Læknablaðið : fylgirit - 03.01.2017, Blaðsíða 63

X V I I I V Í S I N D A R Á Ð S T E F N A H Í
F Y L G I R I T 9 1
LÆKNAblaðið/Fylgirit 91 2017/103 63
V 1 Blóðnatríumlækkun á bráðamóttökum Landspítala:
Lyf sem orsakavaldur
Guðrún Sigurðardóttir1, Pétur S. Gunnarsson1, Anna I. Gunnarsdóttir1, Elín I.
Jacobsen2, Runólfur Pálsson3, Ólafur S. Indriðason3
1Lyfjafræðideild Háskóla Íslands, 2Landspítala, 3læknadeild Háskóla Íslands
gus71@hi.is
Inngangur: Ýmis lyfseðilsskyld lyf eru talin algeng orsök blóðnatríum-
lækkunar. Markmið rannsóknarinnar var að kanna tíðni blóðnatríum-
lækkunar (natríum í sermi (SNa) <135mmól/L) hjá sjúklingum sem leit-
uðu á bráðamóttökur Landspítala (BMT) og tengsl natríumlækkunar við
lyfjanotkun.
Aðferðir: Þetta var afturskyggn faraldsfræðirannsókn þar sem gagna var
aflað úr rafrænu sjúkraskrárkerfi Landspítala fyrir alla sjúklinga 18 ára og
eldri sem komu á BMT árið 2014. Upplýsinga um lyf sjúklinga með blóð-
natríumlækkun og einstaklinga í pöruðum viðmiðunarhópi sjúklinga á
BMT sem höfðu eðlilegt SNa var aflað úr lyfjagagnagrunni landlæknis og
lyfjanotkunin borin saman með McNemar-prófi. Hóparnir voru paraðir
með tilliti til aldurs, kyns, nýrnastarfsemi og ákveðinna sjúkdómsgrein-
inga. Kaplan-Meier-aðferð var notuð við lifunargreiningu og log-rank
próf við samanburð hópa.
Niðurstöður: Alls komu 40.365 einstaklingar á BMT (58.137 heimsóknir).
SNa var mælt í 26.474 heimsóknum 19.159 einstaklinga. Blóðnatríum-
lækkun fannst í 2287 komum 1785 einstaklingum; 62,5% þeirra voru
konur. Tíðni blóðnatríumlækkunar jókst með aldri og var 12,8% hjá
einstaklingum >70 ára. Í samanburði við viðmiðunarhópinn höfðu fleiri
sjúklingar með blóðnatríumlækkun fengið ávísun á tíazíð (25,6% vs.
19,6%, p<0,001), amíloríð (11,0% vs. 7,4%, p<0,001), aldósterónblokka (8,7
vs. 5,5%, p<0,001), PPI-lyf (42,1% vs. 36,9%, p<0,001). Ekki var marktækur
munur á notkun SSRI-lyfja (21,7% vs. 21,3%, p=0.74). Eins árs lifun sjúk-
linga með blóðnatríumlækkun var marktækt verri en viðmiðunarhóps
(78,3% vs 84,6%, p<0,001).
Ályktanir: Blóðnatríumlækkun er algeng meðal sjúklinga á BMT, einkum
hjá eldra fólki og konum, Tíazíð, aldósterónblokkar og PPI-lyf eru líkleg-
ir orsakavaldar blóðnatríumlækkunar og ætti að fara varlega við ávísun
þeirra, þar sem aukin dánartíðni tengist blóðnatríumnækkun.
V 2 Drugs that can cause respiratory depression with concomitant
use of opioids
Bylgja D. Sigmarsdóttir1, Pétur S. Gunnarsson2, Þórunn K. Guðmundsdóttir2,
Sigríður Zoëga3
1Pharmacy, Landspitali – University Hospital, 2Faculty of Pharmaceutical Sciences, UI, 3Faculty
of Nursing, UI
bds5@hi.is
Background: Respiratory depression is a serious life threatening condition
and a known adverse event of opioids. Little i known about the use, the
opioid antidote naloxon in Iceland, and the additive effects of other
potentially respiratory depressive drugs administered with opioids.
Methods: A review and analysis of drugs that can cause respiratory
depression based on information from the scientific literature, medicine
databases and clinical guidelines. A retrospective study was performed
using data collected from the electronic medical records system of
Landspítali University Hospital for all patients, 18 years and older that
had parenteral naloxon administered in the years 2010-2014. Information
about the type of opioid and other respiratory depressive drugs was
collected and the data was further investigated in regards to age, gender
and type of service.
Results: The most potential drugs and drug classes that can cause
respiratory depression when used concomitantly with opioids are
benzodiazepines and other anxiolytics, hypnotics and sedatives, antip-
sychotics, antiepileptics, antihistamins and anesthetics. When use was
examined (n=138) morphine was the most frequent opioid given (49%).
Concominant use of opioids and other respiratory depressive drugs was
seen in 63% of cases, and benzodiazepines were the most frequent drugs
given with opioids (33%).
Conclusion: The concomitant use of benzodiazepines and other sedati-
ve drugs with opioids is frequent, despite the known risk of additive
respiratory depression as described in the literature. Other patient risk
factors such as medical condition, general health and consciousness
should be considered in context with drugs used.
V 3 Majority of patients with psoriatic arthritis are not eligible for
controlled clinical trials
Eydís Rúnarsdóttir1, Anna I. Gunnarsdóttir1,2, Pétur S. Gunnarsson1,2, Þorvarður J.
Löve3, Björn Guðbjörnsson3
1Lyfjafræðideild HÍ, 2Sjúkrahúsapóteki Landspítala, 3læknadeild HÍ, rannsóknarstofu í
gigtarsjúkdómum, Landspítala
annaig@landspitali.is
Objective: To elucidate the proportion of patients with psoriatic arthritis
(PsA) who would meet inclusion criteria of the controlled clinical studies
that were performed leading up to the registration of the TNF inhibitors
(TNFi).
Methods: Data from 329 patients with PsA were obtained from ICEBIO
and medical records at the University Hospital of Iceland and Laekna-
setrid (a private out-patient clinic). The patients were classified accord-
ing to whether they met inclusion criteria of the clinical trials that were
used as data for the registration of each respective TNFi. The reasons for
exclusion were also explored.
Results: 34% of the patients with complete data available met the inclusion
criteria, while 66% of patients did not. Insufficient clinical data in respect
to exclusion and inclusion criteria were available for 13% of the cases. The
proportion of patients who met the inclusion criteria was highest among
those who received adalimumab and etanercept (53%). Patients who
received infliximab had the highest exclusion rate (77%). The main reason
why patients did not meet the inclusion criteria was that their PsA disease
was not sufficiently active (45%).
Conclusions: Our results demonstrate that two thirds of patients with
PsA in Iceland who are treated with biologics would not have qualified
for the pharmacotherapy trials performed leading up to the registration
of the medications. Further studies with regards to whether outcomes are
different between those who met the inclusion criteria and those who did
not remain to be performed.
ÁGRIP VEGGSPJALDA