Programa de Pós Graduação em Assistência Farmacêutica em Rede
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Master Thesis Análise clínica e econômica da conversão do pantoprazol intravenoso para oral em pacientes críticos(Universidade Federal do Rio Grande do Norte, 2025-12-12) Rodrigues, Cássio Alexandre Oliveira; Moreira, Francisca Sueli Monte; Martins, Rand Randall; https://orcid.org/0000-0001-9668-0482; http://lattes.cnpq.br/8062199269259772; https://orcid.org/0000-0001-7069-750X; http://lattes.cnpq.br/5764849324594620; https://orcid.org/0000-0003-3700-856X; http://lattes.cnpq.br/6280233630813832; Oliveira, Luana Cristina Lins de Medeiros; https://orcid.org/0000-0001-9595-1949; http://lattes.cnpq.br/8550362587549379; Diniz, Rodrigo dos Santos; http://lattes.cnpq.br/0085346724655944Introduction: Proton Pump Inhibitors (PPIs) are widely prescribed in hospital care, mainly for stress-related gastric ulcer prophylaxis in critically ill patients. However, many prescriptions have inappropriate indications, and there is excessive use of the intravenous (IV) route even when the oral (PO) route is eligible, an endemic problem in this setting, further intensified by care dynamics. Objective: To evaluate the clinical and economic outcomes of interventions promoting intravenous to oral therapy conversion in critically ill patients receiving intravenous pantoprazole, including physician acceptance and the effects on duration of use by route of administration, length of hospital stays and mortality. Method: A quasi-experimental cost-minimization study conducted in a private ICU from 2019 to 2023, including 172 patients (86 in the intervention group – IG; 86 in the control group – CG). In the IG, the pharmacist recommended IV-to-PO conversion to physicians; in the CG, patients were only observed. Costs (medications and supplies), conversion rate, and clinical outcomes were compared using univariate analysis (p < 0.05). Results: Intravenous to oral therapy conversion occurred in 100% of patients in the IG versus 17.4% in the CG (p < 0.001). The daily cost of oral therapy was 50 times lower (R$ 0.23 vs. R$ 11.12; p < 0.001), resulting in a substantial reduction in total cost (R$ 178.71 vs. R$ 13,959.30). There was also a shorter mean duration of IV use (4.4 vs. 10.5 days; p = 0.001) and longer oral use (7.1 vs. 1.5 days; p < 0.001), with no differences in mortality or length of hospital stay. Conclusion: interventions promoting intravenous to oral therapy conversion reduced costs and the unnecessary use of intravenous pantoprazole, with high physician acceptance and no adverse clinical impact, establishing it as a sustainable, multidisciplinary strategy for optimizing pharmacotherapy in critically ill patients.Master Thesis Avaliação do impacto das interações medicamentosas graves em gestantes hospitalizadas: relevância clínica e desfechos maternofetais(Universidade Federal do Rio Grande do Norte, 2025-01-22) Oliveira, Gabriela Santana; Martins, Rand Randall; Moreira, Francisca Sueli Monte; https://orcid.org/0000-0001-7069-750X; http://lattes.cnpq.br/5764849324594620; http://lattes.cnpq.br/8062199269259772; https://orcid.org/0000-0002-4369-567X; http://lattes.cnpq.br/3214977558850864; Carneiro, Sabrina Maria Portela; Diniz, Rodrigo dos SantosObjective: To assess the impact of severe drug-drug interactions (DDIs) on clinical parameters and maternal-fetal outcomes in high-risk hospitalized pregnant women. Methodology: Prospective cohort study involving 571 hospitalized pregnant women from September 2019 to June 2022, with a mean age of 30.6 years, mostly diagnosed with hypertensive syndromes (69.7%) and gestational diabetes mellitus (57.1%). DDIs were characterized daily using the Lexicomp® database, and clinical parameters related to their mechanisms of action were monitored. Multivariate logistic regression models adjusted for major risk factors for DDI occurrence were used to evaluate the potential influence of severe DDIs on clinical parameters and maternal-fetal outcomes. Results: We identified 203 pregnant women with one or more severe DDIs (35.6%). Risk factors for their occurrence were gestational age (AOR: 0.958; 95% CI: 0.932-0.984), hypertension diagnosis (AOR: 3.997; 95% CI: 2.493-6.409), number of medications (AOR: 1.088; 95% CI: 1.031-1.148), and duration of treatment (AOR:1.184; 95% CI: 1.116-1.257). Concomitant use of dipyrone and acetylsalicylic acid led to increased systolic blood pressure (AOR: 2.124; 95% CI: 1.008-4.474), while patients using scopolamine and levomepromazine simultaneously experienced increased drowsiness (AOR: 5.375; 95% CI: 1.660-17.398) and slight temperature elevation (AOR: 5.956; 95% CI: 1.226- 28.982). Conclusion: Hospitalized pregnant women, especially those with lower gestational age and diagnosed with hypertensive syndromes, are exposed to severe drug-drug interactions. However, these interactions do not significantly impact maternal-fetal clinical outcomes.Master Thesis Interações medicamentosas em Terapia Intensiva Neonatal e suas relações