Introdução: As síndromes hipertensivas gestacionais (SHG) acometem cerca de 10% das gestações e pode representar danos para a mãe e o feto. A farmacoterapia antihipertensiva é o tratamento de primeira linha, contudo as alterações fisiológicas e literatura escassa associadas a gestação promove uma maior vulnerabilidade a ocorrência de Problemas Relacionados a Medicamentos (PRM). Objetivo: caracterizar os PRM quanto a causa, tipo e medicamentos implicados em mulheres hospitalizadas para controle da hipertensão gestacional. Método: Coorte prospectivo (set/2019 a jun/2022) que incluiu 547 gestantes hospitalizadas em acompanhamento diário. Os problemas relacionados à terapia anti-hipertensiva foram classificados de acordo com as diretrizes da Pharmaceutical Care Network Europe (PCNE v 9.0). Os dados foram apresentados descritivamente (Stata v 15.0). Resultados: As pacientes avaliadas tinham em média foi 30,4 anos e 30,9 semanas de idade gestacional. Entre as avaliadas, 441 apresentaram um quadro de SHG sendo as mais frequentes a hipertensão gestacional (34,2%), hipertensão arterial (33,6%) e pré-eclâmpsia (12,8%). Cerca de 62% das portadoras de SHG apresentaram um ou mais PRMs (média de 1,0 ± 0,9 PRM por paciente) com um total de 177 PRM identificados. A maioria dos PRMs foram relacionados à inefetividade terapêutica, destacando-se a metildopa (74, 58,3%) e nifedipino (26, 64,4%). A ocorrência de reações adversas relacionada a metildopa (55, 35,4%) e nifedipino (15, 36,6%) também foram frequentes. As principais causas dos PRMs de inefetividade foram a subdose (86,3%). A detecção de PRMs predominou nas primeiras 48h com 68,9% (122) das ocorrências com destaque para a metildopa (P1.2: 59, 79,3%, P2.1: 35, 77,5%) e nidefipino (P1.2: 12, 50%, P2.1: 10, 66,7%), mas tendem a decrescer consideravelmente já no 4º dia de tratamento. Conclusão: Em suma, os problemas relacionados à terapia anti-hipertensiva são frequentes em gestantes hospitalizadas, sobretudo relacionados à inefetividade terapêutica e a ocorrência de eventos adversos.
Notas
O registro foi originalmente publicado em português. A versão em inglês foi traduzida com o apoio de inteligência artificial.
Abstract
Introduction: Gestational hypertensive disorders (GHD) affect approximately 10% of pregnancies and can pose significant risks to both mother and fetus. First-line treatment for these conditions is antihypertensive pharmacotherapy. However, due to the physiological changes inherent to pregnancy and limited literature, pregnant women are more vulnerable to Medication-Related Problems (MRP). Objective: This study aimed to characterize MRPs in hospitalized women for the management of gestational hypertension, analyzing their causes, types, and implicated medications. Method: A prospective cohort study was conducted from September 2019 to June 2022, involving 547 hospitalized pregnant women monitored daily. Medication-related problems were classified according to the Pharmaceutical Care Network Europe (PCNE v 9.0) guidelines. Data were analyzed descriptively using Stata v 15.0 software. Results: The mean age of the patients was 30.4 years, with a mean gestational age of 30.9 weeks. Among the evaluated pregnant women, 441 presented with some form of GHD, most commonly gestational hypertension (34.2%), hypertension (33.6%), and preeclampsia (12.8%). Approximately 62% of patients with GHD experienced one or more MRPs, with an average of 1.0 ± 0.9 MRPs per patient, totaling 177 identified MRPs. Therapeutic ineffectiveness was the most frequent type of MRP, predominantly associated with methyldopa (74, 58.3%) and nifedipine (26, 64.4%). Adverse reactions related to methyldopa (55, 35.4%) and nifedipine (15, 36.6%) were also significant. The primary cause of ineffectiveness was underdosing (86.3%). Detection of MRPs was most common within the first 48 hours of treatment, accounting for 68.9% (122) of occurrences, with methyldopa (P1.2: 59, 79.3%, P2.1: 35, 77.5%) and nifedipine (P1.2: 12, 50%, P2.1: 10, 66.7%) being prominently noted, showing a significant decline after the fourth day of treatment. Conclusion: This study revealed that medication-related problems are prevalent in hospitalized pregnant women, particularly concerning therapeutic ineffectiveness and adverse events. Careful management of pharmacotherapy in these patients is crucial to ensuring treatment efficacy and minimizing risks to both mother and fetus during pregnancy.
Notes
The record was originally published in Portuguese. The English version was translated with the support of artificial intelligence.
