ANALYSIS OF ACTUAL PRACTICE OF ACUTE ISCHAEMIC STROKE DRUG THERAPY IN INTENSIVE CARE UNIT: CASE SERIES
Sažetak
A case study approach was adopted to analyse the pharmacological management of clinical cases of acute ischaemic stroke subsequent to initial drug treatment administered in the acute setting.
The study was conducted in a tertiary care University hospital, Clinical Centre, Kragujevac, Serbia, during August 2013, in which the rationale of drug prescribing was evaluated in eight cases. The drugs administered were assessed whether they were in accordance with the recommendations by the National Institute of Clinical Excellence (NICE) guidelines. Appropriate drugs such as aspirin were noted to be used in the management of most cases and this was in conformation to these guidelines. Variations from these recommendations included the use of vitamin supplements with antioxidant properties, iron supplements, antibiotics, benzodiazepenes, ranitidine, aminophylline and risperidone. An appropriate indication for these drugs to be administered was neither established.
This study showed that there were instances where an inappropriate route of administration was used.
The noted variations from the recommended guidelines were not justified thus leading to inappropriate drug use and suboptimal care. These can be minimised by clear and precise diagnostic data and conformity to guidelines.
Reference
Schwamm LH, Ali SF, Reeves MJ, Smith EE, Saver JL, Messe S, Bhatt DL, Grau-Sepulveda MV, Peterson ED, Fonarow GC. Temporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischaemic stroke patients at get with the guidelines-stroke hospitals. CircCardio-vascQual Outcomes 2013; 6(5): 543-9.
Kern R, Nagayama M, Toyoda K, Steiner T, Hennerici MG, Shinohara Y. Comparison of the European and Japanese guidelines for the management of ischaemic stroke. Cerebrovasc Dis 2013; 35(5): 402-18.
Huang YC, Hu CJ, Lee TH, Yang JT, Weng HH, Lin LC, Lai SL. The Impact Factors on the Cost and Length of Stay among Acute Ischaemic Stroke. J Stroke Cerebrovasc Dis 2012; 22(7): 152-8.
Donovan AL, Flexman AM, Gelb AW. Blood pressure management in stroke. Curr Opin Anaesthesiol 2012; 25(5): 516-22.
Gilgun-Sherki Y, Rosenbaum Z, Melamed E, Offen D. Antioxidant therapy in acute central nervous system injury: current state. Pharmacol Rev 2002; 54(2): 271-84.
National Institute for Health and Care Excellence, United Kingdom. NICE clinical guideline 68. Stroke: diagnosis and initial management of acute stroke and transient ischaemic attack (TIA), 2008, Available at: http://www.nice.org.uk/nicemedia/live/12018/41331/41331.pdf, last accessed 7.10.2013.
British National Formulary – BNF, March 2013. RCPCH Publications Ltd and the Royal Pharmaceu-tical Society of Great Britain, 2013.
Issa IA, Soubra O, Nakkash H, Soubra L. Variables associated with stress ulcer prophylaxis misuse: a retrospective analysis. Dig Dis Sci 2012; 57(10): 2633-41.
Ye Y, Li J, Yuan Z. Effect of antioxidant vitamin supplementation on cardiovascular outcomes: a meta-analysis of randomized controlled trials. PLoS One 2013; 8(2): e56803.
Sánchez-Moreno C, Jiménez-Escrig A, Martín A. Stroke: roles of B vitamins, homocysteine and antioxi-dants. Nutr Res Rev 2009; 22(1): 49-67.
Ullegaddi R, Powers HJ, Gariballa SE. Antioxidant supplementation with or without B-group vitamins after acute ischaemic stroke: a randomized controlled trial. JPEN J Parenter Enteral Nutr 2006; 30(2): 108-14.
Ullegaddi R, Powers HJ, Gariballa SE. Antioxidant supplementation enhances antioxidant capacity and mitigates oxidative damage following acute ischaemic stroke. Eur J Clin Nutr 2005; 59(12): 1367-73.
Ruvinsky S, Mónaco A, Pérez G, Taicz M, Inda L, Kijko I, Constanzo P, Bologna R. Reasons for inappro-priate prescribing of antibiotics in a high-complexity pediatric hospital. Rev Panam Salud Publica 2011; 30(6): 580-5.
Yezli S, Li H. Antibiotic resistance amongst health-care-associated pathogens in China. Int J Antimicrob Agents 2012; 40(5): 389-97.
Razine R, Azzouzi A, Barkat A, Khoudri I, Hassouni F, Chefchaouni AC, Abouqal R. Prevalence of hospi-tal-acquired infections in the university medical center of Rabat, Morocco. Int Arch Med 2012; 5(1): 26.
Gagne JJ, Maio V, Rabinowitz C. Prevalence and predictors of potential drug-drug interactions in Regione Emilia-Romagna, Italy. J Clin Pharm Ther 2008; 33(2): 141-51.
vanWalraven C, Austin P, Naylor CD. Vitamin B12 injections versus oral supplements. How much money could be saved by switching from injections to pills? Can Fam Physician 2001; 47: 79-86.
Autori zadržavaju autorska prava i pružaju časopisu pravo prvog objavljivanja rada i licenciraju ga Creative Commons licencom koja omogućava drugima da dele rad uz uslov navođenja autorstva i izvornog objavljivanja u ovom časopisu.
Autori mogu izraditi zasebne, ugovorne aranžmane za neekskluzivnu distribuciju rada objavljenog u časopisu (npr. postavljanje u institucionalni repozitorijum ili objavljivanje u knjizi), uz navođenje da je rad izvorno objavljen u ovom časopisu.
Autorima je dozvoljeno i podstiču se da postave objavljeni rad onlajn (npr. u institucionalnom repozitorijumu ili na svojim internet stranicama) pre i tokom postupka prijave priloga, s obzirom da takav postupak može voditi produktivnoj razmeni ideja i ranijoj i većoj citiranosti objavljenog rada (up. Efekat otvorenog pristupa).