Baixe o app para aproveitar ainda mais
Prévia do material em texto
Interciência & Sociedade72 POLIMEDICAÇÃO EM IDOSOS RESUMO: 2�DXPHQWR�GD�SRSXODomR� LGRVD� �HQYHOKHFLPHQWR��p�XP� IDWRU�TXH�DEUDQJH� WRGRV�RV�SDt� VHV� VHP� GLVFULPLQDomR�� WHQGR� RFRUULGR�� KLVWRULFDPHQWH�� HP� SDtVHV� GHVHQYROYLGRV� H�� QD� VHTXrQFLD�� HP�HPHUJHQWHV��$�H[SOLFDomR�SDUD�HVWH�IDWR�VH�EDVHLD�QD�PHOKRULD�GDV�FRQGLo}HV�GH�YLGD�GDV�SRSX� ODo}HV��DYDQoRV�QD�PHGLFLQD��PHOKRULD�QR�VDQHDPHQWR�EiVLFR�H�� FXLGDGRV�FRP�D�VD~GH� LQGLYLGXDO�� 8PD�REVHUYDom¤R�LPSRUWDQWH�TXH�SRGH�VHU�IHLWD�QHVWD�SDUFHOD�GD�SRSXODomR�PXQGLDO�p�R�XVR�GH�YiULRV� PHGLFDPHQWRV�� DXWRPHGLFDomR�� UHDo}HV� DGYHUVDV� DRV�PHGLFDPHQWRV�� LQWHUDo}HV�PHGLFDPHQWRVDV�� SUREOHPDV�TXDQWR�D�QmR�DGHVmR�DR�WUDWDPHQWR�H�GLPLQXLomR�GD�TXDOLGDGH�GH�YLGD�GR�LGRVR� PALAVRAS-CHAVE: ,GRVRV��0HGLFDPHQWRV��6D~GH ABSTRACT: The increase in the aging of the population is a factor that covers all countries without GLVFULPLQDWLRQ��KDYH�RFFXUUHG�KLVWRULFDOO\��¿UVW��LQ�GHYHORSHG�FRXQWULHV�DQG�WKHQ�LQ�HPHUJLQJ�FRXQWULHV�� The explanation for this fact is based on improving the living conditions of populations, advances in medicine, improved sanitation and individual health care. An important observation that can be made in this portion of the world population is the use of various medications, self-medication, adverse drug reactions, drug interactions, problems as non-adherence to treatment and decreased quality of life of the elderly. KEYWORDS: Elderly, Drugs, Health. ROSA, Gabriela Rotello JDELURWHOOR#KRWPDLO�FRP &HQWUR�5HJLRQDO�8QLYHUVLWiULR�GH�(VStULWR�6DQWR�GR�3LQKDO��81,3,1+$/� CAMARGO, Eliana Anunciato Franco HDIFDPDUJR#\DKRR�FRP�EU 8QLYHUVLGDGH�(VWDGXDO�GH�&DPSLQDV��81,&$03� &HQWUR�5HJLRQDO�8QLYHUVLWiULR�GH�(VStULWR�6DQWR�GR�3LQKDO��81,3,1+$/� 1 - INTRODUÇÃO 6HJXQGR�D�2UJDQL]DomR�3DQ�$PH� ULFDQD�GH�6D~GH��23$6��� HQYHOKHFLPHQWR� p� XP� SURFHVVR� VHTXHQFLDO�� LQGLYLGXDO�� FXPXODWLYR�� LUUHYHU� VtYHO�� QmR� SDWROyJLFR�� GH� GHWHULRUDomR� GH� XP�RUJDQLVPR�PDGXUR�H�SUySULR�D�WRGRV�RV� PHPEURV�GH�XPD�HVSpFLH��GH�PDQHLUD�TXH� R� WHPSR�WRUQH�RV�PHQRV�FDSD]HV�GH�ID]HU� IUHQWH�DR�HVWUHVVH�GR�PHLR�DPELHQWH�H��SRU� WDQWR��DXPHQWH�VXD�SRVVLELOLGDGH�GH�PRUWH� �%5,&2/$�HW�DO��������� 6HQGR� R� HQYHOKHFLPHQWR� XP� SUR� FHVVR� ELROyJLFR� TXH� RFRUUH� QDWXUDOPHQWH�� FRP� HOH�� RV� yUJmRV� H� VXDV� IXQo}HV� ¿FDP� SUHMXGLFDGRV��WHQGR�FRPR�XPD�GDV�PXGDQ� oDV� j� DOWHUDomR� GDV� DWLYLGDGHV� UHDOL]DGDV� SHORV�PHGLFDPHQWRV�QR�RUJDQLVPR��&RPR�R� RUJDQLVPR�Mi�QmR�UHVSRQGH�FRPR�DQWHV��DX� PHQWDP�VH�DV�SDWRORJLDV�FU{QLFDV�H�VXUJH�D� SROLPHGLFDomR�TXH�p�XP�SUREOHPD�GH�VD~GH� S~EOLFD��GHYLGR�DR�DXPHQWR�GRV�FXVWRV�FRP� VHUYLoRV� GH� VD~GH� H� PHGLFDPHQWRV�� VHP� que isso se traduza em aumento da