Standard drug consumption: a study with elderly people in Primary Health Care

Marinho, Josefa Muriele da Silva; Medeiros, Karyne Beatriz Almeida de; Fonseca, Romário Nóbrega Santos; Araujo, Thiego Santos de; Barros, Wanessa Cristina Tomaz dos Santos; Oliveira, Luciane Paula Batista Araújo de

doi:10.1590/0034-7167-2020-0729

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 74 (3) • 2021 • https://doi.org/10.1590/0034-7167-2020-0729 copy

Standard drug consumption: a study with elderly people in Primary Health Care

Consumo estándar de drogas: un estudio con personas mayores en Atención Primaria de Salud

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify the pattern of medication consumption among the elderly assisted in Primary Health Care.

Methods:

Descriptive, quantitative, cross-sectional study, with a sample of 315 elderly people, in a city in rural Rio Grande do Norte.

Results:

The average age was 72.41 years, with an average consumption of 3.15 medications per day, ranging from 1 to 16 medications daily. There was a prevalence of antihypertensives, antidiabetics, hypolipidemic and psychotropic drugs. 238 different drugs were mentioned, 15 of which were “potentially inappropriate drugs” for the elderly. Most of these patients follow treatment according to medical prescription, with low self-medication. Most elderly people buy their drugs, although many are available for free.

Conclusion:

The most consumed drugs are consistent with the most reported diseases (hypertension and diabetes). The daily use of inappropriate medications for the elderly is worrying, especially psychotropics, given the risks of dependence or health complications of these users.

Descriptors:
Aged; Drug Utilization; Primary Health Care; Nursing; Pharmacoepidemiology

Characteristics	Frequencies	%
Sex
Female	205	65.08
Male	110	34.92
Age group
Up to 75 years	222	70.48
Over 75 years	93	29.52
Educational level^* Note:
Illiterate / Semi-literate	165	53.40
Complete early childhood education	36	11.65
Incomplete early childhood education	50	16.19
Complete elementary school	17	5.50
Incomplete elementary school	17	5.50
Complete high school	10	3.24
Incomplete high school	9	2.91
Complete higher education	4	1.29
Incomplete higher education	1	0.32
Monthly family income
Up to 1 minimum wage	188	62.05
Above 1 minimum wage	115	37.95
Number of medications per day
Up to 3	207	65.71
4 or more	108	34.29
Smoking
Yes	30	9.71
No	279	90.29
Ethics
Yes	17	5.50
No	292	94.50
Physical activity
Yes	117	37.86
No	192	62.14
Personal background (multiple answer)
Arterial hypertension	213	67.62
Diabetes	189	60.00
Osteoarticular diseases	88	27.94
Others	74	23.49
Total	315	100.00

Antihypertensive	241	76.50
Antidiabetic	74	23.49
Hypolipidemic	71	22.53
Psychotropic	65	20.63
Anti-inflammatories	50	15.87
Antiulcer	24	7.62
Supplements	24	7.62
Corticosteroids	22	6.98
Bisphosphonates	21	6.67
Pain relievers	18	5.71
Thyroid hormones	16	5.08
Muscle relaxant	16	5.08
Vitamins	14	4.44
Diuretics	10	3.17
Others	112	35.55

	Response	Absolute frequency	%
Anti-hypertensive
Prescriber	Physician	350	99.43
Prescriber	Own account	2	0.57
Presentation of medicines	Pills	342	96.88
	Capsules	8	2.27
	Drops	3	0.85
Fractionation	Yes	21	6.10
Fractionation	No	323	93.90
Compliance with the prescription	Yes	321	93.31
Compliance with the prescription	No	20	5.81
Antidiabetic
Prescriber	Physician	85	100.00
Presentation of medicines	Pills	80	94.12
	Injectable liquid	4	4.71
	Drops	1	1.18
Fractionation	Yes	7	8.24
Fractionation	No	78	91.76
Compliance with the prescription	Yes	7	8.24
Compliance with the prescription	No	78	91.76
Hypolipidemic
Prescriber	Physician	54	100.00
Presentation of medicines	Pills	52	96.30
	Capsules	1	1.85
	Drops	1	1.85
Fractionation	Yes	3	5.77
Fractionation	No	49	94.23
Compliance with the prescription	Yes	50	96.15
Compliance with the prescription	No	2	3.85

