Ramos Grazielle Viana, Japiassú André Miguel, Bozza Fernando Augusto, Guaraldo Lusiele
Instituto Nacional de Infectologia Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, RJ, BR.
Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, BR.
Clinics (Sao Paulo). 2018 Feb 19;73:e148. doi: 10.6061/clinics/2018/e148.
The aim of this study was to develop a strategy to identify adverse drug events associated with drug-drug interactions by analyzing the prescriptions of critically ill patients.
This retrospective study included HIV/AIDS patients who were admitted to an intensive care unit between November 2006 and September 2008. Data were collected in two stages. In the first stage, three prescriptions administered throughout the entire duration of these patients' hospitalization were reviewed, with the Micromedex database used to search for potential drug-drug interactions. In the second stage, a search for adverse drug events in all available medical, nursing and laboratory records was performed. The probability that a drug-drug interaction caused each adverse drug events was assessed using the Naranjo algorithm.
A total of 186 drug prescriptions of 62 HIV/AIDS patients were analyzed. There were 331 potential drug-drug interactions, and 9% of these potential interactions resulted in adverse drug events in 16 patients; these adverse drug events included treatment failure (16.7%) and adverse reactions (83.3%). Most of the adverse drug reactions were classified as possible based on the Naranjo algorithm.
The approach used in this study allowed for the detection of adverse drug events related to 9% of the potential drug-drug interactions that were identified; these adverse drug events affected 26% of the study population. With the monitoring of adverse drug events based on prescriptions, a combination of the evaluation of potential drug-drug interactions by clinical pharmacy services and the monitoring of critically ill patients is an effective strategy that can be used as a complementary tool for safety assessments and the prevention of adverse drug events.
本研究旨在制定一种策略，通过分析重症患者的处方来识别与药物相互作用相关的不良药物事件。
这项回顾性研究纳入了2006年11月至2008年9月期间入住重症监护病房的艾滋病毒/艾滋病患者。数据分两个阶段收集。在第一阶段，审查了这些患者住院期间全程使用的三份处方，并使用Micromedex数据库搜索潜在的药物相互作用。在第二阶段，在所有可用的医疗、护理和实验室记录中搜索不良药物事件。使用Naranjo算法评估药物相互作用导致每种不良药物事件的可能性。
共分析了62例艾滋病毒/艾滋病患者的186份药物处方。有331种潜在的药物相互作用，其中9%的潜在相互作用在16例患者中导致了不良药物事件；这些不良药物事件包括治疗失败（16.7%）和不良反应（83.3%）。根据Naranjo算法，大多数不良反应被归类为可能。
本研究中使用的方法能够检测出与9%已识别的潜在药物相互作用相关的不良药物事件；这些不良药物事件影响了26%的研究人群。通过基于处方监测不良药物事件，临床药学服务对潜在药物相互作用的评估与对重症患者的监测相结合是一种有效的策略，可作为安全评估和预防不良药物事件的补充工具。
