{"id":13979,"date":"2025-07-24T10:40:27","date_gmt":"2025-07-24T08:40:27","guid":{"rendered":"https:\/\/staging.ivrt.de\/?p=13979"},"modified":"2026-04-28T17:35:29","modified_gmt":"2026-04-28T15:35:29","slug":"ordinationskaskader-hos-aeldre-mennesker-nar-en-bivirkning-forer-til-den-naeste-ordination","status":"publish","type":"post","link":"https:\/\/staging.ivrt.de\/da\/studien-evidenz\/prescribing-cascades-bei-aelteren-menschen-wenn-eine-nebenwirkung-zur-naechsten-verordnung-fuehrt\/","title":{"rendered":"\u201eOrdinationskaskade\u201c hos \u00e6ldre mennesker: N\u00e5r en bivirkning f\u00f8rer til den n\u00e6ste ordination"},"content":{"rendered":"<p class=\"wp-block-paragraph\"><strong>For fagfolk:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En ny unders\u00f8gelse fra Irland viser hyppige l\u00e6gemiddelkaskader hos \u00e6ldre \u2013 ogs\u00e5 med vestibul\u00e6r relevans:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\ud83d\udd17 <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40494622\/\" data-type=\"link\" data-id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40494622\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Original studie p\u00e5 PubMed<\/strong><\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Baggrund<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>lovgivningsm\u00e6ssige kaskader\u00a0<\/strong>opst\u00e5r, n\u00e5r en bivirkning af et l\u00e6gemiddel feiltolkes som en ny sygdom \u2013 og derefter behandles med et yderligere l\u00e6gemiddel. \u00c6ldre mennesker med multimorbiditet og polyfarmaci er s\u00e6rligt udsatte. Den nye analyse af irske udskrivningsdata unders\u00f8gte for f\u00f8rste gang 9 s\u00e5danne kaskader hos over 530.000 personer over 65 \u00e5r.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Forskningsdesign<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Kilde<strong>:<\/strong>\u00a0Irlands nationale receptdatabase (GMS-ordningen)<\/li>\n\n\n\n<li>Metode: Receptsekvens-symmetrianalyse<\/li>\n\n\n\n<li>Observationsvindue: 365 dage<\/li>\n\n\n\n<li>Befolkning: 533.464 \u00e6ldre mennesker \u2265 65 \u00e5r<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>De fem mest almindelige receptionskaskader \u2013 klinisk forklaret<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">1. Blodtryksmedicin \u2192 Diuretikum<br>Hyppighed: 2,6\u202f% | Risikoen er n\u00e6sten fordoblet (aSR 1,93)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Typisk tilf\u00e6lde:<br><\/strong>En calciumkanalblokker s\u00e6nker blodtrykket, men for\u00e5rsager perifere \u00f8demer. I stedet for at skifte pr\u00e6paratet tilf\u00f8jes et diuretika.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00f8lje<br><\/strong>\u2192 Elektrolytforstyrrelser, kredsl\u00f8bsproblemer, svimmelhed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>2. Prostatamedicin \u2192 Medicin mod svimmelhed (vestibul\u00e6rt sedativum)<br><\/strong>Hyppighed: 3,0\u202f% | Risikoen er forh\u00f8jet med 63\u202f% (aSR 1,63)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Typisk tilf\u00e6lde:<\/strong><br>En alfa-1-blokker mod prostatahyperplasi s\u00e6nker blodtrykket og f\u00f8rer til ortostatisk svimmelheid. I stedet for at reducere dosen udskrives et vestibul\u00e6rt sedativum \u2013 selvom der ikke foreligger nogen vestibul\u00e6r \u00e5rsag.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00f8lje<\/strong><br>D\u00e6mpning af den centrale ligev\u00e6gtsbearbejdning, gangusikkerhed, faldrisiko.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Antidepressivum \u2192 Sovemiddel<\/strong><br>Hyppighed: 2,5\u202f% | Risikoen er forh\u00f8jet med 54\u202f% (aSR 1,54)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Typisk tilf\u00e6lde:<\/strong><br>En patient p\u00e5begynder behandling med en selektiv serotonin- eller noradrenalin-genoptagelsesh\u00e6mmer. Der opst\u00e5r ind- eller igennemsovningsbesv\u00e6r, hvorefter der udskrives et ekstra sovemiddel.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00f8lje<\/strong><br>\u2192 Tr\u00e6thed i dagtimerne, faldrisici, afh\u00e6ngighedspotentiale.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Antipsychotikum \u2192 Parkinsonmiddel<\/strong><br>Hyppighed: 0,4\u202f% | Risikoen er forh\u00f8jet med 20\u202f% (aSR 1,20)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Typisk tilf\u00e6lde:<\/strong><br>Et antipsykotikum for\u00e5rsager ekstrapyramidale symptomer (f.eks. rigor, tremor). Disse behandles medicinsk med et antiparkinsonmiddel.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00f8lje<\/strong><br>Belastning af det dopaminerge system, nye bivirkninger.