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Evaluation of the use of benzodiazepines among pharmacy course students at the Presidente Antônio Carlos-Barbacena-MG university center

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ORIGINAL ARTICLE

BARBOSA, Dara Cezário [1], ZINI, Cintia Elena Leite [2]

BARBOSA, Dara Cezário. ZINI, Cintia Elena Leite. Evaluation of the use of benzodiazepines among pharmacy course students at the Presidente Antônio Carlos-Barbacena-MG university center. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year. 06, Ed. 11, Vol. 02, pp. 05-18. November 2021. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/health/use-of-benzodiazepines

ABSTRACT

Benzodiazepines are used as hypnotics, sedatives, anxiolytics, anticonvulsants and muscle relaxants, being among the most prescribed and used drugs in the world. The progressive increase in the number of users is an important point to be discussed, since its continuous use has been associated with abstinence syndromes, dependence, tolerance and adverse reactions, becoming a cause for concern, especially in the university context. The present article presents as problematic the hypothesis that the use of benzodiazepines is frequent in university students of the pharmacy course of Unipac Barbacena – MG. In this context, the aim of this study was to know the profile of use of these drugs by pharmacy students at Unipac Barbacena – MG. Data were collected through an online questionnaire via Google Forms, available from August 22 to September 30, 2020 (Opinion CEP Unipac 4,212,688). Thirty questionnaires were considered valid, most of them women aged between 21 and 25 years (57%). Benzodiazepines were used by 66.6% of the participants, and the drug with the highest frequency was clonazepam (41%), followed by diazepam (22%) and alprazolam (19%). Among the reasons for use, anxiety (44%), depression (18%) and insomnia (18%) stand out. Of the students who used benzodiazepines, 65% did so for a period longer than 6 months, which can induce dependence and withdrawal syndrome, contradicting recommendations from the package leaflet and the literature. The data reveal a significant use of these drugs by students and the pharmacist plays a central role in rational use and may motivate institutional actions in this sense.

Keywords: Benzodiazepines, Students, Rational use of medicines.

INTRODUCTION

The intense transformation stemming from the last century has led to the excessive emergence of anxiety disorders, depression, among others. Within this oppressive environment, the undergraduate program is highlighted: critical period and greater vulnerability of students, since, because it is an environment that presents several anxiogenic factors, it contributes to the development of anxiety and other conditions in which it will be necessary to use medication. (MARCHI, 2013)

Among the various psychotropic drugs acting on the central nervous system (CNS) the class of benzodiazepines (JUNIOR, 2014) stand out. The mechanism of action of this class of drugs occurs by the ability to bind to a specific regulatory site on the gamma-aminobutyric acid receptor (GABA). As a result of this binding, there is an potentiation of gaba-inhibiting neuro-inhibitory action, which leads to a reduction in cellular excitability. Therefore, there is an increase in the inibiotory processes in the CNS, thus causing a depressive effect (CARLINI, 2001; RIBEIRO, 2017). They act as hypnotics, sedatives, anticonvulsants and muscle relaxants, and are mainly used in the treatment of acute anxiety and transient insomnia (ZORZANELLI, 2019).

The long half-life, the possibility of diversified routes of administration and the high therapeutic index contribute to the wide dissemination of this class among physicians and patients. According to reports from international agencies such as WHO and The International Narcotics Control Board (INCB), there are indications of the indiscriminate use of these drugs and insufficient control in developing countries, such as Brazil (MENDES, 2015).

The complexity involved in the use of such drugs is correlated with the serious problems they cause, and there is no prevalence of benefits when compared to the difficulties that may arise in a situation of dependence from the use. The dependence of benzodiazepines causes damage to the patient’s health, both in the social and quality of life (JUNIOR, 2014). This class also presents enormous potential for abstinence syndrome and adverse reactions, such as sedation, respiratory depression, psychomotor changes, cognitive dysfunction (ZORZANELLI, 2019; COMHUPES, 2013). It is recommended that the treatment does not exceed a period of six months (JUNIOR, 2014).

