CC BY
2
МЕДИЦИНА И ЗДОРОВЬЕ
UDC 615.1+615.252.349.7-03.-06: 616.379-008.64
Moroz V.A., D.Sci.Med, professor Department of Clinical Pharmacology and Clinical Pharmacy
National Pharmaceutical University
Ukraine, Kharkiv
CLINICAL AND PHARMACEUTICAL ANALYSIS FEATURES OF USE OF ORAL HYPOGLYCEMIC AGENTS
С целью оценки рациональности применения пероральных сахароснижающих препаратов ретроспективно проанализированы 106 историй болезни пациентов с сахарным диабетом второго типа в возрасте от 42 до 75 лет. Нерациональное применение препаратов выявлено более чем у двух третей пациентов (при выраженной сердечно-сосудистой патологии; прием с препаратами, влияющими на сахароснижающую активность, риск развития лактоацидоза т.п.). Повышение качества лечения требует тщательной коррекции фармакотерапии, что обосновывает необходимость участия в этом процессе клинического фармаколога/фармацевта.
Ключевые слова: сахарный диабет, сахароснижающие препараты, метформин, лактоацидоз.
In order to evaluate the rationality of the use of oral hypoglycemic agents retrospectively analyzed 106 medical histories of patients with diabetes mellitus type 2 aged 42 to 75 years. Irrational application of preparations found in more than two-thirds of patients (with severe cardiovascular disease; with drugs affecting glucose-lowering activity, the risk of lactic acidosis, etc.). Improving the quality of treatment requires careful adjustment of pharmacotherapy, which justifies the need for participation in the process of clinical pharmacist.
Keywords: diabetes mellitus, hypoglycemic agents, metformin, lactic acidosis.
Diabetes mellitus now represents a significant medical and social problem for most countries. On August 2011 there were an estimated 346 mln diabetic patients, the vast majority of whom had diabetes mellitus of type 2 (DM2). The main objective of the treatment of DM2 is to compensate its course, which achieved by a complex of different methods: optimization of lifestyle and diet, as well as the use of oral hypoglycemic agents (OHA). At the same time OHA possess number of side effects, especially when taking with other drugs and at presence of concomitant diseases. The frequency of significant adverse reactions due to OHA is at least 11% of hospital admissions. In addition, elderly patients are prone to polypharmacy, often in need of treatment correction. All this underlines the importance of rationalizing OHA reception in different clinical situations [1, 2].
The objective of the study was to explore a range of oral hypoglycemic agents taken by DM2 patients, with an estimate of their rational use and development of appropriate recommendations.
Material and Methods: Retrospectively analyzed 106 case histories of patients with DM2 (49 men and 57 women aged from 42 to 75 years) who received OHA and stay in-patient treatment at the University Clinic. Studied aspects of the rational use of drugs: dosage, pharmacological and pharmaceutical compatibility, availability of various types of contraindications, side effects, etc. Patients with decompensated diabetes and significant comorbidity, take insulin excluded from the study.
Results and discussion: Preparations of sulfonylurea derivatives (PSD) took 57 persons (53.8% of patients). Accordingly, metformin used in 49 patients (46.2%). The combination of the two OHA in both groups among our patients not observed. Among PSDs most frequently used glibenclamide - 42.1% of the corresponding group or 20 patients with an average degree of gravity and 4 - a severe form of DM2. The second frequency was glimepiride (28.0%), and more gliquidone (19.3%) and gliclazide (1.5%). With in-depth analysis reveals cases of irrational use of OHA, the following.
Insufficient dosage. Glibenclamide was used in nine patients (15.8% of received) in the low dose as evidenced by elevated levels of glucose. Rational was an increase in the daily dose of OHA and strict adherence to the recommendations for non-drug treatment (diet, exercise stress, smoking cessation, weight loss, etc.). For this important role of the conscious cooperation of the patient, based on explanatory work of health professionals. Statistics show that insufficient dosage of the OHA occurs often enough. In the study K.H. Yoon et al. [3] for a year and half of treatment target level of HbA1 achieved only in 60% of cases. Difficulties compensation of DM2 at particular time interval based on the fact that its cure does not begin with the onset of disease, and already on the background of morphological changes in tissues and organs generated in 5-10 years or more [4,
5].
Using OHA at hypoglycemic symptoms was found in two patients who had previously symptoms of hypoglycemia with their use for 2 years or more. Hypoglycemia as a side effect of DM2 treatment is a factor that significantly increases the patient's mortality rate. The ability of PSD provoke hypoglycemia caused their exclusion from official lists in the USA. Although the frequency of this effect is now estimated at 0.9-1.5%, but the risk is real. There would be rational for replacement PSD to metformin, or alternatively, the use of acarbose, miglitol, pioglitazone or rosiglitazone, which are devoid of this side effect [4, 6].
Application OHA at angina pectoris was found in five patients with coronary heart disease with functional classes III-IV, with myocardial infarction in anamnesis and severe atherosclerosis. Glibenclamide has a low selectivity on the potassium channel of the P-cells of the pancreas and has a depressant effect on myocardial contractility. This fact has been well studied, including experimentally and described in the scientific literature. Although the number of publications is a
discussion about the significance of this effect, but there was a suitable replacement glibenclamide or glimepiride to highly selective gliclazide, have virtually no effect on the myocardium [2, 5].