qua� OLGDGH�GH�YLGD�GHVWD�SDUFHOD�GD�SRSXODomR� �628=$�HW�DO���������6$17,6�������� $� SROLPHGLFDomR�� WDPEpP� FRQKH� FLGD�FRPR�SROLIDUPiFLD�RX�SROLIDUPDFRWHUD� SLD��VLQ{QLPRV�GH�XVR�VLPXOWkQHR�H�GH�IRUPD� FU{QLFD�GH�IiUPDFRV�SDUD�GRHQoDV�H�VLQWR� PDV�GLVWLQWRV�SHOR�PHVPR�LQGLYLGXR��SUiWLFD� FDGD�YH]�PDLV�IUHTXHQWH�HP�LGRVRV��DXPHQ� WD�D�SUREDELOLGDGH�GH�UHDo}HV�DGYHUVDV�DR� PHGLFDPHQWR��LQWHUDo}HV�PHGLFDPHQWRVDV�� GLPLQXLomR�GD�DGHVmR�DR�WUDWDPHQWR�H�WR[L� cidade, entre outros fatores. Diante disso, FDEH�DRV�SUR¿VVLRQDLV�GD�VD~GH�DGRWDUHP� HVWUDWpJLDV� SDUD� PHOKRUDU� D� GLQkPLFD� GR� XVR�GH�PHGLFDPHQWRV�SHORV� LGRVRV�� IUHQWH� jV�SHFXOLDULGDGHV�GHVWH�JUXSR�GH�SHVVRDV� $� SROLPHGLFDomR� p� FRQVLGHUDGD� XP�SUREOHPD�GH� VD~GH� S~EOLFD�� TXH� UHÀH� WH� FRQGLo}HV� VRFLRHFRQ{PLFDV� GHVIDYRUi� Interciência & Sociedade73 ,QWHUFLrQFLD� �6RFLHGDGH��,661���������������9RO�����1��������� YHLV� WDQWR�SDUD�R�(VWDGR� �UHVSRQViYHO� SRU� GLVSRQLELOL]DU� PHGLFDomR� QHFHVViULD� QDV� XQLGDGHV�EiVLFDV�GH�VD~GH�H�VROXFLRQDU�D� GHPDQGD�SRU�PpGLFRV�HVSHFLDOLVWDV��TXDQ� WR�SDUD�D�SRSXODomR�LGRVD�TXH�HQFRQWUD�LQ~� PHUDV�GL¿FXOGDGHV�HP�UHODomR�j�XWLOL]DomR� GH�PHGLFDPHQWRV�� D� VDEHU�� GL¿FXOGDGH� GH� ORFRPRomR�SDUD� EXVFD� �DTXLVLomR�� H�� SULQ� FLSDOPHQWH��GL¿FXOGDGH�GH�HQWHQGLPHQWR�GD� SUHVFULomR�� LQFOXLQGR�R�PRGR�GH�XWLOL]DomR�� 7DLV�GL¿FXOGDGHV�UHVXOWDP�QD�GLPLQXLomR�GD� DGHVmR�DR�WUDWDPHQWR�H�QD�EDL[D�TXDOLGDGH� GH�YLGD�REVHUYDGD�QHVWHV�SDFLHQWHV� 2. EPIDEMIOLOGIA DO ENVELHECIMEN- TO $� ORQJHYLGDGH� p� VHP� G~YLGD� XP� WULXQIR�� 1R�HQWDQWR��DV�FRQGLo}HV�GH�YLGD�REVHUYD� GDV�HP�SHVVRDV�LGRVDV�YDULD�JUDQGHPHQWH� TXDQGR�VH�FRQVLGHUD�SDtVHV�GHVHQYROYLGRV� H�SDtVHV�HP�GHVHQYROYLPHQWR��1RV�GHVHQ� YROYLGRV��R�HQYHOKHFLPHQWR�RFRUUH�DVVRFLD� GR�jV�PHOKRULDV�QDV�FRQGLo}HV�GH�YLGD��SR� UpP�� QRV� SDtVHV� HP� GHVHQYROYLPHQWR�� HP� FRQWUDSDUWLGD�� HVVH� SURFHVVR� DFRQWHFH� GH� IRUPD�UiSLGD��QmR�SHUPLWLQGR�DR�LQGLYtGXR�H� DR�SRGHU�S~EOLFR��WHPSR�SDUD�XPD�UHRUJDQL� zação social e consequente reestruturação GD�iUHD�GH�VD~GH��GH�PRGR�TXH�HVWD�VHMD� DGHTXDGD� SDUD� DWHQGHU� DV� QRYDV� GHPDQ� GDV� HPHUJHQWHV�� 2� HQYHOKHFLPHQWR� DQWHV� YLVWR�FRPR�IHQ{PHQR��KRMH�ID]�SDUWH�GD�UHD� OLGDGH�GDV�VRFLHGDGHV��%5$6,/�������� (VSHFL¿FDPHQWH� VREUH� R�%UDVLO�� D� SDUFHOD� GH� LGRVRV� QD� SRSXODomR� YHP� DX� PHQWDQGR� QDV� ~OWLPDV� GpFDGDV�� (QWUH� R� SHUtRGR�GH������H�������KRXYH�XP�FRQVL� GHUiYHO� DXPHQWR� GD� H[SHFWDWLYD� GH� YLGD� GD� SRSXODomR�� GHYLGR�� DV� Do}HV� GH� VD~GH� S~EOLFD�� YDFLQDomR�� VDQHDPHQWR� EiVLFR� H� DRV�DYDQoRV�PpGLFR�WHFQROyJLFRV��(P�WRGR� PXQGR� D� SURSRUomR� GH� SHVVRDV� FRP� ��� DQRV�RX�PDLV�HVWi�FUHVFHQGR�UDSLGDPHQWH�� WUDWD�VH�GH�XPD�UHVSRVWD�jV�PXGDQoDV�GH� DOJXQV�LQGLFDGRUHV�GH�VD~GH��HVSHFLDOPHQ� te a queda da mortalidade e aumento da HVSHUDQoD�GH�YLGD��8P�IDWRU�QHJDWLYR�SUR� YHQLHQWH�GR�HQYHOKHFLPHQWR��p�TXH�R�PHV� PR�VRIUH�LQÀXrQFLDV�GRV�SURFHVVRV�GH�GLV� FULPLQDomR��H[FOXVmR�DVVRFLDGR�DR�JrQHUR�� HWQLD�� UDFLVPR��FRQGLo}HV�VRFLDLV�H�HFRQ{� PLFDV��UHJLmR�GHPRJUi¿FD�H�ORFDOL]DomR�GH� PRUDGLD�� �%5,&2/$� HW� DO��� ������ %5$6,/�� ������ 