{"id":13979,"date":"2025-07-24T10:40:27","date_gmt":"2025-07-24T08:40:27","guid":{"rendered":"https:\/\/ivrt.de\/?p=13979"},"modified":"2026-04-28T17:35:29","modified_gmt":"2026-04-28T15:35:29","slug":"yaslilarda-recete-kaskadlari-bir-yan-etkinin-bir-sonraki-receteye-yol-actigi-durumlar","status":"publish","type":"post","link":"https:\/\/ivrt.de\/tr\/studien-evidenz\/prescribing-cascades-bei-aelteren-menschen-wenn-eine-nebenwirkung-zur-naechsten-verordnung-fuehrt\/","title":{"rendered":"\u201eYa\u015fl\u0131larda \u201cRe\u00e7ete Kaskad\u0131\u201c: Bir yan etkinin bir sonraki re\u00e7eteye yol a\u00e7mas\u0131"},"content":{"rendered":"<p><strong>Uzman personel i\u00e7in:<\/strong><\/p>\n\n\n\n<p>\u0130rlanda'dan yap\u0131lan yeni bir \u00e7al\u0131\u015fma, ya\u015fl\u0131l\u0131kta s\u0131k g\u00f6r\u00fclen ila\u00e7 kaskadlar\u0131n\u0131 ortaya koyuyor \u2013 bunlar vestib\u00fcler a\u00e7\u0131dan da \u00f6nem ta\u015f\u0131yor:<\/p>\n\n\n\n<p>\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>PubMed'deki Orijinal \u00c7al\u0131\u015fma<\/strong><\/a><\/p>\n\n\n\n<p><strong>Arka plan<\/strong><\/p>\n\n\n\n<p><strong>Y\u00f6netmelik kademeleri\u00a0<\/strong>bir ilac\u0131n yan etkisi yeni bir hastal\u0131k olarak yanl\u0131\u015f yorumland\u0131\u011f\u0131nda ve ard\u0131ndan ba\u015fka bir ila\u00e7la tedavi edildi\u011finde ortaya \u00e7\u0131kar. \u00c7oklu hastal\u0131klar\u0131 (multimorbidite) ve \u00e7oklu ila\u00e7 kullan\u0131m\u0131 (polifarmasi) olan ya\u015fl\u0131 insanlar \u00f6zellikle risk alt\u0131ndad\u0131r. \u0130rlanda re\u00e7ete verileri \u00fczerine yap\u0131lan yeni analiz, 65 ya\u015f \u00fcst\u00fc 530.000'den fazla ki\u015fide bu t\u00fcr 9 kaskad\u0131 ilk kez inceledi.<\/p>\n\n\n\n<p><strong>Ara\u015ft\u0131rma tasar\u0131m\u0131<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hangi<strong>:<\/strong>\u00a0\u0130rlanda Ulusal Re\u00e7ete Veritaban\u0131 (GMS Sistemi)<\/li>\n\n\n\n<li>Y\u00f6ntem: Re\u00e7ete S\u0131ra Simetri Analizi<\/li>\n\n\n\n<li>G\u00f6zlem penceresi: 365 g\u00fcn<\/li>\n\n\n\n<li>N\u00fcfus: 533.464 ya\u015fl\u0131 insan \u2265 65 ya\u015f<\/li>\n<\/ul>\n\n\n\n<p><strong>En yayg\u0131n be\u015f re\u00e7ete kaskad\u0131 \u2013 klinik olarak a\u00e7\u0131kland\u0131<\/strong><\/p>\n\n\n\n<p>1. Tansiyon ilac\u0131 \u2192 Di\u00fcretik<br>S\u0131kl\u0131k: 2,6\u202f% | Risk neredeyse iki kat\u0131na \u00e7\u0131km\u0131\u015ft\u0131r (aSR 1,93)<\/p>\n\n\n\n<p><strong>Tipik vaka:<br><\/strong>Bir kalsiyum kanal blokeri kan bas\u0131nc\u0131n\u0131 d\u00fc\u015f\u00fcr\u00fcr ancak periferik \u00f6deme neden olur. \u0130lac\u0131 de\u011fi\u015ftirmek yerine bir di\u00fcretik eklenir.