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>5. Beroligende middel \u2192 Antipsykotikum<\/strong><br>Hyppighed: 3,2\u202f% | Risikoen er forh\u00f8jet med 15\u202f% (aSR 1,15)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Typisk tilf\u00e6lde:<\/strong><br>Et benzodiazepin f\u00f8rer til paradoksal reaktion (rastl\u00f8shed, forvirring). Derefter f\u00f8lger ordination af et neuroleptikum.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00f8lje<\/strong><br>Sedering, gangforstyrrelser, deliriumrisiko.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Betydning for praksis<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Svimmelhed, s\u00f8vnforstyrrelser eller forvirring b\u00f8r unders\u00f8ges kritisk for bivirkninger.<\/li>\n\n\n\n<li>Vestibul\u00e6re sedativa ordineres ofte mod uspecifik svimmelhed \u2013 uden <a href=\"https:\/\/staging.ivrt.de\/da\/patientuddannelse\/diagnostiske-tests-for-balanceforstyrrelser\/\" data-type=\"post\" data-id=\"8955\">vestibul\u00e6r udredning<\/a>.<\/li>\n\n\n\n<li>Rezeptionskaskaden \u00f8ger risikoen for fald, forringer livskvaliteten og fremmer funktionel tilbagegang.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Konklusion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ordinationskaskader er hyppige og klinisk relevante \u2013 is\u00e6r <a href=\"https:\/\/staging.ivrt.de\/da\/patientuddannelse\/presbyvestibulopati-aldersbetinget-svimmelhed\/\" data-type=\"post\" data-id=\"7179\" target=\"_blank\" rel=\"noreferrer noopener\">i geriatrisk kontekst med balanceforstyrrelser<\/a>. For fysioterapeuter, l\u00e6ger og apotekere er det afg\u00f8rende at vurdere ethvert nyt symptom kritisk.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>\ud83d\udc49 Vil du l\u00e6re, hvordan man sikkert genkender og differentierer vestibul\u00e6rt betinget svimmelhed?<br>og behandlet?<\/strong><br>Aktuelle efteruddannelsestilbud finder du i <strong><a href=\"https:\/\/staging.ivrt.de\/da\/for-sundhedsfagligt-personale\/efteruddannelsessogning\/\" data-type=\"link\" data-id=\"https:\/\/staging.ivrt.de\/fuer-medizinisches-fachpersonal\/fortbildungssuche\/\">IVRT-Efteruddannelsess\u00f8gning<\/a>.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Til patienter \u2013 forklaret p\u00e5 en enkel m\u00e5de<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>De fem mest almindelige medicinkaskader \u2013 enkelt forklaret<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\ud83d\udcc4 <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40494622\/\" data-type=\"link\" data-id=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40421807\/\" target=\"_blank\" rel=\"noreferrer noopener\">Til originalstudiet<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">1.&nbsp;<strong>Blodtryksmedicin \u2192 Vanddrivende middel<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hyppighed: 2,6\u202f%<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Hvad sker der?<\/strong><br>En blodtryksneds\u00e6ttende medicin (calciumkanalblokker) kan for\u00e5rsage v\u00e6ske i benene. I stedet for at tilpasse medicinen, ordineres et ekstra vanddrivende middel (diuretikum).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00f8lje<\/strong><br>Mineralstoffmangel, kredsl\u00f8bsproblemer, svimmelhed \u2013 og en h\u00f8jere risiko for fald.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">2.&nbsp;<strong>Medicin mod svimmelhed<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hyppighed: 3,0\u202f%<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Hvad sker der?<\/strong><br>Et middel mod prostatabeskv\u00e6r kan s\u00e6nke blodtrykket \u2013 is\u00e6r n\u00e5r man rejser sig. Der opst\u00e5r svimmelhed. I stedet for at afhj\u00e6lpe \u00e5rsagen udskrives der medicin mod svimmelhed \u2013 selvom ligev\u00e6gtsorganet er sundt.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00f8lje<\/strong><br>Medicinen mod svimmelhed d\u00e6mper de hjerneregler, der er ansvarlige for balancen. Man f\u00f8ler sig usikker p\u00e5 benene \u2013 risikoen for fald stiger.<br>\ud83d\udc49 Vigtigt: Disse midler mod svimmelhed er kun beregnet til akutte n\u00f8dsituationer \u2013 og aldrig i l\u00e6ngere tid end et par dage!<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">3.&nbsp;<strong>Sovemiddel<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hyppighed: 2,5\u202f%<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Hvad sker der?<\/strong><br>Et nyt antidepressivum f\u00f8rer til s\u00f8vnproblemer. I stedet for at lede efter en bedre l\u00f8sning sammen, udskrives der derudover et sovemiddel.