Show simple item record

dc.contributor.advisorStefanović, Srđan
dc.contributor.otherTončev, Gordana
dc.contributor.otherJanković, Slobodan
dc.contributor.otherDinčić, Evica
dc.creatorAleksić, Dejan
dc.date.accessioned2020-10-24T12:35:03Z
dc.date.available2020-10-24T12:35:03Z
dc.date.issued2020-07-29
dc.identifier.urihttp://eteze.kg.ac.rs/application/showtheses?thesesId=7549
dc.identifier.urihttps://fedorabg.bg.ac.rs/fedora/get/o:1262/bdef:Content/download
dc.identifier.urihttps://nardus.mpn.gov.rs/handle/123456789/17544
dc.descriptionUvod: Klinički relevantne potencijalne interakcije lekova (PIL) smatraju se neželjenim reakcijama na lek koje se mogu sprečiti. Cilj ove disertacije bio je da utvrdi učestalost PIL kod pacijenata sa akutnim moždanim udarom (AMU) i istraži faktore rizika, odnosno protektivne faktore koji imaju značajan uticaj na pojavu kontraindikovanih PIL. Materijal i metod: Sprovedena je opservaciona retrospektivna studija sa usađenom case-control studijom među pacijentima koji su lečeni od AMU u neurološkoj jedinici intenzivne nege (NJIN). PIL su identifikovane korišćenjem Micromedex® softvera. Na osnovu postojanja ili nepostojanja kontraindikovanih PIL, učesnici su podeljeni u grupu slučajeva i kontrolnu grupu u sve tri različite studijske populacije (akutni ishemijski moždani udar (AIMU), intracerebralna hemoragija (ICH) i subarahnoidalna hemoragija (SAH). Sprovedene su i dve kvalitativne metode: intervju metodom fokus grupe i delfi proces. Rezultati: Ukupno je analizirano 832 pacijenta. Svi pacijenti sa AIMU su bili izloženi najmanje jednoj PIL, dok je učestalost identične pojave zabeležena kod 98,2% pacijenata sa ICH, odnosno kod 92,3% sa SAH. Aspirin, diklofenak i varfarin bili su najčešći lekovi uključeni u PIL. Ceftriakson/soli kalcijuma, ketorolak/aspirin i metoklopramid/risperidon bile su najčešće kontraindikovane PIL. Broj lekova (OR = 1,20, 95% CI 1,12-1,29) i primena antipsihotika (najčešće risperidona) (OR = 3,01, 95% CI 1,59-5,71) u terapiji značajno je povećala verovatnoću PIL kod AIMU, a broj farmakološko-hemijskih podgrupa (OR = 1,19, 95% CI 1,05-1,35), i primena antikoagulantne terapije (niskomolekularni heparin i varfarin) (OR = 7,40, CI 1,12-48,96) kod pacijenata sa ICH. Intervju metodom fokus grupe je pokazao da je rešenje za slabo poznavanje problema PIL kod neurologa kontinuirana medicinska edukacija svih aktera koji učestvuju u propisivanju terapije i o online identifikatorima za PIL i njihovo rutinsko korišćenje kod pacijenata sa AMU. Stručnjaci u delfi procesu su se složili da je potrebno definisati preporuke u vidu vodiča medicine zasnovane na dokazima o PIL kod obolelih od AMU.sr
dc.descriptionIntroduction: Clinically relevant potential drug-drug interactions (pDDI) are considered to be preventable adverse drug reactions (ADR). The aim of this study was to determine the incidence of pDDI in patients with stroke and to investigate significant risk factors associated with the occurrence of contraindicated pDDI. Material and method: This observational retrospective cohort and nested case-control study was carried out among patients treated for stroke in the Neurological Intensive Care Unit (NICU). pDDIs were identified using Micromedex® software. Based on the presence or absence of contraindicated pDDI, participants were divided into cases and controls group in all three different study populations (acute ischemic stroke (AIS), intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)). Two qualitative methods were also implemented: focus group and delphi process. Results: A total of 832 patients were analyzed. All study patients with AIS were exposed to at least one pDDI, while the incidence of identical occurrence was observed in 98.2% of patients with ICH and 92.3% with SAH. Aspirin, diclofenac and warfarin were the most common drugs included in pDDI. Ceftriaxone/calcium salts, ketorolac/aspirin, and metoclopramide/risperidone were identified as the most commonly contraindicated pDDIs. The number of drugs (OR = 1,20, 95% CI 1,12-1,2) and the use of antipsychotics (most risperidone) (O R= 3,01, 95% CI 1,59-5,71) in therapy significantly increased the likelihood of contraindicated pDDI in AIS, and the number of pharmacological-chemical subgroups (ОR = 1,19, 95% CI 1,05-1,35), and the use of anticoagulant therapy (low-molecular-weihgt heparin and warfarin) (ОR = 7,40, 95% CI 1,12-48,96) in patients with ICH. A focus group interview showed that addressing the poor knowledge of neurologists about pDDIs and utility of drug interaction software required the implementation of continuing medical education programs with the involvement of all healthcare professionals involved in prescribing therapy, as well as the routine use of online available tools for checking pDDIS in clinical practice. The experts in the delphi process agreed that it is necessary to define recommendations in the form of a „evidence based“ medicine guideline on pDDI in patients with stroke. Conclusions: This research point out that patients with stroke are often exposed to pDDIs. Full precautions from a prevention standpoint should be devoted to the addition of any new drug to therapy, especially when neurologists decide to prescribe antipsychotics, such as risperidone in patients with AIS, as well as anticoagulant therapy (low molecular weight heparin) and warfarin). in patients with ICH. Focus group members agreed that introducing an electronic prescribing program into the NICU with an alarm that warns about pDDIs while prescribing and introducing new drug would be one way to reduce the incidence of pDDIs. Experts from the delphi process have reached a consensus in defining the recommendation/guidelines of evidence based medicine of pDDIs in patients with AIS.en
dc.formatapplication/pdf
dc.languagesr
dc.publisherУниверзитет у Крагујевцу, Факултет медицинских наукаsr
dc.rightsopenAccessen
dc.sourceУниверзитет у Крагујевцуsr
dc.subjectonline identifikatorisr
dc.subjectonline checkersen
dc.subjectMicromedexen
dc.subjectpotential drugdrug interactionsen
dc.subjectstrokeen
dc.subjectrisk factorsen
dc.subjectrisperidoneen
dc.subjectMicromedexsr
dc.subjectpotencijalne interakcije lekovasr
dc.subjectakutni moždani udarsr
dc.subjectfaktori rizikasr
dc.subjectrisperidonsr
dc.titleAnaliza faktora rizika za nastanak nepoželjnih interakcija lekova kod pacijenata u neurološkoj jedinici intenzivne negesr
dc.typedoctoralThesisen
dc.rights.licenseBY-NC-ND
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/66169/Disertacija.pdf
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/66170/Izvestaj_Dejan_Aleksic_Medicina.pdf


Files in this item

Thumbnail
Thumbnail

This item appears in the following Collection(s)

Show simple item record