6HJXQGR�DV�SURMHo}HV�HVWDWtVWLFDV� GD�2UJDQL]DomR�0XQGLDO�GD�6D~GH��206��� HVWLPD�VH� TXH� HQWUH� RV� DQRV� GH� ����� H� ������D�SRSXODomR�GH�LGRVRV�QR�SDtV�FUHV� FHUi����YH]HV�FRQWUD���YH]HV�GD�SRSXODomR� total, o que nos colocará em termos absolu� WRV�FRPR�SRUWDGRUHV�GD�VH[WD�PDLRU�SRSX� ODomR�GH� LGRVRV�GR�PXQGR�� LVWR�p��FRP���� PLOK}HV�GH�SHVVRDV�FRP����DQRV�RX�PDLV� �%5,&2/$�HW�DO��������� 3. DOENÇAS PREVALENTES NOS IDO- SOS 2�HQYHOKHFLPHQWR� QRUPDO� �VHQHVFrQFLD�� p� TXDQGR� RFRUUHP� DOWHUDo}HV� LQHYLWiYHLV� QR� funcionamento do organismo relacionadas FRP�D�LGDGH��FRPR�DSDUHFLPHQWR�GH�UXJDV� QD�SHOH��PXGDQoD�QD�FRORUDomR�GRV�FDEHORV� H�PHQRU�UHVLVWrQFLD�ItVLFD��3RUpP�GHYH�VHU� GLIHUHQFLDGR�GR�HQYHOKHFLPHQWR�SDWROyJLFR� �VHQLOLGDGH��� TXH� VH� WUDWD� GDV� FRQVHTXrQ� FLDV�GH�FHUWDV�GRHQoDV��FRPR��RVWHRSRURVH�� FDWDUDWD��$O]KHLPHU��3(/(*5,12�������� 7DPEpP� SRGH� VHU� FRPSUHHQGLGR� FRPR�XP�SURFHVVR�QDWXUDO�� FRQWtQXR�� LQGL� YLGXDO�H�LUUHYHUVtYHO��GH�GLPLQXLomR�SURJUHV� VLYD�GD�UHVHUYD�IXQFLRQDO�GRV�LQGLYtGXRV��R� TXH� HP� FRQGLo}HV� QRUPDLV� QmR� FRVWXPD� SURYRFDU� JUDQGHV� SUREOHPDV�� (P� FRQGL� o}HV�GH�VREUHFDUJD��R�HQYHOKHFLPHQWR�SD� WROyJLFR��QDV�GRHQoDV��HVWUHVVH�HPRFLRQDO�� DFLGHQWHV��� SRGH� RFDVLRQDU� XPD� FRQGLomR� SDWROyJLFD�TXH�H[LMD�DVVLVWrQFLD��VDOLHQWDQ� GR� TXH� FHUWDV� DOWHUDo}HV� SRGHP� WHU� VHXV� HIHLWRV�GLPLQXtGRV�SHOD�DVVLPLODomR�GH�XP� HVWLOR� GH� YLGD� PDLV� DWLYR� �%5$6,/�� ������ 3(/(*5,12�������� $� 7DEHOD� �� DSUHVHQWD� XP� HVWXGR� realizado no Rio Grande do Sul com idosos e as UHVSHFWLYDV� SRUFHQWDJHQV� GDV� GRHQoDV� PDLV�FRPXQV�HQFRQWUDGDV�QDTXHOD�UHJLmR�SDUD� R�DQR�GH������ Interciência & Sociedade74 ,QWHUFLrQFLD� �6RFLHGDGH��,661���������������9RO�����1��������� Doenças Percentual (%) 'RHQoDV�FDUGLRYDVFXODUHV ���� 'RHQoDV�HQGyFULQDV�QXWULFLRQDLV�H�PHWDEyOLFDV ���� 'RHQoDV�GR�VLVWHPD�RVWHRPXVFXODU�H�WHFLGR�FRQMXQWLYR ���� 7UDQVWRUQRV�PHQWDLV�H�GH�FRPSRUWDPHQWR ���� 'RHQoDV�GRV�ROKRV�H�DQH[RV ��� 'RHQoDV�GRV�DSDUHOKR�JHQLWXULQiULR��� 'RHQoDV�UHVSLWDUyULDV ��� 'RHQoDV�GR�VLVWHPD�QHUYRVR ��� Outros ��� Tabela 1 ±�'RHQoDV�SUHYDOHQWHV�REVHUYDGDV�HP�XP�HVWXGR�UHDOL]DGR�QR�(VWDGR�GR�5LR�*UDQGH�GR� 6XO������� )RQWH��*$87e5,2�HW�DO������� 4. MUDANÇAS FISIOLÓGICAS NO META- BOLISMO DO IDOSO $V� PXGDQoDV� ¿VLROyJLFDV� GHFRU� rentes da idade alteram a absorção, dis� WULEXLomR�� R� PHWDEROLVPR� H� H[FUHomR� GH� IiUPDFRV��SRLV�PRGL¿FDP�D�DomR�GHVWHV�H� DIHWDP�VXD�FRQFHQWUDomR�QR�VLWLR�UHFHSWRU�� (VVDV� DOWHUDo}HV� VmR� FRPXQV� D� WRGDV� DV� SHVVRDV�TXH�HQYHOKHFHP��SRUpP��VHX�LQLFLR� H�LQWHQVLGDGH�YDULDP�GH�LQGLYLGXR�SDUD�LQGL� YLGXR��3(/(*5,12�������� 'HQWUH� DV� PXGDQoDV� ¿VLROyJLFDV� GHVWDFDP�VH�DOWHUDo}HV�QD�FRPSRVLomR�GD� PDVVD�FRUSRUDO��HVWDWXUD��IXQo}HV�FDUGtDFD�� SXOPRQDU��UHQDO�H�GLJHVWLYD��VLVWHPDV�QHUYR� VR�H�HQGyFULQR��3(/(*5,12�������� As mudanças decorrentes da com� SRVLomR� FRUSRUDO�� PHWDEROLVPR� EDVDO�� ÀX� [R� VDQJXtQHR� KHSiWLFR� H� WD[D� GH� ¿OWUDomR� JORPHUXODU� SRGHP� SUHMXGLFDU� D� DEVRUomR�� GLVWULEXLomR�� PHWDEROL]DomR� H� H[FUHomR� GD� maioria