High cognitive risk drugs in Cuba's Basic Medicines List: safety implications

Understanding differences in risk factors can assist in identifying means to reduce racial/ethnic disparities in type 2 diabetes (T2D) prevalence. Different types of blood pressure (BP) lowering drugs are associated with different levels of T2D risk. This study examined the utilization of BP-lowering drugs among US adults aged 18 and over without diabetes with diagnosed hypertension by racial/ethnic group. We used self-report or ICD-10 diagnostic codes to identify our study population using the 2016-2019 Medical Expenditure Panel Survey. The high T2D risk drugs included beta-blockers and diuretics and the low-risk drugs were ACEI and ARBs. We calculated the percentage of high-risk and low-risk drug use in non-Hispanic Black (NHB) , non-Hispanic White (NHW) , Hispanic, and Asian persons. Logistic regression was used to compare the uses of two drug types across different racial/ethnic groups, controlling for demographics, history of cardiovascular and renal diseases, insurance, duration of hypertension, and general health measurements. We have identified 18,283 individuals, with a mean age of 60.7 and 52.4% were females. Compared with NHB, NHW persons (adjusted odds ratio (aOR) :0.90, 95% CI: 0.58-0.98) , Hispanic (aOR:0.62, 95% CI: 0.56-0.70) , and Asian (aOR:0.54, 95% CI: 0.46-0.64) persons were less likely to receive high-risk drugs. Meanwhile, NHW (aOR: 1.19, 95% CI: 1.09-1.29) , Hispanic (aOR:1.14, 95% CI: 1.03-1.27) , and Asian (aOR:1.19, 95% CI: 1.02-1.40) persons were more likely to use low-risk drugs than NHB persons (all p<0.05) . The highest use of high-risk BP-lowering drugs and the lowest use of low-risk BP-lowering drugs by NHB persons could increase their risks of T2D and contribute to disparities in T2D prevalence between NHB and other racial/ethnic groups. Future studies can quantify the effect of the BP-lowering drug choices on T2D disparities. Disclosure H. Shao: Board Member; BRAVO4HEALTH, LLC. K. Alkhuzam: None. J. Guo: None. T. Jiao: None. S. M. Smith: None. P. Zhang: None. E. W. Gregg: None.

Detecting patients at risk of falls during hospital stay is of utmost importance to implement preventive measures. To determine the frequency of patients with a high risk of falls admitted to a medical-surgical ward. To assess the preventive measures implemented. Review of medical records of 376 patients aged 20 to 97 years (28% older than 70 years) admitted to a clinical hospital in a period of four months. Eleven percent of patients had a history of falls, 50% had a sensory deficit, 68% had unstable gait, 8% had a neurological risk condition, 8% had drowsiness or disorientation, 4% had psychomotor agitation or delirium, 86 % used high risk medications, 73% used 2 or more high risk drugs and 72% were using devices that decrease mobility. One hundred forty-one patients (38%) had a high risk of falling. The mean age of the latter was 77 years, 89% had a sensory deficit, 96% had unstable gait, 4% had psychomotor agitation or delirium and 98% used high risk drugs. Less than 1% had a medical prescription of a caregiver, physical restraints or antipsychotics, however, 21% of patients had a caregiver. The percentage of patients with a high risk of falling is important. The main risk factors were sensory deficit, unstable gait and the use of high risk medications. The low frequency of preventive measures prescriptions is striking.

In recent years, starting from the pharmacy, in order to meet the medication needs of patients, dispatching to the service points and ending with the application to the patient, there is a risk of heath loss and high cost loss due to drug losses. These losses occur as follows; theft, losing during transport between floors, counting errors, incomplete billing. In particular, drug group losses, known as high risk drugs, which can have a significant impact on the functioning of the body, lead to serious health risks first, followed by financial losses. Due to these losses in hospital inventory, wrong results can be obtained. The developed system is intended to operate exactly at this point. With the use of an electronic drawer, high-risk drugs are controlled by means of specially protected medication pockets and the required safety process can be accessed before each use. In this way, a special measure is taken for high-risk drugs and each process is followed. As a result of all these studies, thanks to the features of the drawer, in installed area, the high-risk drug management is taken under control in a short period of time and the aim was to minimize patient health risk and to reduce the cost of drug losses.