<\/p>\n\n\n\n<p><strong>Takip:<br><\/strong>Elektrolit bozukluklar\u0131, dola\u015f\u0131m sorunlar\u0131, ba\u015f d\u00f6nmesi.<\/p>\n\n\n\n<p><strong>2. Prostatamedikament \u2192 Schwindelmedikament (vestibul\u00e4res Sedativum)<br><\/strong>S\u0131kl\u0131k: 3,0\u202f% | Risk 63\u202f% oran\u0131nda artm\u0131\u015ft\u0131r (aSR 1,63)<\/p>\n\n\n\n<p><strong>Tipik vaka:<\/strong><br>Prostata hiperplazisi i\u00e7in kullan\u0131lan bir alfa-1 bloker tansiyonu d\u00fc\u015f\u00fcr\u00fcr ve ortostatik ba\u015f d\u00f6nmesine yol a\u00e7ar. Dozu azaltmak yerine, vestib\u00fcler bir neden olmamas\u0131na ra\u011fmen bir vestib\u00fcler sedatif re\u00e7ete edilir.<\/p>\n\n\n\n<p><strong>Takip:<\/strong><br>Merkezi denge i\u015flemenin bask\u0131lanmas\u0131, y\u00fcr\u00fcme belirsizli\u011fi, d\u00fc\u015fme riski.<\/p>\n\n\n\n<p><strong>3. Antidepresan \u2192 Uyku ilac\u0131<\/strong><br>S\u0131kl\u0131k: 2,5\u202f% | Risk 54\u202f% oran\u0131nda artm\u0131\u015ft\u0131r (aSR 1,54)<\/p>\n\n\n\n<p><strong>Tipik vaka:<\/strong><br>Bir hasta se\u00e7ici serotonin veya noradrenalin geri al\u0131m inhibit\u00f6r\u00fc ile tedaviye ba\u015flar. Uykuya dalma veya uykuyu s\u00fcrd\u00fcrme bozukluklar\u0131 ortaya \u00e7\u0131kar, bunun \u00fczerine ek bir uyku ilac\u0131 re\u00e7ete edilir.<\/p>\n\n\n\n<p><strong>Takip:<\/strong><br>G\u00fcnd\u00fcz yorgunlu\u011fu, d\u00fc\u015fme riski, ba\u011f\u0131ml\u0131l\u0131k potansiyeli.<\/p>\n\n\n\n<p><strong>4. Antipsikotik \u2192 Parkinson ilac\u0131<\/strong><br>S\u0131kl\u0131k: 0,4\u202f% | Risk 20\u202f% oran\u0131nda artm\u0131\u015ft\u0131r (aSR 1,20)<\/p>\n\n\n\n<p><strong>Tipik vaka:<\/strong><br>Bir antipsikotik ekstrapiramidal semptomlara (\u00f6rn. rijidite, tremor) neden olur. Bunlar ila\u00e7la bir antiparkinson ajan\u0131 ile tedavi edilir.<\/p>\n\n\n\n<p><strong>Takip:<\/strong><br>Dopaminerjik sistemin y\u00fcklenmesi, yeni yan etkiler.<\/p>\n\n\n\n<p><strong>Sakinle\u015ftirici \u2192 Antipsikotik<\/strong><br>S\u0131kl\u0131k: 3,2\u202f% | Risk 15\u202f% oran\u0131nda artm\u0131\u015ft\u0131r (aSR 1,15)<\/p>\n\n\n\n<p><strong>Tipik vaka:<\/strong><br>Bir benzodiazepin paradoksal bir reaksiyona (huzursuzluk, konf\u00fczyon) yol a\u00e7ar. Ard\u0131ndan bir n\u00f6roleptik re\u00e7ete edilir.<\/p>\n\n\n\n<p><strong>Takip:<\/strong><br>Sedasyon, y\u00fcr\u00fcme bozukluklar\u0131, deliryum riski.