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Authors
Abstract(s)
Este relatório encontra-se dividido em 2 capítulos. O primeiro capítulo intitulado
“Tremor como Reação Adversa a Medicamentos em Idosos” é relativo à vertente de
investigação.
Associadas à utilização de medicamentos podem surgir reações adversas a
medicamentos (RAM). As RAM podem resultar num impacto negativo na saúde do
doente, especialmente numa população com um risco maior de multimorbilidade,
geralmente polimedicada e, por isso, mais fragilizada, como é a população idosa. A
farmacovigilância melhora a segurança dos medicamentos através da deteção,
avaliação e prevenção de RAM. O tremor é uma manifestação comum em idosos e
pode ser limitativo, dependendo do grau de incapacidade que causa no estilo de
vida do doente. Alguns fármacos são conhecidos por puderem induzir tremor. O
objetivo deste trabalho foi analisar e avaliar o tremor enquanto RAM em idosos.
Efetuou-se um estudo retrospetivo das notificações que referiam o tremor como
RAM reportadas ao Sistema Nacional de Farmacovigilância, que é coordenado pelo
INFARMED. Inicialmente realizou-se uma pesquisa onde se incluiu todas as
notificações referentes a doentes com idade igual ou superior a 65 anos com os
termos LLT (Lowest Level Terms) “tremor” e “involuntary movements” do
dicionário MedDRA, recebidas até 31/12/2021. Seguidamente, foram eliminadas as
notificações duplicadas ou com informação incompleta. Posteriormente a
população foi avaliada quanto à distribuição por sexo e idade e foi analisada a
respetiva taxa de polimedicação. As notificações de reações adversas foram
analisadas quanto à classe do(s) medicamento(s) suspeito(s), de acordo com a
classificação ATC (Anatomical Therapeutic Chemical) da Organização Mundial de
Saúde, ao grau de gravidade, relação de causalidade entre o fármaco e a RAM e
evolução do caso. Os casos com risco de vida ou que resultaram em morte sofreram
uma análise mais detalhada. Após a eliminação das notificações incompletas,
duplicadas e anuladas, foram analisadas 241 notificações das 385 notificações
iniciais, que reportavam tremor como RAM. A população era composta
maioritariamente por indivíduos do sexo feminino (63%) e pertencentes à faixa
etária dos 65-74 anos (59%). A prevalência de polimedicação foi de 53%, sendo que em 27% dos casos os doentes faziam uso de 5 ou mais fármacos simultaneamente.
As subclasses farmacoterapêuticas dos fármacos suspeitos de causarem tremor
mais reportadas foram os antineoplásicos (23%), as vacinas contra a covid-19
(24%), os psicoanaléticos (7%), os psicolépticos (5%), os antibacterianos (5%) e, os
analgésicos (5%). Foram consideradas graves 137 notificações que obedeceram a
153 critérios de gravidade. A evolução da RAM “tremor” foi cura em 77% das
notificações, tendo evoluído para morte apenas uma notificação entre as
analisadas.
Tendo em vista os resultados apresentados neste estudo, conclui-se que é
importante um cuidado redobrado ao prescrever estas subclasses
farmacoterapêuticas neste grupo etário, devendo o profissional de saúde estar
alerta para a possibilidade do surgimento desta RAM. É fundamental aumentar a
vigilância nos regimes terapêuticos dos idosos, por exemplo, através da verificação
do uso de fármacos desnecessários ou duplicados, o qual constitui um fator de risco
importante para o surgimento de RAM. A importância de notificar qualquer RAM
dos doentes, quer seja no portal RAM ou junto de algum profissional de saúde é
fundamental, uma vez que contribui para o aumento da segurança dos doentes.
O segundo capítulo está relacionado com a minha experiência profissionalizante
em farmácia comunitária. Neste capítulo são relatadas todas as atividades
desempenhadas, assim como as competências adquiridas no âmbito do meu estágio
decorrido no período de 7 de fevereiro a 23 de junho de 2023, na Farmácia Alves
Dias em Celorico de Basto.