The use of benzodiazepines by students is a reality and can be influenced by a number of factors, which include sociocultural circumstances, absence of information programs on self-medication, the ease of obtaining prescriptions, mainly by health students. In addition to these, the knowledge acquired in the 4 curricular disciplines is also insufficient to modify the perception in relation to the risk associated with the irrational use of these drugs (RIBEIRO, 2017).

Pharmacists play a key role in promoting the rational use of medicines. Through pharmaceutical care and care, this professional can provide the population with more information about rational use, which ensures greater safety and efficacy during therapy, together with a minimization of adverse drug reactions (MARCHI, 2013; BARRETO, 2019).

This article presents as problematic the hypothesis that the use of benzodiazepines is part of the reality of university pharmacy students at Unipac Barbacena – MG, due to the context in which they are inserted, such as the anxiety generated by the load of studies and the need to obtain good grades.

Starting from the context of increasing irrational use of benzodiazepines, as well as the performance of the pharmacist as an active professional in promoting the rational use of medicines, the present study aimed to know the profile of the use of benzodiazepines by pharmacy students of the Presidente Antônio Carlos University Center (Unipac) of Barbacena – MG and its determinants.

DEVELOPMENT

It refers to a descriptive study and quantitative approach with academics enrolled in the Pharmacy course of the Presidente Antônio Carlos University Center (Unipac) of Barbacena-MG, in the semester 2020/2. The theoretical sample n consisted of 153 individuals, referring to the number of students enrolled in the course during the 2nd semester of 2020. The inclusion criteria were: being regularly enrolled in the Pharmacy course of Unipac Barbacena. Exclusion criteria were: students who did not fully complete the questionnaire; students who refused to participate in the research; students who gave up answering the questionnaire after the survey started. The participants explained the objectives of the research and clarified the principles of confidentiality, privacy, anonymity and the guarantee that non-participation or withdrawal at any time of the research would not cause losses and/or constraints. After clarification, the participants were invited to sign a Free and Informed Consent Form. Data were collected by applying a semi-structured questionnaire (adapted according to the needs of the study), elaborated based on the work of Mendes (2015), containing 13 questions, objective and discursive, referring to the use of benzodiazepines. The questionnaire was applied online, using the Google Forms tool, 5 available free of charge on the Google platform to students of the Pharmacy course, the University Center Presidente Antônio Carlos (Unipac) Barbacena / MG, with the consent of the Academic Direction. The questionnaire was available for the period from August 22 to September 30, 2020. The project was approved by the Ethics and Research Committee (CEP) involving human beings of Unipac, CAAE:4.212.688. The data obtained were processed and analyzed using descriptive statistics (mean, standard deviation, absolute and relative frequency) using the Microsoft Office Excel software®.

RESULTS AND DISCUSSION

Of the 153 students enrolled in the 2nd semester of 2020 in the Pharmacy course of Unipac Barbacena, 34 answered the questionnaire. Of these, 4 participants were excluded because they did not answer the questionnaire completely. Thirty questionnaires were considered valid. Graph 1 shows the distribution by period of the students: 11 (36%) correspond to students from the tenth period, 8 (27%) from the sixth, 7 (23%) from the eighth, 2 (7%) from the third and the other 2 (7%) to the second. In the sample collected, there was a prevalence of 26 (87%), with a predominance of age from 21 to 25 years 17 (57%). Between 26 and 29 years were added 6 (20%), between 30 and 53 years 7 (23%), as shown in Graph 2. Of these students, 20 (66.6%) have already used benzodiazepines during their lives.

Figure 1: Distribution by period of the students of the Pharmacy course.

Source: Survey Data (2020)

Graph 2: Age group of participants.

Source: Survey Data (2020)

The predominance of females and the ages mentioned above are similar to the results of studies conducted by Ribeiro (2017), with nursing and pharmacy students from a private college in southwestern Bahia, who demonstrated a predominance of women (66.7% and 51.1%) between the ages of 18 to 28 years and 18 to over 30 years, respectively, consuming benzodiazepines.

