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The risk of ADRs increases with the number of drugs taken [5]. Older people have a higher prevalence of comorbidities, and only a few decades after the.

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Presentazione sul tema: "The risk of ADRs increases with the number of drugs taken [5]. Older people have a higher prevalence of comorbidities, and only a few decades after the."— Transcript della presentazione:

1 The risk of ADRs increases with the number of drugs taken [5]. Older people have a higher prevalence of comorbidities, and only a few decades after the first pharmaceutical discoveries many elderly now use a substantial and still increasing number of drugs on a regular basis [6]. There is some recent evidence that controlled medication discontinuation can improve the subjective quality of life in the elderly [8, 9].

2 PaeseN.Setting%PIMFFarmacoCriteri Germania 73665Comm AntidepressiviPRISCUS USA 397NH Fra91.8GastroentMAI>=1 USA 8139Medic. 7.8OR=2AnalgesiciBeers 97 Europa 2707Home c19.8PentossifillinaBeers 97/03, McLoad Olanda Comm14.3LA BZDBeers 03 Italy Comm18.0DoxazosinaBeers 03 USA Hosp49-38HSSedativiBeers 03 Francia 30683Comm25.4* AnalgesiciBeers 97 French update Francia 35259Comm53.5PentossifillFrench PIM Anticoliner. LA BZD Irlanda 732LTC63.7PpiSTOPP 42.9BZDBeers 03 Irlanda Nord Comm34PPISTOPP Norvegia (>70) Comm LA BZDNORGEP Spagna 100NH79PPI-NO CaDSTOPP START 95PsicotropiAusralian System * 33.5% to 19.3% from 1995 to 2004

3 D Fialova et al, JAMA, 2005

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5 B Bongue et al: Pharmacoepidemiology and Drug Safety, 2009; 18: 1125–1133

6 Reazioni avverse di potenziale importanza nell'anziano: 1. Ipomagnesemia 2. Riduzione assorbimento del calcio carbonato 3. Infezioni respiratorie 4. Diarrea da Cl.difficile 5. Poliposi gastrica 6. Gastrite atrofica in soggetti H. Pylori

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8 DA Zinc et al, Aliment Pharmacol Ther, 2005 Conclusions: Our data verifies that practitioners routinely start general medical in-patients on acid suppression without an appropriate indication. Many of these prescriptions are continued at discharge for no apparent reason, leading to their long-term misuse.

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11 Drugs and Aging, 2012

12 Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study J Schuling et al. BMC Family Practice 2012, 13:56

13 AA VV G Ital Farmacol Clin, 2012, 26, 4:

14 Drugs Aging Aug 1;29(8):659-67

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16 CASO CLINICO sulla prescrizione di farmaci nell'anziano - 2

17 CASO CLINICO sulla prescrizione di farmaci nell'anziano - 3

18 CASO CLINICO sulla prescrizione di farmaci nell'anziano - 4

19 GERIATRI GENOVA (N=22)AUSTRALIA Drug n (%) □ pravastatina19 (86.4) □ setralina17 (77.3) □ digossina14 (63.6) □ oxazepam13 (59.1) □ gliclazide 12 (54.5) □ spironolattone 12 (54.5) □ donepezil 12 (54.5) □ alendronato 12 (54.5) □ omeprazolo 12 (54.5) □ CaCO310 (45.5) □ Movicol® 9 (40.9) □ carbidopa-benserazide 7 (31.8) □ Perindopril 7 (31.8)

20 (+23%) (+25%) (+27%) (+52%) (+50%) (+23%) (+38%) (+25%) (+18%) (+22%) (+37%) (0 %) AUSTRALIA Drug n (%) □ pravastatina19 (86.4) □ setralina17 (77.3) □ digossina14 (63.6) □ oxazepam13 (59.1) □ gliclazide 12 (54.5) □ spironolattone 12 (54.5) □ donepezil 12 (54.5) □ alendronato 12 (54.5) □ omeprazolo 12 (54.5) □ CaCO310 (45.5) □ Movicol® 9 (40.9) □ carbidopa-benserazide 7 (31.8) □ Perindopril 7 (31.8) GERIATRI GENOVA (N=22)

21 FARMACI CON IL MAGGIORE CONSENSO AUSTRALIA CARVEDILOLO COLECALCIFEROLO FUROSEMIDE DIGOSSINA PERINDOPRIL OMEPRAZOLO GERIATRI GENOVA CARVEDILOLO COLECALCIFEROLO FUROSEMIDE PERINDOPRIL ISOSORBIDE CARBIDOPA/BENSER

22 Geriatri ospedalieri vs geriatri territoriali Farmaci da sospenderePravastatina (93.3)Oxazepam(100) (i 7 vizi capitali)Gliclazide(73.3)Sertralina(85.7) Numero medio sosp.:Setralina(73.3)Pravastatina(71.4) Totale 7.3Alendronato (73.3)Omeprazolo(71.4) H7.3Digossina(66.7)Movicol(71.4) T7.3Spironolatt.(53.3)Spironolattone(57.1) Omeprazolo (46.7)Digossina(57.1) Farmaci da confermareCarvedilolo(100)Perindopril(85.7) (i magnifici 7)Colecalcifer(93.3)Carvedilolo(71.4) Totale7.2Furosemide(93.3)Furosemide(57.1) H7.3Perindopril(53.3)Isosorbide(57.1) T7.0Isosorbide(46.7)Warfarin(57.1) Movicol(46.7)Carbid/Bens(57.1) Carbid/Bens(40.0)Colecalciferolo(42.9) I dubbi amleticiParac/Cod(60.0)Donepezil(71.4) Isosorbide(46.7)Spironolattone(42.9) Oxazepam(46.7)Warfarin(42.9) HT

23 Tecniche Sale e Pepe SALE (in zucca) Semplificare Avversi (eventi) Lista di farmaci Evidenze di efficacia PEPE Personalizzare Educare Pazienza (tempo disponibile) Effetti da interazione Bhavik M. Shah,, Emily R. Hajjar, Clin Geriatr Med 28 (2012) 173–186

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