Gumbrevičius, Gintautas

Background and Objectives: Previous studies have shown that a major part of adverse drug reactions (ADRs) are preventable, and they contribute to increased morbidity, mortality, and costs. To our knowledge, no study investigating preventable ADRs has been carried out in Lithuania. Therefore, the aim of this study was to characterize ADRs in the intensive care unit (ICU) of a secondary care Lithuanian hospital as well as to identify drug classes and organ systems most commonly implicated in preventable and nonpreventable ADRs. Materials and Methods: This observational prospective study was conducted in an 18-bed ICU of Kaunas Hospital of the Lithuanian University of Health Sciences from 1 September 2021 to 31 August 2023. All ADRs were assessed for causality, severity, and preventability. The Anatomical Therapeutic and Chemical (ATC) system was used to classify drug classes implicated in ADRs. The organ systems affected were analyzed using the Medical Dictionary for Regulatory Activities (MedDRA). Results: A total of 154 patients with a median age of 78.8 years (range, 18–97) were enrolled into this study. There were 255 ADRs identified; preventable ADRs accounted for 87.5%. Among the preventable ADRs, the top three therapeutic subgroups were antithrombotic agents (26.5%), anti-inflammatory and antirheumatic products (22.0%), and blood substitutes and perfusion solutions (20.2%). Meanwhile, among nonpreventable ADRs, antibacterials for systemic use (62.5%) and antithrombotic agents (46.9%) were the two most common therapeutic subgroups. The gastrointestinal as well as the skin and subcutaneous tissues organ systems were more likely to be affected by nonpreventable ADRs (56.3% vs. 17.5%, p ˂ 0.05 and 12.5% vs. 0.4%, p ˂ 0.05, respectively), while the renal and urinary organ systems were more likely to be affected by preventable ADRs (38.1% vs. 6.3%, p ˂ 0.05). Conclusions: Our study showed a very high incidence of preventable ADRs (87.5%). Drugs affecting blood and blood-forming organs were most frequently implicated in these ADRs. This area deserves special attention and strategies need to be implemented to reduce the incidence of preventable ADRs and their impact on the healthcare system. Moreover, it emphasizes the need for future studies at a national level as, to our knowledge, this is the first study addressing the issues of avoidable harm at the ICU of one Lithuanian hospital.

Viena hiponatremiją lemiančių priežasčių - tiazidinių diuretikų vartojimas. Hiponatremija nustatoma, kai natrio (Na1) kiekis kraujyje yra < 135 mmol/1. Literatūroje nurodoma, kad dėl tiazidinių diuretikų sukeltos hiponatremijos į ligoninę patenka daugiau nei 10 proc. visų pacientų, kuriems nustatytas šis sutrikimas. Ji gali sunkinti tiazidinių diuretikų vartojimą asmenimis, kurie jautrūs šiai diuretikų grupei, ir didinti sergamumą bei mirštamumą. Be to, hiponatremiją gali lemti ir kiti paciento kartu vartojami vaistai bei esamos ligos. Daugeliui pacientų Na+ sumažėjimas yra besimptomis arba simptomai nėra labai ryškūs. Tačiau pacientams, kuriuos hiponatremija ištinka staiga, gali atsirasti tokios komplikacijos, kaip traukuliai ir koma.

Šis leidinys skirtas visiems gydytojams ir farmacijos specialistams, kurie domisi racionaliu vaistų skyrimu ir vartojimu. Kaip žinia, vaistai yra dažniausia pacientams taikoma terapinė intervencija. Todėl racionalus vaistų skyrimas, pagrįstas mokslo įrodymais, yra svarbus paciento gydymo garantas. Kita vertus, dažnas pacientas nevartoja vaistų taip, kaip nurodė gydytojas ar vaistininkas. Dėl to pacientai patiria vaistų vartojimo problemų, dažnėja šalutinis vaistų poveikis. [...] Leidinys „Racionalus vaistų skyrimas ir vartojimas“ suteikia papildomų žinių apie racionalų vaistų skyrimą ir vartojimą gydant dažniausius klinikinėje praktikoje sutinkamus susirgimus bei suteikia galimybes atpažinti ir spręsti su vaistų vartojimu susijusias problemas.