dos fármacos. Por isso, os idosos WHQGHP� D� DSUHVHQWDU� UHDo}HV� DGYHUVDV� D� PHGLFDPHQWRV�HP�WD[DV�PDLV�HOHYDGDV�TXH� D�SRSXODomR�GH�PHQRV�LGDGH��%5,&2/$�HW� DO��������� �����$OWHUDo}HV�)DUPDFRFLQpWLFDV $V� DOWHUDo}HV� GR� WLSR� IDUPDFRFL� QpWLFDV� HQYROYHP� SURFHVVRV� GHVGH� D� DG� PLQLVWUDomR�� DEVRUomR� DWp� D� H[FUHomR� GRV� IiUPDFRV�GR�RUJDQLVPR��(VFROKHU�D�YLD�GH� DGPLQLVWUDomR� GH� XP� DJHQWH� WHUDSrXWLFR� SRVVXL�YDQWDJHQV�H�GHVYDQWDJHQV�TXH�GH� SHQGHP�GDV�SURSULHGDGHV�GR�IiUPDFR��IRU� PD�IDUPDFrXWLFD��ORFDLV�GH�DEVRUomR��DOpP� GH�FDUDFWHUtVWLFDV�GR�SDFLHQWH�H�TXDGUR�SD� WROyJLFR��6,/9$�������� Em idosos, a administração de IRUPDV�IDUPDFrXWLFDV�RUDLV�SRGH�VHU�SUHMX� GLFDGD� GHYLGR� DR� ³DIURX[DPHQWR´� GD�PXV� FXODWXUD� RURIDUtQJHD�H� GLPLQXLomR�GR� ÀX[R� VDOLYDU��WRUQDQGR�D�ERFD�VHFD��RFDVLRQDQGR� GHVWD� IRUPD�� SUREOHPDV�GH�GHJOXWLomR�GRV� PHGLFDPHQWRV�QHVWHV�LQGLYtGXRV��%5,&2/$� HW�DO��������� 2XWUD�REVHUYDomR�D�VHU�IHLWD�p�UH� ODWLYD� j� DEVRUomR� GR� IiUPDFR��3DUD� TXH� R� PHVPR�DWLQMD� VHX� ORFDO� GH�DomR�p� SUHFLVR� TXH� DWUDYHVVH� EDUUHLUDV� ELROyJLFDV� DWp� R� VDQJXH��$OpP� GLVVR�� D� DEVRUomR� SRGH� VHU� LQÀXHQFLDGD�SRU� IDWRUHV�FRPR� OLSRVVROXELOL� GDGH��KLGURVVROXELOLGDGH��HVWDELOLGDGH��SHVR� PROHFXODU�� FDUJD� HOpWULFD�� IRUPD� IDUPDFrX� tica, concentração no local de absorção e YHORFLGDGH�GH�GLVVROXomR�GR�IiUPDFR��6,/� 9$�������� 2�SURFHVVR�GH�HQYHOKHFLPHQWR�DO� WHUD�IXQo}HV�JDVWURLQWHVWLQDLV�TXH�DJHP�VR� EUH� D� DEVRUomR�GHVWHV� FRPSRVWRV��2EVHU� YD�VH�XP�DXPHQWR�GR�S+�JiVWULFR�� GHYLGR� D� UHGXomR�QD�SURGXomR�GH�iFLGR�FORUtGULFR� �+&/�� H� VHFUHomR� JiVWULFD�� RFRUUH� DWUDVR� QR�HVYD]LDPHQWR�JiVWULFR�SRU�XPD�PRWLOLGD� GH�GLPLQXtGD�H�UHGX]LGD�iUHD�GH�DEVRUomR�� alterando a ionização e solubilidade dos fármacos e/ou aumentando a degradação VHFXQGiULD� j� DomR� GR� iFLGR� FORUtGULFR� QRV� Interciência & Sociedade75 ,QWHUFLrQFLD� �6RFLHGDGH��,661���������������9RO�����1��������� PHGLFDPHQWRV��%5,&2/$�HW�DO���������0$� 7,$6��������� 2FRUUH�XPD�UHGXomR�GR�ÀX[R�VDQ� JXtQHR� KHSiWLFR�� UHWDUGDQGR� D� DEVRUomR�� 7DPEpP� RFRUUH� GLPLQXLomR� GR� HIHLWR� GH� SULPHLUD� SDVVDJHP� KHSiWLFD� DXPHQWDQGR� D�GLVSRQLELOLGDGH�GDV�GURJDV�QD�FLUFXODomR� VLVWrPLFD��%5,&2/$�HW�DO��������� �����$OWHUDo}HV�)DUPDFRGLQkPLFDV 'XUDQWH�R�HQYHOKHFLPHQWR�RFRUUHP� DOWHUDo}HV� D� QtYHLV� PROHFXODUHV�� FHOXODU�� WHFLGXDO� H� RUJkQLFR�� TXH� FRQWULEXHP� SDUD� D� GLPLQXLomR� SURJUHVVLYD� GD� FDSDFLGDGH� IXQFLRQDO��$�FDSDFLGDGH�GH�PDQXWHQomR�GD� KRPHRVWDVH��PDQXWHQomR�GR�HTXLOtEULR��p�R� SULQFLSDO�IDWRU�TXH�GLIHUHQFLD�R�LGRVR�GR�MR� YHP���3(/(*5,12�������� $V� DOWHUDo}HV� GRV� PHFDQLVPRV� homeostáticos em idosos está relaciona� GR� j� DSDUHQWH� DOWHUDomR� GD� VHQVLELOLGDGH� D� GLYHUVRV� IiUPDFRV�� GHFRUUHQWHV� GD� GL� PLQXLomR� GH� YiULDV� IXQo}HV� RUJkQLFDV� WDLV� FRPR��UHGXomR�QD�DomR�GR�VLVWHPD�QHUYRVR� DXW{QRPR�� FRP� R� DXPHQWR� GD� KLSRWHQVmR� RUWRVWiWLFD�H�GLVIXQo}HV�UHQDLV�H�LQWHVWLQDLV�� PHQRU�FRQWUROH�SRVWXUDO��GL¿FXOGDGH�GD�WHU� PRUUHJXODomR�� GLPLQXLomR� GD� FDSDFLGDGH� FRJQLWLYD��DOWHUDo}HV�PHWDEyOLFDV��DXPHQWR� GD�LQWROHUkQFLD�D�JOLFRVH�H�UHVSRVWD�LPXQR� OyJLFD�GLPLQXtGD��SDUWLFXODUPHQWH�D�FHOXODU�� �6,/9$�HW�DO���������%5,&2/$�HW�DO��������� 