{"id":3440,"date":"2022-01-14T06:00:20","date_gmt":"2022-01-14T03:00:20","guid":{"rendered":"https:\/\/tatd.org.tr\/toksikoloji\/?p=3440"},"modified":"2022-01-14T06:19:05","modified_gmt":"2022-01-14T03:19:05","slug":"antikolinerjik-yuk-ve-kirik-riski","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2022\/01\/14\/antikolinerjik-yuk-ve-kirik-riski\/","title":{"rendered":"Antikolinerjik y\u00fck ve k\u0131r\u0131k riskine ili\u015fkin g\u00f6zlemsel \u00e7al\u0131\u015fmalar\u0131n meta analizi: Geleneksel \u00f6l\u00e7eklerinin de\u011ferlendirilmesi"},"content":{"rendered":"

Uzun zamand\u0131r geni\u015f bir tedavi spektrumunda kulland\u0131\u011f\u0131m\u0131z antikolinerjik ila\u00e7lar\u0131n artan k\u0131r\u0131k riski ile ili\u015fkisi tart\u0131\u015f\u0131lmaya devam eden bir konudur. Bu yaz\u0131m\u0131zda Ogawa ve arkada\u015flar\u0131n\u0131n \u201cJournal of Pharmaceutical Health Care and Sciences\u201d dergisinde yay\u0131nlanan \u201cA meta-analysis of observational studies on anticholinergic burden and fracture risk: evaluation of conventional burden scales<\/a>\u201d isimli, d\u00f6rt antikolinerjik y\u00fck \u00f6l\u00e7e\u011fini kullanarak, antikolinerjik ila\u00e7lar ile k\u0131r\u0131k riski aras\u0131ndaki ili\u015fkiyi de\u011ferlendiren, kohort \u00e7al\u0131\u015fmalar\u0131 veya vaka kontrol \u00e7al\u0131\u015fmalar\u0131ndan derledikleri meta analizi size sunmaya gayret edece\u011fim.<\/em><\/p>\n

Antikolinerjik ila\u00e7lar, merkezi ve periferik sinir sistemlerindeki muskarinik resept\u00f6rlere ba\u011flanarak asetilkolin arac\u0131l\u0131 cevab\u0131 inhibe eder. Bu ila\u00e7lar\u0131n kullan\u0131m\u0131 y\u0131llar i\u00e7erisinde art\u0131\u015f g\u00f6stermi\u015ftir [1]. Antikolinerjik ila\u00e7lar, psikotrop ila\u00e7lar, antiparkinson ila\u00e7lar, a\u015f\u0131r\u0131-aktif mesane ila\u00e7lar\u0131 ve baz\u0131 antiaritmik ila\u00e7lar (disopiramid gibi) dahil olmak \u00fczere geni\u015f bir fizyolojik etki spektrumuna sahip ila\u00e7lar\u0131 i\u00e7erir. Bu nedenle, birden fazla doktordan re\u00e7ete alan hastalarda, antikolinerjik ila\u00e7lar\u0131n birlikte kullan\u0131lmas\u0131 nedeniyle potansiyel olarak artan antikolinerjik y\u00fck vard\u0131r.<\/p>\n

Daha \u00f6nceki baz\u0131 \u00e7al\u0131\u015fmalarda [2\u20134], olanzapin ve paroksetin kullananlar\u0131n, kullanmayanlara g\u00f6re s\u0131ras\u0131yla 1.49 kat ve 1.21 kat daha y\u00fcksek k\u0131r\u0131k riskine sahip oldu\u011fu tespit edilmi\u015ftir. Di\u011fer yandan antikolinerjik ila\u00e7lar\u0131n \u00f6nemli bir k\u0131r\u0131k riski ile ili\u015fkisinin olmad\u0131\u011f\u0131n\u0131 belirten \u00e7al\u0131\u015fmalar da mevcuttur [5,6]. Bu nedenle antikolinerjik ila\u00e7 kullan\u0131m\u0131n\u0131n k\u0131r\u0131k riskini art\u0131r\u0131p art\u0131rmad\u0131\u011f\u0131 konusu tart\u0131\u015fmal\u0131d\u0131r.<\/p>\n

