High‐Throughput Screening for Prescribing Cascades Among Real‐World Angiotensin‐Converting Enzyme Inhibitor Initiators
Pharmacoepidemiology and Drug Safety,
Год журнала:
2025,
Номер
34(3)
Опубликована: Март 1, 2025
ABSTRACT
Purpose
Angiotensin‐converting
enzyme
inhibitors
(ACEIs)
are
commonly
prescribed,
but
their
adverse
effects
may
prompt
new
drug
prescription(s),
known
as
prescribing
cascades
(PCs).
We
aimed
to
identify
potential
ACEI‐induced
PCs
using
high‐throughput
sequence
symmetry
analysis.
Methods
Using
claims
data
from
a
national
sample
of
Medicare
beneficiaries
(2011–2020),
we
identified
ACEI
users
aged
≥
66
years
with
continuous
enrollment
360
days
before
and
180
after
initiation.
screened
for
initiation
446
other
(non‐antihypertensive)
“marker”
classes
within
±90
initiation,
generating
ratios
(SRs)
reflecting
proportions
starting
the
marker
class
versus
Adjusted
SRs
(aSRs)
accounted
trends
over
time.
For
significant
aSRs,
calculated
naturalistic
number
needed
harm
(NNTH),
signals
underwent
clinical
review
plausibility.
Results
308
579
initiators
(mean
age
76.1
±
7.5
years;
59.6%
female;
88.6%
hypertension).
Of
evaluated,
81
were
significant,
42
(52%)
classified
review.
The
strongest
ranked
by
lowest
NNTH
included
corticosteroids
(NNTH
313;
95%
CI,
262–392)
serotonin
type
3
(5‐HT
)
antagonists
496;
392–689);
highest
aSR
sympathomimetics
(aSR,
1.97;
1.10–3.53)
antianemic
preparations
1.87;
1.31–2.67).
Conclusion
Identified
cascade
indicative
possibly
underrecognized
events
in
this
cohort.
findings
hypothesis‐generating
require
further
investigation
determine
extent
impact
on
health
outcomes.
Язык: Английский
Evidence-based pharmacotherapy in cardiology. National guideline
Rational Pharmacotherapy in Cardiology,
Год журнала:
2024,
Номер
20(1), С. 105 - 170
Опубликована: Март 29, 2024
.
Identifying and quantifying potentially problematic prescribing cascades in clinical practice: A mixed‐methods study
Journal of the American Geriatrics Society,
Год журнала:
2024,
Номер
unknown
Опубликована: Сен. 20, 2024
Abstract
Background
A
prescribing
cascade
occurs
when
medication
causes
an
adverse
drug
reaction
(ADR)
that
leads
to
the
prescription
of
additional
medication.
Prescribing
cascades
can
cause
excess
burden,
which
is
particular
concern
in
older
adults.
This
study
aims
identify
and
quantify
potentially
problematic
relevant
for
clinical
practice.
Methods
mixed‐methods
was
conducted.
First,
were
identified
through
literature
search.
An
expert
panel
(
n
=
16)
pharmacists
physicians
assessed
whether
these
problematic.
Next,
a
cohort
quantified
adults
using
Dutch
community
pharmacy
data
period
2015–2020.
Additionally,
influence
multiple
medications
causing
same
ADR
evaluated.
Prescription
sequence
symmetry
analysis
used
calculate
adjusted
ratios
(aSRs),
adjusting
temporal
trends.
aSR
>1.0
indicates
occurrence
cascade.
In
subgroup
analysis,
aSRs
calculated
Results
Seventy‐six
three
provided
by
experts.
Of
these,
66
(83.5%)
considered
significant
positive
found
41
(62.1%)
cascades.
The
highest
amiodarone
hypothyroidism
treated
with
thyroid
hormones
(4.63
[95%
confidence
interval
4.40–4.85]),
based
on
565
incident
users.
biggest
population
34,645)
angiotensin
converting
enzyme‐inhibitors
urinary
tract
infections
antibiotics.
Regarding
four
potential
ADRs,
higher
people
as
compared
only
one
those
medications.
Among
remained
37
Conclusion
overview
generated
These
results
support
healthcare
providers
intervene
reduce
burden
Язык: Английский
Polypharmacy: Prevention and management
Klinická farmakologie a farmacie,
Год журнала:
2024,
Номер
38(2), С. 76 - 82
Опубликована: Июль 15, 2024
Polypragmazie
v
souvislosti
s
léčivy
znamená
předepisování,
vydávání
nebo
užívání
více
léčiv
současně.
Správné
charakterizování
preskripce
či
léčiva
konkrétním
pacientem
umožňuje
volbu
vhodné
změny.
Cílem
racionální
farmakoterapie
je
minimalizace
lékové
zátěže,
což
vyžaduje
řízený
a
mnohdy
déle
trvající
zásah
postupně
realizované
změny
terapii
pacienta
návaznosti
na
individuálně
vyhodnocené
identifikované
problémy.
K
omezení
nevhodné
polypragmazie
lze
využít
například
možnosti
depreskripce
zacílením
uplatňovaná
preskripčních
kaskádách
komplexně
zaměřené
postupy
koncepty.
Práce
představuje
problematiku
kaskád
jejich
řešení
rámci
optimalizace
farmakoterapie.
Charakterizuje
koncepty
kampaně
"Méně
více",
"Vybírejte
rozumně"
"Cesta
pacienta".
Doporučení
upozornění
formulovaná
těchto
konceptů
kampaní
mají
za
cíl
soustředit
pozornost
zdravotnických
pracovníků
důležitost
zhodnocení
zvážení
nutnosti
jimi
aplikovaných
postupů.
