Abstract
ABSTRACTObjective:To characterize severe potential drug interactions in maternal intensive care, and to determine their frequency, risk factors and potential risk medications.Methods:An observational and longitudinal study conducted between December 2014 and December 2015 in a maternal intensive care unit. Clinical data were collected and severe potential drug interactions were identified on pregnant inpatients. The drug interactions were classified by type, prevalence and exposure rate. A multivariate logistic regression model was used to identify the severe potential drug interactions and the related drugs (p<0.05).Results:A total of 95.1% of patients were exposed to, at least, one potential drug interaction; in that, 91.7% 33.9% were related to, respectively, moderate and severe potential drug interactions. The patients were exposed, on average, on 69.2% of days they were in the intensive care unit. The main drugs involved in more severe drug interactions were magnesium sulfate, metoclopramide, propranolol and diazepam.Conclusion:The severe potential drug interactions were observed in almost all patients of the study, and, approximately one third of those interactions were related to greater severity and resulted in exposure during long hospital stay. The higher number of prescribed drugs and its previous use of medications at home increase the occurrence of severe potential drug interactions.
Highlights
Care of critically ill patients in intensive care units (ICU) entails extensive use of medications and consequent polypharmacy
Prescription of several drugs increase occurrence of adverse events, especially drug interactions, leading to greater costs and longer hospital stay.[1,2,3] A potential drug-drug interaction (PDI) is defined as the concurrent administration of two potentially interactive drugs, with a prevalence of 46% to 80% among intensive care patients.[1,4,5,6] Because of clinical severity, critically ill patients have a lower capacity for drug elimination, increasing the risk of damage resulting from PDI.[3,4,5,7]
The treatment of pregnant women at ICU is associated with emergency obstetric care.[8,9] In developed countries, it is estimated that 2% or less of pregnant women are admitted to the ICU, while in developing countries this rate is approximately 10%.(9) The main reasons for admission in maternal ICU are related to hemorrhage and hypertensive disorders of pregnancy.[8,9,10] Other less common reasons include heart disease, genitourinary infection, obstetric complications, such as ectopic pregnancy and miscarriages, non-genitourinary infection, sepsis, cerebrovascular disease, and pulmonary embolism.[9,10]
Summary
Care of critically ill patients in intensive care units (ICU) entails extensive use of medications and consequent polypharmacy. Prescription of several drugs increase occurrence of adverse events, especially drug interactions, leading to greater costs and longer hospital stay.[1,2,3] A potential drug-drug interaction (PDI) is defined as the concurrent administration of two potentially interactive drugs, with a prevalence of 46% to 80% among intensive care patients.[1,4,5,6] Because of clinical severity, critically ill patients have a lower capacity for drug elimination, increasing the risk of damage resulting from PDI.[3,4,5,7]. There is scarce literature on frequency of clinically significant PDI in pregnant women, in addition to characterization of these events in patients admitted to maternal ICU
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