<\/p>\n\n\n\n<p><strong>Pratikteki \u00d6nemi<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ba\u015f d\u00f6nmesi, uyku bozukluklar\u0131 veya bilin\u00e7 bulan\u0131kl\u0131\u011f\u0131 yan etkiler a\u00e7\u0131s\u0131ndan ele\u015ftirel bir g\u00f6zle incelenmelidir.<\/li>\n\n\n\n<li>Vestib\u00fcler sedatifler, genellikle spesifik olmayan ba\u015f d\u00f6nmesi i\u00e7in re\u00e7ete edilir \u2013 ancak <a href=\"https:\/\/ivrt.de\/tr\/hasta-egitimi\/denge-bozukluklari-ve-bas-doenmesi-semptomlari-icin-tanisal-testler\/\" data-type=\"post\" data-id=\"8955\">vestib\u00fcler tan\u0131<\/a>.<\/li>\n\n\n\n<li>Re\u00e7ete kaskadlar\u0131 d\u00fc\u015fme riskini art\u0131r\u0131r, ya\u015fam kalitesini k\u00f6t\u00fcle\u015ftirir ve fonksiyonel gerilemeyi te\u015fvik eder.<\/li>\n<\/ul>\n\n\n\n<p><strong>Sonu\u00e7<\/strong><\/p>\n\n\n\n<p>Re\u00e7ete kaskadlar\u0131 s\u0131kt\u0131r ve klinik olarak \u00f6nemlidir \u2013 \u00f6zellikle <a href=\"https:\/\/ivrt.de\/tr\/hasta-egitimi\/yaslilik-vestibulopatisi-yasa-bagli-bas-doenmesi-ve-yuerueme-guevensizligi\/\" data-type=\"post\" data-id=\"7179\" target=\"_blank\" rel=\"noreferrer noopener\">geriatrik ba\u011flamda denge bozukluklar\u0131 ile<\/a>. Fizyoterapistler, doktorlar ve eczac\u0131lar i\u00e7in her yeni semptomun kritik bir \u015fekilde incelenmesi esast\u0131r.<\/p>\n\n\n\n<p><strong>\ud83d\udc49 Vestib\u00fcler kaynakl\u0131 ba\u015f d\u00f6nmesini g\u00fcvenli bir \u015fekilde nas\u0131l tan\u0131yaca\u011f\u0131n\u0131z\u0131 ve ay\u0131rt edece\u011finizi \u00f6\u011frenmek ister misiniz?<br>ve tedavi edildi mi?<\/strong><br>G\u00fcncel e\u011fitim tekliflerini \u015furada bulabilirsiniz: <strong><a href=\"https:\/\/ivrt.de\/tr\/saglik-personeli-icin\/hizmet-ici-egitim-arama\/\" data-type=\"link\" data-id=\"https:\/\/ivrt.de\/fuer-medizinisches-fachpersonal\/fortbildungssuche\/\">IVRT E\u011fitim Arama<\/a>.<\/strong><\/p>\n\n\n\n<p><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Hastalar i\u00e7in \u2013 basit\u00e7e a\u00e7\u0131kland\u0131<\/strong><\/p>\n\n\n\n<p><strong>En yayg\u0131n be\u015f ila\u00e7 kaskad\u0131 \u2013 basit\u00e7e a\u00e7\u0131kland\u0131<\/strong><\/p>\n\n\n\n<p>\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\">Orijinal \u00e7al\u0131\u015fmaya<\/a><\/p>\n\n\n\n<p>1.&nbsp;<strong>Tansiyon ilac\u0131 \u2192 \u0130drar s\u00f6kt\u00fcr\u00fcc\u00fc ila\u00e7<\/strong><\/p>\n\n\n\n<p>S\u0131kl\u0131k: 2,6\u202f%<\/p>\n\n\n\n<p><strong>Ne oluyor?<\/strong><br>Bir tansiyon ilac\u0131 (kalsiyum kanal blokeri) bacaklarda su toplanmas\u0131na neden olabilir. \u0130lac\u0131 de\u011fi\u015ftirmek yerine ek bir idrar s\u00f6kt\u00fcr\u00fcc\u00fc (di\u00fcretik) re\u00e7ete edilir.