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      Manifestación de una interacción farmacológica entre rivastigmina y tolterodina en un paciente geriátrico con diagnósticos de Parkinson y vejiga hiperactiva: reporte de caso Translated title: Management of the drug interaction between rivastigmine and tolterodine in one elderly patient with Parkinson and overactive bladder

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          Abstract

          RESUMEN El uso conjunto de medicamentos anticolinérgicos e inhibidores de la colinesterasa no es recomendado por los fabricantes de los productos, ya que pueden afectar la función cognitiva de los pacientes, esto se ve acentuado en la población geriátrica polimedicada. Uno de los problemas relacionados a la medicación, en los que los farmacéuticos realizan con frecuencia intervenciones, es el número de interacciones farmacológicas potenciales que pueden expresarse con los distintos medicamentos que emplean los pacientes. Presentamos el caso de un paciente con diagnóstico de Parkinson y vejiga neurogénica que presentó pérdida de la concentración y memoria asociada a una interacción farmacológica entre un inhibidor directo de la colinesterasa (rivastigmina) y un anticolinérgico (tolterodina). El mecanismo descrito para la interacción es la disminución del efecto esperado de rivastigmina por efecto de inhibición de la tolterodina en los receptores colinérgicos, impidiendo la liberación de acetilcolina y quitando así el blanco terapéutico de la enzima que se inhibe por efecto de la tolterodina. La intervención oportuna y el manejo adecuado de las interacciones farmacológicas durante la atención sanitaria es de suma importancia para evitar daños en los pacientes, incluido la exacerbación de enfermedades que se encuentran controladas, debido a la adición de otros medicamentos a la farmacoterapia.

          Translated abstract

          SUMMARY The use of anticholinergic and cholinesterase inhibitors set is not recommended by drug laboratory producers, because the use of the drugs can affect the cognitive function of the patients, this is more common in the elderly and polymedicated population. For the pharmacist is a challenge to have control of the number of potential drug interactions that can express with the different drugs that the patient has in a prescription. We present a case of an expression of drug-drug interaction between anticholinergic (tolterodine) and direct cholinesterase inhibitor (rivastigmine) in a patient with Parkinson disease and overactive bladder, the outcome of this interaction is the decrease the effect of rivastigmine by inhibition of cholinergic receptors, keep the inhibition of release acetylcholine and remove the target of the enzyme that rivastigmine inhibit, the expression of the interaction in the patient is expressed in loss of concentration and memory, the management and report of this interaction is very important for the patient with control of the disease.

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          Proposal for a new tool to evaluate drug interaction cases.

          The assessment of causation for a potential drug interaction requires thoughtful consideration of the properties of both the object and precipitant drugs, patient-specific factors, and the possible contribution of other drugs that the patient may be taking. The Naranjo nomogram was designed to evaluate single-drug adverse events, not drug-drug interactions. Several of the questions on the Naranjo nomogram do not apply to potential drug-drug interactions, while others do not specify object or precipitant drug. Nevertheless, it has been inappropriately used to evaluate drug-drug interactions. The Drug Interaction Probability Scale (DIPS) was developed to provide a guide to evaluating drug interaction causation in a specific patient. It is intended to be used to assist practitioners in the assessment of drug interaction-induced adverse outcomes. The DIPS uses a series of questions relating to the potential drug interaction to estimate a probability score. An accurate assessment using the DIPS requires knowledge of the pharmacologic properties of both the object and precipitant drugs. Inadequate knowledge of either the drugs involved or the basic mechanisms of interaction will be a limitation for some users. The DIPS can also serve as a guide in the preparation of articles describing case reports of drug interactions, as well as in the evaluation of published case reports.
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            Dual use of bladder anticholinergics and cholinesterase inhibitors: long-term functional and cognitive outcomes.

            To determine the cognitive and functional consequences of dual use of cholinesterase inhibitors (ChIs) and the bladder anticholinergics oxybutynin or tolterodine. Prospective cohort study. Nursing homes (NHs) in the state of Indiana. Three thousand five hundred thirty-six Medicaid-eligible NH residents aged 65 and older taking a ChI between January 1, 2003, and December 31, 2004. Residents were excluded if they were taking an anticholinergic other than oxybutynin or tolterodine. Indiana Medicaid claims data were merged with data from the Minimum Data Set (MDS). Repeated-measures analyses were performed to assess the effects of dual therapy on change in cognitive function measured using the MDS Cognition Scale (MDS-COGS; scored 0-10) and change in activity of daily living (ADL) function using the seven ADL items in the MDS (scored 0-28). Potential covariates included age, sex, race, number of medications, and Charlson Comorbidity Index score. Three hundred seventy-six (10.6%) residents were prescribed oxybutynin or tolterodine concomitantly with a ChI. In residents in the top quartile of ADL function, ADL function declined an average of 1.08 points per quarter when not taking bladder anticholinergics (ChI alone), compared with 1.62 points per quarter when taking dual therapy, a 50% greater rate in quarterly decline in ADL function (P=.01). There was no excess decline attributable to dual therapy in MDS-COGS scores or in ADL function for residents who started out with lower functioning. In higher-functioning NH residents, dual use of ChIs and bladder anticholinergics may result in greater rates of functional decline than use of ChIs alone. The MDS-COGS may not be sensitive enough to detect differences in cognition due to dual use.
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              World Alzheimer Report 2016: Improving healthcare for people with dementia. Coverage, quality and costs now and in the future

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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                2020
                : 30
                : 4
                : 343-346
                Affiliations
                [1] Cuautitlán Izcalli orgnameUniversidad Nacional Autónoma de México orgdiv1Facultad de Estudios Superiores Cuautitlán orgdiv2Sección de Bioquímica y Farmacología Humana Mexico
                Article
                S1699-714X2020000400015 S1699-714X(20)03000400015
                10.4321/s1699-714x2020000400015
                b79154ec-3612-40fc-97e4-ebceadaced81

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 27 August 2019
                : 11 November 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 11, Pages: 4
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                Parkinson,interacción farmacológica,rivastigmina,tolterodina,anticholinergic,inhibition,interaction,rivastigmine,tolterodine

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