Antikolinerjik y\u00fck\u00fc belirlemek i\u00e7in antikolinerjik risk \u00f6l\u00e7e\u011fi (ARS) [7], antikolinerjik bili\u015fsel y\u00fck (ACB) [8,9], antikolinerjik ila\u00e7 \u00f6l\u00e7e\u011fi (ADS) [10] ve ila\u00e7 y\u00fck\u00fc indeksi-antikolinerjik bile\u015fen (DBIAch) [11] \u00f6l\u00e7ekleri geli\u015ftirilmi\u015ftir. Bir\u00e7ok \u00e7al\u0131\u015fmada bu \u00f6l\u00e7ekler kullan\u0131larak \u00f6l\u00e7\u00fclen antikolinerjik y\u00fck ile d\u00fc\u015fmeye ba\u011fl\u0131 k\u0131r\u0131klar aras\u0131ndaki ili\u015fki bildirilmi\u015f, ancak k\u0131r\u0131klar \u00fczerindeki antikolinerjik etkinin do\u011frudan nedensel mekanizmas\u0131 bug\u00fcne kadar kan\u0131tlanamam\u0131\u015ft\u0131r [12\u201314]. Reinold ve ark. [14], ARS kullanan \u00e7al\u0131\u015fmalarda antikolinerjik y\u00fck ve olas\u0131 doza maruziyet gradyan\u0131 ile artan k\u0131r\u0131k riski aras\u0131nda bir ili\u015fki oldu\u011funu g\u00f6stermi\u015fse de ACB, ADS ve DBI-Ach gibi di\u011fer antikolinerjik y\u00fck \u00f6l\u00e7ekleri ile k\u0131r\u0131k riski aras\u0131ndaki ili\u015fki hala belirsizdir.<\/p>\n

ARS, ACB, DBI-Ach ve ADS antikolinerjik y\u00fck\u00fc de\u011ferlendirmek i\u00e7in yayg\u0131n olarak kullan\u0131lan \u00f6l\u00e7eklerdir. ARS’de ila\u00e7lar 0 (antikolinerjik yan etki riski yok veya d\u00fc\u015f\u00fck) ile 3 (y\u00fcksek potansiyel risk) aras\u0131nda derecelendirilir. ACB’de, olas\u0131 antikolinerjik etkileri olan ila\u00e7lar, 1’den (klinik olarak anlaml\u0131 olumsuz bili\u015fsel etkiler bilinmiyor) 3’e (klinik olarak anlaml\u0131 olumsuz bili\u015fsel etkiler) kadar derecelendirilir. ADS, ila\u00e7lar\u0131n antikolinerjik etkilerini 0’dan (bilinen antikolinerjik aktivite yok) 3’e (\u00f6nemli \u00f6l\u00e7\u00fcde belirgin antikolinerjik aktivite) 4 puanl\u0131k bir \u00f6l\u00e7ekte s\u0131ralar. Bu antikolinerjik y\u00fck \u00f6l\u00e7eklerinin (ARS, ACB ve ADS) her birinde bir birey i\u00e7in toplam antikolinerjik ilaca maruz kalma, t\u00fcm ila\u00e7lar\u0131n puanlar\u0131n\u0131n toplam\u0131d\u0131r. ACB ve ARS i\u00e7in kullan\u0131lan ila\u00e7lar\u0131n puanlar\u0131 Ek Dosya 1\u2019de g\u00f6sterilmi\u015ftir. DBI ise hem antikolinerjik (DBI-Ach) hem de yat\u0131\u015ft\u0131r\u0131c\u0131 ila\u00e7lara maruziyeti hesaplayan farmakolojik bir risk de\u011ferlendirme arac\u0131d\u0131r. DBI, k\u00fcm\u00fclatif maruz kalma ve doz yan\u0131t\u0131 ilkesine dayanmaktad\u0131r.<\/p>\n

