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Resumo Objetivo: Analisar a satisfação dos responsáveis por adolescentes com as informações recebidas para o uso dos medicamentos psicofármacos. Métodos: Estudo transversal realizado em ambulatório de referência entre 2017 e 2019, em Brasília, com 173 responsáveis por adolescentes diagnosticados com transtornos mentais e comportamentais em uso de psicofármacos. O questionário Satisfaction with Information about Medicines Scale (SIMS) foi utilizado para identificar o grau de satisfação em relação às informações recebidas sobre os medicamentos. Resultados: A maioria dos responsáveis estava insatisfeita quanto às informações recebidas sobre psicofármacos (n=112; 64,7%). Destacou-se a insatisfação com as informações sobre potenciais problemas do medicamento (n=127; 73,4%), quando comparada à ação e ao uso (n=89; 51,5%). As informações sobre o impacto do medicamento na vida sexual do adolescente foram consideradas insatisfatórias ou inexistentes. Conclusões: A satisfação dos responsáveis com as informações recebidas sobre psicofármacos foi baixa. Os participantes demonstraram insatisfação com as informações sobre potenciais problemas, especialmente às relacionadas ao impacto na vida sexual dos adolescentes.

Objective: To analyze the satisfaction of those responsible for adolescents with information received for the use of psychotropic drugs. Methods: Cross-sectional study carried out in a reference outpatient clinic in Brasília between 2017 and 2019. It involved 173 legal representatives of adolescents diagnosed with Mental and Behavioral Disorders using psychotropic drugs. In order to identify the level of satisfaction about the information received on psychotropic drugs, the Satisfaction with Information about Medicines Scale (SIMS) was used. Results: Most guardians were dissatisfied with the information received on psychotropic drugs (n=112; 64.7%). The dissatisfaction with information about potential problems of medication was the one that stood out the most (n=127; 73.4%) when compared to information about action and usage (n=89; 51.5%). Participants considered information on the impact of medication on the adolescent’s sexual life unsatisfactory or nonexistent. Conclusions: The parents’ satisfaction with the information received about psychotropic drugs was low. Participants showed dissatisfaction with the information about potential problems, especially related to the impact on the sexual life of their tutored. Resumo Objetivo: Analisar a satisfação dos responsáveis por adolescentes com as informações recebidas para o uso dos medicamentos psicofármacos. Métodos: Estudo transversal realizado em ambulatório de referência entre 2017 e 2019, em Brasília, com 173 responsáveis por adolescentes diagnosticados com transtornos mentais e comportamentais em uso de psicofármacos. O questionário Satisfaction with Information about Medicines Scale (SIMS) foi utilizado para identificar o grau de satisfação em relação às informações recebidas sobre os medicamentos. Resultados: A maioria dos responsáveis estava insatisfeita quanto às informações recebidas sobre psicofármacos (n=112; 64,7%). Destacou-se a insatisfação com as informações sobre potenciais problemas do medicamento (n=127; 73,4%), quando comparada à ação e ao uso (n=89; 51,5%). As informações sobre o impacto do medicamento na vida sexual do adolescente foram consideradas insatisfatórias ou inexistentes. Conclusões: A satisfação dos responsáveis com as informações recebidas sobre psicofármacos foi baixa. Os participantes demonstraram insatisfação com as informações sobre potenciais problemas, especialmente às relacionadas ao impacto na vida sexual dos adolescentes.