Ši mokomoji knyga skirta studentams ir gydytojams-rezidentams, bet klinikiniame darbe ji galėtų būti naudinga visų specialybių gydytojams, savo kompetencijų ribose skiriantiems gydymui benzodiazepinus (BZD). Pagrindinis šio leidinio tikslas – padėti medicinos, slaugos ir psichologijos specialybių studentams, studijuojantiems psichiatrijos discipliną, suprasti šios psichotropinių vaistų grupės specifiškumą ir pagrindines iškylančias problemas, o gydytojams psichiatrijos rezidentams ir gydytojams vaikų ir paaglių rezidentams – įgyti teorinių žinių apie gydymo BZD klinikinius ypatumus. Per pastarąjį deimtmetį pastebėta, kad BZD skiriama vis dažniau. Tai ypač būdinga pacientams apsilankius pas šeimos medicinos gydytoją. BZD vis dažniau vartojami kartu su opiatais bei kitais psichotropiniais medikamentais, dažnai tai daroma nesilaikant registruotų skyrimo indikacijų. BZD lengva paskirti, bet dažnai būna labai sunku juos nutraukti. Apžvelgus įrodymais pagrįstos medicinos duomenų bazes, randama mažai BZD vartojimo rekomendacijų, nors juos skiria daug skirtingų specialybių gydytojų, o vartojimo sritis yra labai plati. BZD vartojimo statistika tiek Europoje, tiek Lietuvoje nėra gerai ištirta. Daugumoje epidemiologinių tyrimų nebuvo atsižvelgta į didelį privačių gydytojų skirtų nekompensuojamų BZD kiekį arba nevertintas BZD skyrimas senyvo amžiaus pacientams. Vien Vokietijoje priklausomų nuo BZD asmenų gali būti nuo 128 tūkst. iki 1,6 mln.Jie dažnai vartojami ilgai, nors nėra įrodymų, patvirtinančių BZD veiksmingumą po 8 ar 10 savaičių. Su BZD perdozavimu siejamas mirtingumas. Rekomenduojama senyvo amžiaus pacientams vengti BZD vartojimo., BZD vartojimo indikacijų yra daug (nerimo sutrikimai, nemiga, traukuliai, alkoholio nutraukimo sindromas, raumenų spazmai, neuropatinis skausmas), ši mokomoji knyga apie BZD farmakologines savybes, klasifikavimą, vartojimą bei nutraukimo rekomenda

The glomerular filtration rate (GFR), according to which the drug dose for patients with chronic kidney disease (CKD) is adjusted, is computed with estimators (eGFR) that are developed specifically for CKD. These particular types of estimators are also used in population pharmacokinetic (pop PK) modelling in drug development. Similar approaches without scientific validation have been proposed for patients with acute kidney injury (AKI), yet it is uncertain which specific eGFR should be used for drug dosing or in pop PK models in patients with AKI. In our study, we included 34 patients with AKI and vancomycin (VCM) treatment, and we built both individual PK and pop PK (non-linear mixed-effects, one-compartment) models to see which eGFR estimator is the best covariate. In these models different eGFRs (Cockcroft-Gault, MDRD, CKD-EPI 2009, Jelliffe and Jelliffe, Chen et al., and Yashiro et al. 2013) were used. We included six additional patients to validate the final pop PK model. All eGFRs underrate the true renal clearance in the AKI, so we created pop PK models for VCM dosing in AKI with all eGFRs, to discover that the most accurate model was the one with the Cockcroft-Gault estimator. Since the eGFRs underestimate the true renal clearance in AKI, they are inaccurate for clinical drug dosing decisions, with the exception of the Cockcroft-Gault one, which is appropriate for the pop PK models intended for drug development purposes in AKI.

Dabigatran etexilate is a direct oral anticoagulant (thrombin inhibitor) used for the prevention of stroke and systemic thromboembolic events in patients with permanent atrial fibrillation; prevention of venous thromboembolic events and deep veins thrombosis; treatment and prevention of pulmonary embolism. Dabigatran is a relatively new drug, and as a result, its interactions with other medications and their significance are not fully known. A 72 years old male, having a medical history of heart and renal failure, was hospitalized for pneumonia treatment. The patient was taking several drugs, including dabigatran 150 mg twice daily and ranolazine 750 mg twice daily. His creatinine clearance was 45.22 mL/min, International Normalized Ratio (INR)—7.03. Dabigatran was discontinued. After 9 days, INR decreased to 1.33, and after 6 days, creatinine clearance increased to 64.39 mL/min. The patient was taking an adequate dosage of dabigatran, thus dabigatran was thought to be overdosed due to its interaction with ranolazine because dabigatran is a p-glycoprotein substrate, whereas ranolazine is the inhibitor of this transporter. Dabigatran and ranolazine should be used with caution in patients with renal failure. It is recommended to use smaller doses of both medications and observe coagulation parameters if needed.

