{"id":117200,"date":"2018-03-11T10:46:37","date_gmt":"2018-03-11T10:46:37","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/estudio-observacional-prospectivo-sobre-interacciones-medicamentosas-en-pacientes-onco-hematologicos\/"},"modified":"2018-03-11T10:46:37","modified_gmt":"2018-03-11T10:46:37","slug":"estudio-observacional-prospectivo-sobre-interacciones-medicamentosas-en-pacientes-onco-hematologicos","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/farmacologia\/estudio-observacional-prospectivo-sobre-interacciones-medicamentosas-en-pacientes-onco-hematologicos\/","title":{"rendered":"Estudio observacional prospectivo sobre interacciones medicamentosas en pacientes onco-hematol\u00f3gicos."},"content":{"rendered":"<h2>Tesis doctoral de <strong> M\u00aa Angeles Fern\u00e1ndez De Palencia Espinosa <\/strong><\/h2>\n<p>Resumen el conocimiento y el manejo adecuado de las interacciones medicamentosas mejoran la calidad, seguridad y eficiencia de los tratamientos prescritos a los pacientes. objetivos: 1. Determinar la preValencia de tratamientos con interacciones farmacol\u00f3gicas (if) potenciales en pacientes onco-hematol\u00f3gicos ingresados, distinguiendo tres grupos poblacionales (poblaci\u00f3n pedi\u00e1trica, poblaci\u00f3n adulta hematol\u00f3gica y poblaci\u00f3n adulta oncol\u00f3gica) y usando dos bases de datos, micromedex\u00c2\u00bf y drug interaction facts\u00c2\u00bf (dif\u00c2\u00bf). 2. Determinar la densidad de incidencia de if potenciales en tratamientos de pacientes en las mismas poblaciones. 3. Describir las caracter\u00edsticas de los pacientes, de los tratamientos y de las if potenciales detectadas. 4. Determinar los factores de riesgo asociados a la presencia de interacciones totales y cl\u00ednicamente relevantes para los 3 grupos poblacionales y las dos bases de datos. 5. Comparar el nivel de concordancia de dos bases de datos en cuanto a la detecci\u00f3n de interacciones potenciales y su nivel de severidad. 6. Describir las interacciones con relevancia cl\u00ednica m\u00e1s frecuentes y proponer alternativas farmacol\u00f3gicas o estrategias de reducci\u00f3n de riesgo. metodolog\u00eda: estudio observacional prospectivo descriptivo, durante 12 semanas, sobre if potenciales detectadas en los tratamientos m\u00e9dicos de pacientes onco-hematol\u00f3gicos ingresados, adultos o pedi\u00e1tricos, independientemente de que recibieran tratamiento antineopl\u00e1sico o no. Adem\u00e1s de los tratamientos m\u00e9dicos se recopilaron datos demogr\u00e1ficos, cl\u00ednicos y anal\u00edticos. Para la detecci\u00f3n de las if, se cotejaron todas las l\u00edneas de prescripci\u00f3n del tratamiento en 2 bases de datos, micromedex\u00c2\u00bf y dif\u00c2\u00bf, y se registraron todas las if detectadas por pares, junto con el grado de severidad y evidencia otorgados, el mecanismo de interacci\u00f3n y la descripci\u00f3n del efecto. Para establecer la relevancia cl\u00ednica de las if detectadas, se sigui\u00f3 el siguiente criterio:  &quot;\tpara las if detectadas con micromedex\u00c2\u00bf, se consideraron cl\u00ednicamente relevantes todas aquellas con nivel de severidad contraindicado, grave y moderado, independientemente del nivel de evidencia. &quot;\tpara las if detectadas con dif\u00c2\u00bf, se consideraron cl\u00ednicamente relevantes todas aquellas con nivel de severidad grave y moderado, independientemente del nivel de evidencia y del grado de significaci\u00f3n.  se realiz\u00f3 un an\u00e1lisis descriptivo, tanto num\u00e9rico como nominal, de los datos demogr\u00e1ficos, cl\u00ednicos y anal\u00edticos, as\u00ed como de los medicamentos prescritos en los tratamientos estudiados y de las if potenciales totales y cl\u00ednicamente relevantes detectadas por ambas bases de datos. Se recurri\u00f3 a modelos de regresi\u00f3n log\u00edstica y regresi\u00f3n lineal para identificar los factores de riesgo asociados con las if, bien