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Strategies for Avoiding Typical Drug–Drug Interactions and Drug-Related Problems in Patients with Vascular Diseases

Background and objectives: Drug–drug interactions and drug-related problems in patients with vascular diseases are common. To date, very few studies have focused on these important problems. The aim of the present study is to investigate the most common drug–drug interactions and DRPs in patients wi...

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Autores principales: Schmelzer, Klaus Peter, Liebetrau, Dominik, Kämmerer, Wolfgang, Meisinger, Christine, Hyhlik-Dürr, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10142821/
https://www.ncbi.nlm.nih.gov/pubmed/37109738
http://dx.doi.org/10.3390/medicina59040780
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author Schmelzer, Klaus Peter
Liebetrau, Dominik
Kämmerer, Wolfgang
Meisinger, Christine
Hyhlik-Dürr, Alexander
author_facet Schmelzer, Klaus Peter
Liebetrau, Dominik
Kämmerer, Wolfgang
Meisinger, Christine
Hyhlik-Dürr, Alexander
author_sort Schmelzer, Klaus Peter
collection PubMed
description Background and objectives: Drug–drug interactions and drug-related problems in patients with vascular diseases are common. To date, very few studies have focused on these important problems. The aim of the present study is to investigate the most common drug–drug interactions and DRPs in patients with vascular diseases. Materials and Methods: The medications of 1322 patients were reviewed manually in the time period from 11/2017 to 11/2018; the medications of 96 patients were entered into a clinical decision support system. Potential drug problems were identified, and a read-through consensus was reached between a clinical pharmacist and a vascular surgeon during the clinical curve visits; possible modifications were implemented. The focus was on additional dose adjustment and drug antagonization on drug interactions. Interactions were classified as contraindicated/high-risk combination (drugs must not be combined), clinically serious (interaction can be potentially life-threatening or have serious, possibly irreversible consequences), or potentially clinically relevant and moderate (interaction can lead to therapeutically relevant consequences). Results: A total of 111 interactions were observed. Of these, 6 contraindicated/high-risk combinations, 81 clinically serious interactions, and 24 potentially clinically relevant and moderate interactions were identified. Furthermore, 114 interventions were recorded and categorized. Discontinued use of the drug (36.0%) and drug dose adjustment (35.1%) were the most common interventions. Mostly, antibiotic therapy was continued unnecessarily (10/96; 10.4%), and the adjustment of the dosage to kidney function was overlooked in 40/96; 41.7% of the cases. In the most common cases, a dose reduction was not considered necessary. Here, unadjusted doses of antibiotics were found in 9/96, 9.3% of the cases. Notes for medical professionals summarized information that did not require direct intervention but rather increased attention on the part of the ward doctor. It was usually necessary to monitor laboratory parameters (49/96, 51.0%) or the patients for side effects (17/96, 17.7%), which were expected with the combinations used. Conclusions: This study could help identify problematic drug groups and develop prevention strategies for drug-related problems in patients with vascular diseases. A multidisciplinary collaboration between the different professional groups (clinical pharmacists and surgeons) might optimize the medication process. Collaborative care could have a positive impact on therapeutic outcomes and make drug therapy safer for patients with vascular diseases.
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spelling pubmed-101428212023-04-29 Strategies for Avoiding Typical Drug–Drug Interactions and Drug-Related Problems in Patients with Vascular Diseases Schmelzer, Klaus Peter Liebetrau, Dominik Kämmerer, Wolfgang Meisinger, Christine Hyhlik-Dürr, Alexander Medicina (Kaunas) Article Background and objectives: Drug–drug interactions and drug-related problems in patients with vascular diseases are common. To date, very few studies have focused on these important problems. The aim of the present study is to investigate the most common drug–drug interactions and DRPs in patients with vascular diseases. Materials and Methods: The medications of 1322 patients were reviewed manually in the time period from 11/2017 to 11/2018; the medications of 96 patients were entered into a clinical decision support system. Potential drug problems were identified, and a read-through consensus was reached between a clinical pharmacist and a vascular surgeon during the clinical curve visits; possible modifications were implemented. The focus was on additional dose adjustment and drug antagonization on drug interactions. Interactions were classified as contraindicated/high-risk combination (drugs must not be combined), clinically serious (interaction can be potentially life-threatening or have serious, possibly irreversible consequences), or potentially clinically relevant and moderate (interaction can lead to therapeutically relevant consequences). Results: A total of 111 interactions were observed. Of these, 6 contraindicated/high-risk combinations, 81 clinically serious interactions, and 24 potentially clinically relevant and moderate interactions were identified. Furthermore, 114 interventions were recorded and categorized. Discontinued use of the drug (36.0%) and drug dose adjustment (35.1%) were the most common interventions. Mostly, antibiotic therapy was continued unnecessarily (10/96; 10.4%), and the adjustment of the dosage to kidney function was overlooked in 40/96; 41.7% of the cases. In the most common cases, a dose reduction was not considered necessary. Here, unadjusted doses of antibiotics were found in 9/96, 9.3% of the cases. Notes for medical professionals summarized information that did not require direct intervention but rather increased attention on the part of the ward doctor. It was usually necessary to monitor laboratory parameters (49/96, 51.0%) or the patients for side effects (17/96, 17.7%), which were expected with the combinations used. Conclusions: This study could help identify problematic drug groups and develop prevention strategies for drug-related problems in patients with vascular diseases. A multidisciplinary collaboration between the different professional groups (clinical pharmacists and surgeons) might optimize the medication process. Collaborative care could have a positive impact on therapeutic outcomes and make drug therapy safer for patients with vascular diseases. MDPI 2023-04-17 /pmc/articles/PMC10142821/ /pubmed/37109738 http://dx.doi.org/10.3390/medicina59040780 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Schmelzer, Klaus Peter
Liebetrau, Dominik
Kämmerer, Wolfgang
Meisinger, Christine
Hyhlik-Dürr, Alexander
Strategies for Avoiding Typical Drug–Drug Interactions and Drug-Related Problems in Patients with Vascular Diseases
title Strategies for Avoiding Typical Drug–Drug Interactions and Drug-Related Problems in Patients with Vascular Diseases
title_full Strategies for Avoiding Typical Drug–Drug Interactions and Drug-Related Problems in Patients with Vascular Diseases
title_fullStr Strategies for Avoiding Typical Drug–Drug Interactions and Drug-Related Problems in Patients with Vascular Diseases
title_full_unstemmed Strategies for Avoiding Typical Drug–Drug Interactions and Drug-Related Problems in Patients with Vascular Diseases
title_short Strategies for Avoiding Typical Drug–Drug Interactions and Drug-Related Problems in Patients with Vascular Diseases
title_sort strategies for avoiding typical drug–drug interactions and drug-related problems in patients with vascular diseases
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10142821/
https://www.ncbi.nlm.nih.gov/pubmed/37109738
http://dx.doi.org/10.3390/medicina59040780
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