PSICOFÁRMACOS POTENCIALMENTE INAPROPRIADOS PARA IDOSOS

Caroline Ribeiro Borja-Oliveira, Cíntia Pincelli Assato

Resumo


Os antipsicóticos, benzodiazepínicos e antidepressivos são psicofármacos comumente empregados no tratamento dos sintomas comportamentais e psicológicos da demência (SCPD). Porém, o uso de certos psicofármacos em idosos pode oferecer uma relação risco-benefício desvantajosa e com repercussões negativas para seu estado de saúde e qualidade de vida. O objetivo foi identificar psicofármacos considerados potencialmente inapropriados para idosos. Os critérios de Beers e o Screening Tool of Older Persons’ Prescriptions (STOPP) são instrumentos constituídos por listas de fármacos considerados potencialmente inapropriados para maiores de 65 anos. Por meio da análise dessas listas, neste estudo bibliográfico, com abordagem exploratória e descritiva, foram identificados os psicofármacos potencialmente inapropriados para idosos comumente empregados no tratamento das SPCD e sintetizadas as justificativas para restrição de uso desses fármacos, descritas nesses instrumentos. Entre os psicofármacos inapropriados encontrados, destacam-se os antidepressivos tricíclicos, aminas terciárias, que podem desencadear hipotensão ortostática, e sedação, sendo altamente anticolinérgicos; antipsicóticos típicos, que elevam o risco de acidente vascular cerebral e de mortalidade em indivíduos com demência; e os benzodiazepínicos, que aumentam o risco de défice cognitivo, delírio, quedas, fraturas e acidentes com veículos motorizados. Os fármacos potencialmente inapropriados para idosos são aqueles que devem ser evitados nessa faixa etária. Sua prescrição requer considerar a relação risco-benefício, a disponibilidade de agentes alternativos e de recursos não farmacológicos, a escolha da menor dose necessária e o monitoramento dos efeitos no paciente, proporcionando, assim, maior segurança ao idoso e melhora no âmbito biopsicossocial e, portanto, da qualidade de vida.


Palavras-chave


Doença Iatrogênica. Prescrição Inadequada. Psicotrópicos. Toxicidade de Drogas. Saúde do Idoso.

Texto completo:

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Referências


AGENCY FOR HEALTHCARE POLICY AND RESEARCH. Depression Guidelines Panel. Depression in Primary Care: Clinical Practice Guideline, n. 5. Rockville, MD: AHPQ, 1993.

AMERICAN GERIATRICS SOCIETY. Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, Malden, MA, v. 60, n. 4, p. 616-631, Apr. 2012.

ASSOCIAÇÃO MÉDICA BRASILEIRA. Agência Nacional de Saúde Suplementar. Sociedade Brasileira de Geriatria e Gerontologia. Academia Brasileira de Neurologia Sociedade Brasileira de Medicina de Família e Comunidade. Doença de Alzheimer: prevenção e tratamento. Diretrizes clínicas na saúde suplementar, 2010. Disponível em: http://www.projetodiretrizes.org.br/ans/diretrizes/doenca_de_alzheimer-prevencao_e_tratamento.pdf. Acesso em: 7 maio 2011.

BAUER, Michael et al. Diretrizes da World Federation of Societies of Biological Psychiatry (WFSBP) para tratamento biológico de transtornos depressivos unipolares, 1ª parte: tratamento agudo e de continuação do transtorno depressivo maior. Revista de Psiquiatria Clínica, São Paulo, v. 36, supl 2, p. 17-57, 2009.

BEERS, Mark H. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Archives of Internal Medicine, Chicago, v. 157, n. 14, p. 1531-1536, July 1997.

BEERS, Mark H. et al. Explicit criteria for determining inappropriate medication use in nursing home residents. Archives of Internal Medicine, Chicago, v. 151, n. 9, p. 1825-1832, Sept. 1991.

BORJA-OLIVEIRA, Caroline Ribeiro. Atenção ao idoso no domicílio: o enfoque da farmácia. In: DOMINGUES, Marisa Accioly; LEMOS, Naira Dutra (Org.). Gerontologia: os desafios nos diversos cenários de atenção. São Paulo: Editora Manole, 2010.

BREKKE, Mette et al. Pharmacologically inappropriate prescriptions for elderly patients in general practice: How common? Scandinavian Journal of Primary Health Care, Oslo, v. 26, n. 2, p. 80-85, 2008.

BRUNONI, André Russowsky et al. Patterns of benzodiazepine and antidepressant use among middle-aged adults. The Brazilian longitudinal study of adult health (ELSA-Brasil). Journal of Affective Disorders, Amsterdam, v. 151, n. 1, p. 71-77, Oct. 2013.

