Incorrect Use Of Drugs Research Articles

Effects of hemoperfusion first aid process reengineering on electrolyte disturbance, liver function and prognosis in patients with acute poisoning

ABSTRACT Acute poisoning is a frequently encountered medical emergency in the emergency room, typically resulting from the incorrect use of drugs or pesticides, and is characterized by sudden onset of severe symptoms, often leading to fatalities. This research was to explore the effect of hemoperfusion first aid process reengineering on electrolyte disturbance, liver function and prognosis in patients with acute poisoning. From August 2019 to July 2021, 137 patients with acute poisoning who received first aid process reengineering were selected as the observation group, and 151 patients with acute poisoning who received routine first aid were selected as the control group. The success rate, first aid-related indicators, electrolyte, liver function, and prognosis and survival were recorded after first aid treatment. The observation group had a 100% effective rate on the third day of first aid, which was significantly higher than the control group (91.39%). The observation group also had shorter time for emesis induction, poisoning assessment, venous transfusion, consciousness recovery, opening of the blood purification circuit, and start of hemoperfusion than the control group (P < 0.05). Additionally, the observation group showed lower levels of alpionine aminotransferase, total bilirubin, serum creatinine, and urea nitrogen after treatment, and a significantly lower mortality rate (6.57%) than the control group (26.28%) (P < 0.05). Hemoperfusion first aid process reengineering in patients with acute poisoning can improve the success rate of first aid, shorten the time of first aid, improve the electrolyte disturbance, treatment effect, liver function and blood routine of the patients.

How readable are antihypertensive drug inserts?

Aim: Patients can be protected against possible complications when antihypertensive drugs are regularly and properly used for the treatment of hypertension. The readability of package inserts increases treatment compliance. In the present study, the purpose was to determine the readability level of antihypertensive package inserts.&#x0D; Materials and Method: A total of 64 commonly used antihypertensive drugs were selected for this study. The readability scores of the package inserts for the selected drugs were calculated according to the Readability Scales developed by Atesman and Bezirci-Yılmaz.&#x0D; Results: The readability level for the selected package inserts were found to be suitable for an average of 11-12 years of education and high school education level according to the Atesman and Bezirci-Yılmaz Readability Scales, respectively.&#x0D; Conclusion: When it is considered that the average schooling year in Turkey is 6.5 years, the readability level of antihypertensive package inserts is highly above this level. It is recommended to simplify the package inserts to increase readability and drug compliance and prevent incorrect drug use.

Drug resistance profile and detection of genes responsible for methicillin resistance in Staphylococcus aureus isolated from municipal waste

Currently, we are facing the ever-increasing phenomenon of bacteria being resistant to antibiotics. It is the consequence of excessive and incorrect use of drugs. The phenomenon is a global problem affecting bacteria both in their hospital population and in the natural environment. Municipal waste is an environment conducive to the development of microorganisms, therefore it contains various groups of bacteria, including drug-resistant staphylococci. The aim of the study was to identify species of bacteria, determine their antibiotic resistance, and assess the occurrence of genes responsible for methicillin resistance in Staphylococcus aureus isolated from mixed municipal waste. Strains were isolated by Koch’s serial dilution method with the use of microbiological media. Species were identified using the MALDI TOF-MS technique, whereas the drug resistance profile was determined by disk diffusion and molecular PCR methods. 250 isolates of S. aureus were collected. The highest resistance found was to cefoxitin, erythromycin and tetracycline. Among the bacteria collected, resistance to 1, 2, 3 or 4 antibiotics at the same time was the most common, with a maximum of 10. Additionally, 45 (18%) MDR (multidrug-resistant) isolates were detected. Methicillin resistance was found by the disk diffusion test in 60 (24%) strains, while the mecA gene was detected in as many as 180 (72%) isolates.

