Studie zur Bestandserhebung und Therapieoptimierung der Pharmakotherapie von Parkinson-Patienten nach Kriterien der Arzneimitteltherapiesicherheit

Das Parkinson Syndrom ist eine der größten neurologischen Erkrankungsgruppen. Die Prävalenz in der Gesamtbevölkerung liegt bei 108-257/100 000 Einwohnern, bei Personen älter als 65 Jahre bei 1-2%. Zurzeit gibt es ca. 220.000 Parkinson-Patienten in Deutschland. Das mittlere Erkrankungsalter liegt bei...

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Bibliographic Details
Main Author: Müller-Rebstein, Saskia Katharina Eva
Contributors: Culmsee, Carsten (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2016
Online Access:PDF Full Text
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Parkinson’s disease (PD) is one of the most relevant neurological diseases today. The prevalence in the society is 108-257/100.000. For persons older than 65 years it increases up to 1-2%. Currently 220.000 persons suffer from PD in Germany. The mean age at the onset of PD is 55-60 years. Because of the demographic development, the PD evolves to a very widespread disease with a high relevance for the healthcare system. Due to the correlated age-related diseases, PD usually occurs with many concomitant diseases. Additionally, PD goes along with many non-motor problems. Especially geriatric patients often have comodbidities of the cardiovascular system, which need to be monitored during the therapy or could even be contraindicated. This complex cluster of symptoms often causes a pronounced polypharmacy, which is a risk factor for drug safety. During this study the medication regime of inpatients of a neurological hospital specialized for PD was analysed on admission and discharge. A prospective observational study with at at least 100 patients was conducted in a neurological hospital specialized for PD on 26 days of presence over a period of 14 months. Inclusion criteria were the following: 1. stationary hospitalized in the Paracelsus-Elena-Clinic, 2. diagnosis of PD, 3. at least one comorbidity, which required additional pharmacotherapy, 4. polypharmacy in the medication regime at discharge, i.e. at least five different medications, 5. accepted consent form to participate in the study, 6. personal briefing about the study conducted by the pharmacist. The aim of this study was the detection of the most common and most serious drug-related problems in the pharmacotherapy of PD. Due to the population of the study, the evaluated medication was typical for patients in a late stage of PD. Desired and undesired relevant drug interactions as well as contraindications were indicated by analyzing the professional information provided by the manufacturers. Consequently guidance for an optimized pharmacotherapy of PD were identified. Applied on a wider group of PD patients, this guidance for an improved pharmacotherapy of PD can directly improve the drug safety for the full range of PD patients. 127 patients were included in the study. The mean age of the population was 70,2 years (+/- 9.7 years). The median Hoehn&Yahr stage of all included patients was IV. Levodopa, Entacapone and Pramipexol were the most often prescriped PD agents. The biggest group of comedication were agents for the cardiovascular system, the nervous system and the alimentary system. For legibility reasons the interactions and contraindications of all PD agents were clustered. Three clusters of interactions were found in the medication analysis: • Interactions with CNS active drugs • CYP-Interactions • Interactions with QT-time prolonging drugs Contraindications were clustered into four groups: • Internistic contraindications • Neurological contraindications • Haemetopoietic contraindications • Contraindications due to QT-time prolonging drugs in the comedication All other interactions and contraindications were pooled in the cluster “others”.