Ogawa ve arkada\u015flar\u0131 bu \u00e7al\u0131\u015fmada, yayg\u0131n olarak kullan\u0131lan d\u00f6rt antikolinerjik y\u00fck \u00f6l\u00e7e\u011fi (ARS, ACB, ADS ve DBI-Ach.) kullan\u0131larak \u00f6l\u00e7\u00fclen antikolinerjik ila\u00e7 y\u00fck\u00fc ile k\u0131r\u0131k riski aras\u0131ndaki ili\u015fkiyi a\u00e7\u0131klamay\u0131 ama\u00e7layan bir meta-analiz yapm\u0131\u015flar.<\/p>\n

Meta-analizde kullan\u0131lacak \u00e7al\u0131\u015fmalar\u0131n taranmas\u0131nda PubMed (1966 – Mart 2021), Cochrane Library (1974 – Mart 2021), Scopus (1970 – Mart 2021) ve Ichushi-web (1983 – Mart 2021) kullan\u0131lm\u0131\u015f ve bu veritabanlar\u0131nda \u201cantikolinerjik\u201d, \u201cila\u00e7 y\u00fck\u00fc indeksi\u201d, \u201ckolinerjik antagonistler\u201d, \u201ck\u0131r\u0131k\u201d ve \u201ck\u0131r\u0131klar, kemik\u201d gibi MeSH terimleri veya anahtar s\u00f6zc\u00fckleri kullan\u0131larak 327 \u00e7al\u0131\u015fma bulunmu\u015f. Ara\u015ft\u0131rmac\u0131lar taraf\u0131ndan dahil etme\/hari\u00e7 tutma kriterlerine g\u00f6re bu \u00e7al\u0131\u015fmalardan 10\u2019u meta analizde kullan\u0131lmaya uygun bulunmu\u015ftur [12,13,15\u201322], (Tablo 1 ve Tablo 2).<\/p>\n

Tablo 1.<\/strong> Mevcut meta-analizde yer alan kohort \u00e7al\u0131\u015fmalar\u0131n\u0131n \u00f6zellikleri<\/p>\n

\n\n\n\n\n\n\n\n\n\n\n
\u00c7al\u0131\u015fma<\/strong><\/td>\n\u00dclke<\/strong><\/td>\n\u00d6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fc (AC ila\u00e7 kullananlar, (n))<\/strong><\/td>\nKad\u0131n (%)<\/strong><\/td>\nYa\u015f <\/strong><\/td>\nAnatomik k\u0131r\u0131k b\u00f6lgesi<\/strong><\/td>\nAC y\u00fck\u00fc \u00f6l\u00e7e\u011fi<\/strong><\/td>\nOrtalama takip<\/strong><\/td>\n<\/tr>\n
Bali ve ark.<\/p>\n

(2016)<\/p>\n

[15]<\/td>\n

Amerika<\/td>\n9240<\/p>\n

(4620)<\/td>\n

67<\/td>\n\u226565<\/td>\nKal\u00e7a<\/td>\nARS,<\/p>\n

ACB,<\/p>\n

ADS<\/td>\n

2.0 y\u0131l<\/td>\n<\/tr>\n
Crispo ve ark. (2016)<\/p>\n

[16]<\/td>\n

Kanada<\/td>\n16,302<\/p>\n

(13,839)<\/td>\n

47<\/td>\n\u226570<\/td>\nHerhangi b\u00f6lge<\/td>\nARS<\/td>\n3\u20136 g\u00fcn: 2463 ki\u015fi 7\u201330 g\u00fcn: 5799 ki\u015fi \u226531 g\u00fcn: 141 ki\u015fi<\/td>\n<\/tr>\n
Hsu ve ark.<\/p>\n

(2017)<\/p>\n

[13]<\/td>\n

Tayvan<\/td>\n116,043<\/p>\n

(43,301)<\/td>\n

50<\/td>\n\u226565<\/td>\nHerhangi b\u00f6lge<\/td>\nARS,<\/p>\n

ACB,<\/p>\n

DBI-Ach<\/td>\n

8.3 y\u0131l<\/td>\n<\/tr>\n
Ishida<\/p>\n

ve ark..<\/p>\n

(2019)<\/p>\n

[17]<\/td>\n

Amerika<\/td>\n60,007<\/p>\n

(3745)<\/td>\n

56<\/td>\n\u226565<\/td>\nKal\u00e7a, femur, pelvis, ayak, kol, el veya aksiyal iskelet<\/td>\nACB<\/td>\n243 g\u00fcn<\/td>\n<\/tr>\n
Kao ve ark.<\/p>\n

