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Authors
Advisor(s)
Abstract(s)
O presente trabalho realizado no âmbito da Unidade Curricular “ Estágio”, do Mestrado
Integrado em Ciências Farmacêuticas, encontra-se dividido em três capítulos que
descrevem respetivamente, o meu trabalho de investigação referente aos
anticoagulantes orais, o meu estágio curricular em Farmácia Comunitária e o meu
estágio curricular em Farmácia Hospitalar.
O primeiro capítulo aborda os riscos associados aos anticoagulantes orais. Em
Portugal, estão comercializados os antagonistas da vitamina k, como a varfarina. Porém
face às suas limitações, nos últimos anos, foram introduzidos no mercado novos
anticoagulantes orais com uma maior especificidade e facilidade de uso. Estes são
designados como anticoagulantes orais diretos (rivaroxabano, apixabano, dabigatrano e
o edoxabano). Este capítulo destaca o papel notório da Farmacovigilância, na
monitorização contínua dos anticoagulantes orais, em prol da saúde pública, uma vez
que a Farmacovigilância tem como objetivo fulcral garantir a segurança dos
medicamentos com autorização de introdução no mercado, através da recolha e
avaliação das Reações adversas a medicamentos (RAM), implementando medidas para
reduzir a sua ocorrência. Neste âmbito, foram analisadas as notificações de RAM
submetidas ao Sistema Nacional de Farmacovigilância, entre 2012 e 2021, bem como as
interações dos anticoagulantes orais com os medicamentos e com as plantas
medicinais. Relativamente às notificações de RAM foram avaliados vários parâmetros,
sendo que o anticoagulante mais notificado e com principal destaque nesta análise foi o
dabigatrano, com 388 notificações de RAM. Em relação à demografia da população,
houve uma maior taxa de notificação na população idosa, sendo o género feminino
mais prevalente. A maioria das notificações é referente a RAM graves e verificou-se
uma maior taxa de notificação por parte dos médicos, seguidos dos farmacêuticos. Os
grupos System Organ Class mais notificados foram “Doenças gastrointestinais” e
“Doenças do sistema nervoso”, e o Preferred Term mais notificado foi “Hemorragia
gastrointestinal”.
Neste capítulo de modo a identificar os riscos referentes aos anticoagulantes orais foi
ainda realizada uma pesquisa bibliográfica. A varfarina apresenta interação com vários
medicamentos e plantas medicinais, visto que é metabolizada por várias isoformas do
citocromo 450, assim os medicamentos e plantas que sejam indutores ou inibidores
destas enzimas vão interferir com o seu metabolismo. Apesar dos anticoagulantes orais diretos apresentarem menos interações quando comparados com a varfarina, estes
interagem com os indutores fortes da citocromo 3A4, indutores fortes da
glicoproteína-P, inibidores fortes da citocromo 3A4 e da glicoproteína-P, consoante o
anticoagulante oral direto. Existem algumas plantas com as quais é requerida
precaução na sua administração conjunta, nomeadamente as que interferem com a
glicoproteína-P e com o citocromo 3A4. Em suma, os anticoagulantes orais apresentam
interações e RAM que exigem uma monitorização contínua. Assim, a sua identificação e
caracterização são pontos de partida importantes para melhorar a segurança dos
anticoagulantes orais na população.
O segundo capítulo é referente à realização do estágio curricular em Farmácia
Comunitária decorrido entre fevereiro e abril de 2023, na Farmácia Teixeira, sob a
orientação da Dr. Edgar Fernandes. Neste capítulo é descrita a minha experiência e
todas as atividades e funções inerentes ao exercício da profissão farmacêutica
desenvolvidas durante o estágio. Com um principal destaque no aconselhamento
farmacêutico e na promoção do uso racional do medicamento. No decurso do estágio
curricular apliquei os conhecimentos científicos assimilados durante o curso, tendo
obtido novos conhecimentos e competências, no âmbito da interação com o utente.