3RGHP� RFRUUHU� PRGL¿FDo}HV� QRV� UHFHSWRUHV�H�VtWLRV�GH�DomR�FRP�YiULRV�SRQ� WRV�HQWUH�D� LQWHUDomR� IiUPDFR�UHFHSWRU�H�R� HIHLWR�IDUPDFROyJLFR�¿QDO��(VVDV�DOWHUDo}HV� IUHTXHQWHPHQWH�VH�LQLFLDP�SRU�YROWD�GRV���� DQRV� GH� LGDGH�� H� VH� UHODFLRQDP� HVSHFLDO� PHQWH�D�UHFHSWRUHV�HVSHFt¿FRV��EHWD�DGUH� QpUJLFRV��DOID�DGUHQpUJLFRV��FROLQpUJLFRV���H� aumento da sensibilidade aos benzodiaze� StQLFRV�UHODFLRQDGRV�FRP�UHFHSWRUHV�*$%$� �%5,&2/$�HW�DO���������6,/9$�HW�DO��������� 5. USO RACIONAL DE MEDICAMENTOS PELA POPULAÇÃO IDOSA 'H¿QH�VH� FRPR� ³XVR� UDFLRQDO� GH� PHGLFDPHQWRV´� TXDQGR� RV� SDFLHQWHV� UH� FHEHP�R�PHGLFDPHQWR� DGHTXDGR� jV� VXDV� QHFHVVLGDGHV� FOtQLFDV�� QDV� GRVHV� FRUUHV� SRQGHQWHV�DV�QHFHVVLGDGHV�LQGLYLGXDLV��GX� UDQWH�XP�SHUtRGR�GH�WHPSR�DGHTXDGR�H�DR� PHQRU�FXVWR�SDUD�D�FRPXQLGDGH��%5,&2/$� HW�DO��������� 2�JUDQGH�GHVD¿R�GRV�SUR¿VVLRQDLV� GD�iUHD�GD�VD~GH�p�FRQWULEXLU�QD�SURPRomR� GR� XVR� UDFLRQDO� GRV� PHGLFDPHQWRV�� YLVWR� TXH�RV�LGRVRV�XWLOL]DP�XP�Q~PHUR�HOHYDGR� GH� HVSHFLDOLGDGHV� IDUPDFrXWLFDV� GLVWLQWDV�� FRQWULEXLQGR�PXLWDV�YH]HV�SDUD�R�XVR� LUUD� cional desses medicamentos, que se traduz QR� FRQVXPR� H[FHVVLYR� GH� PHGLFDomR� VX� SpUÀXD��RFDVLRQDQGR�IDWRUHV�QHJDWLYRV�TXH� SUHMXGLFDP�D�VXD�TXDOLGDGH�GH�YLGD��%25� 72/21�HW�DO����������$VVLP��FDEH�DRV�SUR� ¿VVLRQDLV�GD�iUHD�GD�VD~GH�FRQVFLHQWL]DU�H� RULHQWDU�D�SRSXODomR�LGRVD�H�VHXV�FXLGDGR� UHV�VREUH�R�TXH�GHYH�VHU�HYLWDGR��%5,&2/$� HW�DO��������� $OJXPDV�PHGLGDV�VmR�LPSRUWDQWHV�� são elas: � 1mR� ID]HU�XVR�GH�DXWRPHGL� cação, ou seja, ingestão de medica� PHQWRV�SRU�FRQWD�SUySULD��VHP�SUHV� FULomR��QHP�RULHQWDomR�PpGLFD� � 1mR�VXEVWLWXLU�RX� LQFOXLU�PH� GLFDPHQWRV� VHP� FRQKHFLPHQWR�Pp� GLFR� � ,QIRUPDU� RV� SUR¿VVLRQDLV� GH� VD~GH�TXDLV�PHGLFDPHQWRV�HVWi� ID� ]HQGR�XVR��SDUD�HYLWDU�R�XVR�VLPXO� WkQHR�GH�GURJDV�TXH�SRGHP�SURYR� FDU� LQWHUDo}HV� PHGLFDPHQWRVDV� RX� DJUDYRV�DGYLQGRV�GD�SROLPHGLFDomR� � )D]HU�R�XVR�FRUUHWR�GRV�PH� GLFDPHQWRV��DGHVmR�DR�WUDWDPHQWR��� DWHQWDQGR�VH�D�KRUiULRV��GRVHV��GLDV� GH� LQJHVWmR�� DWHQGHU� R� WHPSR�PtQL� PR�RX�Pi[LPR�GR�XVR�GH�DOJXQV�PH� GLFDPHQWRV� FRPR�� SRU� H[HPSOR�� RV� DQWLGHSUHVVLYRV�� TXH� UHTXHUHP� XP� WHPSR�PtQLPR�GH�XVR� �%5,&2/$�HW� DO��������� 6. POLIMEDICAÇÃO $� GH¿QLomR� GH� SROLPHGLFDomR� p� FRQWURYHUVD��RQGH�SRGH�VHU�GH¿QLGD�FRPR� R� XVR� GH� XP�PHGLFDPHQWR� SDUD� FRUULJLU� R� HIHLWR�DGYHUVR�GH�RXWUR�RX�GR�DXPHQWR�GR� Q~PHUR� GH� PHGLFDPHQWRV� FRQVLGHUDQGR� FLQFR�RX�PDLV�DVVRFLDo}HV�SRGHQGR�DLQGD� RFDVLRQDU��QmR�DGHVmR�� UHDo}HV�DGYHUVDV�� Interciência & Sociedade76 ,QWHUFLrQFLD� �6RFLHGDGH��,661���������������9RO�����1��������� erros de medicação, aumento do risco de