(2018)<\/p>\n

[18]<\/td>\n

Tayvan<\/td>\n14,635<\/p>\n

(2927)<\/td>\n

69<\/td>\n52.0\u00b1 16.9<\/p>\n

(\u00e7al\u0131\u015fma grubu),<\/p>\n

51.9\u00b1 17.1<\/p>\n

(kontrol)<\/td>\n

Herhangi b\u00f6lge<\/td>\nACB<\/td>\n3.0 y\u0131l<\/td>\n<\/tr>\n
Lu ve ark.<\/p>\n

(2015)<\/p>\n

[19]<\/td>\n

Tayvan<\/td>\n59,042<\/p>\n

(7461)<\/td>\n

49<\/td>\n\u226565<\/td>\nHerhangi b\u00f6lge<\/td>\nARS<\/td>\n7.95 \u00b1 3.03 y\u0131l<\/td>\n<\/tr>\n
Moga<\/p>\n

ve ark. (2013)<\/p>\n

[21]<\/td>\n

Amerika<\/td>\n6594<\/p>\n

(1125)<\/td>\n

4<\/td>\n\u226565<\/td>\nKal\u00e7a veya herhangi b\u00f6lge<\/td>\nARS,<\/p>\n

ACB,<\/p>\n

ADS<\/td>\n

AC kullananlar: 49 g\u00fcn (medyan), AC kullanmayanlar: 95 g\u00fcn (medyan)<\/td>\n<\/tr>\n
S\u00f8rensen<\/p>\n

ve ark. (2013)<\/p>\n

[22]<\/td>\n

Danimarka<\/td>\n2224<\/p>\n

(1216)<\/td>\n

Belirtilmemi\u015f<\/td>\n68.6 \u00b1\u00a012.8<\/td>\nKal\u00e7a<\/td>\nARS,<\/p>\n

ACB,<\/p>\n

ADS<\/td>\n

Belirtilmemi\u015f<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

Tablo 2. <\/strong>Mevcut meta-analizde yer alan vaka kontrol \u00e7al\u0131\u015fmalar\u0131n\u0131n \u00f6zellikleri<\/p>\n

\n\n\n\n\n
\u00c7al\u0131\u015fma<\/strong><\/td>\n\u00dclke<\/strong><\/td>\n\u00d6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fc (vaka\/kontrol)<\/strong><\/td>\nKad\u0131n (%)<\/strong><\/td>\nYa\u015f <\/strong><\/td>\nAnatomik k\u0131r\u0131k b\u00f6lgesi<\/strong><\/td>\nAC y\u00fck\u00fc \u00f6l\u00e7e\u011fi<\/strong><\/td>\nAC kullan\u0131m s\u00fcresi<\/strong><\/td>\n<\/tr>\n
Chatterjee<\/p>\n

ve ark. (2016)<\/p>\n

[12]<\/td>\n

Amerika<\/td>\n202260<\/p>\n

(40452\/161808)<\/td>\n

81.1 \u00b1 7.4<\/td>\n85<\/td>\nKal\u00e7a veya femur<\/td>\nADS<\/td>\nK\u0131r\u0131ktan 30-90 g\u00fcn \u00f6nce re\u00e7ete edilmi\u015f<\/td>\n<\/tr>\n
Machado-<\/p>\n

Duque ve ark.<\/p>\n

(2018) [20]<\/td>\n

Kolombiya<\/td>\n900<\/p>\n

(300\/600)<\/td>\n

81.6 \u00b1 8.9<\/td>\n71<\/td>\nKal\u00e7a<\/td>\nARS<\/td>\nK\u0131r\u0131ktan 30 g\u00fcn \u00f6nce re\u00e7ete edilmi\u015f<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