Researchers have recently expanded the scope of study of transmission patterns of AIDS to incorporate spatial and geographical questions. United States diffusion patterns of this disease appear to indicate that it may emanate from urban area epicenters to areas of low and moderate prevalence. The travel patterns of injecting drug users (IDUs) and the extent to which they engage in high risk drug and sexual activities was examined as an explanation of diffusion of the HIV virus from one community to another. The study population of 49,621 was comprised of subjects recruited from approximately 60 sites nationwide from 1988–1991. While the data are limited in some ways, they partially support a diffusion explanation of HIV transmission for males and females. The analysis demonstrates that low prevalence cities were significantly more likely to have been the destinations of both men and women who engaged in high risk drug and sexual activities. In addition, HIV seropositive drug users who engaged in high risk drug and sexual behaviors in destination cities were more likely than seronegatives to travel to high or low seroprevalence areas than to moderate prevalence areas. The findings suggest a need for effective HIV prevention educational messages about the risks of traveling and participating in high risk activities.

Understanding the epidemiology and risk factors of adverse drug reactions (ADRs) is important in order to develop appropriate prevention strategies. This study aimed to identify risk factors associated with ADRs in hospitalised children and recommend strategies to minimise ADRs. A prospective multicentre cohort study was conducted on paediatric general medical wards in five European and non-European hospitals. ADRs were identified by intensive chart review. Multivariable logistic regression was used to investigate risk factors associated with ADRs. For the risk factor analysis, prescribed drugs were divided into high-risk and low-risk drug groups. Analgesics, anti-epileptics, antibacterials and antimycotics for systemic use, corticosteroids for systemic use and immunosuppressant agents were considered as high-risk groups whereas the remaining drug classes were defined as low-risk drug groups. A total of 1,253 paediatric patients were identified [Australia (n = 145), Germany (n = 372), Hong Kong (n = 138), Malaysia (n = 291), UK (n = 307)]. A total of 328 ADRs were observed in 16.7% of patients (186/1,115). Use of five or more low-risk drugs per patient or three or more high-risk drugs was a strong predictor for ADRs (OR 4.7, 95% CI 2.4-9.3; OR 6.5, 95% CI 2.7-16.0 respectively; p < 0.001). Older children were more likely to experience ADRs; gender was not significantly associated. To reduce the risk of ADRs in children, clinicians and pharmacists should aim to minimise polypharmacy and be aware of higher ADR risks associated with some drug groups.

BackgroundJC Standards impose at hospitals organisation to develop a method to improve high risk drugs safety.PurposeEuropean Institute of Oncology (EIO) decided to develop this method improving the safety of high-alert...

The frequency of road traffic accidents (RTAs) is higher in China than in other countries, and traffic safety is a more complex issue. Our study of RTA severity differences among 31 provinces in China identifies the most important traffic management issues in each province. Provinces with the highest RTA risk were identified from RTA mortality data for 31 provinces during 2004–2013. Then provinces with the highest risk according to mortality/per capita GDP, mortality/10,000 vehicles, and mortality/100,000 persons were determined to eliminate the effect of differences in economic development, vehicle numbers, and population on mortality rates. The results show that Guangdong, Zhejiang, Jiangsu, Shandong, Sichuan, Anhui, Fujian, and Hebei have the highest RTA risk in China. Tibet, Anhui, Guangxi, Qinghai, Sinkiang, Gansu, Zhejiang, and Guangdong have the highest risk trend. Thus, Anhui, Zhejiang, and Guangdong have both the highest RTA risk and the highest risk trend. We discuss environmental, road, vehicle, and human causes of RTAs for the province groups. Improving traffic management, strengthening the deterrent effect of legal penalties, and establishing a road safety culture could reduce RTAs in China.