CAHIR, Caitriona et al. Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. British Journal of Clinical Pharmacology, London, v. 77, n. 1, p. 201–210, Jan. 2014.

CARAMELLI, Paulo; BOTTINO, Cássio M. C. Tratando os sintomas comportamentais e psicológicos da demência (SCPD). Jornal Brasileiro de Psiquiatria, Rio de Janeiro, v. 56, n. 2, p. 83-87, jun. 2007.

CARNAHAN, R. M. et al. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: Associations with serum anticholinergic activity. Journal of Clinical Pharmacology, Oxford, v. 46, n. 12, p. 1481-1486, Dec. 2006.

COOK, Joan M. et al. Physicians’ perspectives on prescribing benzodiazepines for older adults: a qualitative study. Journal of General Internal Medicine, Philadelphia, PA, v. 22, n. 3, p. 303-307, Mar. 2007.

DAROWSKI, Adam; CHAMBERS, Sally-Ann C. F.; CHAMBERS, David J. Antidepressants and falls in the elderly. Drugs & Aging, Auckland, v. 26, n. 5, p. 381-394, May 2009.

DESAI, Abhilash K.; SCHWARTZ, Lori; GROSSBERG, George T. Behavioral disturbance in dementia. Current Psychiatry Reports, Philadelphia, PA, v. 14, n. 4, p. 298-309, Aug. 2012.

DIMITROW, Maarit S. et al. Comparison of prescribing criteria to evaluate the appropriateness of drug treatment in individuals aged 65 and older: a systematic review. Journal of the American Geriatrics Society, New York, v. 59, n. 8, p. 1521-1530, July 2011.

DURÁN, Carlos E.; AZERMAI, Majda; VANDER STICHELE, Robert H. Systematic review of anticholinergic risk scales in older adults. European Journal of Clinical Pharmacology, Berlin, v. 69, n. 7, p. 1485-1496, July 2013.

FICK, Donna M. et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Archives of Internal Medicine, Chicago, v. 163, n. 22, p. 2716-2724, Dec. 2003

FORLENZA, Orestes Vicente; CRETAZ, Eric; DINIZ, Breno Satler de Oliveira. O uso de antipsicóticos em pacientes com diagnóstico de demência. Revista Brasileira de Psiquiatria, São Paulo, v. 30, n. 3, p. 265-270, set. 2008.

FRANK, Cristopher. Pharmacologic treatment of depression in the elderly. Canadian Family Physician, Willowdale, Canada, v. 60, n. 2, p. 121-126, Feb. 2014.

GALLAGHER, Paul et al. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. International Journal of Clinical Pharmacology and Therapeutics, Munich, v. 46, n. 2, p. 72-83, Feb. 2008.

GARCIA, Robert M. Five ways you can reduce inappropriate prescribing in the elderly: a systematic review. Journal of Family Practice, New York, v. 55, n. 4, p. 305-312, Apr. 2006.

GLASS, Jennifer et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. British Medical Journal, London, v. 331, n. 7526, p. 1169, Nov. 2005.

HANLON, Joseph T. et al. Potential underuse, overuse, and inappropriate use of antidepressants in older veteran nursing home residents. Journal of the American Geriatrics Society, New York, v. 59, n. 8, p. 1412-1420, Aug. 2011.

HILL, Keith D.; WEE, Rohan. Psychotropic drug-induced falls in older people: a review of interventions aimed at reducing the problem. Drugs & Aging, Auckland, v. 29, n. 1, p. 15-30, Jan. 2012.

HOLT, Stefanie; SCHMIEDL, Sven; THÜRMAN, Petra A. Potentially Inappropriate Medications in the Elderly: The PRISCUS List. Deutsches Ärzteblatt International, Cologne, v. 107, n. 31-32, p. 543-551, Aug. 2010.

HORI, Koji et al. Assessment of pharmacological toxicity using serum anticholinergic activity in a patient with dementia. Psychiatry and Clinical Neurosciences, Carlton, Vic., v. 59, n. 4, p. 508-510, Aug. 2005.

KIM, Dong Sook; HEO, Soon Im; LEE, Suk Hyang. Development of a List of Potentially Inappropriate Drugs for the Korean Elderly Using the Delphi Method. Healthcare Informatics Research, Seoul, v. 16., n. 4, p. 231-252, Dec. 2010.

LAROCHE, Marie-Laure; CHARMES, Jean-Pierre; MERLE, Louis. Potentially inappropriate medications in the elderly: a French consensus panel list. European Journal of Clinical Pharmacology, Berlin, v. 63, n. 8, p. 725-731, Aug. 2007.

