Data collection of the study ocurred between June 1 and November 15, 2017. The sample was composed of the medical records of all patients who were hospitalized in ICUa and MC of the HUAC. PPkI were identified and classified using the MICROMEDEX® Healthcare Series 2.0 software. The data were tabulated in Microsoft Office EXCEL® 2007 worksheets and analyzed by statistical software R. The main descriptive statistics of the sample were initially obtained and the data normality was assessed by the Anderson-Darlin test. The Pearson Chi-square test was used to verify possible associations between the study variables (p<0.05). The Yates correction was adopted in cases where the expected frequencies were less than 5. The univariate logistic regression adjusted to the gamma regression model was used to verify the relationship between the dependent variables and the occurrence of PPkI (independent variable). Spearman's correlation test was used to analyze the correlation between the variables drugs prescribed and drugs administered and the occurrence of PPkI. A significance level of 5% was adopted. Results: we verified a high prevalence of PPkI in the ICUa and MC (90,3% and 82,6%). The medical records of 225 patients were evaluated, being 75 of the ICUa and 150 of the MC, and an amount of 771 prescriptions (ICUa, n = 332; MC, n = 439). Polypharmacy, hospitalization time and greater number of comorbidities were associated to PPkI. Most of the PPkI were severe and moderate, with good and regular evidence. An amount of 56% of the PPkI occurred in the ICUa. The PPkI between drug and food (66,5%) were more frequent. The most prevalent PPkI pairs in the ICUa were midazolam + omeprazole and fentanyl + grapefruit and in MC was ciprofloxacin + simvastatin and captopril + food. Conclusion: In spite of the complexity of the ICUa, the high prevalence of PPkI indicates the need for its follow-up in the general hospital context. Knowledge about PPkI profile associated to a continuous practice of screening, monitoring and evaluation by a multiprofessional team, through the use of a drug interactions database represents an important process that must be effectively implemented to minimize the risk of adverse reactions resulted from such interactions, enhancing drug therapy and thus contributing to patient safety.