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Evaluation of rationality and risks of pharmacotherapy in older patients in long-term care facilities
Lukačišinová, Anna ; Fialová, Daniela (advisor) ; Alušík, Štefan (referee) ; Paluch, Zoltán (referee)
Objectives Main objectives of this doctoral thesis were to review available information on pharmacological properties of benzodiazepines and their age-related changes; to evaluate the prevalence of benzodiazepine use in older patients residing in long term care facilities; to investigate the association between use of benzodiazepines and occurrence of falls in acutely hospitalized older patients; and to describe utilization of benzodiazepines in the Czech Republic. Methods A narrative review of literature focused on pharmacokinetics, pharmacodynamics, adverse effects and association of benzodiazepines with falls in older population was conducted. The evaluation of benzodiazepine use in long term care facilities was analysed in a retrospective cross-sectional study using data from the EC 7th Framework Program SHELTER project (Service and Health in the Elderly in Long Term Care). A prospective cohort study data of acutely hospitalized patients in Australia were used to evaluate association between benzodiazepines and falls. To describe utilization of benzodiazepines in the Czech Republic, data from the State Institute for Drug Control and from databases of General Health Insurance Fund were used. This dissertation thesis is a summary of published articles from above stated works and analyses. Results...
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Antiplatelet therapy in elderly
Paluch, Zoltán ; Alušík, Štefan (advisor) ; Perlík, František (referee) ; Martínek, Arnošt (referee)
The aim of our study was to determine the efficacy of antiplatelet therapy in elderly and polymorbid patients. We were interested to know whether selected laboratory parameters, co-existing conditions, and concomitant therapy may affect the antiplatelet effect of low-dose acetylsalicylic acid. In our study groups, we demonstrated high urinary levels of 11-dehydrothromboxane B2 suggesting ineffective antiplatelet therapy. In our series, its prevalence was in excess of 46%. A comparison of groups of aspirin-sensitive and aspirin-resistant patients revealed statistically significant differences in CRP levels, smoking status, previous stroke, and atrial fibrillation. Patients with effective antiplatelet therapy were more often treated with statins, nitrates, and beta-blockers. Determination of the serum levels of salicylates showed a major role in the high prevalence of ineffective antiplatelet therapy was played by patient non-compliance.
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