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Sedation and analgesia in the intensive care unit
Amaç: Yoğun bakım ünitelerinde etkili bir analjezi ve yeterli bir sedasyon sağlamak genel olarak kabul edilen bir amaçtır. Sedasyon ve analjezi skalalarının sedo-analjezi tedavisi üzerine etkilerini değerlendirmek, fentanil ve remifentanili hemodinamik parametreler, organ disfonksiyonu ve yan etkiler açısından karşılaştırmak ve de bir klinik eczacının yoğun bakım ünitesine katkısını değerlendirmek bu çalışmamızdaki esas amaçlarımızdır.Materyal ve Metot: Bu çalışma İstanbul S.B. Göztepe Eğitim ve Araştırma Hastanesinin yoğun bakım ünitesinde yürütülen prospektif, randomize, açık ve kontrollü bir çalışmadır. 34 hasta çalışmaya dahil edildi ve bu hastalar rastgele iki guruba ayrıldı. Tüm hastalara Simultane Aralıklı Mekanik Ventilasyon/Volüm Kontrol (SIMV/VC) modunda mekanik ventilasyon sağlandı. Yoğun bakım ünitesindeki toplam 34 hastaya analjezi ve sedasyon amaçlı ya remifentanil-midazolam (R grubu, n=17) ya da fentanil-midazolam tedavisi (F grubu, n=17) uygulandı. Çalışma protokolüne başlandıktan sonra günlük olarak sedasyon ve analjezi tedavisi ara verilerek hastaların sedasyon ve analjezi düzeyleri değerlendirildi. Riker Sedasyon-Ajitasyon (SAS) ve Ramsey (RS) skalalarına göre midazolam dozu, Davranışsal-Fizyolojik (DFS) skalaya göre ise remifentanil ve fentanil dozları ayarlandı. Hayati bulgular (OAB, CVP, NB, ateş), kan gazı değerleri (PaO2, PaCO2, SpO2, pH), karaciğer enzimleri (ALT, AST), böbrek fonksiyon değerleri (üre, kreatinin) ilk gün iki saatte bir, daha sonraki günlerde ise altı saatte bir kaydedildi.Bulgular ve Sonuç: Hemodinamik parametreler, organ disfonksiyonu ve yan etkiler açısından remifentanil ve fentanil arasında istatiksel olarak anlamlı bir fark gözlenmemiştir (p>0,05). Sedasyon süreleri, mekanik ventilasyon süreleri ve de yoğun bakım ünitesinde kalış süreleri açısından R ve F grupları arasında anlamlı bir fark bulunmamıştır (p>0,05). SAS, RS ve DFS gibi sedasyon ve analjezi değerlendirme skalalarının kullanılması kaliteli bir sedasyon ve analjezi sağlamak için gerekli olduğu anlaşılmıştır. Bunlara ek olarak RS ve SAS skalaları arasında istatiksel açıdan güçlü bir negatif korrelasyon da bulunmuştur (p<0.001). Yoğun bakım hastalarına iyi bir farmasötik bakım verilebilmesi açısından doktorların, klinik eczacıların ve de hemşirelerin bir yoğun bakım ekibi oluşturması çok önemlidir. Yoğun bakım ünitelerindeki en büyük sorunlar ise polifarmasi, geçimsizlik, ilaç yan etkileri ve ilaçların izlenememesidir. Bu problemler bir klinik eczacı katkısıyla kontrol altına alınabilir. Gelecek araştırmalarda yoğun bakım ekibinde bir klinik eczacının rolünü ve faydasını belirleyici çalışmalar yapılabilir.Anahtar Kelimeler: Sedasyon & Analjezi, Remifentanil, Fentanil, Yoğun Bakım Ünitesi, Klinik Eczacı
A pilot study on rational drug use and drug usage habits
Purpose: Irrational drug use and unused drug waste are considerable problems in the modern world. In this study, the main aim was to assess the rational drug use habits and awareness of unused drug wastage among university associates.Materials & Method: The study began with an Unused Drug Gathering Campaign on the campus of Yeditepe University in Istanbul, Turkey. The participants in the campaign were asked to complete a questionnaire about drug use habits and awareness of unused drug waste. 65 participants out of a total of 107 people who were involved in the campaign agreed to complete the questionnaire. The survey questions were formulated based on a literature review, and a score system that measured rational drug use habits was also constructed in the light of the literature. Higher score meant more rational drug use. The results were compared to find any correlation or differences.Result and Conclusion: The mean rational drug use score was 7.14, a relatively high figure. There were no statistically significant differences between rational drug use and socio-demographic parameters. Behavioral patterns related to rational drug use and awareness of unused drug wastage among members of the faculty of pharmacy was generally different from that of other participants. Most of the irrational use problems may be able to be solved by appropriate education. To improve rational drug use, doctors and pharmacists should be competent to educate the public properly. Pharmacists are the most accessible health care professionals for the patient, and have an important role in enhancing rational drug use, and warning about the negative effects of unused drug waste. The need for public health education should be emphasized. Further studies should be conducted to assess the drug use habits of the public; in addition, health care professionals and particularly community pharmacists should encourage the public to correct any harmful drug use behavior.