Oral mucosal burn in a neonate due to accidental wart medicine intake

Caustic ingestion is a problem frequently encountered in children younger than five years of age and mostly in developing countries. It may result in eusophagial, laryngeal, orophanryngeal and oral lesions. An 18 day-old-girl brought to emergency room because she was mistakenly given her fathers’s wart medicine instead of her daily vitamin D medicine. There were severe hyperemia and erosions at her lips, oral mucosa and oropharynx. Her oral nutrition was stopped and intravenous protone pump inhibitor drug has initiated. There were no evidence of gastrointestinal perforation at her abdomen X-ray. Her laboratory test results were completely normal. Endoscopic evaluation was not planned at early period because of her severe oral mucosal lesions. She recieved intravenous methylprednisolone for three days.. An eusophagogastroduedonoscopy was performed on day seven and reported to be normal. She has fully recovered without any sequalea. In this article, incorrect drug use and caustic exposure which are one of the most common household accidents were discussed over a newborn case.

Description of Incompleteness of Prescription Writing at Surabaya Islamic Hospital A. Yani

Introduction: Medication error is an event that harms patients due to incorrect use of drugs during the treatment of health workers. Medication error can lead to increased mortality or mortality, increased duration of hospitalization, and increased cost of treatment. Objective: This study aims to provide an overview of efforts to reduce the incompleteness of prescription writing at Surabaya Islamic Hospital A. Yani in each of its parts, namely inscription, invocation, precriptio, subcribtio, and pro. Method: The type of research used is qualitative case studies and secondary data analysis of patient safety incompleteness of prescription filling at Surabaya A. Yani Islamic Hospital. Data collection by observation and interview. Result and Discussion: The results showed that efforts to reduce the incompleteness of prescriptions carried out by Surabaya A. Yani Islamic Hospital using the E-prescription system. It is hoped that the existence of E-prescription can reduce the occurrence of human error and make it easier for doctors and pharmacists to provide services. Conclusion: The conclusion of this study is that the doctor's identity and the date of writing the prescription in the inscription section, the dose of the drug in the precriptio section, the doctor's paraphrase in the subcriptio section and the patient's weight in the pro section. E-prescriptions are used as an upgrade system to replace manual prescriptions. Evaluation and socialization are carried out as an effort to reduce the number of incompleteness of writing recipes

Public Health Significance of Veterinary Drug Residue in Food Animal Products - A Review

The objective of this review paper was to investigate the public health significance of veterinary drug residues in food of animal origin. Data were collected by means of the search engine and all relevant journals published between 2019 and 2022 and stocked under Google Scholar were retrieved for analysis. The use of veterinary medications in animals that produce food has the potential to leave residues in animal-derived products (meat, milk, eggs and honey), which puts the consumer's health at risk. The inability to follow the withdrawal period and incorrect drug use are the most likely causes of drug residues. The development of antimicrobial drug resistance, hypersensitivity reaction, carcinogenicity, mutagenicity, teratogenicity and alteration of intestine natural flora are the main public health implications of drug residue. The frequent application of tandem or high-resolution mass spectrometry along with liquid chromatography has greatly enhanced analytical methods for residue analysis. This advancement made it possible to quickly conduct targeted searches for hundreds of target compounds in complicated matrices like milk, eggs, honey, or meat and organs after slaughter. Reduction of antimicrobial drug resistance problem has been indicated as one of the most challenging issues related to food safety in the forthcoming years. There is little data available on the extent of veterinary drug residue globally. Therefore, a significant amount of work must be done to assess the scope of the issue, prevent the occurrence of veterinary drug residues and to familiarize animal health professionals with the pharmacokinetics, pharmacodynamics and toxicological effects of veterinary drugs in order to reduce the potential public health risk posed by drug residues in food derived from animals.