Neste âmbito, verifiquei o papel notório do farmacêutico na sociedade, em prol da
saúde pública.
O terceiro capítulo detalha o estágio curricular em Farmácia Hospitalar, realizado nos
Serviços Farmacêuticos da Unidade Local de Saúde da Guarda, entre maio e junho de
2023, sob orientação do Dr. Jorge Aperta. Neste capítulo encontra-se descrita a minha
aprendizagem, bem como todas as tarefas executadas durante este período. Com a
realização do estágio curricular consolidei os conhecimentos científicos que adquiri ao
longo da minha formação académica, bem como adquiri novas competências no âmbito
da Farmácia Hospitalar. Este capítulo destaca ainda o papel do farmacêutico enquanto
especialista do medicamento e como parte integrante nas equipas multidisciplinares.
The present work, carried out in the context of the "Internship" course of the Integrated Master's Degree in Pharmaceutical Sciences, is divided into three chapters that describe, respectively, my research work on oral anticoagulants, my internship in Community Pharmacy, and my internship in Hospital Pharmacy. The first chapter addresses the risks associated with oral anticoagulants. In Portugal, vitamin K antagonists such as warfarin are marketed. However, in recent years, new oral anticoagulants with greater specificity and ease of use have been introduced to the market. These are referred to as direct oral anticoagulants (rivaroxaban, apixaban, dabigatran, and edoxaban). This chapter highlights the significant role of Pharmacovigilance in the continuous monitoring of oral anticoagulants for public health, as Pharmacovigilance's central objective is to ensure the safety of medicines with marketing authorization through the collection and evaluation of adverse drug reactions (ADR), implementing measures to reduce their occurrence. In this context, reports of ADR submitted to the National Pharmacovigilance System between 2012 and 2021 were analyzed, as well as interactions of oral anticoagulants with drugs and medicinal herbs. Regarding ADR reports, various parameters were evaluated, with dabigatran being the most frequently reported anticoagulant, with 388 ADR reports. Concerning the demographic of the population, there was a higher reports rate among the elderly population, with a predominance of females. Most reports were related to serious ADR, and a higher reports rate was observed among physicians, followed by pharmacists. The most frequently reported System Organ Class groups were "Gastrointestinal disorders" and "Nervous system disorders," and the most reported Preferred Term reaction was "Gastrointestinal hemorrhage." In this chapter, in order to identify the risks associated with oral anticoagulants, a bibliographic research was also conducted. Warfarin interacts with various drugs and medicinal herbs since it is metabolized by several cytochrome P450 isoforms. Therefore, drugs and medicinal herbs that are inducers or inhibitors of these enzymes will interfere with its metabolism. Although direct oral anticoagulants have fewer interactions compared to warfarin, they interact with strong inducers of cytochrome 3A4, strong inducers of P-glycoprotein, strong inhibitors of cytochrome 3A4, and Pglycoprotein, depending on the specific direct oral anticoagulant. There are some medicinal herbs for which caution is required when administered together, especially those that interfere with P-glycoprotein and cytochrome 3A4. In summary, oral anticoagulants have interactions and ADRs that require continuous monitoring. Therefore, their identification and characterization are important starting points to improve the safety of oral anticoagulants in the population. The second chapter refers to the completion of the curricular internship in Community Pharmacy, which took place between February and April 2023, at Pharmacy Teixeira, under the guidance of Dr. Edgar Fernandes. In this chapter, my experience and all the activities and functions inherent to the practice of the pharmaceutical profession during the internship are described. With a primary emphasis on pharmaceutical counseling and the promotion of rational drug use. During the curricular internship, I applied the scientific knowledge acquired during the course and gained new knowledge and skills in interacting with patients. In this context, I observed the prominent role of the pharmacist in society, in the interest of public health. The third chapter details the curricular internship in Hospital Pharmacy, carried out at the Pharmacy Services of the Local Health Unit of Guarda, between May and June 2023, under the guidance of Dr. Jorge Aperta. In this chapter, my learning experiences and all the tasks performed during this period are described. Through the completion of the curricular internship, I solidified the scientific knowledge I acquired throughout my academic training and acquired new skills in the field of Hospital Pharmacy. This chapter also highlights the role of the pharmacist as a drug specialist and an integral part of multidisciplinary teams.