Graph 3 shows the benzodiazepine agents most used by pharmacy students, according to the research. Clonazepam was the most used medicine: 13 (41%); followed by Diazepam: 7 (22%); Alprazolam: 6 (19%); Bromazepam: 4 (12%). The least used were Lorazepam: 1 (3%); and Cloxazolam 1 (3%). Anxiety is the main reason for the use of these medications: 17 (44%); followed by depression: 7 (18%); insomnia: 7 (18%); concern: 4 (10%); other reasons: 3 (8%); and pain: 1 (2%).The high frequency of use of clonazepam by students (41%), compared to other benzodiazepine drugs, was also observed in the studies by Ribeiro (2017), there was a predominance of the use of clonazepam among nursing students (33.3%) and pharmacy (40%), and anxiety being one of the main reasons for use (26.7% and 20%). According to Botti (2010), there was also a high use of this medication by nursing students at PUC Minas, Campus Betim, 42.8% among women and 50% among men.

Graph 3: Distribution of benzodiazepines used by pharmacy students.

Source: Survey Data (2020)

Among the students who have already used the medications, 12 (60%) students reported that they started using these drugs during college. Students of health courses demonstrate higher levels of stress and anxiety because they are involved in patient care (RIBEIRO, 2017). Moreover, as the college is an anxiogenic environment, some factors are triggering the development of anxiety, such as insecurity, the fear of making mistakes, dealing with patients, the collection of their development in academic practice (MARCHI, 2013; MERRELL, 2008). Therefore, moved by the need for adaptation to which they are imposed daily, they start to use psychotropic drugs, in particular benzodiazepines, in order to obtain a minimization of their psychic adversities (MELINCAVAGE, 2011; PSICOLOTTO, 2010).

Graph 4 shows the duration of treatment reported by the students. Of these, 7 (35%) were instructed to use these drugs for six months or less, according to what is described in the literature, which recommends that the treatment does not exceed a period of six months (JUNIOR, 2014).

Graph 4: Treatment time reported by pharmacy students.

Source: Survey Data (2020)

It is emphasized that, according to Graph 4, 13 (65%) of the students make the use for a longer time than recommended. Of these, 3 (15%) used it for six months to one year, 5 (25%) for more than one year and 5 (25%) until symptom remission or cure. These data were also observed in studies conducted by Nordon (2009), in which there is a predominance of time of use for a period longer than recommended, from 12 to 35 months (15.2%) and more than 36 months (69.6%). This fact becomes a cause for concern due to the effects caused by the prolonged use of these drugs, which include dependence, abstinence and tolerance (ZORZANELLI, 2019). Regarding the frequency of use, 9 (45%) use it daily, 6 (30%) sporadically and 5 (25%) only in emergency cases. Of the students who used these medications, 9 (45%) stated that they had some effect resulting from the use and 11 (55%) did not present any. It is also observed that drowsiness is the most preponderance side effect among students, 3 (23%) as demonstrated in Graf. 5, according to the study conducted by Ribeiro (2017), in which excessive sleepiness was the predominant side effect among nursing students (73.3%) and pharmacy (77.8%) who used benzodiazepines. According to the literature, the main effects are: dizziness and tinnitus, excessive sleepiness, memory failures, dependence and worsening of motor coordination (SANTOS, 2014; SILVA, 2014).

Graph 5. Side effects reported by respondents.

Source: Survey Data (2020)

Regarding the influence of knowledge acquired during graduation, 9 (35%) said that knowledge makes them more confident, 4 (25%) said that the knowledge acquired in the course leaves them partially confident, which contributes to increased confidence when using these medications. The increase in this confidence over the course is linked to the study of contents such as pharmacokinetics and pharmacodynamics, present within disciplines of the curriculum, in addition to a deeper knowledge about the risks, benefits, interactions and indications of medications by pharmacy students (BARRETO, 2019).