BACKGROUND: Tablet splitting appears common in older adults, but its safety, and the factors associated with this practice, remain unclear. OBJECTIVE: To identify which psychotropic drugs are most often split, which doses are intended with this practice, and whether these doses are provided by the Brazilian Unified Health System (SUS) or commercially available. METHODS: Cross-sectional descriptive study of 632 geriatric outpatients. The number of individuals who split tablets was identified, as well as the psychotropic drugs they used and split. The availability of these drugs on the SUS network and on the market was assessed by checking the 2017 National Formulary of Essential Medicines (RENAME 2017) and the Dictionary of Proprietary Medicinal Products (Dicionário de Especialidades Farmacêuticas) "respectively. RESULTS: Tablet splitting was reported by 178 patients (28.2%). This practice was significantly more common among those aged 80 years or older. Tablet splitting was significantly associated with a greater number of medical visits and a higher pill burden. The most commonly affected therapeutic classes were antipsychotics (23.9%), other psychotropic drugs (18.7%) and antidepressants (12.3%). Of the 20 psychotropic drugs split, 45% were available on the SUS. CONCLUSIONS: Tablet splitting poses a challenge, as there is no guarantee of uniformity of concentration of the active ingredient in the split halves. Although the psychotropic drugs that were split in this sample are commercially available, most were not available from SUS in the desired dose forms for older adults.

Introdução: A manipulação de antineoplásicos para ajuste de dose, como partição de comprimidos, e comum no tratamento de leucemias agudas de crianças e adolescentes. Objetivo: Identificar a frequência e descrever a pratica da partição domiciliar de comprimidos antineoplásicos utilizados no tratamento oral de crianças e adolescentes com leucemias agudas na fase de manutenção. Método: Trata-se de um estudo transversal descritivo, realizado em um hospital pertencente a rede de saúde publica do Distrito Federal com assistência especializada em pediatria. Foram incluídos no estudo crianças e adolescentes entre 1 e 18 anos, diagnosticados com leucemias agudas e em fase de manutenção do tratamento no período de estudo. Foi aplicado um questionário semiestruturado ao responsável principal pela administração dos medicamentos quimioterápicos via oral, podendo ser o cuidador ou a própria criança/adolescente. Foram coletadas variáveis sociodemográficas dos pacientes e cuidadores e variáveis sobre a pratica de partição de medicamentos antineoplásicos no domicilio. Resultados: Todos os 48 entrevistados no período do estudo relataram ter partido comprimidos antineoplásicos ao longo do tratamento de leucemias agudas, sendo estes mercaptopurina (n=45 [93,75%]) e tioguanina (n=3 [6,25%]). Conclusão: A partição de comprimidos antineoplásicos foi uma pratica unanime em virtude da necessidade referida de ajuste de dose individual para o tratamento de leucemias agudas de crianças e adolescentes, considerando a indisponibilidade de formulações adequadas. Os resultados reforçam a necessidade de a partição ser uniformizada e realizada de maneira a minimizar os riscos e a garantir a segurança para as crianças e adolescentes e seus cuidadores.

ResumoA ciclofosfamida (CFM) é um agente alquilante vastamente usado para o tratamento de neoplasias malignas e pode ser usado no tratamento de diversas doenças reumatológicas. O erro de administração de medicamentos pode levar à diminuição da eficácia ou ao aumento da toxicidade medicamentosa. Diversos erros ocorrem na administração de medicamentos injetáveis. O trabalho objetivou a estruturação de uma rotina do uso de ciclofosfamida, bem como a criação de um documento de orientações farmacoterapêuticas para o paciente. A rotina foi esquematizada em três fases, a pré‐quimioterapia (pré‐QT), a administração da ciclofosfamida e a pós‐quimioterapia (pós‐QT), que levaram em consideração os medicamentos que devem ser administrados antes e depois da ciclofosfamida para prevenção aos efeitos adversos, incluindo náusea e cistite hemorrágica. As reações adversas podem alterar os exames laboratoriais e a rotina incluiu manejo clínico para alteração clínica dos leucócitos, das plaquetas, dos neutrófilos e do sódio incluindo o ajuste de dose de ciclofosfamida em caso de insuficiência renal. A ciclofosfamida é responsável por outras reações adversas raras, mas sérias, como hepatotoxicidade, hiponatremia severa e falência cardíaca. Outras reações adversas incluem perda de cabelo, amenorreia e menopausa. A rotina foi composta também por orientações ao paciente pós‐QT. A compatibilidade dos medicamentos injetáveis com o veículo foi descrita, bem como o tempo de estabilidade e o tempo de infusão. A rotina visou ao uso racional da ciclofosfamida e prevenir os efeitos adversos e os episódios de recidiva, os quais podem onerar o sistema de saúde.AbstractCyclophosphamide (CPM) is an alkylating agent widely used for the treatment of malignant neoplasia and which can be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeutic guidelines for the patient. The routine is schematized in three phases: pre‐chemotherapy (pre‐ChT), administration of cyclophosphamide, and post‐chemotherapy (post‐ChT), taking into account the drugs to be administered before and after cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis. Adverse reactions can alter laboratory tests; thus, this routine included clinical management for changes in white blood cells, platelets, neutrophils, and sodium, including cyclophosphamide dose adjustment in the case of kidney disease. Cyclophosphamide is responsible for other rare–but serious–side effects, for instance, hepatotoxicity, severe hyponatremia and heart failure. Other adverse reactions include hair loss, amenorrhea and menopause. In this routine, we also entered guidelines to post‐chemotherapy patients. The compatibility of injectable drugs with the vehicle used has been described, as well as stability and infusion times. The routine aimed at the rational use of cyclophosphamide, with prevention of adverse events and relapse episodes, factors that may burden the health care system.