como probabilidad de aparici\u00f3n del evento (presencia\/ausencia de la if), bien para obtener la ecuaci\u00f3n que determine el n\u00famero de if potenciales en funci\u00f3n de factores de riesgo asociados. En la comparaci\u00f3n entre las bases de datos, y para las interacciones comunes a ambas, se determin\u00f3 la concordancia entre los grados de severidad otorgados por ambas a trav\u00e9s del coeficiente kappa. resultados: se analizaron un total de 1.166 tratamientos m\u00e9dicos, pertenecientes a 341 pacientes. Se encontraron un total de 3.155 if por la base de datos micromedex\u00c2\u00bf, y 1.989 por la base de datos dif\u00c2\u00bf.  los resultados correspondientes a los objetivos principales han sido: &quot;\tservicio de oncolog\u00eda: la preValencia de tratamientos con alguna if potencial fue del 81,69% y 48,21% para micromedex\u00c2\u00bf y dif\u00c2\u00bf; y de tratamientos con alguna if cl\u00ednicamente relevante, del 80,97% y 32,62%, respectivamente. La densidad de incidencia promedio para las if potenciales fue de 222,77 y 102,08 if por 100 tratamientos-d\u00eda; y para las if cl\u00ednicamente relevantes, de 218,63 y 61,72 if por 100 tratamientos-d\u00eda, respectivamente. &quot;\tservicio de hematolog\u00eda: la preValencia de tratamientos con alguna if potencial fue del 74,45% y 69,40% para micromedex\u00c2\u00bf y dif\u00c2\u00bf; y de tratamientos con alguna if cl\u00ednicamente relevante, del 74,13% y 56,78%, respectivamente. La densidad de incidencia promedio para las if potenciales fue de 437,28 y 331,95 if por 100 tratamientos-d\u00eda; y para las if cl\u00ednicamente relevantes, de 428,51 y 240,53 if por 100 tratamientos-d\u00eda, respectivamente. &quot;\tonco-hematolog\u00eda pedi\u00e1trica: la preValencia de tratamientos con alguna if potencial fue del 56,67% y 58,00% para micromedex\u00c2\u00bf y dif\u00c2\u00bf; y de tratamientos con alguna if cl\u00ednicamente relevante, del 44,67% y 51,33%, respectivamente. La densidad de incidencia promedio para las if potenciales fue de 155,70 y 153,82 if por 100 tratamientos-d\u00eda; y para las if cl\u00ednicamente relevantes, de 121,04 y 118,12 if por 100 tratamientos-d\u00eda, respectivamente. de forma general, el principal factor de riesgo asociado a la presencia de if fue el n\u00famero de f\u00e1rmacos, en unos casos como f\u00e1rmacos prescritos en total y en otros como f\u00e1rmacos distintos de los antineopl\u00e1sicos, o incluso ambos. en la comparaci\u00f3n de las bases de datos se observaron m\u00faltiples diferencias, tanto en la capacidad de detectar la presencia de alguna if potencial hallando una concordancia d\u00e9bil (k=0,372 para if totales y k=0,253 para las cl\u00ednicamente relevantes, siendo p&lt;0,0001 en ambos casos), como en el an\u00e1lisis de fiabilidad entre los grados de severidad otorgados por cada base de datos con respecto a las if detectadas en com\u00fan, hallando una concordancia nula con un valor de k=-0,062, siendo p&lt;0,002. por su gravedad potencial y frecuencia, destacan las siguientes if: combinaciones de f\u00e1rmacos depresores del sistema nervioso central; el riesgo de aparici\u00f3n de reacciones extrapiramidales tras la asociaci\u00f3n de f\u00e1rmacos antiem\u00e9ticos; s\u00edndrome serotonin\u00e9rgico por asociaci\u00f3n de 2 f\u00e1rmacos serotonin\u00e9rgicos; la prolongaci\u00f3n del intervalo qt, especialmente por combinaciones de antif\u00fangicos az\u00f3licos, antagonistas de los receptores 5-ht3, antipsic\u00f3ticos, fluoroquinolonas y antidepresivos tric\u00edclicos; y la disminuci\u00f3n o el aumento de los niveles sangu\u00edneos de f\u00e1rmacos inmunosupresores. conclusiones: la preValencia y densidad de incidencia determinadas han sido elevadas para ambas bases de datos y en los tres grupos poblacionales. Existen diferencias importantes entre las bases de datos utilizadas, lo que hace que el grado de concordancia entre ellas sea