KRVSLWDOL]DomR� H� GRV� FXVWRV� FRP� D� VD~GH� �%5,&2/$�HW�DO��������� $LQGD�VHJXQGR�RXWUR�DXWRU��D�GH¿� QLomR�VH�EDVHLD�QR�XVR�GH�YiULRV�PHGLFD� PHQWRV�DR�PHVPR�WHPSR��H[FHVVR�GR�XVR� de medicamentos não necessários ou o uso GH�FLQFR�RX�PDLV�IiUPDFRV��6$17,6�������� 2�WHUPR�SROLPHGLFDomR�DLQGD�SRGH� DSUHVHQWDU� GH¿QLomR� TXDOLWDWLYD� H� TXDQWL� WDWLYD��$�TXDOLWDWLYD� VH� UHIHUH�j�SUHVFULomR�� DGPLQLVWUDomR�RX�XVR�GH�PDLV�WLSRV�GH�PH� GLFDPHQWRV�TXH�QmR�SUHVFULWRV��VHQGR�PDLV� XWLOL]DGD�QRV�(VWDGRV�8QLGRV��-i�D�GH¿QLomR� TXDQWLWDWLYD�VH�UHIHUH�DR�Q~PHUR�GH�PHGLFD� PHQWRV�FRQVXPLGRV��SRGHQGR�VHU�VXEGLYLGL� GD�HP�SROLPHGLFDomR�PHQRU�TXH�p�R�XVR�GH� ��D���PHGLFDPHQWRV��H�SROLPHGLFDomR�PDLRU� TXDQGR�R�XVR�p�GH���RX�PDLV�PHGLFDPHQWRV� �&$59$/+2�������� 3DUD� GLDJQRVWLFDU� H� WUDWDU� D� SROL� PHGLFDomR�p�QHFHVViULR� LGHQWL¿FDU�RV�PH� GLFDPHQWRV�XVDGRV�� VXD� LQGLFDomR� FOtQLFD� H� D� UHVSRVWD� LQGLYLGXDO� DR� WUDWDPHQWR��9H� PRV�TXH�D�SDUWLU� GH�TXDWUR�PHGLFDPHQWRV� DXPHQWD�VH�WUrV�YH]HV�R�ULVFR�GH�XPD�UHD� omR�DGYHUVD�DR�PHGLFDPHQWR�H�HVVD�FKDQ� FH�FUHVFH�FRP�R�Q~PHUR�GH�PHGLFDPHQWRV�� GRLV�PHGLFDPHQWRV������GH�FKDQFH�GH�5HD� omR�$GYHUVD�DR�0HGLFDPHQWR��5$0���FLQFR� PHGLFDPHQWRV� �� ����GH� FKDQFH� GH�5$0�� RLWR�PHGLFDPHQWRV�±������FKDQFH�GH�5$0�� 'H¿QLPRV�5HDomR�$GYHUVD�DR�0HGLFDPHQ� WR��5$0���FRPR�XP�HYHQWR�QRFLYR��QmR�LQ� tencional, que ocorre em doses comumente XVDGDV�SDUD�SUR¿OD[LD��GLDJQyVWLFR�RX�WUDWD� PHQWR��%5,&2/$�HW�DO���������6,/9$�HW�DO��� ������ $� SROLPHGLFDomR� SRGH� RFDVLRQDU� GLYHUVDV� FRQVHTXrQFLDV�� HQWUH� HODV� R� DX� PHQWR�GD�FRPSOH[LGDGH�GR�WUDWDPHQWR�IDU� PDFROyJLFR��FRQIRUPH�R�PpGLFR�PRGL¿FD�R� WUDWDPHQWR�� WRUQDQGR�R�PDLV� FRPSOH[R�H[� tenso, aumentam os fatores associados a QmR�DGHVmR�DR�WUDWDPHQWR��UHDo}HV�DGYHU� VDV�� LQWHUDo}HV�PHGLFDPHQWRVDV�� ULVFR� GH� KRVSLWDOL]Do}HV�H�FXVWRV�FRP�D�PHGLFDomR� �&$59$/+2�������� 7. PADRÃO DE CONSUMO 6DEH�VH� TXH� R� %UDVLO� p� R� TXDUWR� mercado mundial de consumo dos medi� camentos, sendo o mercado farmacêutico brasileiro um dos cinco maiores do mundo, DWLQJLQGR�YHQGDV�GH�����ELOK}HV�GH�GyODUHV� DQR��&$59$/+2�������� 2� XVR� GRV� PHGLFDPHQWRV� YDULD� FRQIRUPH�D�LGDGH��VH[R��FRQGLo}HV�GH�VD~� GH�H�IDWRUHV�VRFLDLV��HFRQ{PLFRV�RX�GHPR� JUi¿FRV��2�FRQVXPR�DOWHUD�VH�DR�ORQJR�GR� WHPSR� H� GD� JHRJUD¿D��$� LGDGH� p� XP� IDWRU� SUHGLWLYR� GR� XVR� GRV� PHGLFDPHQWRV�� H� D� FKDQFH�GH�XWLOL]i�ORV�DXPHQWD�D�SDUWLU� GRV� ���DQRV��1R�%UDVLO�� HVWXGRV�SRSXODFLRQDLV� mostram um uso crescente de medicamen� tos com o aumentar da idade, tanto no inte� ULRU�FRPR�QRV�JUDQGHV�FHQWURV��$FUHGLWD�VH�� que o maior consumo está entre as mulhe� UHV��TXH�DSUHVHQWDP�SLRU�HVWDGR�IXQFLRQDO�� VLQWRPDV� GHSUHVVLYRV� H� PDLRU� Q~PHUR� GH� KRVSLWDOL]Do}HV��52=(1)(/'�������� 2� XVR� GRV� PHGLFDPHQWRV� SHORV� LGRVRV� VH� WRUQD� FDGD� YH]� PDLV� IUHTXHQWH� H�WHP�FRPR�SURSyVLWR�UHVWDXUDU��FRUULJLU�RX� PRGL¿FDU� DV� IXQo}HV�GR�RUJDQLVPR��R�XVR� GRV� PHGLFDPHQWRV� p� FRQVLGHUDGR� LQDGH� TXDGR�TXDQGR�RV� ULVFRV�GR�VHX�XVR�VXSH� UDP� VHXV� EHQHItFLRV�� 