This study evaluated the consumption of psychotropic medications by caregivers of elderly patients with or without dementia. This was a cross-sectional study conducted at all geriatric units in Brasília, Brazil, during a two-month period. Structured interviews were performed with 311 caregivers of people with or without dementia and they completed questionnaires. Among the caregivers, 196 (63%) were caregivers of patients with dementia and 115 (37%) were caregivers of patients without dementia. Forty-four caregivers (14.1%) were taking psychotropic drugs (benzodiazepines or antidepressants), and this usage was more frequent among caregivers of patients with dementia (p

Purpose The objective of this study was to assess the frequency of tablet splitting of psychotropic drugs in a population of older adults with a diagnosis of dementia. Methods This retrospective, cross-sectional study examined a sample of geriatric outpatients seen at a public center specializing in the care of elderly patients, a referral center for management of dementias in general, especially Alzheimer dementia to identify the frequency of tablet splitting of psychotropic drugs and the factors that may be involved in this practice. Comparison of the presence or absence of tablet splitting in relation to several parameters was assessed by means of P values; between-group differences with an α P Findings The presence of dementia was significantly associated with prescriptions implying to split tablets, which was found in 88 patients with dementia (34.9%) versus 90 patients without dementia (23.7%) ( P = 0.002). Among the 88 patients with dementia who split tablets, 64 (72.7%) split tablets of psychotropic drugs. Implications These results indicate the importance of identifying the practice of tablet splitting, particularly when it involves psychotropic drugs, because it entails several factors that can reduce the efficacy of the drug therapy.

Sleep disorders (SD) in patients with dementia are very common in clinical practice. The use of antidepressants with hypnotic actions, such as trazodone, plays an important role in these cases. The aim of this study is to present a profile of the use of trazodone in demented patients with SD, as well as a review of trazodone hydrochloride in SD. We evaluated 178 elderly patients with Alzheimer’s disease and other dementias, clinically presenting SD and treated with hypnosedative medications. In the one-year period comprising the study, 68 (38.2%) of the 178 had sleep disorders. Most patients (114; 64%) had a diagnosis of Alzheimer’s disease. Approximately 85% of patients with SD used hypnosedative drugs. Trazodone was the most commonly used drug among patients (N = 35), with an effectiveness of 65.7%. Trazodone has been shown to be a good option for treatment of the elderly with dementia and associated SD. _________________________________________________________________________________________________________________ RESUMO Distúrbios do sono (DS) em pacientes com demência são muito comuns na prática clínica. O uso de antidepressivos com ação hipnótica, como a trazodona, tem um papel importante nesses casos. O objetivo desse estudo é apresentar um perfil do uso da trazodona em pacientes com demência e com DS, bem como revisar o cloridrato de trazodona no DS. Nós avaliamos 178 idosos com doença de Alzheimer (DA) e outras demências, clinicamente apresentando DS e que foram tratados com medicações hipnossedativas. No período de um ano de estudo, 68 (38,2%) tiveram DS. A maioria (114; 64%) tinham diagnóstico de DA. Aproximadamente 85% usaram fármacos hipnossedativos. A trazodona foi a mais utilizada (N=35), com evidência de melhora de 65,7%. A trazodona mostrou-se ser uma boa opção no tratamento de idosos com demência e DS associado.

