Risk management strategy for preventing the reduced treatment effectiveness from the position of drug interactions and polypharmacy in patients with coronary heart disease

Anna A Gruzdeva,Mikhail V Ilyin,Alexander L Khokhlov

doi:10.3897/rrpharmacology.6.60164

Anna A Gruzdeva, Mikhail V Ilyin + Show 1 more

Open Access

https://doi.org/10.3897/rrpharmacology.6.60164

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Abstract

Introduction: In modern clinical practice, various drug combinations are widely used, especially in cardiological patients. The existing clinical recommendations necessitate using organ protective agents, especially with a patient having a comorbid pathology and with an ineffective monotherapy. In some cases, drug interaction decreases the effectiveness of pharmacotherapy and increases the risk of developing adverse events (AE). The purpose of the study was to analyze the modern pharmacotherapy of patients with coronary heart disease (CHD), identify polypharmacy of treatment, evaluate its significance for the treatment process, and determine ways to solve the problem of using a multi-component system of pharmacotherapy risk management. Materials and methods: The study involved 156 patients with CHD, among whom 39 received more than 8 drugs at a time. Results and discussion: In these patients, the evaluation of drug interactions revealed 580 variants (48 were dangerous, 428 – significant, 104 – insignificant). The administration of a therapy to comorbid patients, taking into account possible changes in the activity of cytochrome P450 isoenzymes, is one of the promising ways to improve the safety of a combined pharmacotherapy. Conclusion: It was revealed that with a mutated cytochrome P450 most of processes of drug biotransformation occurs. And there is a greater risk of developing AE against the background of polypragmasia in polymorbid patients, which makes it possible to individually adjust the dose of beta-blockers, thus affecting the frequency of their development. The choice of management measures should be determined considering all the areas of personalized medicine, including pharmacogenetic predictors, pharmacoepidemiological data, pharmacoeconomic effectiveness, the development of adverse reactions, polypragmasia, and medical and social risk factors.

Highlights

In modern clinical practice, various drug combinations are widely used, especially in cardiological patients
The choice of management measures at the individual level at each stage of the formation of the quality of medical care should be determined taking into account all the areas of personalized medicine, including pharmacogenetic predictors, pharmacoepidemiological data, the pharmacoeconomic effectiveness of the selected therapy, the development of adverse reactions and polypharmacy, as well as medical and social risk factors
In accordance with the clinical guidelines for the diagnosis and treatment of chronic coronary syndrome (CCS) (2019, ESC; 2016, The National Clinical Recommendations), the following groups of drugs are recommended in drug therapy: antiischemic drugs, antiplatelet agents

Summary

Introduction

Various drug combinations are widely used, especially in cardiological patients. The purpose of the study was to analyze the modern pharmacotherapy of patients with coronary heart disease (CHD), identify polypharmacy of treatment, evaluate its significance for the treatment process, and determine ways to solve the problem of using a multi-component system of pharmacotherapy risk management. The choice of management measures should be determined considering all the areas of personalized medicine, including pharmacogenetic predictors, pharmacoepidemiological data, pharmacoeconomic effectiveness, the development of adverse reactions, polypragmasia, and medical and social risk factors. The choice of management measures at the individual level at each stage of the formation of the quality of medical care should be determined by taking into account all the areas of personalized medicine, including pharmacogenetic predictors, pharmacoepidemiological data, the pharmacoeconomic effectiveness of the selected therapy, the development of adverse reactions and polypharmacy, as well as medical and social risk factors. In 26.0% of the patients, potentially dangerous clinical drug interactions (DIs) were recorded, in 5.0%, potentially serious DIs were detected (Jyrkkä et al 2009; Onder et al 2010; Khokhlov 2011; Patterson et al 2012; Moroz and Ryzhova 2015; Khokhlov et al 2016; Martsevich et al 2016; Rostova and Goodilina 2016; Sychev et al 2016)

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