Měli
by
upřednostňovat
péči
založenou
hodnotách
vyvarovat
se
nadbytečnému
zatížení
pacientů
diagnostickými
terapeutickými
intervencemi.
Prescribing cascades in ambulatory care: A structured synthesis of evidence
Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy,
Год журнала:
2023,
Номер
44(1), С. 87 - 96
Опубликована: Сен. 25, 2023
The
strength
of
evidence
for
specific
ambulatory
care
prescribing
cascades,
in
which
a
marker
drug
is
used
to
treat
an
adverse
event
caused
by
index
drug,
has
not
been
well
characterized.
To
perform
structured,
systematic,
and
transparent
review
the
supporting
cascades.
Ninety-four
potential
cascades
identified
through
previously
published
systematic
review.
Systematic
search
literature
further
characterize
(1)
Grading
based
on
observational
studies
investigating
associations
between
drugs,
including:
Level
I-strong
[i.e.
multiple
high-quality
studies];
II-moderate
single
study];
III-fair
[no
but
one
or
more
moderate-quality
IV-poor
[other].
(2)
Listing
associated
with
product's
United
States
Food
Drug
Administration
(FDA)
label.
(3)
Synthesis
mechanisms
linking
drugs
events.
Of
99
94
were
supported
confirmatory
therefore
included
this
related
30
types
reactions
affecting
10
different
anatomic/physiologic
systems
investigated
total
88
studies,
including
prescription
sequential
symmetry
analysis
(n
=
51),
cohort
30),
case-control
7)
studies.
Overall,
from
was
strong
18
(19.1%)
moderate
61
(64.9%),
fair
13
(13.8%),
poor
2
(2.1%).
Although
that
link
events
variable,
FDA
labels
information
about
most
86)
all
we
clinical
are
label,
evidentiary
basis
varies,
many
requiring
relevance.
Язык: Английский
Comprehensive Study of Drug-Induced Pruritus Based on Adverse Drug Reaction Report Database
Pharmaceuticals,
Год журнала:
2023,
Номер
16(10), С. 1500 - 1500
Опубликована: Окт. 21, 2023
Drug-induced
pruritus
triggers
a
desire
to
scratch,
thereby
diminishing
one's
quality
of
life.
Certain
instances
this
phenomenon
follow
complex
mechanisms
action
that
diverge
from
histamine-mediated
pathways,
known
contributors
pruritus.
However,
investigations
into
the
relationship
between
drugs
and
are
limited.
In
study,
data
mining
techniques
were
employed
comprehensively
analyze
characteristics
linked
pruritus,
using
FDA's
Adverse
Event
Reporting
System
(FAERS)
data.
Reports
demonstrated
noteworthy
differences
in
gender,
age,
weight
when
compared
with
non-pruritus
cases.
Among
leading
candidates
for
prompting
ophthalmic
drugs,
systemic
antibacterials,
contrast
media,
dermatological
antifungals,
preparations.
A
principal
component
analysis
showed
second
served
as
an
indicator
distinguishing
onsets
at
mucous
membranes
or
skin's
surface.
Additionally,
third
functioned
categorizing
administration
methods
either
invasive
noninvasive.
Furthermore,
hierarchical
cluster
conducted
on
these
obtained
components
revealed
potential
classifying
based
site
onset
method
drug
administration.
These
findings
contribute
development
targeted
prevention
treatment
strategies
avoiding
clinical
practice.
Язык: Английский
Drug-drug interactions in clinical practice: a literature review and SWOT analysis
Medical Technologies Assessment and Choice,
Год журнала:
2024,
Номер
3, С. 124 - 124
Опубликована: Янв. 1, 2024
Язык: Английский
Geschlechtsspezifische Versorgung in der Gefäßmedizin
Springer Reference Medizin,
Год журнала:
2024,
Номер
unknown, С. 1 - 13
Опубликована: Янв. 1, 2024
Pharmacovigilance and Adverse Drug Reactions Reporting: Healthcare Providers’ Experiences from Southern Highland Tanzania
Advances in Pharmacological and Pharmaceutical Sciences,
Год журнала:
2023,
Номер
2023, С. 1 - 10
Опубликована: Окт. 16, 2023
This
exploratory
qualitative
study
aimed
to
analyze
the
experiences
of
healthcare
providers
(HCPs)
in
pharmacovigilance
(PV)
and
ADR
reporting
southern
highland
zone
Tanzania.In
2022,
an
case
using
in-depth
interviews
(IDIs)
was
conducted
explore
PV
among
HCPs
(doctors,
nurses,
pharmacists).
The
carried
out
a
zonal
referral
hospital
regional
Tanzanian
highlands
zone.
Inductive-deductive
thematic
analysis
adopted
for
data
analysis.Participants
demonstrated
adequate
knowledge
its
related
activities
including
reporting.
Knowing
interactions
wrong
medication
dosage
as
sources
ADR,
signs,
symptoms,
stopping
drug,
treating
symptoms
following
emerged
subthemes
linked
with
identifying
managing
ADR.
Participants
perceived
laborious,
posing
subjective
burden
that
not
all
ADRs
needed
be
reported.
latter
contributed
limited
participation
despite
participants
were
conversant
both
physical
online
platforms.Although
are
well
informed
about
benefits
public
health,
their
involvement
is
low.
In
addition
ongoing
on-the-job
training
regular
supportive
supervision
improve
practice,
there
still
need
other
strategies
used
motives
report
regularly.
Язык: Английский