2� XVR� UDFLRQDO� GRV� PHGLFDPHQWRV�UHTXHU�TXH�R�SDFLHQWH�UHFH� ED�D�PHGLFDomR�DSURSULDGD�D�VXD�QHFHVVL� GDGH�FOLQLFD��HP�GRVHV�DGHTXDGDV��SRU�XP� SHUtRGR� DGHTXDGR� H� DR�PHQRU� FXVWR� SDUD� R�LQGLYLGXR�H�VXD�FRPXQLGDGH��&RQIHUrQFLD� 0XQGLDO� 6REUH� 8VR� 5DFLRQDO� GH� 0HGLFD� PHQWRV��1DLUREL���������0$7,$6�������� &RP�D�LGDGH�DYDQoDGD��RV�LGRVRV� DSUHVHQWDP� PDLRUHV� VLQWRPDV� H� P~OWLSODV� GRHQoDV��ID]HQGR�FRP�TXH�SURFXUHP�PDLV� HVSHFLDOLGDGHV� PpGLFDV� GLIHUHQWHV� DFDUUH� WDQGR�GXSOLFLGDGH�GH�SUHVFULomR�H�DXPHQWR� GRV�FXVWRV�FRP�PHGLFDPHQWRV��,GRVRV�JDV� WDP�HP�PpGLD�����GR�VDOiULR�PtQLPR�FRP� medicamentos de uso regular, ou seja, du� UDQWH����GLDV��HVVH�SUREOHPD�p�DLQGD�PDLRU� TXDQGR� D� SUHVFULomR� QmR� FRUUHVSRQGH� DR� SDGUmR� GH� PHGLFDPHQWRV� HVVHQFLDLV� �3(� /(*5,12��������� 8. DESAFIOS PARA A ATENÇÃO À SAÚ- DE DOS IDOSOS $OpP� GDV� DOWHUDo}HV� ¿VLROyJLFDV�� FRP�R�HQYHOKHFLPHQWR�DXPHQWDP�DV�GRHQ� oDV�FU{QLFDV�H�D�GHSHQGrQFLD��6HJXQGR�D� 206��FHUFD�GH�����GRV�LGRVRV�DSUHVHQWDP� Interciência & Sociedade77 ,QWHUFLrQFLD� �6RFLHGDGH��,661���������������9RO�����1��������� DOJXPD� OLPLWDomR� SDUD� DWLYLGDGHV� FRWLGLD� QDV��FXMDV�SULQFLSDLV�FDXVDV�VmR�SUREOHPDV� RVWHRDUWLFXODUHV� H� Gp¿FLWV� YLVXDLV� H� DXGLWL� YRV�� 2� GLDJQyVWLFR� H� LQWHUYHQomR� SUHFRFH� GD� SHUGD� DXGLWLYD� DVVRFLDGD� j� LGDGH� VmR� IXQGDPHQWDLV�SDUD�D�ERD�TXDOLGDGH�GH�YLGD� GRV�LGRVRV��8P�IDWRU�GH�JUDQGH�LPSRUWkQFLD� DLQGD� p� D� FRPXQLFDomR� TXH� R� SUR¿VVLRQDO� GHYH� HVWDEHOHFHU� FRP� R� LGRVR�� YLVWR� TXH� PXLWDV�YH]HV��HOH�DSUHVHQWD�DOpP�GH�GLPL� QXLomR�DXGLWLYD�H�YLVXDO��SUREOHPDV�GH�PH� PyULD�H�GL¿FXOGDGH�GH�HQWHQGLPHQWR��R�TXH� DFDED�OHYDQGR�DR�LVRODPHQWR�VRFLDO��SUHMX� GLFDQGR�DLQGD�PDLV�VXD�TXDOLGDGH�GH�YLGD�� DVVLP� D� FRPXQLFDomR� HIHWLYD� H� DGHTXDGD� FRP�R� LQGLYLGXR� LGRVR�p� IXQGDPHQWDO� SDUD� TXH�HOH�VH�VLQWD�H�SHUPDQHoD�SVLFRORJLFD� PHQWH�LQWHJUR��3(/(*5,12��������� 9. CONCLUSÕES 6HQGR� R� HQYHOKHFLPHQWR� XP� SUR� FHVVR� QDWXUDO� FRQVHTXHQWH� GDV� DWLYLGDGHV� GR� RUJDQLVPR�� WHPRV� FRP� HOH� SUREOHPDV� decorrentes do uso de medicamentos como D�SROLPHGLFDomR� $� SROLPHGLFDomR� p� FDUDFWHUL]DGD� SHOR�XVR�GH�YiULRV� WLSRV�GH�PHGLFDPHQWRV� SHOR�PHVPR�LQGLYLGXR�D�¿P�GH�FRQWUROH�PD� QXWHQomR�GH�SDWRORJLDV��VHQGR�R�XVR�DOJXQV� DWp�PHVPR�GHVQHFHVViULRV� 7UDWD�VH�GH�XP�SUREOHPD�RQGH�QmR� WHPRV�XPD� VROXomR�SDUD� HUUDGLFDomR� WRWDO� GR� SUREOHPD� �SROLPHGLFDomR��� R� TXH� SRGH� VHU� OHYDGR�HP�FRQVLGHUDomR�p�R� WLSR�HVWLOR� GH�YLGD�TXH�R�LQGLYLGXR�VHJXH�DR�ORQJR�GD� YLGD�FRPR�ERQV�KiELWRV�DOLPHQWDUHV��SUiWLFD� UHJXODU�GH�H[HUFtFLRV� ItVLFRV�� FXLGDGRV�Ei� VLFRV� FRP�D� VD~GH�� VRPHQWH�DVVLP�p�TXH� SRGHPRV� DOFDQoDU� XPD� PHOKRU� TXDOLGDGH� GH�YLGD�FRP�EHP�HVWDU�QD�YHOKLFH�� ,GRVRV� VDXGiYHLV� WHQGHP� D� SUDWLFDU� H[HUFtFLRV� It� VLFRV�� YLYHP� PDLV� H� PHOKRU�� DXPHQWDP� D� FDSDFLGDGH� FRJQLWLYD�� SRVVXHP� PDLRU� LQ� GHSHQGrQFLD� �ItVLFD��PHQWDO�H�VRFLDO���SRV� VXHP�FRQVHTXHQWHPHQWH�PHQRV�SDWRORJLDV� assim necessitando de menos medicamen� WRV��FRQVHTXrQFLD�GLPLQXLomR�GD�SROLPHGL� cação. 