PROFIL TERAPI OBAT PADA PASIEN ISPA DI PUSKESMAS KOTA TENGAH TAHUN 2019

Acute respiratory infections (ARI) is an infectioan that commonly occurs in human of any age however, children and infants are the most vulnerable and most exposed to ARI. The study aims to identify the utilization of drug therapy in patients with ARI, specifically those infants and children patients at Puskesmas Kota Tengah in 2019. it employs a descriptive research design where the obtained data are secondary data that are collected retrospectively besides, the data used in this study are medical prescription documents, including the patient’s name, age, type of drug used, and drug use patternThe finding discloses that drug therapy administered to 116 infants and children patients who suffer from ARI at Puskesmas Kota Tengah in 2019 reveals that the most widely used therapy is the expectorant group(Gliceryl Guaicolate) as many as 61 (62,2%), Antihistamine group (Chlorpheniramine maleate) with a frequency of 75 times (64,1%), Vitamin B Complex with a frequency of 69 times (55,2%), Antibiotik group (Amoxicillin) with a frequency 47 times (41%), Analgesic and Antipyretic group (Paracetamol) is the most widely prescribed with a prescription frequency of 65 times (55,7%). In addition, the parameter of right drug obtains frequency of 22 times with 94 times with the percentage of (81,0%) and incorrect drug obtains a frequncy of 22 times with a percentage of (19,0%), the parameter of right dose for 83 times with a percentage of (71,6%), and incorrect dose for 33 times with a percentage of (28,4%). At the same time, the right drug use pattern parameter involves the right dose, and the right drug obtains a frequency of 94 times with a percentage 0f 8 (81,0%) while the incorrect drug use pattern obtains a frequency 0f 22 times with a percentage 0f (19,0%)

HYPERTENSION CAUSED WITH LONG-TERM UNCONTROLLED USING OF NASAL DECONGESTANTS. HOW SAFE ARE OVER-THE-COUNTER DRUGS FOR SELF-MEDICATION?

Objective: Elevated blood pressure is known to increase the cardiovascular risks. High blood pressure (BP) can be both a consequence of incorrect drug use and other forms of hypertension. Over-the-counter (OTC) drugs can carry a potential risk, but still in a number of countries the OTC drugs can be bought without a doctor‘s prescription. Design and method: A 46-year-old man presented with headache, palpitation, high BP of 160/100 mmHg. These symptoms worsened during last month. The patient was working as a coal miner for 23 years. Bad habits: smoking for 10 years with pack of cigarettes a day. He was diagnosed essential hypertension five years ago and asthma four years ago. He referred to a physician. Mono-therapy of losartan 25 mg twice a day was prescribed, but there was no persistent effect of it. Physical examination: BMI 30.7 kg/m2, office BP 150/100 mmHg, heart rate 92/minute. By chemistry: creatinine 109.11 mkmol/l, GFR 95.4 ml/min (CKD-EPI), total cholesterol 3,86 mmol/l, triglycerides 3.09 mmol/l, HDL 0.88 mmol/l, VLDL 1.4 mmol/l, LDL 1.4 mmol/l. Blood count with a normal range. Ambulatory BP measurements for 24 hours on monotherapy of losartan: the mean pressure per day 143/87 mmHg, a non-dipping BP profile. Both eyes hypertension retinopathy was revealed. He did not have a left ventricular hypertrophy on echocardiogram. The patient revealed the use of OTC nasal decongestants for 20 years to treat the presence of chronic nonallergic rhinitis. The patient was advised to exclude the nasal decongestants. The office BP was 115/80 mm/Hg in the morning and 125/85 mm/Hg in the evening since 10 days after exclusion of nasal drops. Results: A nasal septal deviation was recently revealed. Septoplasty led to successful reduce of his nasal symptoms. On follow-up visit the patient had normal BP level without any antihypertensive therapy. Conclusions: This clinical case demonstrates the importance of drug regulation and potential harm for the OTC drugs use by the general population without of medical appointments. Notably, the importance of using a proper talk with patients suffering hypertension and to suggest a questionnaire aimed at detection of secondary reasons.

What medicines do households keep in their cabinets? Understanding the possession and use of medicines at home and the role of health insurance in Nigeria.