bajo y, por tanto, dificulta la propuesta de alternativas terap\u00e9uticas y el establecimiento de estrategias de reducci\u00f3n de riesgo. summary: the knowledge and a suitable management of drug interactions improve the quality, safety and efficiency of treatments administered to patients. objectives: 1. To determine the prevalence of potential drug-drug interactions (ddis) in treatments from onco-haematological inpatients, distinguishing three population groups (paediatric patients, oncological adult patients and haematological adult patients). Two databases were used, micromedex\u00c2\u00bf and drug interaction facts\u00c2\u00bf (dif\u00c2\u00bf). 2. To determine the incidence density of potential ddis in treatments from onco-haematological patients in the same population groups. 3. To describe the characteristics of patients, treatments and detected potential ddis. 4. To determine the risk factors associated with the presence of both total and clinically relevant ddis by each population group and database. 5. To compare the agreement between both databases regarding to identified potential ddis and their severity rating. 6. To describe the most frequent clinically relevant ddis and to propose pharmacological alternatives or risk reduction strategies. methodology: a prospective, observational and descriptive study was carried out during a 12 weeks period, to detect potential ddis in medical treatments from onco-haematological inpatients, both adults and children, regardless antineoplastic treatment were administered to patients. Apart from treatment sheets, demographical, clinical and analytical data were recorded. Each medication list was screened through micromedex\u00c2\u00bf and dif\u00c2\u00bf. All identified potential ddis were recorded and graded by their level of severity and scientific evidence, with a description of the pharmacological mechanism and their effects. Any ddi detected by each database was considered a potential ddi. A clinically relevant ddi (cr-ddi) was defined according to the level of severity irrespective to the scientific evidence:  &quot;\tfor micromedex\u00c2\u00bf database, those ddis classified as contraindicated, major and moderate. &quot;\tfor dif\u00c2\u00bf, those ddis classified as major and moderate.   a descriptive analysis, both quantitative and qualitative, of demographical, clinical and analytical data was carried out. A list of prescribed drugs and both total and clinically relevant identified ddis by each database was executed too. Logistic and linear regression models were used to identify risk factors associated with ddis, well as probability of ddi occurrence (presence\/absence), well as to obtain an equation that determine the number of potential ddis according to associated risk factors. When comparing both databases, and in the context of commonly detected ddis, kappa statistic was used to evaluate the agreement between their assigned severity ratings. results: a total of 1,166 treatment sheets, belonging to 341 patients, were analysed. The total number of identified ddis was 3,155 by micromedex\u00c2\u00bf and 1,989 by dif\u00c2\u00bf.  results for the main objectives were described as follows: &quot;\toncology department: prevalence of medical orders with any potential ddi was 81.69% and 48.21% by micromedex\u00c2\u00bf and dif\u00c2\u00bf respectively; and prevalence of treatments with any potential cr-ddi was 80.97% and 32.62%, respectively. Mean incidence density considering all potential ddis was 222.77 and 102.08 ddi per 100 treatments-day; regarding to cr-ddis, 218.63 and 61.72 ddis per 100 treatments-day, respectively. &quot;\thaematology department: prevalence of medical orders with any potential ddi was 74.45% and 69.40% by micromedex\u00c2\u00bf and dif\u00c2\u00bf respectively; and prevalence of treatments with any potential cr-ddi was 74.13% and 56.78%, respectively. Mean incidence density considering