com desfechos clínicos(Universidade Federal do Rio Grande do Norte, 2025-01-22) Marques, Daniel Paiva; Martins, Rand Randall; Lima, Waldenice de Alencar Morais; http://lattes.cnpq.br/2575667613995470; http://lattes.cnpq.br/8062199269259772; http://lattes.cnpq.br/2823961499295988; Moreira, Francisca Sueli Monte; Oliveira, Yonara Monique da CostaIntroduction: Neonates under intensive care are susceptible to adverse events due to physiological immaturity, severity of cases, and administration of multiple drugs, increasing the risk of drug interactions (DIs). Unlike adult ICUs, DIs in neonatology are not well characterized, especially regarding clinical relevance and outcomes. Many of these DIs are, in fact, unavoidable, and the lack of data makes it difficult to assess their risk-benefit ratio. Objective: To investigate the occurrence of drug interactions in neonates under intensive care and their relationships with clinical outcomes. Methodology: A prospective cohort study was conducted between March 2023 and March 2024, including 365 patients admitted to the Neonatal Intensive Care Unit (NICU) of Maternidade Escola Januário Cicco (MEJC) and using at least one drug, where neonates were evaluated daily for the occurrence of DIs. Clinical, laboratory, and pharmacotherapeutic parameters were evaluated. The influence of the occurrence of DIs in neonates was correlated with the main clinical outcomes (death, treatment time, and weight variation) through univariate and multivariate modeling (logistic and mixed-effects linear). Results: Approximately 69.9% (255 patients) presented 1 or more interactions during hospitalization, with greater emphasis on interactions involving therapeutic failure (58.6%), potential arrhythmogenic (27.4%), nephrotoxic (18.3%), and those that can cause Central Nervous System depression (16.8%), where the incidence of the group of interactions related to arrhythmia and CNS depression tends to decrease over time (respectively β= -0.106; p<0.01 and β= -0.088; p<0.01). On the other hand, DIs associated with nephrotoxicity increase during hospitalization (β= 0.097; p<0.01). Potential arrhythmia-related DIs increased heart rate by 5.9% (p<0.001), those associated with nephrotoxicity decreased glomerular filtration rate by 44% (p<0.001), and those associated with CNS depression decreased heart rate by 6% (p<0.001). Conclusion: DIs were significantly associated with arrhythmias, nephrotoxicity, and central nervous system depression, negatively impacting critical clinical parameters. Although the risk of arrhythmias and CNS depression decreases with length of stay, the risk of nephrotoxicity increases. These findings emphasize the importance of careful monitoring and management of DIs to improve clinical outcomes in neonates.Master Thesis Potenciais alterações eletrolíticas relacionadas ao uso de medicamentos por pacientes em terapia intensiva neonatal(Universidade Federal do Rio Grande do Norte, 2025-01-22) Silva, Andreza Kelly Fernandes da; Martins, Rand Randall; Diniz, Rodrigo dos Santos; http://lattes.cnpq.br/0085346724655944; http://lattes.cnpq.br/8062199269259772; http://lattes.cnpq.br/7333056537922845; Oliveira, Antônio Manuel Gouveia de; Costa, Tatiana Xavier daIntroduction: Critically neonatal patients are more vulnerable to damage from electrolyte changes and use many medications that can cause them. In the context of neonatal intensive care, clinically delicate conditions associated with abnormal serum concentrations of calcium, potassium, sodium and magnesium are common. The occurrence of these adverse events potentially associated with the use of antimicrobials, diuretics, corticosteroids and proton pump inhibitors is highlighted. Objective: To characterize changes in the electrolyte balance of critically ill neonates related to medication use. Methodology: Analytical, longitudinal and prospective study aimed at evaluating electrolyte changes caused by the use of medications in the Neonatal Intensive Care Unit of Maternity School Januário Cicco (MEJC). To characterize the electrolyte profile, serum concentrations of sodium, potassium, calcium, magnesium and the time of blood sample collection were evaluated.Related to medications that alter electrolytes, the number of medications administered, the type of medication, route of administration, dosage and electrolyte content present in the formulation in mEq or mg will be investigated. The variables will be obtained daily through consultation of the institution's electronic records. Results: 336 newborns were included in the study. The newborns presented gestational age of 33.8 ± 4.0 weeks, with respiratory problems associated with prematurity being the main admission diagnosis (67.5%). After analyzes, initially, related to serum potassium (K+ ), the mean serum K+ concentration in the first 30 days of hospitalization was 4.4 ± 0.3 mEq/L (95% CI 4.2 – 4.5) and the occurrence of hypokalemia is more common when compared to hyperkalemia. The model identified dopamine, norepinephrine and dobutamine as related to