BackgroundGlobally, the possession of medicines stored at home is increasing. However, little is known about the determinants of possessing medicines, their usage according to clinical purpose, which we term ‘correct drug match’, and the role of health insurance.MethodsThis study uses data from a 2013 survey evaluating a health insurance program in Kwara State, Nigeria, which upgraded health facilities and subsidized insurance premiums. The final dataset includes 1,090 households and 4,641 individuals. Multilevel mixed-effects logistic regressions were conducted at both the individual level and at the level of the medicines kept in respondents’ homes to understand the determinants of medicine possession and correct drug match, respectively, and to investigate the effect of health insurance on both.ResultsA total of 9,266 medicines were classified with 61.2% correct match according to self-reported use, 11.9% incorrect match and 26.9% indeterminate. Most medicines (73.0%) were obtained from patent proprietary medicine vendors (PPMVs). At 36.6%, analgesics were the most common medicine held at home, while anti-malarial use had the highest correct match at 96.1%. Antihistamines, vitamins and minerals, expectorants, and antibiotics were most likely to have an incorrect match at respectively 35.8%, 33.6%, 31.9%, and 26.6%. Medicines were less likely to have a correct match when found with the uneducated and obtained from public facilities. Enrolment in the insurance program increased correct matches for specific medicines, notably antihypertensives and antibiotics (odds ratio: 25.15 and 3.60, respectively).ConclusionSince PPMVs serve as both the most popular and better channel compared to the public sector to obtain medicines, we recommend that policymakers strengthen their focus on these vendors to educate communities on medicine types and their correct use. Health insurance programs that provide affordable access to improved-quality health facilities represent another important avenue for reducing the burden of incorrect drug use. This appears increasingly important in view of the global rise in antimicrobial resistance.

Assessment of Pharmaceutical Services in a Southern Brazilian City.

Well-planned and executed pharmaceutical services (PS) are important for proper treatment of the population's health needs, thus enabling the access to essential drugs and promoting their rational use. To assess the situation of PS in the city of Uruguaiana (State of Rio Grande do Sul), Brazil. This cross-sectional study was applied to 650 interviews between June and September of 2013 in 11 Basic Health Units (UBS) and in the Main Pharmacy of the city. The indicators of prescription, of patient's care, and of service, were assessed according to the recommendations of the World Health Organization (WHO).The Instrument of Self-Assessment for Pharmaceutical Services Planning (IAPAF) from the Brazilian Department of Health was used to assess the management and planning capacity of the PS, which was then applied in the Main Pharmacy and in the medicine stockroom. The number of drugs per prescription varied from 1 to 10 (mean = 1.7). The percentages of prescribed drugs by generic name, and included in the City List of Essential Drugs (REMUME) were, respectively, 75.5 and 67.7%; antibiotics were prescribed in 9.7% of the medical appointments. The average time of medical appointment was 6 minutes; 51.4% of the users obtained their prescription; only 18.9% of the patients completely understood their prescriptions. Of the 24 items analyzed in the IAPAF, 12 were found in stage 1 (worst rating), 12 in stage 2, and none in stage 3 (ideal situation). Results seem to show the lack of PS in Uruguaiana with regard to planning, management, and patient's care. The absence of effective management may result in waste and incorrect use of drugs.

Polypharmacy and drug interactions in elderly patients

Although the definition of polypharmacy is not yet clear today, it is generally regarded as drug use more than the patient needs. Advanced age is the most important risk factor for polypharmacy. In addition, other risk factors are loss of current cognitive functions, low socioeconomic level and nursing care. It is seen in about 40% of people over 75 years of age worldwide, varying between countries of extreme poverty. Incorrect drug use, drug side effects and drug-drug interaction lead to unwanted hospitalizations. In particular, cardiovascular drugs pose risks in terms of drug side effects in advanced ages. Altering the pharmacokinetics and pharmacodynamics of the drug along with advanced age lead to more frequent side effects or no effect of the drugs. The most important point to prevent polypharmacy is to inform the patient or the patient's caregiver fully and to target treatment with a minimum number of drugs and doses.

Drug identification and interaction checker based on IoT to minimize adverse drug reactions and improve drug compliance