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00f8lje<\/strong><br>Man f\u00f8ler sig tr\u00e6t om dagen, vakkelvorn \u2013 eller bliver afh\u00e6ngig af sovemidlet.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">4.&nbsp;<strong>Midler mod bev\u00e6gelsesforstyrrelser (Parkinsonmidler)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hyppighed: 0,4\u202f%<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Hvad sker der?<\/strong><br>Et middel mod f.eks. vrangforestillinger eller st\u00e6rk uro kan for\u00e5rsage muskelstivhed eller rysten. I stedet for at revurdere det udl\u00f8sende l\u00e6gemiddel udskrives der medicin mod Parkinsons symptomer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00f8lje<\/strong><br>Endnu flere l\u00e6gemidler og un\u00f8dvendige l\u00e6gemidler mod Parkinsons sygdom \u2013 med nye bivirkninger.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">5.&nbsp;<strong>Beroligende middel \u2192 Middel mod indre uro eller forvirring (neuroleptika)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hyppighed: 3,2\u202f%<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Hvad sker der?<\/strong><br>Et beroligende middel (f.eks. benzodiazepin) f\u00f8rer til paradoksale reaktioner \u2013 f.eks. indre uro eller hallucinationer. Disse behandles derefter med endnu et st\u00e6rkt l\u00e6gemiddel.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>F\u00f8lje<\/strong><br>Tr\u00e6thed, usikker gang, koncentrationsbesv\u00e6r.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Hvad du kan g\u00f8re<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Tal \u00e5bent om dine gener.<\/strong><br>Hvis du bem\u00e6rker nye symptomer, skal du tale med din l\u00e6ge.<br>Sp\u00f8rg helt direkte: \u201eKan det v\u00e6re en bivirkning af medicinen?\u201c<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Indhent en second opinion, hvis du er i tvivl.<\/strong><br>For eksempel p\u00e5 apoteket!<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ved svimmelhed eller balanceforstyrrelser:<\/strong><br>Hvis generne ikke er for\u00e5rsaget af medicin, kan der ogs\u00e5 ligge en vestibul\u00e6r \u00e5rsag bag.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\ud83c\udfaf Vores certificerede&nbsp;<strong>IVRT\u00ae-svimmelheds- og vestibul\u00e6rterapeuter<\/strong>&nbsp;hj\u00e6lper dig individuelt videre: <strong><a href=\"https:\/\/staging.ivrt.de\/da\/for-patienter\/find-terapeut\/\" target=\"_blank\" rel=\"noreferrer noopener\">S\u00f8gning efter IVRT-terapeut<\/a><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a id=\"_msocom_1\"><\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>","protected":false},"excerpt":{"rendered":"<p>F\u00fcr Fachpersonal: Eine neue Studie aus Irland zeigt h\u00e4ufige medikament\u00f6se Kaskaden im Alter \u2013 auch mit vestibul\u00e4rer Relevanz: \ud83d\udd17 Originalstudie auf PubMed Hintergrund Verordnungskaskaden\u00a0entstehen, wenn eine Nebenwirkung eines Medikaments als neue Erkrankung fehlinterpretiert wird \u2013 und dann mit einem weiteren Medikament behandelt wird. Besonders gef\u00e4hrdet sind \u00e4ltere Menschen mit Multimorbidit\u00e4t und Polypharmazie. Die neue Analyse [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":17994,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_surecart_dashboard_logo_width":"180px","_surecart_dashboard_show_logo":true,"_surecart_dashboard_navigation_orders":true,"_surecart_dashboard_navigation_invoices":true,"_surecart_dashboard_navigation_subscriptions":true,"_surecart_dashboard_navigation_downloads":true,"_surecart_dashboard_navigation_billing":true,"_surecart_dashboard_navigation_account":true,"_jf_save_progress":"","iawp_total_views":149,"footnotes":"","_members_access_role":[],"_members_access_error":""},"categories":[215],"tags":[],"class_list":["post-13979","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-studien-evidenz"],"_links":{"self":[{"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/posts\/13979","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/comments?post=13979"}],"version-history":[{"count":1,"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/posts\/13979\/revisions"}],"predecessor-version":[{"id":17490,"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/posts\/13979\/revisions\/17490"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/media\/17994"}],"wp:attachment":[{"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/media?parent=13979"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/categories?post=13979"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/staging.ivrt.de\/da\/wp-json\/wp\/v2\/tags?post=13979"}],"curies":[{"name":"godt spillet","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}