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Risks and problems associated with polypharmacy in older patients - A self-screening tool for identifying risks of pharmacotherapy by patients themselves
Pitrová, Markéta ; Fialová, Daniela (advisor) ; Kostřiba, Jan (referee)
Title: Risks and Problems Associated with Polypharmacy in Older Patients - A Self-Screening Tool for Identifying Risks of Pharmacotherapy by Patients Themselves Author: Markéta Pitrová Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové Supervisor: Assoc. Prof. Daniela Fialová, PharmD, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové and Department of Geriatrics and Gerontology, 1st Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic BACKGROUND With the increasing number of older adults in the population nowadays, the importance of rational pharmacotherapy - the indication of the most effective, most safe and most cost-effective drug treatments - in older people grows. In order to early assess and resolve the risks of pharmacotherapy in this population, different pharmacotherapy risk assessment and risk management tools have been developed for use by physicians, pharmacists and other health care professionals. As the active involvement of older adults in the process of pharmacotherapy risk assessment and risk management increases, it is crucial to create also patient self- assessment tools in this area. Thus, the aim of the diploma thesis was to develop and test in a pilot study a new patient...
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Changes in renal functions in older age and adjustments of drug dosing in seniors
Sidorenko, Daria ; Fialová, Daniela (advisor) ; Pokladníková, Jitka (referee)
Institution/department: Charles University, Faculty of Pharmacy in Hradec Králové, Department of Social and Clinical Pharmacy Title of diploma thesis: Changes in renal functions in older age and adjustments of drug dosing in seniors Thesis supervisor: doc. PharmDr. Daniela Fialová, Ph.D. Thesis consultant: PharmDr. Eliška Dvořáčková, Ph.D. Author: Daria Sidorenko Introduction: Aging of the population is a natural process, when older age is often accompanied by a physiological or pathological decrease in renal functions. It is reported that at the age of 85 years and older, up to 50% of patients have a significant decrease in renal functioning, which requires adjustment of the dosage of drugs. Thus, the correct choice of drug regimen and dose adjustment of drugs in decreased renal functions is important especially in older age, when at the same time there is a more frequent occurrence of severe drug reactions caused also by other pharmacological changes and other risk factors. The aim of the thesis was to determine which drugs with the need for dose adjustment are most often prescribed in the Czech sample of patients of the EuroAgeism H2020 project, whether the dosage regimens for these drugs are correctly determined with respect to renal functions, and in which cases the most common drug errors...
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Evaluation of the rationality of prescribing of selected potentially inappropriate medications in ambulatory geriatric patients (II.)
Želivská, Nela ; Fialová, Daniela (advisor) ; Pokladníková, Jitka (referee)
Institution/Department: Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy Title of diploma thesis: Evaluation of the rationality of prescribing of selected potentially inappropriate medications in ambulatory geriatric patients (II.) Diploma thesis supervisor: Assoc. Prof. Daniela Fialova, PharmDr. Ph.D. Author: Nela Zelivska Introduction: The percentage of geriatric patients in the population is constantly increasing, thus the importance and need for knowledge of rational geriatric pharmacotherapy in everyday clinical practice is also on the rise. Polymorbidity and polypharmacotherapy are very common in geriatric patients, for this reason it is also necessary to regularly review drug regimens in older age and address potential drug- related problems. Criteria for potentially inappropriate medications in the aged (PIMs) have been defined by expert groups as a helpful tool to improve the rationality of drug prescribing in older adults. The risks of PIMs in older patients often outweigh their benefits or there is insufficient scientific evidence of adequate efficacy/safety of these drugs in older adults, for which reason the use of PIMs in older patients should be limited and their rationality of prescribing regularly monitored. This diploma thesis...
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Evaluation of the use of anticholinergic drugs in older age
Ščešňák, Juraj ; Fialová, Daniela (advisor) ; Pokladníková, Jitka (referee)
Introduction Anticholinergic (ACH) medications and medications with partial anticholinergic activity (AA) are prescribed in older patients particularly for the treatment of psychiatric, gastrointestinal, and genitourinary disorders, but also for other disease conditions. AA of combined drug regimens leads to ACH burden, which should be reduced as much as possible in seniors to avoid worsening of geriatric syndromes and other negative health outcomes. The aim of this diploma thesis was, in the first part, to summarize and review all currently published original and modified ACH drug scales, and to create a simple comprehensive tool for the assessment of ACH drug burden in older adults useful not only in clinical practice, but also in research. Furthermore, the focus of this diploma thesis was to describe the prevalence of use of ACH drug regimens and to document associations between administration of AA drug regimens and health problems in geriatric patients. Methods In this study, the search was conducted in 4 different electronic databases: PubMed (N = 582), MEDLINE (N = 518), Scopus (N = 423), and Web of Science (N = 420) to identify all the ACH drug burden scales published between 2000-2022 and to compile a list of AA medication assessed by these scales. The search strategy was created by using...