The present work, carried out in the context of the "Internship" course of the Integrated Master's Degree in Pharmaceutical Sciences, is divided into three chapters that describe, respectively, my research work on oral anticoagulants, my internship in Community Pharmacy, and my internship in Hospital Pharmacy. The first chapter addresses the risks associated with oral anticoagulants. In Portugal, vitamin K antagonists such as warfarin are marketed. However, in recent years, new oral anticoagulants with greater specificity and ease of use have been introduced to the market. These are referred to as direct oral anticoagulants (rivaroxaban, apixaban, dabigatran, and edoxaban). This chapter highlights the significant role of Pharmacovigilance in the continuous monitoring of oral anticoagulants for public health, as Pharmacovigilance's central objective is to ensure the safety of medicines with marketing authorization through the collection and evaluation of adverse drug reactions (ADR), implementing measures to reduce their occurrence. In this context, reports of ADR submitted to the National Pharmacovigilance System between 2012 and 2021 were analyzed, as well as interactions of oral anticoagulants with drugs and medicinal herbs. Regarding ADR reports, various parameters were evaluated, with dabigatran being the most frequently reported anticoagulant, with 388 ADR reports. Concerning the demographic of the population, there was a higher reports rate among the elderly population, with a predominance of females. Most reports were related to serious ADR, and a higher reports rate was observed among physicians, followed by pharmacists. The most frequently reported System Organ Class groups were "Gastrointestinal disorders" and "Nervous system disorders," and the most reported Preferred Term reaction was "Gastrointestinal hemorrhage." In this chapter, in order to identify the risks associated with oral anticoagulants, a bibliographic research was also conducted. Warfarin interacts with various drugs and medicinal herbs since it is metabolized by several cytochrome P450 isoforms. Therefore, drugs and medicinal herbs that are inducers or inhibitors of these enzymes will interfere with its metabolism. Although direct oral anticoagulants have fewer interactions compared to warfarin, they interact with strong inducers of cytochrome 3A4, strong inducers of P-glycoprotein, strong inhibitors of cytochrome 3A4, and Pglycoprotein, depending on the specific direct oral anticoagulant. There are some medicinal herbs for which caution is required when administered together, especially those that interfere with P-glycoprotein and cytochrome 3A4. In summary, oral anticoagulants have interactions and ADRs that require continuous monitoring. Therefore, their identification and characterization are important starting points to improve the safety of oral anticoagulants in the population. The second chapter refers to the completion of the curricular internship in Community Pharmacy, which took place between February and April 2023, at Pharmacy Teixeira, under the guidance of Dr. Edgar Fernandes. In this chapter, my experience and all the activities and functions inherent to the practice of the pharmaceutical profession during the internship are described. With a primary emphasis on pharmaceutical counseling and the promotion of rational drug use. During the curricular internship, I applied the scientific knowledge acquired during the course and gained new knowledge and skills in interacting with patients. In this context, I observed the prominent role of the pharmacist in society, in the interest of public health. The third chapter details the curricular internship in Hospital Pharmacy, carried out at the Pharmacy Services of the Local Health Unit of Guarda, between May and June 2023, under the guidance of Dr. Jorge Aperta. In this chapter, my learning experiences and all the tasks performed during this period are described. Through the completion of the curricular internship, I solidified the scientific knowledge I acquired throughout my academic training and acquired new skills in the field of Hospital Pharmacy. This chapter also highlights the role of the pharmacist as a drug specialist and an integral part of multidisciplinary teams.
Description
Keywords
Anticoagulantes Doac Farmácia Comunitária Farmácia Hospitalar Farmacovigilância Interações Reações Adversas a Medicamentos Riscos Vka