Introduction Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis syndrome (TENS) share immune-mediated etiology for epidermal detachment and pharmacologic triggers. Both conditions are on a spectrum of diseases of varying severity, with TENS representing the graver end of the continuum. The demographics and comorbidities of this population remain relatively unknown due to their rare incidence. Comorbidities determine the causative drugs used, but also afford triggers for the autoimmune cascade resulting in SJS or TENS. We analyzed the trends of comorbid and pharmacologic risk factors associated with these diseases in over 3,000 patients. Methods We used the TriNetX Global Health Research Network from 2009–2020 to identify 3,515 patients diagnosed with SJS or TENS (ICD-10 codes L51.1–51.3). We then obtained annual demographic and comorbidity data. We indexed patients into cohorts that were prescribed a high-risk drug as previously reported in the literature to be associated with SJS and TENS development. Our control cohort consisted of patients that did not take these high-risk drugs. These cohorts were analyzed to identify the relative risk of developing SJS or TENS 4 to 56 days after taking a high-risk drug. Similarly, we excluded co-medication of the other high-risk drugs and compared these patients to our control group. Results The mean age was 46 with a female predominance (59.8%). The most common comorbidities were hypertension (20.2–21.3%), mood affective disorders (12.4–15.8%), or kidney disease (11.6–12.8%), and the prevalence of these have remained constant. Phenobarbital had the highest risk for these diseases (RR: 20.2, CI: 13.58–29.93), with carbamazepine second (RR: 14.1, CI: 8.68–22.85). After excluding other high-risk medication, phenobarbital continued to be associated with the highest risk (RR: 30.3, CI: 16.12–56.73), followed by phenytoin (RR: 25.3, CI: 13.51–47.53) and carbamazepine (RR: 24.7, CI: 13.74–46.34). Well reported triggers like sulfamethoxazole, allopurinol, and sertraline only represented moderate risk (RR: 7.7, CI: 6.11–9.83; RR: 5.2, CI: 2.77–9.73; RR: 1.7, CI: 0.90–3.16) even after excluding co-founding factors. Conclusions This study suggests that seizure disorder medications such as phenobarbital, carbamazepine, and phenytoin demonstrate the highest risk for developing SJS and TENS.

Cibler les médicaments à risque pour optimiser la validation pharmaceutique des prescriptions

Certain broad medication classes have previously been associated with high rates of hospitalisation due to related adverse events in elderly Western Australians, based on clinical coding recorded on inpatient summaries. Similarly, some medications from the Beers Criteria, considered potentially inappropriate in older people, have been linked with an increased risk of unplanned hospitalisation in this population. Our objective was to determine whether risk estimates of drug-related hospitalisations are altered in elderly patients taking 'high-risk drugs' (HRDs) when specific Beers potentially inappropriate medications (PIMS) are taken into consideration. Using the pharmaceutical claims of 251,305 Western Australians aged ≥65years (1993-2005) linked with other health data, we applied a case-time-control design to estimate odds ratios (ORs) for unplanned hospitalisations associated with anticoagulants, antirheumatics, opioids, corticosteroids and four major cardiovascular drug groups, from which attributable fractions (AFs), number and proportion of drug-related admissions were derived. The analysis was repeated, taking into account exposure to eight specific PIMs, and results were compared. A total of 1,899,699 index hospitalisations were involved. Of index subjects, 12-57 % were exposed to each HRD at the time of admission, although the proportions taking both an HRD and one of the selected PIMs were much lower (generally ≤2%, but as high as 8% for combinations involving temazepam and for most PIMs combined with hypertension drugs). Included PIMs (indomethacin, naproxen, temazepam, oxazepam, diazepam, digoxin, amiodarone and ferrous sulphate) all tended to increase ORs, AFs and drug-related hospitalisation estimates in HRD combinations, although this was less evident for opioids and corticosteroids. Indomethacin had the greatest overall impact on HRD ORs/AFs. Indomethacin (OR 1.40; 95% confidence interval [CI] 1.27-1.54) and naproxen (OR 1.22; 1.14-1.31) were associated with higher risks of unplanned hospitalisation than other antirheumatics (overall OR 1.09; 1.06-1.12). Similarly, among cardiac rhythm regulators, amiodarone (OR 1.22; 1.13-1.32) was riskier than digoxin (OR 1.08; 1.04-1.13). For comparisons of drug-related hospitalisation estimates, temazepam yielded the greatest absolute increases, especially with hypertension drugs. Indomethacin and temazepam should be prescribed cautiously in elderly patients, especially in drug combinations. Furthermore, it appears other antirheumatics should be favoured over indomethacin/naproxen and, in situations where both drugs may be appropriate, digoxin over amiodarone. Our methodology may help assess the safety of new medications in drug combinations in preliminary pharmacovigilance investigations.

Pharmaceutical analysis of high-risk prescriptions: Should we be going there?