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Evaluation of the rationality of prescribing of selected potentially inappropriate medications in ambulatory geriatric patients
Leština, Roman ; Fialová, Daniela (advisor) ; Dvořáčková, Eliška (referee)
Institution/department: Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy Title of diploma thesis: Evaluation of the rationality of prescribing of selected potentially inappropriate medications in ambulatory geriatric patients Supervisor: Assoc. Prof. Daniela Fialova, PharmDr. Ph.D. Author: Roman Lestina Introduction: Rational therapy in the geriatric population is an essential area due to the ever-increasing percentage of geriatric patients in the population. Due to the frequent polypharmacotherapy in these patients, including possible polypragmatism, it is important to constantly monitor potential drug problems and address potential drug risks in a timely manner. As an auxiliary tool in rational geriatric pharmacotherapy, expert groups have defined many potentially inappropriate medications (PIMs), which often contribute to drug reactions in the elderly, and which should be given more attention in clinical practice. This diploma thesis focused on 10 selected, most frequently used PIMs in the geriatric outpatient clinic of the University Hospital in Hradec Králové, and its aim was to monitor how often these drugs are prescribed in high-risk situations in geriatric patients (i.e., in the presence of symptoms, laboratory results and diseases, which...
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Ageing of the population and selected aspects of risky drug prescribing in senior age (II.)
Zpěváková, Gabriela ; Fialová, Daniela (advisor) ; Pokladníková, Jitka (referee)
Institution/department: Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy Title of diploma thesis: Ageing of the population and selected aspects of risky drug prescribing in senior age (II.) Supervisor: Assoc. Prof. Daniela Fialova, PharmDr. Ph.D. Author: Gabriela Zpevakova INTRODUCTION: Ageing of the population in developed and developing countries is accompanied with increasing proportion of seniors. Because of age-related physiological and pathological changes, polymorbidity is very common in older patients and often accompanied with polypharmacy and higher risk of drug-drug interactions (DDIs). Moreover, age-related changes in drug pharmacokinetics and pharmacodynamics contribute to higher clinical significance of various DDIs. The aim of this diploma theis was to determine the prevalence and most common DDIs in the Czech sample of seniors assessed during the EuroAgeism H2020 project in three different settings of care - acute, ambulatory care and in community pharmacies. The secondary aim of the thesis was also to thoroughly describe mechanisms of most common DDIs, their clinical relevance and available evidence. METHODOLOGY: For determining the prevalence of DDIs we used Czech data of seniors 65+ (in total N=1602) collected during the...
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ANALYSIS OF PRESCRIBING OF BENZODIAZEPINES IN SENIORS IN THE EUROAGEISM 2020 PROJECT AND POSSIBILITIES OF THE USE OF DEPRESCRIBING METHODS
Balala, Kristián ; Fialová, Daniela (advisor) ; Pokladníková, Jitka (referee)
Introduction: These days we encounter the rising trend of population ageing. Seniors belong to group of patients with specific health-social needs, in which is necessary in following decades support more health care using knowledge of geriatric and gerontology. One of the new approaches, applied in geriatric, clinical pharmaceutical praxis, is the method of deprescribing as well, based on decreasing of drug burden in elderly. The goal of this diploma thesis was to evaluate rationality of benzodiazepine prescription (one of the most frequently used potentially inappropriate medication in elderly) of seniors in European group of EuroAgeism ESR7 H2020 project, especially taking BZD in non-geriatric doses, non-geriatric length of use and risky drug combinations. Another goal of thesis was to specify, how many seniors would be potentially indicated to the method of deprescribing, and how difficult it would be for application of this method due to difficulty of medication misconduct and expected success/failure of this method. Methodology: Data for this diploma thesis were collected between years 2019 and 2021 within the research project EUROAGEISM ESR7 H2020 based on the international cross-sectional study which was carried out in patients in age 65 years and more, examinated in regionally different...