McLEOD, Peter J. et al. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. Canadian Medical Association Journal, Ottawa, v. 156, n. 3, p. 385-391, Feb. 1997.

MANN, Eva et al. Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wiener klinische Wochenschrift, Wien, v. 124, n. 5-6, p. 160-169, Mar. 2012.

MANNESSE, Cyndie K. et al. Characteristics, prevalence, risk factors, and underlying mechanism of hyponatremia in elderly patients treated with antidepressants: A cross-sectional study. Maturitas, Limerick, Ireland, v. 76, n. 4, p. 357-363, Dec. 2013.

MARCUM, Zachary A.; HANLON, Joseph T. Commentary on the new American Geriatric Society beers criteria for potentially inappropriate medication use in older adults. American Journal of Geriatric Pharmacotherapy, Hillsborough, NJ, v. 10, n. 2, p. 151-159, Apr. 2012.

NÓBREGA, Otávio de Toledo; KARNIKOWSKI, Margô Gomes de Oliveira. A terapia medicamentosa no idoso: cuidados na medicação. Ciência & Saúde Coletiva, Rio de Janeiro, v. 10, n. 2, p. 309-313, abr./jun. 2005.

OLIVEIRA, Márcio et al. Brazilian consensus of potentially inappropriate medications in the elderly: preliminary data. Journal of the American Geriatrics Society, New York, v. 63, Supplement 1, p. A147, Apr. 2015.

O’MAHONY, Dennis et al. STOPP & START criteria: A new approach to detecting potentially inappropriate prescribing in old age. European Geriatric Medicine, Paris, v. 1, n. 1, p. 45–51, 2010.

PARR, Jannette M. et al. Views of general practitioners and benzodiazepine users on benzodiazepines: a qualitative analysis. Social Science & Medicine, Oxford, v. 62, n. 5, p. 1237-1249, Sept. 2006.

ROSENHECK, Robert A. et al. Cost-benefit analysis of second-generation antipsychotics and placebo in a randomized trial of the treatment of psychosis and aggression in Alzheimer disease. Archives of General Psychiatry, Chicago, v. 64, n. 11, p. 1259-1268, Nov. 2007.

SALONOJA, M. et al. Withdrawal of psychotropic drugs decreases the risk of falls requiring treatment. Archives of Gerontology and Geriatrics, Amsterdam, v. 54, p. 160-167, Jan./Feb. 2012.

SCHNEIDER, Lon S. et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. The New England Journal of Medicine, Boston, MA, v. 355, n. 15. p. 1525-1538, Oct. 2006.

SILVA, Gilmar de Oliveira Barros et al. Uso de medicamentos contínuos e fatores associados em idosos de Quixadá, Ceará. Revista Brasileira de Epidemiologia, São Paulo, v. 15, n. 2, p. 386-395, jun. 2012.

SOIZA, Roy L.; TALBOT, Hannah S. C. Management of hyponatremia in older people: old threats and new opportunities. Therapeutic Advances in Drug Safety, London, v. 2, n. 1, p. 9-17, Feb. 2011.

SPINEWINE, Anne. Adverse Drug Reactions in Elderly People: The challenge of safer prescribing. British Medical Journal, London, v. 336, n. 7650, p. 956-957, Apr. 2008.

SRISURAPANONT, Manit et al. Benzodiazepine prescribing behaviour and attitudes: a survey among general practitioners practicing in northern Thailand. BMC Family Practice, London, v. 6, p. 27, June 2005.

SULTANA, Janet; CUTRONEO, Paola; TRIFIRò, Gianluca. Clinical and economic burden of adverse drug reactions. Journal of Pharmacology and Pharmacotherapeutics, Mumbai, v. 4, Supplement 1, p. S73–S77, Dec. 2013.

TAMBLYN, Robyn et al. The effectiveness of a new generation of computerized drug alerts in reducing the risk of injury from drug side effects: a cluster randomized trial. Journal of the American Medical Informatics Association, Philadelphia, PA, v. 19, n. 4, p. 635-643, July/Aug. 2012.

TANNENBAUM, Cara et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Internal Medicine, Chicago, v. 174, n. 6, p. 890-898, June 2014.

VAN DER HOOFT, Cornelis S. et al. Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria—a population-based cohort study. British Journal of Clinical Pharmacology, London, v. 60, n. 2, p. 137-144, Aug. 2005.




Estudos Interdisciplinares sobre o Envelhecimento. ISSN: 1517-2473 (impresso) e 2316-2171 (eletrônico)
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