Bu \u00e7al\u0131\u015fmada, antikolinerjik y\u00fck\u00fc de\u011ferlendirmek i\u00e7in hangi antikolinerjik y\u00fck \u00f6l\u00e7e\u011finin kullan\u0131ld\u0131\u011f\u0131na bak\u0131lmaks\u0131z\u0131n, antikolinerjik ila\u00e7 kullan\u0131c\u0131lar\u0131n\u0131n, kullanmayanlara k\u0131yasla k\u0131r\u0131k riskinin \u00f6nemli \u00f6l\u00e7\u00fcde %19 ila 49 oran\u0131nda artt\u0131\u011f\u0131 bulunmu\u015ftur. Ancak ilgin\u00e7 bir \u015fekilde antikolinerjik y\u00fck ile k\u0131r\u0131k riski aras\u0131ndaki ili\u015fki, kullan\u0131lan antikolinerjik y\u00fck \u00f6l\u00e7e\u011fine ba\u011fl\u0131 olarak farkl\u0131 e\u011filimler g\u00f6stermi\u015ftir.<\/p>\n

ARS kullanan \u00e7al\u0131\u015fmalarda oldu\u011fu kadar DBI-Ach kullanan tek bir \u00e7al\u0131\u015fmada da k\u0131r\u0131k riskinin doza ba\u011fl\u0131 olarak artt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. ACB ise di\u011fer antikolinerjik y\u00fck \u00f6l\u00e7eklerinden farkl\u0131 bir e\u011filim sergilemektedir. ACB kullan\u0131rken, y\u00fcksek antikolinerjik y\u00fck (3 veya 4 puan), d\u00fc\u015f\u00fck antikolinerjik y\u00fckten (1 veya 2 puan) daha y\u00fcksek k\u0131r\u0131k riski ile ili\u015fkili olmas\u0131na ra\u011fmen, k\u0131r\u0131k oran\u0131 ACB 1 puan ile 2 puan aras\u0131nda farkl\u0131l\u0131k g\u00f6stermemektedir (RR: 1.12 ve 1.15, s\u0131ras\u0131yla) (\u015eekil 1).<\/p>\n

Dahil edilen \u00e7al\u0131\u015fmalarda antikolinerjik y\u00fck\u00fc hesaplamak i\u00e7in yayg\u0131n olarak ARS ve ACB kullan\u0131ld\u0131\u011f\u0131ndan dolay\u0131 yazarlar, ayn\u0131 kohortu kullanarak, antikolinerjik y\u00fck\u00fc \u00f6l\u00e7mek i\u00e7in ARS ve ACB \u00f6l\u00e7ekleri ile k\u0131r\u0131k riskinin farkl\u0131l\u0131k g\u00f6sterip g\u00f6stermedi\u011fini incelemi\u015fler.<\/p>\n

Meta-analizlerin sonu\u00e7lar\u0131na g\u00f6re k\u0131r\u0131k riski \u201cd\u00fc\u015f\u00fck\u201d ile \u201cy\u00fcksek\u201d aras\u0131nda de\u011fi\u015fen be\u015f kategoriye ayr\u0131lm\u0131\u015f (\u015eekil 1). ACB 1 puan\u0131 ve ACB 2 puanlar\u0131n\u0131n her ikisi de \u201cd\u00fc\u015f\u00fck\u201d k\u0131r\u0131k riski ile ili\u015fkili bulunmu\u015f. ARS i\u00e7in ise k\u0131r\u0131k riski puan art\u0131\u015f\u0131na g\u00f6re progresyon g\u00f6stermektedir. Daha eski tarihli bir \u00e7al\u0131\u015fmada, hastalar\u0131n yakla\u015f\u0131k yar\u0131s\u0131n\u0131n ARS ve ACB dahil farkl\u0131 \u00f6l\u00e7ekler taraf\u0131ndan ayn\u0131 y\u00fck kategorisine s\u0131n\u0131fland\u0131r\u0131ld\u0131\u011f\u0131n\u0131 ve kullan\u0131lan de\u011ferlendirme \u00f6l\u00e7e\u011fine ba\u011fl\u0131 olarak antikolinerjik y\u00fck seviyesinin de\u011fi\u015fti\u011fini bildirilmi\u015ftir [23]. Bu meta analizde ise ARS 1 puan\u0131 ve ACB 3 puanlar\u0131n\u0131n her ikisi de \u201corta\/d\u00fc\u015f\u00fck\u201d k\u0131r\u0131k riski ile ili\u015fkili bulunmu\u015f olup gruplar benzer sonu\u00e7lar g\u00f6stermemekteydi. Bu noktada \u00f6l\u00e7eklerin geli\u015ftirildi\u011fi farkl\u0131 metodolojinin, k\u0131r\u0131k riski tahmininde tutars\u0131zl\u0131\u011fa yol a\u00e7t\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fclebilir. ARS, d\u00fc\u015fme, a\u011f\u0131z kurulu\u011fu, kuru g\u00f6zler, ba\u015f d\u00f6nmesi ve kafa kar\u0131\u015f\u0131kl\u0131\u011f\u0131 gibi antikolinerjik yan etki riskini tahmin etmek i\u00e7in geli\u015ftirilmi\u015ftir [7]. ACB ise bili\u015fsel bozulma riskini \u00f6ng\u00f6rmek i\u00e7in geli\u015ftirilmi\u015ftir [9,10].<\/p>\n