Background and importancePrescription in the emergency department (ED) is compromised by multiple causes which could lead to a higher risk of medication errors.Aim and objectivesTo compare and analyse pharmaceutical interventions...

Fetal rate of behavioral inhibition and preference for novelty during infancy

Introduction: Therapeutic errors are among the main causes of drug-related problems, in terms of enhanced toxicological or reduced therapeutic effect, and concern all stages of the drug chain, from manufacturing to prescription, dispensing and administration. Everyone, pharmacists and doctors in all settings, should be aware of how to prevent and manage them and which drugs are at greatest risk. In this article we will focus on LASA (look alike/sound alike), on FAR (high-risk drugs) and on the guidelines especially for prevention.&#x0D; Methods: The article is a minireview that was written by research in paper and online on PubMed and Embase. We performed a search of any publications available in these databases between the years 1990 and 2022, using the key words: therapeutic errors, misuse / diversion of drugs, drug poisoning. After a review of the titles and abstracts, the articles chosen were considered relevant in providing evidence of the problem. We also added personal knowledge about the topic of the article and used some paper documents.&#x0D; Discussion and Conclusions: Most of the errors in therapy occur during administration, due to errors in doses, posology or interactions or incorrect manipulations of pharmaceutical forms, and in dispensing, due to incorrect interpretation of the prescription or confusion on the packaging in the case of LASAs. Pharmacists and doctors but also patients themselves should pay attention to the time of prescription and doctors to the drug history not only for interactions but also to avoid making mistakes in patients who take drugs with names or packages similar to the one described above. Moreover, attention must be paid in writing the prescription, in dosage, and pharmaceutical forms. Particular attention should be paid to handling by children and to avoiding any misuse of the medicines themselves.

Background Previous clinical trials showed that intensive glucose control did not reduce macrovascular events and mortality. It was speculated that severe hypoglycaemia contributed to these adverse outcomes. More contemporary clinical trials using newer anti-diabetic agents with less hypoglycaemic potential showed a linear relationship between major adverse cardiovascular events (MACE) and HbA1c reduction according to a meta-regression analysis. Purpose The aim of this study was to examine the association between clinical outcomes and HbA1c under different treatment backgrounds in the real-world setting. We hypothesised that when using drugs with minimal hypoglycaemic risk, lower HbA1c would be associated with better outcomes. Methods This was a retrospective population-based cohort study using a multi-centre electronic medical record database. Eligible patients were those diagnosed with type 2 diabetes between 2009 and 2020 who received non-insulin antidiabetic drugs. Patients were stratified into two groups based on the drugs received: drugs with high hypoglycaemic risk (sulphonylurea, meglitinide) and drugs with low hypoglycaemic risk (thiazolidinediones, acarbose, DPP4 inhibitors, GLP1 agonists, SGLT-2 inhibitors). Patients were excluded if they had received these drugs for less than 180 days or had received both high and low hypoglycaemic risk oral drugs simultaneously. HbA1c levels were assessed from the index date to the date of the interested outcome or the end of the study period (31 December 2021), whichever came first. The relationship between HbA1c and clinical outcomes was examined using a Cox proportional hazards model. The outcomes of interest included all-cause mortality and MACE. Results The study population consisted of 6,923 patients, including 3,639 high hypoglycaemic risk drug users and 3,284 low hypoglycaemic risk drug users. Patients with lower HbA1c levels during the follow-up period were older and frailer. After adjusting for baseline covariates, the association between the risk of death and HbA1c presented a U-shaped pattern, and this U-shaped association was similar in the two treatment cohorts (Table 1). On the other hand, the association between the risk of MACE and HbA1c presented a J-shaped pattern. In the high hypoglycaemic risk drug cohort, patients with the highest HbA1c levels (mean HbA1c 9.6%) were associated with a higher risk of MACE compared to the group with a mean HbA1c of 7.2% (hazard ratio [HR] 4.16, 95% confidence interval [CI] 2.07-8.37); lower HbA1c levels were not associated with a lower risk of MACE (Table 2). In contrast, in the low hypoglycaemic risk drug cohort, lower HbA1c levels were associated with a higher risk of MACE (HR 3.82, 95% CI 1.29-11.28). Conclusion Lower HbA1c levels were not associated with a lower risk of all-cause mortality and MACE. Furthermore, this phenomenon was independent of the hypoglycaemic risk of anti-diabetic drugs.