Pharmacotherapy in a specialized endocrinology hospital: polypharmacy and risks of drug interactions on the example of a clinical case study

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Polypharmacy and its negative consequences in multimorbid elderly patients are an important public health problem. It is obvious that with an increase in the number of drugs used, the number of drug interactions and adverse reactions increases.

The article presents a clinical case illustrating the need to monitor the safety of the simultaneous use of multiple drugs in the practice of an endocrinologist, including the use of modern instruments. When analyzing pharmacotherapy using a medical decision support system, drug interactions of moderate significance were identified. The rationality and correction of the drugs used were assessed taking into account the decrease in the filtration function of the kidneys. Using the Beers criteria, drugs that are not recommended for elderly people were identified.

The use of modern tools to assess the rationality of pharmacotherapy in conditions of polypharmacy in the practice of an endocrinologist will help improve the effectiveness of therapy.

Full Text

Restricted Access

About the authors

E. Troshina

Endocrinology Research Centre, Ministry of Health of Russia

Author for correspondence.
Email: aniazr@mail.ru
ORCID iD: 0000-0002-8520-8702

Professor, Corresponding Member of the Russian Academy of Sciences, MD

Russian Federation, Moscow

V. Bogdanova

Endocrinology Research Centre, Ministry of Health of Russia

Email: aniazr@mail.ru
ORCID iD: 0000-0001-7762-7854

Candidate of Medical Sciences

Russian Federation, Moscow

Z.-Sh. Umarkhadzhieva

Endocrinology Research Centre, Ministry of Health of Russia

Email: aniazr@mail.ru
ORCID iD: 0009-0005-0566-5903
Russian Federation, Moscow

References

  1. Mirghani H. The association of polypharmacy to diabetes distress among patients with type 2 diabetes mellitus attending an outpatient clinic in Omdurman-Sudan. Pan Afr Med J. 2018; 29: 1–7. doi: 10.11604/pamj.2018.29.108.13863
  2. Van Oort S., Rutters F., Warlé-van Herwaarden M.F. et al. Diabetes pearl from the parelsnoer initiative. Characteristics associated with polypharmacy in people with type 2 diabetes: the Dutch Diabetes Pearl cohort. Diabet Med. 2021; 38: 14406. doi: 10.1111/dme.14406
  3. Saum K.U., Schottker B., Meid A.D. et al. Is polypharmacy associated with frailty in older people? Results from the ESTHER cohort study. J Am Geriatr Soc. 2017; 65: 27–32. doi: 10.1111/jgs.14718
  4. Stafford G., Villén N., Roso-Llorach A. et al. Combined multimorbidity and polypharmacy patterns in the Elderly: a cross-sectional study in primary health care. Int J Environ Res Public Health. 2021; 18: 9216. doi: 10.3390/ijerph18179216
  5. Barnett K., Mercer S.W., Norbury M. et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380 (9836): 37–43. doi: 10.1016/S0140-6736(12)60240-2
  6. International Diabetes Federation (2021) IDF Diabetes Atlas, 9th edn. Brussels, Belgium: 2019.
  7. Marengoni A., Rizzuto D., Wang H.X. et al. Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc. 2009; 57: 225–30. doi: 10.1111/j.1532-5415.2008.02109.x
  8. Alwhaibi M., Balkhi B., Alhawassi T.M. et al. Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open. 2018; 8: e020852. doi: 10.1136/bmjopen-2017-020852
  9. Remelli F., Ceresini M.G., Trevisan C. et al. Prevalence and impact of polypharmacy in older patients with type 2 diabetes. Aging Clin Exp Res. 2022; 34 (9): 1969–83. doi: 10.1007/s40520-022-02165-1
  10. Лазебник Л.Б., Конев Ю.В., Дроздов В.Н. Полипрагмазия: гериатрический аспект проблемы. Consilium Medicum. 2007; 9 (12): 29–34 [Lazebnik L.B., Konev Yu.V., Drozdov V.N. Polypragmasia: the geriatric aspect of the problem. Consilium Medicum. 2007; 9 (12): 29–34 (in Russ.)].
  11. Delafuente J.C. Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol. 2003; 48 (2): 133–43. doi: 10.1016/j.critrevonc.2003.04.004
  12. Von Euler M., Eliasson E., Ohlen G. et al. Adverse drug reactions causing hospitalization can be monitored from computerized medical records and thereby indicate the quality of drug utilization. Pharmacoepidemiol Drug Saf. 2006; 15 (3): 179–84. doi: 10.1002/pds.1154
  13. McDonnell P.J., Jacobs M.R. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother. 2002; 36 (9): 1331–6. doi: 10.1345/aph.1A333
  14. Hohl C.M., Dankoff J., Colacone A. et al. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emer Med. 2001; 38 (6): 666–71. doi: 10.1067/mem.2001.119456