Hem ARS hem de ACB’ye dahil edilen 35 ila\u00e7tan 22’si uyumlu ARS-ACB skorlar\u0131na sahipken, bu ila\u00e7lar\u0131n hi\u00e7biri k\u0131r\u0131k riski kategorisinde uyumlu de\u011fildir (Ek Dosya 1). \u00d6te yandan, ayn\u0131 k\u0131r\u0131k riski kategorisinde yer alan \u00fc\u00e7 ila\u00e7 (metokabamol, paroksetin ve ketiapin) ARS ve ACB’de farkl\u0131 puanlara sahiptir.<\/p>\n

\u015eekil 1.<\/strong> Hem ARS hem de ACB kullanarak antikolinerjik y\u00fck\u00fc \u00f6l\u00e7en d\u00f6rt \u00e7al\u0131\u015fmay\u0131 i\u00e7eren meta-analiz sonu\u00e7lar\u0131n\u0131n \u00f6zeti<\/p>\n

\"\"<\/p>\n

Genel olarak ya\u015fl\u0131 ki\u015filerde hepatik ve renal klirensin azalmas\u0131 gibi farmakokinetik de\u011fi\u015fiklikler ve antikolinerjik ila\u00e7lara duyarl\u0131l\u0131\u011f\u0131n artmas\u0131 gibi farmakodinamik de\u011fi\u015fiklikler meydana gelir. Bu meta-analizde de 65 ya\u015f ve \u00fczeri hasta alt grubunda, antikolinerjik ila\u00e7 kullananlar\u0131n, antikolinerjik ila\u00e7 kullanmayanlara g\u00f6re, kullan\u0131lan antikolinerjik y\u00fck \u00f6l\u00e7e\u011finden ba\u011f\u0131ms\u0131z olarak k\u0131r\u0131k riskinin artt\u0131\u011f\u0131n\u0131 g\u00f6sterilmi\u015ftir. Antikolinerjik ila\u00e7lar\u0131n tipik bir s\u0131n\u0131f\u0131 olan psikotroplar\u0131n d\u00fc\u015fmelere neden oldu\u011fu iyi bilinmektedir [24]. Bu analizin sonu\u00e7lar\u0131 da antikolinerjik ila\u00e7lar\u0131n sadece d\u00fc\u015fme riskini de\u011fil ayn\u0131 zamanda k\u0131r\u0131k riskini de art\u0131rabilece\u011fini g\u00f6stermektedir.<\/p>\n