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Uplatnění regionální produkce ovoce a zeleniny ve školních stravovacích zařízeních Jihočeského kraje
FIALOVÁ, Daniela
The diploma thesis deals with the identification and evaluation of factors that affect the application of regional fruit and vegetable production in school catering facilities. The Czech Republic and the South Bohemian Region are not particularly self-sufficient in fruit and vegetable production. The opening of the market in the last three decades has made it possible to cover a large part of the demand for fruit and vegetables by importing completely new species for us, but gradually also common species, which are pushing the production of domestic growers out of the market. In addition to the economic impact, imports also have a negative impact on the environment, but also on employment and the loss of adequate self-sufficiency. The diploma thesis follows up on the bachelor's thesis, which sought out fruit and vegetable growers in the South Bohemian Region and found out the range of production and its application in school catering facilities. In this work, the need for fruit and vegetables in school canteens of the South Bohemian region and the potential of its coverage by regional producers is specified. The aim is to evaluate the factors influencing the application of regional fruit and vegetable production in school canteens and to suggest possible measures to improve the current situation. The questionnaire survey and controlled interviews with local growers show that the existing programs "School Fruit" and "Product and Food Map of the South Bohemian Region" do not sufficiently fulfill their functions. The relatively low competitiveness of suppliers of domestic production has its share in this. The improvement of the situation is hindered by the great fragmentation of producers, relatively small quantities and sometimes the quality and availability of production, lack of processing capacity, seasonality and lack of suitable storage space, product price and at the same time low ability to communicate, cooperate, abide by agreements and form stable relationships.
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Evaluation of the racionality of pharmacotherapy in geriatric patients in ambulatory and acute care- analyses of pain treatment and use of opioids
Slaná, Adriana ; Fialová, Daniela (advisor) ; Pokladníková, Jitka (referee)
Institution/department: Charles University, Faculty of Pharmacy in Hradec Králové, Department of Social and Clinical Pharmacy Title of rigorous thesis: Evaluation of the rationality of pharmacotherapy in geriatric patients in ambulatory and acute care- analyses of pain treatments and use of opioids Supervisor: Assoc. Prof. Daniela Fialová, PharmDr. Ph.D. Author: Adriana Slaná Objectives: The core issue in geriatric treatment is the selection of the most appropriate and the safest drug regimen. Geriatric patients often suffer from multiple disorders and particularly seniors with unresolved pain tend to use polypharmacy, often irrationally. This study focused on the description of pain prevalence and use of opioids in seniors in two settings of care (acute and ambulatory care) in the Czech Republic and on analyses of negative outcomes associated with use of opioids in combined drug regimens. Methods: Data were collected during 2018-2019 in various healthcare facilities in the Czech Republic as the part of EUROAGEISM H2020 ESR7 project. Prospective study included assessments of 1152 patients who were 65 years or older in acute (N=589) or ambulatory (N= 563) care in 4 cities (Prague, Brno, Hradec Králové and Opava). Data were collected through the standardised questionnaire, using interviews with patients and...
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Rationality of benzodiazepines use in older patients
Magátová, Adriana ; Fialová, Daniela (advisor) ; Lukačišinová, Anna (referee)
Institution/department: Charles University, Faculty of Pharmacy in Hradec Králové, Department of Social and Clinical Pharmacy Title of diploma thesis: Rationality of benzodiazepine use in older patients Supervisor: Assoc. Prof. Daniela Fialová, PharmDr. Ph.D. Author: Adriana Magátová Introduction: Benzodiazepines are one of the most commonly prescribed potentially inappropriate drugs (PIMs) in geriatric patients in Europe and are responsible for common problems associated with risky drug prescription in older age (eg, cognitive impairment, falls, orthostatic hypotension, drug dependence, and others). Physiological and pathophysiological changes associated with the aging process, as well as frequent polymorbidity and polypharmacotherapy, are associated with more frequent occurrence of drug-related complications in older age. With the growing proportion of geriatric population, the importance of preventing drug complications in older adults increases. The aim of this study was to compare prescribing habits in the use of BZD and in the use of drug combinations with sedative potential and to determine the association of their use with drug-related risks in geriatric patients in community pharmacy practice in Spain (SP) and the Czech Republic (CZ) and in groups of patients assessed in various healthcare settings...
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