Vadovėlis "Kardiologijos pagrindai" platus ir svarus leidinys, apimantis sindrominę diagnostiką, paciento ištyrimo metodiką, kardiologijoje vartojamų vaistų klinikinę farmakologiją, vaizdinius tyrimo metodus ir atskirų širdies ir kraujagyslių sistemos ligų diagnostiką bei gydymą. Vadovėlį rengė 46 autoriai. Pastarasis dešimtmetis medicinoje išsiskyrė įrodymais grįstos medicinos įsigalėjimu, diagnostikai bei gydymui naudojamų technologijų sudėtingumu ir įvairove, labai greitu mokslo bei technikos naujovių įdiegimu į kasdienę klinikinę praktiką. Todėl kilo poreikis parengti visiškai naują kardiologijos vadovėlį, kuris taptų ne tik priemone studentams mokyti, bet ir kiekvieno gydytojo rezidento, vidaus ligų gydytojo, kardiologo parankine knyga. Laikas bėga labai greitai, todėl net rengiant šį vadovėlį keitėsi daugelio ligų diagnostikos bei gydymo rekomendacijos, nes sparti moklo pažanga ir nauji duomenys nuolat keičia mūsų požiūrį į daugelį dalykų, kurie atrodė aiškūs ir nusistovėję.

Background and objective: Irrational nonsteroidal antiinflammatory drugs (NSAIDs) use is the main cause of adverse effects associated hospitalisations among all medicines leading to extremely increased costs for health care. Undoubtedly, measures should be taken to prevent it. An important step is pharmacoepidemiological studies which can reveal predominant problems and encourage further decisions. So, our purpose was to study the utilization of nonopioid analgesics (ATC codes N02B; M01A) and to analyse compliance with World Health Organisation's (WHO) guidelines for the treatment of pain and the European Medicines Agency's (EMA) safety recommendations in Lithuania comparing to other European countries. Materials and methods: The defined daily dose (DDD) methodology was applied to assess analgesics, classified in N02B and M01A, utilization, expressed in DDDs/1000 inhabitants/day. Results: Over the 11-year period, the utilization of N02B and M01A increased by 22.8% in Lithuania. Contrary to WHO recommendations on pain management, all Baltic countries were more likely to use NSAIDs than other analgesics and antipyretics: in 2015, NSAIDs were used 6.04; 5.79 and 6.11 times more than those of N02B in Lithuania, Estonia and Latvia, respectively, whereas Scandinavian countries prefered N02B to M01A group: in Denmark utilization of other analgesics and antipyretics was 2.33 times higher than NSAIDs, in Sweden - 1.24 times higher. In Norway, the use of both groups was similar. In Scandinavian countries paracetamol was the analgesic of first choice, whereas in Lithuania it took only the third place. Although EMA has restricted the use of certain NSAIDs - COX-2 inhibitors, nimesulide and diclofenac - their use has consistently increased (15.91; 2.83 and 1.41 times respectively) showing incompliance with international guidelines. Conclusions: Neither EMA's safety policy nor WHO guidelines for the treatment of pain do not...[...].

Background and objective: Irrational use of nonsteroidal anti-inflammatory drugs (NSAIDs) is the main cause of adverse effects-associated hospitalizations among all medication groups leading to extremely increased costs for health care. Pharmacoepidemiological studies can partly reveal such issues and encourage further decisions. Therefore, the aim of our study was to evaluate the utilization of non-opioid analgesics (ATC classification N02B and M01A) in Lithuania, and to compare it with that of other Baltic and Scandinavian countries in terms of compliance to the WHO pain treatment guidelines and the EMA safety recommendations on NSAID use. Materials and methods: The dispensing data were obtained from the sales analysis software provider in the Baltic countries (SoftDent, Ltd., Kaunas, Lithuania); State Medicine Control Agencies of Lithuania, Latvia, and Estonia; Norwegian Prescription Database; Swedish Database for Medicines; and Danish Prescription Database. Data included the utilization of both prescription and over-the-counter drugs. Utilization was expressed in defined daily doses (DDD)/1000 inhabitants/day. Results: During the 11-year period, the utilization of drugs belonging to the N02B and M01A groups increased by 22.8%, from 58.37 in 2005 to 71.68 DDD/1000 inhabitants/day in 2016 in Lithuania. Contrary to the WHO guidelines on pain management, all Baltic countries were more likely to use NSAIDs than other analgesics and antipyretics: in 2015, the drugs of the M01A group were used 6.04, 5.79, and 6.11 times more than those of N02B in Lithuania, Estonia, and Latvia, respectively, whereas the Scandinavian countries preferred the N02B to the M01A group: in Denmark and Sweden, the utilization of other analgesics and antipyretics was 2.33 and 1.24, respectively, times higher than that of NSAIDs. In Norway, the use of both groups was similar. [...].

Širdies ir kraujagyslių ligos, tarp jų ir insultas, Lietuvoje ir pasaulyje yra pagrindinė žmonių mirties priežastis. Jų dažnumą mažina tinkama mityba, didesnis fizinis aktyvumas, kūno svorio ir lipidų apykaitos sunorminimas, rūkymo atsisakymas, efektyvus arterinės hipertenzijos ir cukrinio diabeto gydymas.