[Study of anticholinergic burden in chronic treatments of outpatients in the Community Pharmacy].

Abstract

Abstract: The current aging of the population leads to an increase in morbidity and mortality, especially due to the higher incidence of chronic diseases and the need for associated polymedication. Among the drugs that are usually used to treat the most common pathologies in elderly patients, there are a large number of drugs with anticholinergic activity, which translates into anticholinergic effects, adverse effects that, although they can appear at any age, are especially significant in older patients, in whom the associated clinical consequences are important.

Objectives: To analyze the use of anticholinergic activity drugs in outpatients, anticholinergic adverse effects and the anticholinergic burden associated with the chronic treatment of such patients.

Methods: A descriptive, observational, cross-sectional study was carried out in polymedicated patients who came to the pharmacy to pick up their medication, which included at least one drug with AA. The anticholinergic burden was calculated with the online application "ACB calculator", using the anticholinergic load value given by the ARS, ADS, ACB and DBI scales.The association between anticholinergic burden and adverse effects manifested in the last six months, the pathologies present, the pharmacological groups used and the number of prescribed drugs with anticholinergic activity were analyzed. In the statistical analysis, the "Spearman's Rho" correlation coefficient was used to study the correlation between the different variables, and the non-parametric "Mann-Whitney U" test was used to study the relationship between anticholinergic adverse effects and anticholinergic burden. The level of statistical significance was set at p<0.05.

Results: A total of 44 patients were analyzed, with a mean age of 73.36 ± 12.34 years, of which 77.3% were women. The most frequent anticholinergic adverse effects were, at peripheral level dry mouth and constipation (54.5% and 38.6% respectively), and at central level dizziness and memory loss (31.8% and 40.9%, respectively). The patients took an average of 10.86 ± 3.88 drugs daily, of which 34% had anticholinergic activity. The drugs most frequently used by the patients were tramadol (27.2%) and lorazepam (34.1%). Statistically significant correlations were obtained between: i) the number of central anticholinergic adverse effects using the ARS (P=0.009, CI:0.097-0.622) and ADS (P=0.017, CI:0.061-0.872) scales, ii) the Drug Burden Index (DBI) and the number of prescribed drugswith anticholinergic activity (P<0.001, CI:0.558-0.851), iii) the DBI index and drugs in the groups N02 (analgesics) (P<0.001, CI:0.279-0.724), N06 (psychoanaleptics) and N06A (antidepressants) with the ARS scale (P<0.001, CI:0.416-0.791; P<0.001, CI:0.345-0.757, respectively).

Conclusions: The population studied is exposed to a high number of drugs with anticholinergic activity, mainly psycholeptics, psychoanaleptics and opioid analgesics, which, although the most prescribed do not have a high anticholinergic activity, do contribute to the anticholinergic load of the treatments.