Medication (Class)	Implications of use in elderly patients
Doxazosin (antihypertensive, alpha-1 blocker)	Use associated with high risk of orthostatic hypotension. Not recommended for routine treatment of hypertension. There are alternatives with better risk-benefit ratio⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾.
Amitriptyline (antidepressant)	Highly anticholinergic, sedative and causes orthostatic hypotension⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾.
Insulin	Higher risk of hypoglycaemia. Avoid use based on capillary blood glucose⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾.
Alprazolam Lorazepam (benzodiazepines)	They increase the risk of cognitive impairment, delirium, falls, fractures and car accidents. Avoid all benzodiazepines to treat insomnia, restlessness or delirium. They may be appropriate to treat seizures, REM sleep disorders, benzodiazepine and ethanol withdrawal syndrome, severe generalized anxiety disorder, in perioperative anaesthesia and palliative care⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾.
Digoxin	The decrease in renal clearance with aging increases the risk of digitalis intoxication. In addition, in heart failure, higher doses increase the risk of toxicity and do not offer greater benefits⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾.
Cyclobenzaprine (muscle relaxant)	Anticholinergic effects such as sedation and consequent risk of fracture. The effectiveness at doses tolerated by the elderly is questionable⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾.
Diltiazem (calcium channel blocker)	They can worsen constipation. Have the potential to promote fluid retention and worsen heart failure⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾.
Nortriptyline Paroxetine (antidepressants)	Both are highly anticholinergic, sedative and cause orthostatic hypotension⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾. Paroxetine can produce ataxia, impaired psychomotor function, syncope and additional falls. May worsen hyponatremia⁽¹³13 Oliveira MG, Amorim WW, Oliveira CRB, Coqueiro HL, Gusmão LC, Passos LC. Brazilian consensus of potentially inappropriate medication for elderly people. Geriatr Gerontol Aging. 2016;10(4):168-81. https://doi.org/10.5327/Z2447-211520161600054 https://doi.org/10.5327/Z2447-2115201616... ⁾.
Ibuprofen Naproxen Piroxican (non-steroidal anti-inflammatory drugs - NSAIDs)	They increase the risk of gastrointestinal bleeding and peptic ulcer in those aged 75 years or older or who use oral or parenteral corticosteroids, anticoagulants or antiplatelet agents. The use of proton pump inhibitors reduces, but does not eliminate, the risk. Avoid chronic use, except when there are no alternatives and it is possible to associate with a gastroprotective agent. Piroxicam and ibuprofen have the potential to promote fluid retention and exacerbate heart failure⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾.
Phenobarbital (anticonvulsant, barbiturate)	High proportion of physical dependence, tolerance to sleep induction and risk of overdose at low doses⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾. Ability to produce ataxia, impaired psychomotor function, syncope and additional falls⁽¹³13 Oliveira MG, Amorim WW, Oliveira CRB, Coqueiro HL, Gusmão LC, Passos LC. Brazilian consensus of potentially inappropriate medication for elderly people. Geriatr Gerontol Aging. 2016;10(4):168-81. https://doi.org/10.5327/Z2447-211520161600054 https://doi.org/10.5327/Z2447-2115201616... ⁾.
Tramadol (opioid)	It can exacerbate or cause syndrome of inappropriate antidiuretic hormone (SIADH) or hyponatremia syndrome; closely monitor sodium levels when starting or changing dosages in adults⁽¹⁴14 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication use in older adults. JAGS. 2019;67(4):674-94. https://doi.org/10.1111/jgs.15767 https://doi.org/10.1111/jgs.15767... ⁾. Risk of: severe constipation; exacerbation of cognitive deficit; somnolence; postural hypotension, vertigo. Decreases the seizure threshold, with acceptable use in patients with well-controlled seizures, for which alternative agents have not been effective⁽¹³13 Oliveira MG, Amorim WW, Oliveira CRB, Coqueiro HL, Gusmão LC, Passos LC. Brazilian consensus of potentially inappropriate medication for elderly people. Geriatr Gerontol Aging. 2016;10(4):168-81. https://doi.org/10.5327/Z2447-211520161600054 https://doi.org/10.5327/Z2447-2115201616... ⁾.

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[1] Corresponding author: Luciane Paula Batista Araújo de Oliveira. E-mail: lucianepoliveira@yahoo.com.br