PubMed · 11045421
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R L Siegel. Sildenafil-nitrate interactions.. https://doi.org/10.1080/10903120090941173
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OBJECTIVE: The objective of this study is to assess the usefulness of a programme of attention to pharmaceutical prescriptions (APP) so as to detect medicine-related problems. DESIGN: A descriptive study of the findings after six months operation of this programme. SETTING: Five primary care centres in the Bahía-Cádiz Area. PATIENTS: All the patients (499) who requested advice on their drug therapy and were included at the request and on the criterion of their doctor were studied. INTERVENTION: We introduced the APP programme for chronic patients, with two basic aims: Care: to detect medicine-related problems and propose individual solutions. Teaching: to bring drug-therapy skills used in clinical practice into line with the scientific evidence available. MEASUREMENTS AND RESULTS: We focused on the detection of problems related to the most common medicines, with direct and relevant incidence on morbidity and mortality. We detected 236 cases (47%) of possible therapeutic improvement that had important implications for associated morbidity, of which 114 (23%) also had implications for mortality. 56% of the patients took more than 4 medicines, multiple medication that could easily be reduced in 43.5% of cases, so avoiding the use of medicines of low intrinsic value. CONCLUSIONS: The programme was very useful, as numerous very clinically relevant problems were detected and information was gained that the doctor can use to bring drug therapy into line with the available scientific evidence.
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Pharmacogenetics deals with the differences in effect of drugs caused by genetic variation. Differences can occur in therapeutic effect and in adverse events. Genetic variation in metabolism may result in high concentrations of drugs and an increased risk of adverse effects in slow metabolizers, which is important when using for example antidepressants or chemotherapy. Genetic variation also occurs in proteins interacting with drugs, which may change the effect of e.g. asthma drugs and antipsychotics. The selection of drugs and their dosages may be improved, and the number of adverse effects reduced by pharmacogenetic investigations. However, it may be important also in case of medical examinations for insurances and job appointments, since some patients may turn out to need expensive drugs or to be susceptible to a certain disease. Therefore, the use of genetic data in these instances has to be regulated.