  15. Stanton LA, Peterson GM, Rumble RH, et al. Drug-related admission to an Australian hospital. Clin Pharm Ther. 1994; 19 (6): 341–7. doi: 10.1111/j.1365-2710.1994.tb00691.x
  16. Gnjidic D., Hilmer S., Blyth F. et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012; 65 (9): 989–95. doi: 10.1016/j.jclinepi.2012.02.018
  17. Сычев Д.А., Отделенов В.А., Краснова Н.М. и др. Полипрагмазия: взгляд клинического фармаколога. Терапевтический архив. 2016; 88 (12): 94–102 [Sychev D.A., Otdelenov V.A., Krasnova N.M. et al. Polypragmasy: A clinical pharmacologist’s view. Therapeutic Archive. 2016; 88 (12): 94–102 (in Russ.)] doi: 10.17116/terarkh2016881294-102
  18. Панова Е.А., Серов В.А., Шутов А.М. и др. Полипрагмазия у амбулаторных пациентов пожилого возраста. Ульяновский медико-биологический журнал. 2019; 2: 16–22 [Panova E. A., Serov V. A., Shutov A. M. et al. Polypharmacy in elderly outpatients. Ulyanovsk Medical and Biological Journal. 2019; 2: 16–22 (in Russ.)]. doi: 10.34014/2227-1848-2019-2-16-22
  19. Ermakov D., Fomina E., Kartashova O. Specific features of rational pharmacotherapy in elderly patients. Eur J Hosp Pharm. 2023; 30 (6): 322–7. doi: 10.1136/ejhpharm-2021-002980
  20. Батищева Г.А., Елисеева Д.М., Котлярова Д.К. и др. Полипрагмазия у пациентов с сахарным диабетом 2 типа и хронической болезнью почек. Кардиоваскулярная терапия и профилактика. 2023; 22 (6S): 46 [Batishheva G. A., Eliseeva D. M., Kotlyarova D. K. et al. Polypragmasia in patients with type 2 diabetes mellitus and chronic kidney disease. Cardiovascular therapy and prevention. 2023; 22 (6S): 46 (in Russ.)] doi: 10.15829/1728-8800-2023-6S
  21. Tessema Z., Yibeltal D., Wubetu M. et al. Drug-Drug interaction among admitted patients at primary, district and referral hospitals’ medical wards in East Gojjam Zone, Amhara Regional State, Ethiopia. SAGE Open Medicine. 2021; 9: 1–6. doi: 10.1177/20503121211035050
  22. Leendertse A.J., Egberts A.C., Stoker L.J. et al. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med. 2008; 168 (17): 1890–6. doi: 10.1001/archinternmed.2008.3
  23. Hamilton R.A., Briceland L.L., Andritz M.H. Frequency of hospitalization after exposure to known drug-drug interactions in a Medicaid population. Pharmacotherapy. 1998; 18 (5): 1112–20. doi: 10.1002/j.1875-9114.1998.tb03942.x
  24. Johnell K., Klarin I. The relationship between number of drugs and potential drug-drug interactions in the elderly: a study of over 600,000 elderly patients from the Swedish Prescribed Drug Register. Drug Saf. 2007; 30 (10): 911–8. doi: 10.2165/00002018-200730100-00009
  25. Отделенов В.А., Новакова А.И., Карасев А.В. и др. Оценка частоты потенциально значимых межлекарственных взаимодействий у больных с полипрагмазией в многопрофильном стационаре. Клиническая фармакология и терапия. 2012; 21 (5): 81–5 [Otdelenov V. A. Novakova A.I., Karasev A.V. et al. Estimation of the incidence of potentially significant drug-drug interactions in patients with polypharmacy in the general hospital. Clinical pharmacology and therapeutics. 2012; 21 (5): 81–5 (in Russ.)].
  26. Казаков А.С., Лепахин В.К., Астахова А.В. Осложнения фармакотерапии, связанные с взаимодействием лекарственных средств. Российский медико-биологический вестник имени академика И.П. Павлова. 2013; 21 (3): 70–6 [Kazakov A.S., Lepakhin V.K., Astakhova A.V. Drug-drug interactions like a reason of adverse drug reactions. I.P. Pavlov Russian Medical Biological Herald. 2013; 21 (3): 70–6 (in Russ.)]. doi: 10.17816/PAVLOVJ2013370-76
  27. Guzman-Prado Y., Vita R., Samson O. Concomitant Use of Levothyroxine and Proton Pump Inhibitors in Patients with Primary Hypothyroidism: a Systematic Review. J Gen Intern Med. 2021; 36 (6): 1726–33. doi: 10.1007/s11606-020-06403-y
  28. Lespessailles E., Toumi H. Proton Pump Inhibitors and Bone Health: An Update Narrative Review. Int J Mol Sci. 2022; 23 (18): 10733. doi: 10.3390/ijms231810733
  29. Park Y.H., Seong J.M., Cho S. et al. Effects of proton pump inhibitor use on risk of Clostridium difficile infection: a hospital cohort study. J Gastroenterol. 2019; 54 (12): 1052–60. doi: 10.1007/s00535-019-01598-2
  30. Черняева М.С., Остроумова О.Д., Сычев Д.А. Лекарственно индуцированная ортостатическая гипотензия. Клиническая фармакология и терапия. 2018; 27 (5): 57–63 [Chernyaeva M. S., Ostroumova O. D., Sy`chev D. A. Drug-induced orthostatic hypotention. Clinical pharmacology and therapeutics. 2018; 27 (5): 57–63 (in Russ.)]. doi: 10.32756/0869-5490-2018-5-57-63

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2024 Russkiy Vrach Publishing House

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies