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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 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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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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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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Cardiovascular risc factors and complications associated with atherosclerosis - their prevalence and control in seniors in the EUROAGEISM H2020 project
Kubíková, Veronika ; Fialová, Daniela (advisor) ; Kostřiba, Jan (referee)
INTRODUCTION Cardiovascular diseases (CVD) are currently on the first place among the causes of death worldwide and also in the Czech Republic (CR). The most common causes of death among CVDs are disorders associated with atherosclerosis (ATS) and the prevalence of atherosclerosis and their complications increases with increasing age. The aim of this diploma thesis was to document CVS morbidity in geriatric patients in the sample of FIP7 program of the EUROAGEISM H2020 project, mainly the prevalence of CVS disorders associated with ATS, and to evaluate the controll of risk factors associatedwith general risks of progression of ATS. METHODS The data collection for this theses was carried out in the CR from September 2018 to January 2019 in patients in acute care at the age of 65 and older at geriatric wards in Hradec Králové (HK) and Brno. Patients involved in the study were those admitted to hospitalization at the time of data collection, were complying with inclusion criteria and undersigned the informed consent. The Ethics committee of the Faculy of Pharmacy, Charles University and ethics committee of participating healthcare facilities approved the project. Information have been obtained using the questionnaire for comprehensive geriatric assessment which is the secured instrument of the...
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Ageing of the population and selected aspects of the rationality of drug prescribing of statins in older age (II.)
Pekařová, Martina ; Fialová, Daniela (advisor) ; Kostřiba, Jan (referee)
Title: Ageing of the population and selected aspects of the rationality of drug prescribing of statins in older age (II.) Author: Martina Pekařová Tutor: Assoc. Prof. Daniela Fialová, PharmDr, Ph.D. University: Charles University Faculty: Faculty of Pharmacy in Hradec Králové Department: Department of Social and Clinical Pharmacy INTRODUCTION: In the geriatric population, cardiovascular diseases based on atherosclerosis rank first place in morbidity and mortality. A positive effect on cardiovascular morbidity can generally reduce overall morbidity, polymorbidity, polypharmacotherapy, and prolong the quality of life of older patients. Statins are often underprescribedin the treatment of ATS heart disease in older age or are underdosed in both primary and secondary prevention. The main goals of the diploma thesis was to analyze the rationality of statin prescription in the Czech population of seniors, assessed in the EuroAgeism H2020 project in three different health care settings (acute, outpatient and community pharmacy settings of health care). The aim was to describe various aspects of rational / irrational statine therapy in patients older than 65 years (choice of drugs, drug combinations, dosing timing, indications according to the degree of CVS risk in seniors, and indications in the presence...
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The rational use of proton pump inhibitors among geriatric patients in the Czech Republic
Geletová, Ivana ; Fialová, Daniela (advisor) ; Kostřiba, Jan (referee)
Institution/department: Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy Title of diploma thesis: The rational use of proton pump inhibitors among geriatric patients in the Czech Republic Supervisor: Assoc. Prof. Daniela Fialova, PharmDr. Ph.D. Author: Ivana Geletova Introduction: The dynamic process of ageing requires adequate attention at a global level, mainly in the area of providing a proper healthcare. Ageing process is specific by significant involutional changes and is often complicated by higher polymorbidity and polypharmacotherapy. Therefore, it is necessary to eliminate the negative impact of possible drug-related and nondrug-related risk factors and to ensure the rational use of medicines. Proton pump inhibitors (PPIs) are one of the most frequently prescribed classes of drugs in older adults, administered especially for the treatment of gastrointestinal tract (GIT) disorders associated with increased secretion of gastric acid and/or impairment of GIT or as a preventive treatment of potential drug-related and other gastropathies. This diploma thesis focused on evaluating the prevalence of use of PPIs among geriatric patients in acute, ambulatory and pharmacy settings of healthcare in the Czech Republic, in the EUROAGEISM H2020...
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Ageing of the population and use of low-dose drug regimens in older patients (II.)
Koleníková, Jana ; Fialová, Daniela (advisor) ; Kostřiba, Jan (referee)
Title: Ageing of the population and use of low-dose drug regimens in older patients (ii.) Author: Jana Koleníková Tutor: Assoc. Prof. Daniela Fialová, PharmD, Ph.D. University: Charles University Faculty: Faculty of Pharmacy in Hradec Králové Department: Department of Social and Clinical Pharmacy Introduction: Proportion of seniors in the population is increasing worldwide, therefore rational pharmacotherapy in older adults is more emphasized. The drug pharmacokinetics and pharmacodynamics change in older age due to physiological and pathological changes, but also due to frequent polymorbidity and polypharmacotherapy. The use of certain medicines is therefore considered risky in seniors. For this reason, explicit expert criteria of medications potentially inappropriate in the aged (so called PIMs) have been created in many countries. Considering the fact that seniors were usually not included in randomized controlled trials, information about specific dosing in older adults for many medications is not stated in Summary of Product Characteristics (SmPCs) which provide basic information on effective and safe administration of medicines. The aim of the diploma thesis was to clarify whether in case of PIMs specific information about geriatric dosing is stated in SmPCs, or at least general warnings that...
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