This report is divided into 2 chapters. The first chapter entitled “Tremor as an adverse drug reaction in the elderly” is related to the research aspect. Adverse drug reactions (ADR) may occur associated with the use of drugs. ADR have a detrimental effect on health, particularly in populations like the elderly who are more vulnerable due to increased risk of polymedication and multimorbidity. Pharmacovigilance improves the safety of drugs through the detection, evaluation and prevention of ADR. Tremor is a more common manifestation in the elderly and can be limiting depending on the degree of disability it causes in the patient's lifestyle. Some drugs are known to induce tremor. The objective of this study was to analyze and evaluate tremor as an ADR in the elderly. A retrospective study was carried out of reports referring to tremor as ADR reported to the National Pharmacovigilance System, which is coordinated by INFARMED. Initially, a search was carried out including all reports referring to patients aged 65 years or over with the LLT (Lowest Level Terms) “tremor” and “involuntary movements” from the MedDRA dictionary, received by 12/31/2021. Duplicate reports or reports with incomplete information were eliminated. Subsequently, the population was evaluated regarding distribution by gender and age and the respective polypharmacy rate was analyzed. Reports of adverse reactions were analyzed according to the class of the suspected drug(s), according to the ATC (Anatomical Therapeutic Chemical) classification of the World Health Organization, the degree of seriousness, causal relationship between the drug and ADR and evolution of the case. Reports that were life-threatening or resulted in death underwent more detailed analysis. After eliminating incomplete, duplicate and cancelled reports, 241 of the 385 initial reports reporting tremor as an ADR were analyzed. The reported population was mostly female (63%) and in the 65-74 age group (59%). The prevalence of polymedication was 53%, with 27% of patients taking 5 or more drugs simultaneously. The most prevalent pharmacotherapeutic subclasses suspected to causing tremor ADRs were antineoplastics (23%), COVID19 vaccines (24%), psychoanaleptics (7%), psycholeptics (5%), antibacterials (5%) and analgesics (5%). A total of 137 reports were considered serious and met 153 seriousness criteria. The evolution of the ADR “tremor” was: “cure” in 77% of the reports, with only one report among those analyzed evolving to “death”. According to the results presented in this study, we conclude that an extra care is very important when prescribing these pharmacotherapeutic subclasses and healthcare professionals must be alert to the possibility of this ADR appearing in these regimens. It is essential to increase vigilance in the therapeutic regimes of the elderly, for example, through verification of the use of unnecessary or duplicate drugs, which constitutes an important risk factor for the emergence of ADR. It is fundamental transmit to the patients the importance of reporting any ADR, whether on the RAM portal or with a health professional, to reduce the rate of underreporting and, in this way, improve the national pharmacovigilance system as it contributes to the increase of patient safety. The second chapter is related to my professional experience in community pharmacy. This chapter reports all the activities performed, as well as the skills developed during my curricular internship carried out at Farmácia Alves Dias, in Celorico de Basto, from February 7 to June 23, 2023.
This report is divided into 2 chapters. The first chapter entitled “Tremor as an adverse drug reaction in the elderly” is related to the research aspect. Adverse drug reactions (ADR) may occur associated with the use of drugs. ADR have a detrimental effect on health, particularly in populations like the elderly who are more vulnerable due to increased risk of polymedication and multimorbidity. Pharmacovigilance improves the safety of drugs through the detection, evaluation and prevention of ADR. Tremor is a more common manifestation in the elderly and can be limiting depending on the degree of disability it causes in the patient's lifestyle. Some drugs are known to induce tremor. The objective of this study was to analyze and evaluate tremor as an ADR in the elderly. A retrospective study was carried out of reports referring to tremor as ADR reported to the National Pharmacovigilance System, which is coordinated by INFARMED. Initially, a search was carried out including all reports referring to patients aged 65 years or over with the LLT (Lowest Level Terms) “tremor” and “involuntary movements” from the MedDRA dictionary, received by 12/31/2021. Duplicate reports or reports with incomplete information were eliminated. Subsequently, the population was evaluated regarding distribution by gender and age and the respective polypharmacy rate was analyzed. Reports of adverse reactions were analyzed according to the class of the suspected drug(s), according to the ATC (Anatomical Therapeutic Chemical) classification of the World Health Organization, the degree of seriousness, causal relationship between the drug and ADR and evolution of the case. Reports that were life-threatening or resulted in death underwent more detailed analysis. After eliminating incomplete, duplicate and cancelled reports, 241 of the 385 initial reports reporting tremor as an ADR were analyzed. The reported population was mostly female (63%) and in the 65-74 age group (59%). The prevalence of polymedication was 53%, with 27% of patients taking 5 or more drugs simultaneously. The most prevalent pharmacotherapeutic subclasses suspected to causing tremor ADRs were antineoplastics (23%), COVID19 vaccines (24%), psychoanaleptics (7%), psycholeptics (5%), antibacterials (5%) and analgesics (5%). A total of 137 reports were considered serious and met 153 seriousness criteria. The evolution of the ADR “tremor” was: “cure” in 77% of the reports, with only one report among those analyzed evolving to “death”. According to the results presented in this study, we conclude that an extra care is very important when prescribing these pharmacotherapeutic subclasses and healthcare professionals must be alert to the possibility of this ADR appearing in these regimens. It is essential to increase vigilance in the therapeutic regimes of the elderly, for example, through verification of the use of unnecessary or duplicate drugs, which constitutes an important risk factor for the emergence of ADR. It is fundamental transmit to the patients the importance of reporting any ADR, whether on the RAM portal or with a health professional, to reduce the rate of underreporting and, in this way, improve the national pharmacovigilance system as it contributes to the increase of patient safety. The second chapter is related to my professional experience in community pharmacy. This chapter reports all the activities performed, as well as the skills developed during my curricular internship carried out at Farmácia Alves Dias, in Celorico de Basto, from February 7 to June 23, 2023.
Description
Keywords
Farmacovigilância Idoso Polimedicação Reação Adversa a Medicamentos Tremor