Ramanisblog

Tag: Pharmacology

  • Many Dialysis Patients Undergoing PCI Receive Improper Medication, With Higher Risk of Bleeding

    ScienceDaily (Dec. 11, 2009) — Approximately 20 percent of dialysis patients undergoing a percutaneous coronary intervention (PCI; procedure such as angioplasty) are given an antithrombotic medication they should not receive, which may increase their risk for in-hospital bleeding, according to a study in the December 9 issue of JAMA.
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    “In the United States, medication errors are implicated in more than 100,000 deaths annually. Medication errors include adverse drug reactions related to inappropriately prescribed or administered drugs. To minimize inappropriate medication use, the U.S. Food and Drug Administration (FDA) guides pharmaceutical manufacturers and clinicians through drug labeling of which medications are contraindicated or not recommended for use in specific patient groups,” the authors write. “Little is known about the use of such medications and their effects on outcomes in clinical practice.”
    Thomas T. Tsai, M.D., M.Sc., of the Denver VA Medical Center and University of Colorado Denver, and colleagues examined the use of the contraindicated/not-recommended antithrombotic agents enoxaparin and eptifibatide among dialysis patients undergoing percutaneous coronary intervention (PCI) and their association with outcomes. The researchers used data from the National Cardiovascular Data Registry (NCDR) from 829 U.S. hospitals on 22,778 dialysis patients who underwent PCI between Jan. 2004 and August 2008. The study focused on the outcomes of in-hospital bleeding and death.
    The researchers found that overall, 5,084 patients (22.3 percent) received a contraindicated antithrombotic medication; 2,375 (46.7 percent) received enoxaparin, 3,261 (64.1 percent) received eptifibatide, and 552 (10.9 percent) received both. In unadjusted analysis, patients who received contraindicated antithrombotics experienced higher rates of in-hospital major bleeding (5.6 percent vs. 2.9 percent) and death (6.5 percent vs. 3.9 percent). Further analysis indicated that receipt of contraindicated antithrombotics was significantly associated with increased in-hospital major bleeding, but no significant association was found with in-hospital death.
    “This study therefore demonstrates that these medications are used in clinical practice despite FDA-directed labeling, and their use is associated with adverse patient outcomes,” the authors write.
    “Educational efforts targeting clinicians who prescribe these medications and quality improvement interventions, such as amending clinical pathway order sets to include consideration of renal function, are urgently needed.”

  • Sedatives, Mood-Altering Drugs Related to Falls Among Elderly: UBC Study

    Nothing can replace physical work ,open air, sea and sky for curing depression and insomnia.Any drug,whether habit forming or not,barbiturate based or not, will cause only serious side effects.One may note people above fifty normally fall in the bath room and in most cases it is the onset of further disorders coming to the fore.Safe it is for the elderly not to lock the bathroom/toilet from inside and keep people informed in advance that the room is engaged.It is the safest prevention from calamity.I have known at least two cases of people around 50,in robust health, having had a fatal heart attack while they were in the bathroom.
    Beware.
    ScienceDaily (Nov. 24, 2009) — Falls among elderly people are significantly associated with several classes of drugs, including sedatives often prescribed as sleep aids and medications used to treat mood disorders, according to a study led by a University of British Columbia expert in pharmaceutical outcomes research.

    The study, published Nov. 23 in the Archives of Internal Medicine, provides the latest quantitative evidence of the impact of certain classes of medication on falling among seniors. Falling and fall-related complications such as hip fractures are the fifth leading cause of death in the developed world, the study noted.
    Antidepressants showed the strongest statistical association with falling, possibly because older drugs in this class have significant sedative properties. Anti-psychotics/neuroleptics often used to treat schizophrenia and other psychoses and benzodiazepines such as valium were also significantly associated with falls.
    “These findings reinforce the need for judicious use of medications in elderly people at risk of falling,” says principal investigator Carlo Marra, a UBC associate professor of Pharmaceutical Sciences. “Safer alternatives, such as counseling, shorter-term or less-sedating therapies, may be more appropriate for certain conditions.”
    The UBC study examined the effects of nine classes of drugs. It updated, expanded and analyzed 22 international observational studies from 1996-2007 investigating falls among people aged 60 years or older. The analysis included data on more than 79,000 participants and both prescription and over-the-counter medications.
    Narcotics (painkillers) were found not to be statistically associated with falling among the classes studied, a finding that requires further research, says Marra, a Canada Research Chair in Pharmaceutical Outcomes in the Collaboration for Outcomes Research and Evaluation based in the Faculty of Pharmaceutical Sciences and a member of the Centre for Hip Health and Mobility, part of Vancouver Coastal Health Research Institute.
    Other medication classes studied include anti-hypertensives (used to reduce blood pressure); diuretics; beta-blockers used to treat heart conditions; and non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen. “Elderly people may be more sensitive to drugs’ effects and less efficient at metabolizing medications, leading to adverse events, which in turn lead to falls,” adds Marra, who is also a research scientist at the Centre for Health Evaluation and Outcome Sciences at Providence Health.
    Prescribing medications to seniors has increased substantially over the past decade, according to the study. For example, the BC Rx Atlas, recently published by UBC researchers, shows that more than one in seven people aged 80 or older filled at least one antidepressant prescription in 2006. In addition, determining which medication classes are associated with falls remains a challenge since seniors are often on multiple medications for multiple health conditions, with new drugs entering the market on a regular basis, says Marra.
    In follow-up research, he aims to explore how pharmacists can identify patients at risk of falling and educate them about medication use to ensure their safety.
    Co-authors include: Dr. Karim Khan; John Woolcott; Kathryn Richardson; Matthew Wiens; Bhavini Patel; and Judith Marin.
    Research was supported (in part) by the Canadian Institutes of Health Research and the Michael Smith Foundation for Health Research.
    http://www.sciencedaily.com/releases/2009/11/091123171410.htm