10. REFERÊNCIAS BIBLIOGRÁFICAS %5$6,/��0LQLVWpULR�GD�6D~GH��6HFUHWDULD�GH�$WHQomR� j� 6D~GH�� 'HSDUWDPHQWR� GH�$WHQomR� %iVLFD�� (QYH� OKHFLPHQWR� H�6D~GH�GD�3HVVRD� ,GRVD��Caderno de Atenção Básica,� %UDVtOLD� �� ')�� HG�� ��� Q�� ���� ������ 'LVSRQtYHO� HP�� KWWS���EYVPV�VDXGH�JRY�EU�EYV�SXEOL� FDFRHV�HQYHOKHFLPHQWRBVDXGHBSHVVRDBLGRVD�SGI�� $FHVVR�HP�����PDL��������� %2572/21��&��3��.$51,.296.,��2��*��0��$66,6�� 0��$XWRPHGLFDomR�9HUVXV�,QGLFDomR�)DUPDFrXWLFD��R� SUR¿VVLRQDO�GH�IDUPiFLD�QD�DWHQomR�SULPDULD�j�VD~GH� do idoso. Revista APS��Y������Q�����S������D������MXO�� GH]�������� %5,&2/$��&��3��$��6��628=$��5��&��)��0217$*1,1,�� .��0285$'��$��(QYHOKHFLPHQWR� GD�3RSXODomR� H� D� Polifarmácia. Revista Eletrônica da Sociedade Bra- sileira de Clínica Médica – Regional São Paulo,�Y�� ���Q�����-XOKR������ &$59$/+2��&��)��0��A Polifarmácia em Idosos no Município de São Paulo – Estudo SABE – Saúde, Bem-estar e Envelhecimento. 'LVVHUWDomR� DSUH� VHQWDGD�DR�3URJUDPD�GH�3yV�*UDGXDomR�HP�6D~GH� 3~EOLFD��8QLYHUVLGDGH�GH�6mR�3DXOR�±�)DFXOGDGH�GH� 6D~GH�3~EOLFD������� *$87e5,2��3��'��6$1726��&��6��6��3(/=(5��7��0�� %$5526�� -�� (�� %$80*$57(1�� /�� &DUDFWHUL]DomR� dos idosos usuários de medicação residentes em LQVWLWXLomR�GH�ORQJD�SHUPDQrQFLD��Revista da Escola de Enfermagem da USP��6mR�3DXOR��Y������Q����'H]�� ����� 0$7,$6��0��)��$��3HU¿O�7HUDSrXWLFR�H�5LVFR�GH�,Q- teracção Medicamentosa no Idoso. Dissertação DSUHVHQWDGD�j�SDUD�REWHQomR�GR�JUDX�HP�PHVWUH�HP� *HURQWRORJLD��6HFomR�$XW{QRPD�GH�&LrQFLDV�GD�6D~� GH��3RUWXJDO�������� 3(/(*5,12��6��3��3HUVSHFWLYD�ELRSVLFROyJLFD�GR�HQ� YHOKHFLPHQWR�� 6HFUHWDULD� (VWDGXDO� GH�$VVLVWrQFLD� H� 'HVHQYROYLPHQWR�6RFLDO��Fundação Padre Anchieta, 6mR�3DXOR������� 52=(1)(/'�� 6�� 3UHYDOrQFLD�� IDWRUHV� DVVRFLDGRV� H� PDX�XVR�GH�PHGLFDPHQWRV�HQWUH�RV�LGRVRV��XPD�UHYL� são. Cadernos de Saúde Pública��5LR�GH�-DQHLUR��S�� ���������PDL��-XQ�������� 6$17,6��6��/��3��7��Polimedicação e Medicação Po- tencialmente Inapropriada no Idoso: estudo des- critivo de base populacional em cuidados de saú- de primários. Dissertação de Mestrado em Geriatria, )DFXOGDGH� GH� 0HGLFLQD�� 8QLYHUVLGDGH� GH� &RLPEUD�� 3RUWXJDO�������� 6,/9$��$��7��$QWRQLR��Apostila de Farmacologia Far- mácia/UniPinhal,�������$EVRUomR��'LVWULEXLomR��0H� WDOL]DomR�H�([FUHomR�GRV�IiUPDFRV��S�����±����� 6,/9$��5��6&+0,'7��)��2��6,/9$��6��3ROLIDUPiFLD�HP� geriatria. Revista da AMRIGS, 3RUWR�$OHJUH��S������ �����DEUL��MXQ������� 628=$��0��3��6$1726��/��/��6,/9(,5$��1��$��&��)iU� Interciência & Sociedade78 ,QWHUFLrQFLD� �6RFLHGDGH��,661���������������9RO�����1���������PDFRV�HP�,GRVRV��Secretaria de Ciência, Tecnolo- gia e Insumos Estratégicos/MS – FTN,�������'LV� SRQtYHO�HP��KWWS���SRUWDO�VDXGH�JRY�EU�SRUWDO�DUTXLYRV� PXOWLPHGLD�SDJLQDFDUWLOKD�GRFV�IDUPDFRVL�SGI�� $FHV� VR�HP�����PDL�������
Compartilhar