Drug compliance and adverse drug reactions (ADR) are two of the most important issues regarding patient safety throughout the worldwide healthcare sector. ADR prevalence is 6.7 % throughout hospitals worldwide, with an international death rate of 0.32 % of the total of the patients. This rate is even higher in Ambient Assisted Living environments, where 15 % of the patients suffer clinically significant interactions due to patient non-compliance to drug dosage and schedule of intake in addition to suffering from polypharmacy. These instances increase with age and cause risks of drug interactions, adverse effects, and toxicity. However, with a tight follow-up of the drug treatment, complications of incorrect drug use can be reduced. For that purpose, we propose an innovative system based on the Internet of Things (IoT) for the drug identification and the monitoring of medication. IoT is applied to examine drugs in order to fulfill treatment, to detect harmful side effects of pharmaceutical excipients, allergies, liver/renal contradictions, and harmful side effects during pregnancy. The IoT design acknowledges that the aforementioned problems are worldwide so the solution supports several IoT identification technologies: barcode, Radio Frequency Identification, Near Field Communication, and a new solution developed for low-income countries based on IrDA in collaboration with the World Health Organization. These technologies are integrated in personal devices such as smart-phones, PDAs, PCs, and in our IoT-based personal healthcare device called Movital.

Prevention of adverse events in the administration of drugs

Incorrect use of drugs may cause adverse events with serious consequences for patients. Adverse event (Adverse events) refers to an event related to the care process and which involves an injury to the patient, unintended and undesirable. Errors in drug therapy (also called error of therapy) are predictable events that may cause or lead to the inappropriate use of the drug or a threat to hospitalized patients, which may occur during the process of managing the drug for prevention and therefore should be considered by the whole management system of healthcare. These events, predictable and avoidable must be differentiated from the adverse drug reactions (ADR-Adverse Drug Reaction), linked to the drug itself and that are detected and evaluated by pharmacovigilance. The causes of errors in therapy are multifactorial and involve different health professionals. Basically 5 categories of error are recognized . • Error limitation • Clerical error / interpretation, • Error processing; • Error distribution • Administration error

La gestione del rischio iatrogeno nell’anziano

Iatrogenic risk in the elderly is the consequence of an incorrect use of drugs. It may be caused by comorbidities, polypharmacy and pharmacokinetic and pharmacodynamic changes. Factors influencing the effect of a drug are closely linked to genetic polymorphism of hepatic enzymes, drug-drug, drug-disease and drug-food interactions, smoke and alcohol. In this article we will try to focus on the possible factors influencing iatrogenic damage; we will also describe some case reports on adverse drug events in the elderly. Finally, we analyze if there are guidelines driving doctors in the appropriate prescription of drugs for a better management of iatrogenic risk. According to the last evidences, a rationale approach to pharmacological management of elderly people consists in individualizing and simplifying treatment, choosing the most appropriate drug, starting from low dosage and gradually increasing it. The best outcome is to obtain the greatest effect by the lowest possible dosage. Reducing the number of drugs, in order to have a better compliance, and considering possible and sometimes dangerous interactions is another reasonable outcome. At the moment there are no guidelines for facing comorbidities; Beers criteria, which define the use of potentially inappropriate drugs in the elderly, together with a multidisciplinary cooperation among doctors, pharmacists and nurses, may be useful tools for a good management of iatrogenic risk in elderly people.

Adverse Drug Events Associated With the Antidotes for Methanol and Ethylene Glycol Poisoning: A Comparison of Ethanol and Fomepizole

We investigate adverse drug events associated with antidotes ethanol and fomepizole in methanol or ethylene glycol poisonings. An "adverse drug event" is harm associated with normal or incorrect drug use. We describe type, frequency, severity, seriousness, and onset time of adverse drug events and test the hypothesis that fomepizole results in fewer adverse drug events than ethanol. This cohort study included patients aged 13 years or older, hospitalized between 1996 and 2005 for methanol or ethylene glycol poisoning (identified by International Classification of Diseases, Ninth Revision or 10th Revision codes) and treated with at least 1 dose of ethanol or fomepizole. Two abstractors separately reviewed each chart, identifying new clinical events during antidote treatment. Three toxicologists determined, by consensus, which events were adverse drug events. The primary outcome was at least 1 adverse drug event, expressed as adverse drug event rate per person-day of antidote treatment. Association between time to first adverse drug event and antidote type was modeled by Cox regression, adjusted for confounders. Two hundred twenty-three charts were reviewed and 172 analyzed. Toxicologists identified at least 1 adverse drug event in 74 of 130 (57%) ethanol-treated and 5 of 42 (12%) fomepizole-treated cases. Central nervous system symptoms accounted for most adverse drug events (48% ethanol-treated, 2% fomepizole-treated). Severe adverse drug events occurred in 26 of 130 (20%) ethanol-treated (coma, extreme agitation, cardiovascular) and 2 of 42 (5%) fomepizole-treated (coma, cardiovascular). Serious (life-threatening) adverse drug events occurred in 11 of 130 (8%) ethanol-treated (respiratory depression, hypotension) and 1 of 42 (2%) fomepizole-treated (hypotension, bradycardia) cases. Median adverse drug event onset was within 3 hours after the start of either antidote. Ethanol and fomepizole adverse drug event rates were 0.93 and 0.13 adverse drug events per treatment-day, respectively. Adjusted hazard ratio was 0.16 (95% confidence interval 0.06, 0.40). Given observational study limitations, results suggest lower occurrence of adverse drug events with fomepizole than ethanol.