Using the OHA at heart_ failure found in two cases metformin prescribing in patients with chronic heart failure (14.3% of patients treated with it). In these conditions, particularly when combined with renal or respiratory failure, greatly increases the probability of developing lactic acidosis. The metformin officially contraindicated at heart's ejection fraction <50%. The debate in literature about the admissibility of such reception in heart failure and after myocardial infarction, as well as ongoing research is give very contradictory results now [3, 5].
Application of the OHA in renal _ failure. Revealed one case of glibenclamide appointment with a decrease in the glomerular filtration rate <60 mL/min and two
- metformin. Moreover, two out of three cases these were elderly patients (71 and 73 years). Reduced kidney function greatly increases the sensitivity of patients to hypoglycemia, which is much more dangerous for elderly patients. Also, metformin and some PSD (glyburide and glimepiride) or completely removed by the kidneys, or have similar active metabolites. Glibenclamide should be changed to gliclazide, and to aged patients was better to prescribe insulin [1, 4].
Reception OHA together with drugs that change their glucose-lowering activity. In 17 patients (29.8%) diagnosed receiving using with OHA drugs to reduce their glucose-lowering activity (thiazide diuretics, nicotinic acid, phenytoin, and estrogens). In addition, 29 patients (50.9%) used medications, potentiating their hypoglycemic effect (ACE inhibitors, pentoxifylline, anabolic steroids, fluconazole, norfloxacin and fenofibrate). In all cases, to reduce the risk of lactic acidosis drugs could be easily replaced by safer analogues [2, 6].
Application of the CAP with drugs that potentially can cause lactic acidosis observed in 12 patients (24.5% of those taking metformin) - loop diuretics, alcohol-containing drugs and p2-agonists. In another case, metformin accept patients with a history of the development of lactic acidosis.
Conclusions: Using PSD of patients with DM2 was 53.8%, and metformin
- 46.2%. In the first case, the most common (42.1%) used glibenclamide and having the best pharmacological characteristics glimepiride - much less (28.0%). In general, irrational use of the OHA identified more than two thirds of patients (with severe cardiovascular disease, with drugs that alter its glucose-lowering activity, etc.). Improving the quality of the treatment of DM2 requires a thorough correction of pharmacotherapy, which justifies the need to participate in this process of clinical pharmacist.
References:
1. The tolerability and safety of DPP-4 inhibitors for the treatment of older people with type 2 diabetes mellitus: an observational study / A. Viljoen [et al.] // Br J Diabetes Vasc Dis. - 2013. - № 4(13). - P. 187-191.
2. Emergency hospitalizations for adverse drug events in older Americans / D.S. Budnitz [et al.] // N Engl J Med. - 2011. - № 21(365). - P. 2002-2012.
3. Comparison of the Efficacy of Glimepiride, Metformin, and Rosiglitazone Monotherapy in Korean Drug-Naive Type 2 Diabetic Patients: The Practical Evidence of Antidiabetic Monotherapy Study / K.H. Yoon [et al.] // Diabetes Metab J. - 2011. - № 1(35). - P. 26-33.
4. American Diabetes Association. Standards of Medical Care in Diabetes - 2012 // Diabetes Care. - 2012. - v.35 (suppl.). - S. 30-32.
5. Forbes, J.M. Mechanisms of Diabetic Complications / J.M. Forbes, M.E. Cooper // Physiol. Rev. - 2013. - № 1(93). - P. 137-188.
6. Lebovitz, H.E. Type 2 diabetes: the evolution of a disease / H.E. Lebovitz // Br J Diabetes Vasc Dis. - 2012. - № 6(12). - P. 290-298.
УДК 616.5-003.829.6
Горюнова О.Б., кандидат технических наук, доцент доцент кафедры товароведения и товарной экспертизы ФГБОУВПО «РЭУ им. Г.В. Плеханова»
Россия, г. Москва Скачкова В. А. студент 4 курса ФГБОУ ВПО «РЭУ им. Г.В.Плеханова»
Россия, г. Москва ЗАЩИТНЫЕ СВОЙСТВА КОСМЕТИЧЕСКИХ СРЕДСТВ ДЛЯ ЗАГАРА В СОЛЯРИИ И ИХ ОПРЕДЕЛЕНИЕ Безопасность загара в солярии зависит от многих факторов, в том числе от защитных свойств специальных косметических средств, предназначенных для этой процедуры. В работе представлены результаты определения солнцезащитного фактора косметических кремов для загара в солярии и их сравнительная характеристика.
Ключевые слова: загар в солярии, солнцезащитный фактор косметических средств для загара в солярии
Goryunova O.B., Candidate of Engineering Sciences, Docent Associate Professor of merchandising and product expertise department
Plekhanov Russian University of Economics
Russia, Moscow Skachkova V.A. 4 year student
Plekhanov Russian University of Economics
Russia, Moscow
PROTECTIVE PROPERTIES OF THE COSMETICS FOR TANNING IN SOLARIUM AND ITS DETERMINATION
Safety of tanning in solarium depends on many factors including protective properties of the cosmetics for tanning in solarium. The article examines the results of determination of sun protection factor for cosmetics for tanning in solarium and comparative characteristics of this cosmetics.