all potential ddis was 437.28 and 331.95 ddis per 100 treatments-day; regarding to cr-ddis, 428.51 and 240.53 ddis per 100 treatments-day, respectively. &quot;\tonco-haematological paediatric section: prevalence of medical orders with any potential ddi was 56.67% and 58.00% by micromedex\u00c2\u00bf and dif\u00c2\u00bf respectively; and prevalence of treatments with any potential cr-ddi was 44.67% and 51.33%, respectively. Mean incidence density considering all potential ddis was 155.70 and 153.82 ddis per 100 treatments-day; regarding to cr-ddis, 121.04 and 118.12 ddis per 100 treatments-day, respectively. globally, the main risk factor associated with the presence of ddis was the drugs number, sometimes as total prescribed drugs, others as non-antineoplastic drugs, or even both. several differences were observed when comparing both databases, such as the ability to detect any potential ddi finding a weak congruence (k=0.372 by total ddis and k=0.253 regarding to cr-ddis; p&lt;0.0001 in both instances), or analyzing the reliability of severity ratings in the context of commonly detected ddis by both databases, finding a null congruence (k=-0.062; p&lt;0.002). given their potential severity and frequency, we would like to highlight the following ddis: combinations of central nervous system depressants; increased risk of extrapyramidal reactions when antiemetics are associated; serotoninergic syndrome when 2 serotoninergic agents are co-administered; qt interval prolongation, especially if some drugs are combined, such as azole antifungals, 5-ht3 antagonists, antipsychotics, fluoroquinolones and tricyclic antidepressants; and an increase or a decrease in serum concentrations of immunosuppressant agents. conclusions: prevalence and incidence density of ddis were elevated, considering both databases and all three population groups. There are important differences between databases, so the congruence of severity ratings was low. This fact makes difficult a proposal based on alternative drugs and the establishment of risk reduction strategies.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Estudio observacional prospectivo sobre interacciones medicamentosas en pacientes onco-hematol\u00f3gicos.<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Estudio observacional prospectivo sobre interacciones medicamentosas en pacientes onco-hematol\u00f3gicos. <\/li>\n<li><strong>Autor:<\/strong>\u00a0 M\u00aa Angeles Fern\u00e1ndez De Palencia Espinosa <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 27\/02\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>M. Sacramento Diaz Carrasco<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Jos\u00e9 Mar\u00eda Moraleda jim\u00e9nez <\/li>\n<li>Carlos mario Carceles rodriguez (vocal)<\/li>\n<li>Mar\u00eda del pilar Aznarte padial (vocal)<\/li>\n<li>josefa Leon villar (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de M\u00aa Angeles Fern\u00e1ndez De Palencia Espinosa Resumen el conocimiento y el manejo adecuado de las interacciones medicamentosas [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[957,8235],"tags":[24978,24983,64420,102885,207853,231050],"class_list":["post-117200","post","type-post","status-publish","format-standard","hentry","category-farmacologia","category-murcia","tag-carlos-mario-carceles-rodriguez","tag-jose-maria-moraleda-jimenez","tag-josefa-leon-villar","tag-m-sacramento-diaz-carrasco","tag-maria-del-pilar-aznarte-padial","tag-ma-angeles-fernandez-de-palencia-espinosa"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117200","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=117200"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/117200\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=117200"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=117200"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=117200"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}