Study of enteroparasites infection frequency and chemotherapeutic agents used in pediatric patients in a community living in Porto Alegre, RS, Brazil.

Parasitic infections caused by intestinal protozoan and helminths affect more than two billion people worldwide and chemotherapy is the most commonly used therapeutic procedure. Considering the problems created by parasitic infections and the incorrect use of drugs, the aim of this work was to detect the frequency of enteroparasites infection and to estimate the use of chemotherapeutic agents in children living in the periphery of the city of Porto Alegre, RS, Brazil. Ninety-six preschool age children, who had parasitological exams and who used antiparasitic drugs, were analyzed. The efficacy of treatment was evaluated by stool examination repeated six months after treatment. The same diagnostic test was used to evaluate parasitological cure, which was defined as absence of eggs and cysts in the stool. From these children, 79 (82.3%) were contaminated by some species of parasite, the most prevalent were Ascaris lumbricoides, Trichuris trichiura and Giardia lamblia. The most commonly used drugs were mebendazole (86% of prescriptions) and metronidazole (30.3%). The cure rate in the 79 children, examined 6 months after treatment, was 65.3% for A. lumbricoides and 66.1% for T. trichiura. This study suggests that a continuous education program regarding the prevention and treatment of parasitic infections is an essential tool for their eradication.

Validity of self-reported drug use in chronic pain patients.

Previous researchers have reported that in psychiatric populations many patients provide incorrect self-report information on current drug use. Therefore, the purposes of the present study were to determine the percentage of chronic pain patients (CPPs) using illicit drugs (cannabis, cocaine), to determine the percentage of CPPs who provide incorrect self-report drug use information in the psychiatric examination, and to identify some variables that could help in identifying the CPP likely to provide an incorrect drug use history using drug urine toxicologies. DESIGN/SETTING/PARTICIPANTS/OUTCOME MEASURES: Two hundred seventy-four CPP consecutive admissions to a pain facility were psychiatrically examined according to criteria in the Diagnostic and statistical manual of mental disorders (3rd ed., rev; DSM-III-R), with special emphasis on all current drug use. Immediately after the psychiatric examination, all CPPs were asked to consent to urine toxicology. Urine was tested for benzodiazepines, opioids, tricyclics, propoxyphene, cannabinoids, barbiturates, amphetamines, methadone, methaqualone, phencyclidine, alcohol, and cocaine. CPPs were then segregated into three groups: negative toxicology, positive toxicology but concordant with self-report of current drug use, and positive toxicology discordant with self-report of current drug use. These groups were statistically compared with each other with regard to age, gender, race, workers' compensation status, and prevalence of individual DSM-III-R psychoactive substance use disorders. Sensitivities were also calculated for two conditions: accuracy of toxicology and accuracy of self-report. Toxicologies were obtained from 226 (82.5%) of the CPPs. Toxicologies were negative in 121 (53.5%) and positive in 105 (46.5%) of the CPPs. Of the 226 CPPs, 8.4% had illicit drugs in the urine (6.2% cannabis, 2.2% cocaine). Twenty (8.8%) of the CPPs provided incorrect self-report information about current drug use, the incorrect information most frequently about illicit drugs. Drug urine toxicology sensitivity results indicated that a significant percentage of CPPs was claiming to be taking a drug but was not taking it or taking it incorrectly. The psychiatric examination drug self-report sensitivity results indicated that a significant percentage of CPPs was withholding or providing incorrect information on current drug use. Lowest self-report sensitivity results were in reference to illicit drugs. CPPs who were more likely to provide incorrect psychiatric examination self-report information about current drug use were more likely to be younger, to be a workers' compensation CPP, and to have been assigned a DSM-III-R diagnosis of polysubstance abuse in remission. A significant percentage of CPPs appears to provide incorrect information on current illicit drug use. Urine toxicology studies may have a place in the identification of drugs for which incorrect information may be provided by CPPs. There are many possible reasons, such as assay error, that could lead to apparent misinformation. In the clinical setting, these possibilities should be considered if urine toxicology results appear to be incongruent with psychiatric examination drug use self-report.