Sonu\u00e7 olarak antikolinerjik ila\u00e7 kullan\u0131m\u0131 genel olarak k\u0131r\u0131k riskini art\u0131r\u0131r. Y\u00fck artt\u0131k\u00e7a k\u0131r\u0131k riskinin artt\u0131\u011f\u0131 da g\u00f6r\u00fclmektedir. Ancak antikolinerjik y\u00fck ile k\u0131r\u0131k riski aras\u0131ndaki ili\u015fki kullan\u0131lan antikolinerjik y\u00fck \u00f6l\u00e7e\u011fine g\u00f6re farkl\u0131l\u0131k g\u00f6sterebilir. Meta analizin sonu\u00e7 \u00f6nerisi sa\u011fl\u0131k profesyonellerinin k\u0131r\u0131k riskini \u00f6nlemek i\u00e7in re\u00e7ete edilen antikolinerjik ila\u00e7lar\u0131, her ila\u00e7 i\u00e7in kapsaml\u0131 bir \u015fekilde de\u011ferlendirmeleri y\u00f6n\u00fcndedir.<\/p>\n

 <\/p>\n

Ek Dosya 1.<\/strong> Hem ARS hem de ACB’ye dahil edilen otuz be\u015f ila\u00e7.<\/p>\n

\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Drug name<\/td>\nConcordance between ARS and ACB scores<\/td>\nARS<\/p>\n

(points)<\/td>\n

ACB<\/p>\n

(points)<\/td>\n

Concordance in fracture risk between ARS and ACB<\/td>\nFracture risk category using ARS<\/td>\nFracture risk category using ACB<\/td>\n<\/tr>\n
Amantadine<\/td>\n\u2713<\/td>\n2<\/td>\n2<\/td>\n–<\/td>\nmedium<\/td>\nlow<\/td>\n<\/tr>\n
Amitriptyline<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Atropine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Benztropine*<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Chlorpheniramine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Chlorpromazine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Cyclobenzaprine*<\/td>\n\u2713<\/td>\n2<\/td>\n2<\/td>\n–<\/td>\nmedium<\/td>\nlow<\/td>\n<\/tr>\n
Dicyclomine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Diphenhydramine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Haloperidol<\/td>\n\u2713<\/td>\n1<\/td>\n1<\/td>\n–<\/td>\nmedium\/low<\/td>\nlow<\/td>\n<\/tr>\n
Hydroxyzine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Hyoscyamine*<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Imipramine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Meclizine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Oxybutynin<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Perphenazine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Promethazine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Ranitidine<\/td>\n\u2713<\/td>\n1<\/td>\n1<\/td>\n–<\/td>\nmedium\/low<\/td>\nlow<\/td>\n<\/tr>\n
Risperidone<\/td>\n\u2713<\/td>\n1<\/td>\n1<\/td>\n–<\/td>\nmedium\/low<\/td>\nlow<\/td>\n<\/tr>\n
Thioridazine*<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Trazodone<\/td>\n\u2713<\/td>\n1<\/td>\n1<\/td>\n–<\/td>\nmedium\/low<\/td>\nlow<\/td>\n<\/tr>\n
Trifluoperazine<\/td>\n\u2713<\/td>\n3<\/td>\n3<\/td>\n–<\/td>\nmedium\/high<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Cetirizine<\/td>\n–<\/td>\n2<\/td>\n1<\/td>\n–<\/td>\nmedium<\/td>\nlow<\/td>\n<\/tr>\n
Cimetidine<\/td>\n–<\/td>\n2<\/td>\n1<\/td>\n–<\/td>\nmedium<\/td>\nlow<\/td>\n<\/tr>\n
Clozapine<\/td>\n–<\/td>\n2<\/td>\n3<\/td>\n–<\/td>\nmedium<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Cyproheptadine<\/td>\n–<\/td>\n3<\/td>\n2<\/td>\n–<\/td>\nmedium\/high<\/td>\nlow<\/td>\n<\/tr>\n
Desipramine*<\/td>\n–<\/td>\n2<\/td>\n3<\/td>\n–<\/td>\nmedium<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Loperamide<\/td>\n–<\/td>\n2<\/td>\n1<\/td>\n–<\/td>\nmedium<\/td>\nlow<\/td>\n<\/tr>\n
Loratadine<\/td>\n–<\/td>\n2<\/td>\n1<\/td>\n–<\/td>\nmedium<\/td>\nlow<\/td>\n<\/tr>\n
Methocarbamol<\/td>\n–<\/td>\n1<\/td>\n3<\/td>\n\u2713<\/td>\nmedium\/low<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Nortriptyline<\/td>\n–<\/td>\n2<\/td>\n3<\/td>\n–<\/td>\nmedium<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Olanzapine<\/td>\n–<\/td>\n2<\/td>\n3<\/td>\n–<\/td>\nmedium<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Paroxetine<\/td>\n–<\/td>\n1<\/td>\n3<\/td>\n\u2713<\/td>\nmedium\/low<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Quetiapine<\/td>\n–<\/td>\n1<\/td>\n3<\/td>\n\u2713<\/td>\nmedium\/low<\/td>\nmedium\/low<\/td>\n<\/tr>\n
Tolterodine<\/td>\n–<\/td>\n2<\/td>\n3<\/td>\n–<\/td>\nmedium<\/td>\nmedium\/low<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

