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PPGASFAR PROGRAMA DE PÓS GRADUAÇÃO EM ASSISTÊNCIA FARMACÊUTICA EM REDE CENTRO DE CIÊNCIAS DA SAÚDE Phone: Not available E-mail: Not available https://posgraduacao.ufrn.br/ppgasfar

Dissertations/Thesis

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2025

	Dissertations
1	ÍTALO HENRIQUE MEDEIROS DAMASCENO Prevalence and risk factors associated with inadequate technique of use of the inhalation device in patients with asthma and COPD Advisor : RAND RANDALL MARTINS COMMITTEE MEMBERS : IVONETE BATISTA DE ARAUJO RAND RANDALL MARTINS YONARA MONIQUE DA COSTA OLIVEIRA Data: Jan 22, 2025 Show Abstract Asthma and Chronic Obstructive Pulmonary Disease (COPD) are chronic respiratory diseases affecting millions of people worldwide, resulting in high morbidity and mortality. Inadequate use of inhalation devices (IDs) is a critical factor that compromises treatment effectiveness, leading to increased hospitalizations and worsening symptoms. This study aimed to analyze the prevalence of inadequate techniques in the administration of IDs among patients with asthma and COPD, identify critical errors and associated risk factors, and propose pharmaceutical interventions to improve the use of these devices. An observational, cross-sectional study was conducted with 575 patients attended at a pulmonary outpatient clinic in a university hospital and a specialized unit, both in Natal, Brazil. Participants, aged 18 and older with a diagnosis of asthma and/or COPD, completed questionnaires on sociodemographic characteristics and performed inhalation techniques for evaluation. Treatment adherence was assessed using the Morisky-Green-Levine test, while inhalation technique was analyzed using specific checklists for each ID, considering as critical errors those with the highest potential to affect drug effectiveness, such as poor expiration, inadequate sealing around the mouthpiece, improper inspiration, and failure to pause during inhalation. Results showed a high prevalence of inadequate inhalation technique (55.2%), with the most frequent errors being improper inspiration (61.2%) and incorrect inhalation pause (56.6%). Multivariate analysis indicated that factors such as older age (OR: 1.016), lower household income (OR: 2.450), worsening symptoms with exertion (OR: 1.935), and asthma diagnosis (OR: 3.596) are significantly associated with inadequate technique. These findings highlight the complexity involved in using IDs and the need for ongoing educational interventions, especially targeted at vulnerable populations. Implementing training and guidance programs, as well as using checklists during consultations, are suggested strategies to enhance adherence and treatment effectiveness. In conclusion, this study highlights the high prevalence of inadequate techniques in the administration of IDs among patients with asthma and COPD. The identified critical errors and associated risk factors underscore the importance of targeted educational interventions to optimize the use of IDs and, consequently, improve the management of respiratory diseases.
2	DANIEL PAIVA MARQUES Profile of drug interactions in a Neonatal Intensive Care Unit and their associated clinical outcomes Advisor : RAND RANDALL MARTINS COMMITTEE MEMBERS : FRANCISCA SUELI MONTE MOREIRA RAND RANDALL MARTINS YONARA MONIQUE DA COSTA OLIVEIRA Data: Jan 22, 2025 Show Abstract Introduction: Neonates in intensive care are susceptible to adverse events due to physiological immaturity, severity of cases, and the administration of multiple medications, increasing the risk of drug-drug interactions (DDIs). Unlike adult ICUs, DDIs in neonatology are not well characterized, especially concerning clinical relevance and outcomes. Many of these interactions are, in fact, unavoidable, and the lack of data complicates the assessment of their risk-benefit ratio. Objective: The aim of this study is to investigate the influence of potential DDIs on clinical outcomes in neonates under intensive care. Methodology: A prospective cohort study will be conducted in the Neonatal Intensive Care Unit (NICU) at the Maternidade Escola Januario Cicco (MEJC), where neonates will be evaluated daily for the occurrence of DDIs. Clinical-laboratory and pharmacotherapeutic parameters will be assessed daily. The influence of DDIs on neonates will be correlated with key clinical outcomes (death, treatment duration, and weight variation) through univariate and multivariate modeling (logistic and linear mixed-effects). Results: About 69.9% (255 patients) experienced one or more interactions during hospitalization, particularly involving antimicrobials (58.6%), potential arrhythmogenic interactions (27.4%), nephrotoxic interactions (18.3%), and those that may cause central nervous system depression (16.8%). The incidence of arrhythmia-related and CNS depression-related interactions tends to decrease over the days (β = -0.106; p < 0.01 and β = -0.088; p < 0.01, respectively). Conversely, interactions associated with nephrotoxicity increase during hospitalization (β = 0.097; p < 0.01). Potentially arrhythmogenic interactions raised heart rate by 5.9% (p < 0.001), those associated with nephrotoxicity decreased glomerular filtration values by 44% (p < 0.001), and those associated with CNS depression reduced heart rate by 6% (p < 0.001). Conclusion: DDIs 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 over the course of hospitalization, the risk of nephrotoxicity increases. These findings emphasize the importance of careful monitoring and management of DDIs to improve clinical outcomes in neonates.
3	GABRIELA SANTANA OLIVEIRA EVALUATION OF THE IMPACT OF SERIOUS DRUG INTERACTIONS IN HOSPITALIZED PREGNANT WOMEN: CLINICAL RELEVANCE AND MATERNAL-FETAL OUTCOMES Advisor : RAND RANDALL MARTINS COMMITTEE MEMBERS : SABRINA MARIA PORTELA CARNEIRO RAND RANDALL MARTINS RODRIGO DOS SANTOS DINIZ Data: Jan 22, 2025 Show Abstract Objective: 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.
4	ANDREZA KELLY FERNANDES DA SILVA Potential electrolyte alterations related to medication use by patients in neonatal intensive care Advisor : RAND RANDALL MARTINS COMMITTEE MEMBERS : ANTONIO MANUEL GOUVEIA DE OLIVEIRA RAND RANDALL MARTINS TATIANA XAVIER DA COSTA Data: Jan 22, 2025 Show Abstract Introduction: 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 Januario 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 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.

2024

	Dissertations
1	ANA BEATRIZ DANTAS GOMES Early Use of Meropenem and Increased Risk of Necrotizing Enterocolitis in Neonates Under Neonatal Intensive Care Advisor : RAND RANDALL MARTINS COMMITTEE MEMBERS : IVONETE BATISTA DE ARAUJO RAND RANDALL MARTINS RODRIGO DOS SANTOS DINIZ YONARA MONIQUE DA COSTA OLIVEIRA Data: Dec 13, 2024 Show Abstract BACKGROUND: 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), methicillinresistant 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.