Smoking-drug interactions with multiple drug usage in elderly people
Kaftan G. Smoking-Drug Interactions In Elderly People With Multiple Drug Usage. Yeditepe University Institute of Health Sciences Clinical Pharmacy Master Thesis. Istanbul, 2013. Purpose: Smoking-drug interactions in elderly people should be considered as a potential health risk and patients should be monitored closely during the change of smoking habit especially when they use particular drugs, a possible blood-plasma concentration variation may cause serious health consequences. Purpose of this study is to highlight the potential clinical risks of smoking-drug interactions in elderly people. Materials and Methods: The study was conducted at the Institution of Kayışdağı Darülaceze, a government organization for elderly as a nursing home, in Istanbul, Turkey. Routinely smoking 226 residents with multiple drug usage, are evaluated in our study. Drugs which have the possibility of interaction with smoking, are investigated in this study. Macros and formulas were designed via Microsoft Visual Basic that analyses the data and evaluates statistical outcomes. Correlation of smoking-drug interactions and multiple drug usage is analyzed by SPSS, statistical analysis program. Results and Discussion: There was a significant increase in the number of drugs that are interacted with smoking as multiple drug usage increase (p < 0.05). 27.25% of the patients have cardiovascular diseases, while 25,45% have psychiatric diseases, 14,07% have endocrinologic diseases, 10,78% have respiratory diseases and 5.69% have cognitive diseases. 29 patients were receiving theophylline which is a drug with narrow therapeutic index and use of theophylline might generate health risk due to its interaction potential with smoking during smoking cessation. Some of the antipsychotics might cause health risk in case of any change in their blood-plasma concentrations. Olanzapine was used on 48 patients, chlorpromazine was used on 12 patients and risperidone was used on 16 patients. Variations in dose or plasma concentration of antipsychotics might cause adverse effects or recurrence of the symptoms of psychiatric diseases might be observed. Although clinical significance of smoking-drug interactions has not been analyzed in detail, possible risks of mentioned drug groups are emphasized in many studies. Substrates of induced enzymes from PAHs such as particular antipsychotics, medicines with narrow therapeutic index and other groups that create risk in case of discontinuation should be monitored closely if patient starts or quits smoking. Especially, elderly patients in nursing homes are much more susceptible to those interactions compared to adults. Conclusion: Smoking-drug interactions with multiple drug usage in elderly people while changing their smoking habits may cause clinical health risks to patients. This potential risks should be assessed widely by physicians and the importance of patient monitorization for adverse effects should be highlighted by clinical pharmacists. When patients, whose drugs might have affected from smoking through pharmacokinetic and pharmacodynamic pathways, stop smoking; interaction status of the drugs should be investigated, clinical significance of any potential interaction should be determined, possible adverse effects of the drugs should be monitored closely and dose adjustment should be assessed if necessary.