Responses from pharmaceutical companies to doctors' requests for more drug information in Pakistan: postal survey

What health professionals know about medicines resembles the information provided in the advertisements of pharmaceutical companies rather than the scientific literature.1 Drug companies spend 15-20% of their income on promotion.2...

Are Too Many Drugs Prescribed for the Elderly After All?

To the Editor:—In recent issues of JAGS there are two interesting papers on “Prescribing for the Elderly.”1,2 The authors review literature and report the evidence that elderly patients tend to receive more drugs than younger patients; however they conclude that there is little evidence in literature to support the common belief that the elderly, as a group, take excessive quantities of drugs. We believe that it is the ambivalence with which this problem is considered that produces such different conclusions. On one hand drug consumption is seen in the light of the high prevalence of side-effects, e.g., diuretics cause hypokalemia and hyperglycemia or benzodiazepines cause postural hypotension and delirium, and thus it is considered that too many drugs are administered to elderly people.3–5 On the other hand, there are reports of undertreatment as a consequence of neglect towards the diseases of elderly patients.6,7 Our department carried out a multidimensional study on a geriatric population living in a nursing home. One of the parameters assessed was diagnosis and the related pattern of drug consumption (102 elderly subjects; 31 males, 77.8 ± 7.6 years old and 71 females, 81.2 ± 7.6 years old). Table 1 indicates the prevalence of main diagnosis susceptible to pharmacological treatment and related treatments. Data indicate that some diseases are overtreated and some are neglected. In particular, we found more frequent treatment for illnesses that usually produce discomfort for the patient or for the staff (e.g., gastrointestinal disturbances and agitation, respectively), whereas we found less frequent treatment for diseases (e.g., chronic heart failure and arthritis) that produce more serious symptoms only if particular functions are required. For example, bed- or chair-ridden patients do not complain about symptoms until they have to move or walk. Along the same line, only 42% of depressed elderly patients are treated whereas 83% of patients with disruptive behavior receive treatment. Adequate care of disorders in the elderly should direct our attention not only to the large number of drugs used and their possible side-effects, but also to the high prevalence of patients suffering from illnesses and not receiving adequate pharmacologic treatment. If we passively consider epidemiologic results it may be concluded that elderly people have an elevated intake of drugs; but, as physicians, we must assess the patient and not compute numbers. It would be harmful to the health of the elderly if our concern for the incorrect use of drugs negatively influenced our capability to improve health conditions, in particular for symptoms that undermine well-being during aging.

Some principles of medication in geriatrics.

In geriatrics, inappropriate and incorrect use of drugs is reflected in a higher percentage of untoward effects. Most reactions are identified readily but some are lost in the induced disturbances of physiologic balance that occur more readily in the aged. Improper dosage, injudicious methods of administration, and lack of awareness of drug interactions are common and are associated with failure to quantitate the reactive capacities of aging body resources. The paucity of didactic instruction and the difficulty which aged patients encounter in observing a medical regimen add to the problems of therapy. The fact that aging alters drug effects and that drug effects alter senescent functions emphasizes the need to be familiar with the roster of confirmed pharmacologic data. Observance of such regulations would improve treatment of the individual patient. Medication schedules must be in line with recognized levels of normality in senescence. These precautions will reduce the chances of initiating primary or sequential mishaps when drugs are administered to the elderly who are more susceptible to side effects and less likely to be responsive to reparative measures.