Evaluation of adequacy of pharmacotherapy for insomnia and pain among elderly in the Metlika retirement home

Starostniki pogosto jemljejo več različnih zdravil hkrati, zlasti pogosta je uporaba analgetikov in zdravil za zdravljenje nespec?nosti. Zaradi sočasnih obolenj in polifarmakoterapije je pri starostnikih zdravljenje bolečine in nespečnosti precej zahtevno. Z raziskavo smo ovrednotili ustreznost na recept predpisanih zdravil za zdravljenje nespečnosti in bolečine pri oskrbovancih Doma starejših občanov Metlika. Znotraj teh terapevtskih skupin zdravil smo preverili tudi potencialno neprimerna zdravila za starostnike ter potencialne interakcije z drugimi sočasno predpisanimi zdravili. V raziskavo smo vključili vse oskrbovance Doma starejših občanov Metlika, stare 65 let ali več, ki so redno ali po potrebi prejemali zdravila za sistemsko zdravljenje bolečine in/ali nespečnosti. Vse potrebne podatke smo na izbrani dan v letu 2018 pridobili iz medicinske domske dokumentacije. Primernost posameznih zdravil smo ovrednotili s pomočjo smernic za zdravljenje nespečnosti oziroma bolečine in liste PRISCUS, ustreznost odmerkov s pomočjo Povzetkov glavnih značilnosti zdravila, potencialne interakcije med zdravili pa s podatkovno bazo Lexicomp. Izmed vseh oskrbovancev, ki so bili nastanjeni v domu, jih je 98 prejemalo zdravila za zdravljenje nespečnosti in/ali bolečine. Od tega je bilo 62 (63,3 %) žensk, s povprečno starostjo 84,9 let, in 36 (36,7 %) moških, pri katerih je povprečna starost znašala 77,9 let. Zdravila za zdravljenje nespečnosti je imelo predpisanih 77 (78,6 %) oskrbovancev. Skupno so prejemali 8 različnih zdravilnih učinkovin, najpogosteje zolpidem (47 predpisov), sledili so mu benzodiazepini (alprazolam, bromazepam diazepam in lorazepam) in kvetiapin. Navedene zdravilne učinkovine po evropskih smernicah niso primerne za dolgotrajno zdravljenje nespečnosti. Med zdravili za zdravljenje nespečnosti ne sodijo med potencialno neprimerna za starostnike le kvetiapin, trazodon in klometiazol. Zdravila za zdravljenje bolečine je prejemalo 87 (88,8 %) oskrbovancev, ki so imeli predpisanih 12 različnih zdravilnih učinkovin. 58 (66,7 %) oskrbovancev je imelo predpisano kombinacijo tramadola in paracetamola, ki sta ji sledila paracetamol ter metamizol. Strokovna priporočila odsvetujejo zdravljenje bolečine pri starostnikih z nesteroidnimi antirevmatiki z dolgotrajnim delovanjem, v našem primeru sta bila to etorikoksib in indometacin. Med zdravili za zdravljenje bolečine sodita med potencialno neprimerna za starostnike le indometacin in etorikoksib. Pri pregledu odmerkov zdravil za zdravljenje nespečnosti oz. bolečine so bili pri 5 oskrbovancih prekoračeni dnevni maksimalni odmerki. Pri 77 (78,5 %) starostnikih smo identificirali potencialne interakcije, in sicer 212 primerov interakcij D in 9 primerov interakcij X. Največ interakcij tipa D je bilo s tramadolom, zolpidemom in kvetapinom, največ X interakcij pa s kvetiapinom.Elderly people take several different drugs at the same time, common is use of analgesics and drugs for treatment of insomnia. Due to concomitant diseases and polypharmacotherapy treatment of pain and insomnia represents a great challenge in elderly. The study evaluated the adequacy of pharmacotherapy for insomnia and pain among elderly in the retirement home in Metlika. Among these drugs we checked whether they were potentially inappropriate for the elderly and if there was a risk for potential drug-drug interactions with other concomitant drugs. In the study we included residents of the retirement home Metlika, who were at least 65 years old and received prescription drugs for systemic treatment of insomnia and/or pain, either for regular use or when needed. All the necessary data was obtained in the retirement home from a doctor’s medical documentation on the selected day in the year 2018. Adequacy of individual drugs was evaluated using guidelines for pharmacotherapy of insomnia or pain and PRISCUS list, dose adequacy was checked using the Summary of Product Characteristics and potential drug-drug interactions were identified by Lexicomp datebase. Among all the residents of the retirement home, 98 of them received drugs for the treatment of insomnia and/or pain. 62 (63.3%) of them were women, with an average age of 84,9 years, and 36 (36.7%) were men, with an average age of 77.9 years. Drugs for insomnia were prescribed to 77 (78.6%) residents. Altogether they received 8 different drugs, the most commonly zolpidem (47 prescriptions), followed by benzodiazepines (alprazolam, bromazepam, diazepam and lorazepam) and quetiapine. According to the European guidelines these drugs are not recommended for long-term use. Among all prescribed drugs for insomnia, only quetiapine, trazodone and clomethiazole are not potentially inappropriate drugs for elderly. Drugs for treatment of pain were prescribed to 87 (88.8%) residents and altogether they received 12 different drugs. Most of the residents (66.7%) were taking a combination of tramadol and paracetamol, followed by paracetamol and metamizole. According to the guidelines the use of long-acting non-steroidal anti-inflammatory drugs (in our case indomethacin and etoricoxib) are not recommended for the treatment of pain in elderly. Among the prescribed drugs for treatment of pain only indomethacin and etorocoxib belong to potentially inappropriate drugs for elderly. Maximum daily doses of drugs for treatment of insomnia or pain were exceeded in 5 residents. We identified potential drug interactions in 77 (78.5%) residents. All together we identified 212 interactions of type D and 9 interactions of type X. Most interactions of type D were caused by tramadol, zolpidem and quetiapine and most interactions of type X were caused by quetiapine