Chronic cough caused by interstitial pneumopathy can present a therapeutic dilemma, and the use of tramadol in the treatment of this symptom might be an alternative to improve the quality of life in patients. The present study describes a patient with rheumatoid arthritis and interstitial lung disease lasting 11 years who developed dry cough secondary to interstitial pneumopathy but was nonresponsive to several treatments (codeine 20 mg q6h; clobutinol 240 mg/d; and dextromethorphan 10 mg q4h).The purpose of this study was to investigate, for an individual patient, the effectiveness of tramadol 50 mg compared with placebo, and whether tramadol provided any antitussive benefit.This was an N-of-1 double-blind, randomized controlled trial of tramadol against placebo. Treatment was administered in 3 pairs, each consisting of 2 periods in which either tramadol 50 mg BID or placebo was administered for 6 days, followed by a 2-day washout period, and then the administration of the alternate for 6 days. A 2-day washout period was also carried out after pairs 1 and 2. Per pair, the sequence of treatments was randomized. Outcome measures were: the intensity of daytime and nighttime cough, assessed by a visual analog scale (VAS) ranging from 0 to 5 (0 = no cough, 5 = distressing cough); and the patient's perception regarding her health state (better, same, or worse).A 55-year-old black woman (height, 153 cm; weight, 71 kg) was in the study. In all treatment pairs, cough intensity, as reported by the patient using the VAS, was significantly lower with tramadol compared with placebo (P0.001), both in the daytime (2 vs 5, respectively) and at nighttime (1 vs 4). Regarding the patient's health state, in all periods in which tramadol was administered, the patient reported feeling better than when placebo was administered. At the begin- ning of pair 2, the use of rescue tramadol 50 mg (un-blinded) was permitted due to cough intensity. In the remaining treatment periods in which placebo was administered, rescue tramadol was administered, whereas rescue tramadol was not needed during the periods in which tramadol was administered.Tramadol appeared to be effective in controlling cough in this patient. Because no similar report was found in the literature, further studies assessing the efficacy of tramadol as an antitussive agent are warranted.

The treatments of choice in Alzheimer's disease (AD) are cholinesterase inhibitors and NMDA-receptor antagonists, although doubts remain about the therapeutic effectiveness of these drugs. Herbal medicine products have been used in the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD) but with various responses. The objective of this article was to review evidences from controlled studies in order to determine whether herbs can be useful in the treatment of cognitive disorders in the elderly. Randomized controlled studies assessing AD in individuals older than 65 years were identified through searches of MEDLINE, LILACS, Cochrane Library, dissertation Abstract (USA), ADEAR (Alzheimer's Disease Clinical Trials Database), National Research Register, Current Controlled trials, Centerwatch Trials Database and PsychINFO Journal Articles. The search combined the terms Alzheimer disease, dementia, cognition disorders, Herbal, Phytotherapy. The crossover results were evaluated by the Jadad's measurement scale. The systematic review identified two herbs and herbal formulations with therapeutic effects for the treatment of AD:Melissa officinalis,Salvia officinalisand Yi-Gan San and BDW (Ba Wei Di Huang Wan).Ginkgo bilobawas identified in a meta-analysis study. All five herbs are useful for cognitive impairment of AD.M. officinalisand Yi-Gan San are also useful in agitation, for they have sedative effects. These herbs and formulations have demonstrated good therapeutic effectiveness but these results need to be compared with those of traditional drugs. Further large multicenter studies should be conducted in order to test the cost-effectiveness of these herbs for AD and the impact in the control of cognitive deterioration.