Regarding the prescription, 16 (80%) of the students reported that they started using these medications through medical indication. According to a study conducted by Mendes (2015) 90% of physicians with different specialties reported prescribing psychotropic drugs. It is observed that the indication of benzodiazepines is a habit that is widespread in the routine of medical prescriptions (MENDES, 2015). Several studies show that this class of medicines is among the most frequently prescribed substances and used regularly by more than 10% of the population in numerous countries (ALVES, 2016). Its widespread use among physicians and patients is associated with several reasons, such as long half-life, diversity of routes of administration, high therapeutic index, possibility of active metabolites. In addition to the pharmacological characteristics mentioned, the popularity among patients and the price of this class are also shown to be conditioning factors for prescription (MENDES, 2015).

During treatment, 14 (70%) of the students stated that they tried to discontinue the use of the drug during treatment and 6 (30%) did not try. Of these, 4 (20%) reported that they had difficulties with interruption and 3 (15%) reported partial difficulty. Graph 6 shows the difficulties that arose during forced discontinuation of treatment, with insomnia being the predominant symptom: 4 (34%); followed by anxiety: 2 (17%); and dependence: 2 (17%). Abstinence, agitation, mood swings, and irritability have also been reported, but less frequently. According to a study conducted by Nordon (2009), 91.3% of the women who used the medications and who sought treatment in primary care tried to perform the interruption and 60.9% did not succeed in the process, and the persistence of symptoms prior to use, anxiety and nocturnal paraesthesias were the main reasons for failure.

Graph 6. Difficulties reported in the interruption of treatment by pharmacy students.

Source: Survey Data (2020)

It should be emphasized that withdrawal should occur slowly and gradually, due to the frequent appearance of severe symptoms from abstinence and the “rebound effect”, especially sleep-related disorders. In addition to these, other problems during the withdrawal process may arise, such as anxiety, restlessness, lethargy, sedation and inability to perform certain daily activities (JUNIOR, 2014; MANTOVANI, 2019). Regarding the permanence of the effect, 10 (50%) of the students stated that there was no reduction in the effect over time, 5 (25%) reported a partial reduction of the effect and the other 5 (25%) reported no loss of effect. According to the results of the study conducted by Mendes (2015) there is a prevalence of efficacy throughout treatment (68.57%) reported by users, and the loss of this long-term efficacy is lower (31.43%). But this reduction in the effect may be associated with the phenomenon of tolerance, which develops due to chronic use of the drug. In their case, there is a compensatory change in benzodiazepine and GABA receptors, causing them to become less responsive, which triggers a reduction in their injunctions. This causes the initial dose to have less effect, requiring a higher dose to obtain the original effect (MENDES, 2015).

The pharmacist as an active promoter of health plays a primary role in guiding the use of these medications. Through therapeutic counseling, there is a contribution to its rational use, ensuring greater safety and efficacy of therapy, reduction of possible drug interactions and minimization of adverse reactions, which are commonly observed during chronic use of these drugs and may become a serious problem within the health sector (MARCHI, 2013; BARRETO, 2008; ALVES, 2016).

FINAL CONSIDERATIONS

The number of respondents was lower than expected, which is attributed to the application of the online form, since there was no face-to-face contact to request the answers. However, the results found in this study demonstrated that the use of benzodiazepines by pharmacy students at Unipac Barbacena-MG is expressive, confirming the initial hypothesis, composed mostly of women. The main reasons for benzodiazepine use were anxiety, depression and insomnia and clonazepam and diazepam the most frequently used medications. It was observed use for a longer time than recommended, and a greater confidence in the use due to the knowledge acquired during the course. Based on the context of the evaluation of the profile of these students and the determinants involved in the use of benzodiazepines, it is concluded that it is pertinent to discuss the subject as well as the implementation of actions in the faculty that stimulate the rational use of these drugs.

REFERENCES

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[1] Graduated in Pharmacy. ORCID: https://orcid.org/0000-0003-2904-7526

[2] Guidance counselor.

Submitted: October, 2021.

Approved: November, 2021.

5/5 - (5 votes)
Dara Cezário Barbosa

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