AC: Antikolinerjik, ACB: antikolinerjik bili\u015fsel y\u00fck \u00f6l\u00e7e\u011fi, ARS: antikolinerjik risk \u00f6l\u00e7e\u011fi, *Japonya’da kullan\u0131lmamaktad\u0131r.<\/p>\n

 <\/p>\n

Kaynaklar<\/strong><\/p>\n

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[20]\u00a0\u00a0\u00a0\u00a0 Machado-Duque ME, Casta\u00f1o-Montoya JP, Medina-Morales DA, Castro-Rodr\u00edguez A, Gonz\u00e1lez-Montoya A, Machado-Alba JE. Drugs With Anticholinergic Potential and Risk of Falls With Hip Fracture in the Elderly Patients: A Case\u2013Control Study. J Geriatr Psychiatry Neurol 2018;31:63\u20139. https:\/\/doi.org\/10.1177\/0891988718757370.<\/p>\n

[21]\u00a0\u00a0\u00a0\u00a0 Moga DC, Carnahan RM, Lund BC, Pendergast JF, Wallace RB, Torner JC, et al. Risks and Benefits of Bladder Antimuscarinics Among Elderly Residents of Veterans Affairs Community Living Centers. J Am Med Dir Assoc 2013;14:749\u201360. https:\/\/doi.org\/10.1016\/j.jamda.2013.03.008.<\/p>\n

[22]\u00a0\u00a0\u00a0\u00a0 S\u00f8rensen HJ, Jensen SOW, Nielsen J. Schizophrenia, antipsychotics and risk of hip fracture: A population-based analysis. Eur Neuropsychopharmacol 2013;23:872\u20138. https:\/\/doi.org\/10.1016\/j.euroneuro.2013.04.002.<\/p>\n

[23]\u00a0\u00a0\u00a0\u00a0 Pont LG, Nielen JTH, McLachlan AJ, Gnjidic D, Chan L, Cumming RG, et al. Measuring anticholinergic drug exposure in older community-dwelling Australian men: a comparison of four different measures. Br J Clin Pharmacol 2015;80:1169\u201375. https:\/\/doi.org\/10.1111\/bcp.12670.<\/p>\n

[24]\u00a0\u00a0\u00a0\u00a0 Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009;169:1952\u201360. https:\/\/doi.org\/10.1001\/archinternmed.2009.357.<\/p>\n","protected":false},"excerpt":{"rendered":"

Uzun zamand\u0131r geni\u015f bir tedavi spektrumunda kulland\u0131\u011f\u0131m\u0131z antikolinerjik ila\u00e7lar\u0131n artan k\u0131r\u0131k riski ile ili\u015fkisi tart\u0131\u015f\u0131lmaya devam eden bir konudur. Bu yaz\u0131m\u0131zda Ogawa…<\/p>\n","protected":false},"author":212,"featured_media":3442,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10010,10014,10019],"tags":[10020,10021,10023,10022],"class_list":["post-3440","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-slider","category-akademik-blog-yazisi","category-tft","tag-antikolinerjik","tag-kirik","tag-metaanaliz","tag-tft"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3440","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/212"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=3440"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3440\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/3442"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=3440"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=3440"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=3440"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}