the tendency for increased serum K+ levels (respectively β=0,449; SE = 0,206; p=0,029; β=1,075; SE = 0,287; p=0,001; β= 0,283; SE = 0,145; p=0,050). Conclusion: The vasoactive amines dopamine, norepinephrine and dobutamine were identified as associated with elevated serum K+ levels, highlighting norepinephrine as having the greatest potential for a clinically relevant change.Master Thesis Prevalência e fatores de risco associados à não conformidade técnica no uso de dispositivos inalatórios em pacientes com doenças respiratórias crônicas(Universidade Federal do Rio Grande do Norte, 2025-01-22) Damasceno, Ítalo Henrique Medeiros; Martins, Rand Randall; Diniz, Rodrigo dos Santos; http://lattes.cnpq.br/0085346724655944; http://lattes.cnpq.br/8062199269259772; http://lattes.cnpq.br/6067810198856559; Araújo, Ivonete Batista de; Oliveira, Yonara Monique da CostaAsthma and Chronic Obstructive Pulmonary Disease (COPD) are chronic respiratory diseases that affect millions of people worldwide, resulting in high morbidity and mortality. Improper use of inhalation devices (ID) is a critical factor that compromises treatment effectiveness, leading to increased hospitalizations and symptom worsening. This study aimed to detect the prevalence of non-conformity with inhalation technique among patients with asthma and COPD, as well as to identify critical errors and associated risk factors. An observational and cross-sectional study was conducted between May 2022 and July 2024, with 575 patients attending a pulmonology outpatient clinic at a university hospital and a specialized care unit, both in Natal, Brazil. Participants, aged 18 years and older, diagnosed with asthma and/or COPD, completed questionnaires on sociodemographic characteristics and performed the inhalation technique for evaluation. Treatment adherence was assessed using the Morisky-Green-Levine test, while the inhalation technique was analyzed using checklists specific to each ID, considering as critical errors those with the greatest potential to affect medication effectiveness, such as insufficient exhalation, inadequate seal around the mouthpiece, improper inhalation, and failure to perform an inhalation pause. The results showed a high prevalence of non-compliance with the inhalation technique (55.2%), with the most frequent errors being improper inhalation (61.2%) and incorrect inhalation pause (56.6%). Multivariate analysis indicated that factors such as advanced age (OR: 1.016), lower family income (OR: 2.450), worsening of symptoms with exertion (OR: 1.935), and asthma diagnosis (OR: 3.596) were significantly associated with non-conformity in the technique. In conclusion, this study highlights the high prevalence of non-conformity with inhalation technique among patients with asthma and COPD. Identifying and characterizing critical errors and associated risk factors emphasize the importance of developing educational interventions aimed at optimizing the use of IDs and, consequently, improving the control of respiratory diseases.Master Thesis O uso precoce de Meropenem e o aumento do risco de enterocolite necrosante em recém-nascidos sob terapia intensiva neonatal(Universidade Federal do Rio Grande do Norte, 2024-12-13) Gomes, Ana Beatriz Dantas; Martins, Rand Randall; Moreira, Francisca Sueli Monte; https://orcid.org/0000-0001-7069-750X; http://lattes.cnpq.br/5764849324594620; http://lattes.cnpq.br/8062199269259772; http://lattes.cnpq.br/7115113423678944; Araújo, Ivonete Batista de; Diniz, Rodrigo dos Santos; Oliveira, Yonara Monique da CostaBACKGROUND: Necrotizing enterocolitis (NEC) is the leading cause of mortality among preterm neonates with inflammatory bowel disease. While the prior use of antimicrobials is recognized as a risk factor for NEC, there is limited understanding of which specific antimicrobials pose a higher risk. This study aims to identify antimicrobials associated with an increased risk of NEC in neonates undergoing intensive therapy. METHODS: A retrospective cohort study assessed 594 neonates (mean gestational age: 33.2 ± 4.4 weeks; mean birth weight: 1978.3 ± 1010.2 g) receiving intensive care and antimicrobial treatment at a Brazilian Teaching Maternity Hospital. Multivariate logistic regression identified factors associated with NEC, serving as adjustment variables in examining the relationship between prior antimicrobial use and NEC occurrence (p<0.05). RESULTS: Risk factors for NEC included gestational age (OR 1.250, 95% CI 1.134- 1.377), birth weight (OR 0.998, 95% CI 0.997- 0.999), congenital heart disease (OR 4.777, 95% CI 2.217– 10.293), methicillin-resistant Staphylococcus aureus (MRSA) marker (OR 2.748, 95% CI 2.067- 7.705), and prolonged hospitalization (OR 1.004, 95% CI 1.000- 1.008). Meropenem, administered around the 17th day of hospitalization, preceded NEC diagnosis around the 34th day (17.5, 95% CI 10.6– 24.4 vs. 34.5, 95% CI 20.3– 42.7 days; p = 0.03). CONCLUSION: The prior administration of meropenem was associated with a higher incidence of NEC in neonates under intensive care.