<\/p>\n\n\n\n<p><strong>Takip:<\/strong><br>Mineral eksikli\u011fi, dola\u015f\u0131m sorunlar\u0131, ba\u015f d\u00f6nmesi \u2013 ve daha y\u00fcksek bir d\u00fc\u015fme riski.<\/p>\n\n\n\n<p>2.&nbsp;<strong>Ba\u015f d\u00f6nmesi ila\u00e7lar\u0131<\/strong><\/p>\n\n\n\n<p>S\u0131kl\u0131k: 3,0\u202f%<\/p>\n\n\n\n<p><strong>Ne oluyor?<\/strong><br>Prostat \u015fikayetlerine y\u00f6nelik bir ila\u00e7 kan bas\u0131nc\u0131n\u0131 d\u00fc\u015f\u00fcrebilir; \u00f6zellikle de aya\u011fa kalkarken. Ba\u015f d\u00f6nmesi ortaya \u00e7\u0131kar. Sorunun k\u00f6kenini \u00e7\u00f6zmek yerine, denge organ\u0131 sa\u011fl\u0131kl\u0131 olmas\u0131na ra\u011fmen ba\u015f d\u00f6nmesine kar\u015f\u0131 bir ila\u00e7 re\u00e7ete edilir.<\/p>\n\n\n\n<p><strong>Takip:<\/strong><br>Ba\u015f d\u00f6nmesi ilac\u0131, dengeyi sa\u011flayan beyin b\u00f6lgelerini bask\u0131lar. \u0130nsan kendini ayakta g\u00fcvensiz hisseder \u2013 d\u00fc\u015fme riski artar.<br>\ud83d\udc49 Wichtig: Diese Schwindelmittel sind nur f\u00fcr den akuten Notfall gedacht \u2013 und nie f\u00fcr l\u00e4nger als wenige Tage!<\/p>\n\n\n\n<p>3.&nbsp;<strong>Antidepresan \u2192 Uyku ilac\u0131<\/strong><\/p>\n\n\n\n<p>S\u0131kl\u0131k: 2,5\u202f%<\/p>\n\n\n\n<p><strong>Ne oluyor?<\/strong><br>Yeni bir antidepresan uyku sorunlar\u0131na yol a\u00e7\u0131yor. Birlikte daha iyi bir \u00e7\u00f6z\u00fcm aramak yerine, ek olarak bir uyku ilac\u0131 re\u00e7ete ediliyor.<\/p>\n\n\n\n<p><strong>Takip:<\/strong><br>\u0130nsan g\u00fcn i\u00e7inde yorgun, halsiz hisseder \u2013 ya da uyku ilac\u0131na ba\u011f\u0131ml\u0131 hale gelir.<\/p>\n\n\n\n<p>4.&nbsp;<strong>Ruhsal rahats\u0131zl\u0131klar i\u00e7in ila\u00e7 \u2192 Hareket bozukluklar\u0131 i\u00e7in ila\u00e7 (Parkinson ilac\u0131)<\/strong><\/p>\n\n\n\n<p>S\u0131kl\u0131k: 0,4\u202f%<\/p>\n\n\n\n<p><strong>Ne oluyor?<\/strong><br>\u00d6rne\u011fin sanr\u0131lar veya \u015fiddetli huzursuzluk i\u00e7in kullan\u0131lan bir ila\u00e7, kas stiffness ya da titremeye neden olabilir. As\u0131l sebeb olan ilac\u0131 g\u00f6zden ge\u00e7irmek yerine, Parkinson semptomlar\u0131na kar\u015f\u0131 bir ila\u00e7 re\u00e7ete edilir.<\/p>\n\n\n\n<p><strong>Takip:<\/strong><br>Parkinson i\u00e7in daha da fazla ve gereksiz ila\u00e7 \u2013 yeni yan etkileriyle birlikte.<\/p>\n\n\n\n<p>5.&nbsp;<strong>Sakinle\u015ftirici \u2192 \u0130\u00e7 huzursuzluk veya kar\u0131\u015f\u0131kl\u0131k (konf\u00fczyon) kar\u015f\u0131t\u0131 ila\u00e7 (N\u00f6roleptik)<\/strong><\/p>\n\n\n\n<p>S\u0131kl\u0131k: 3,2\u202f%<\/p>\n\n\n\n<p><strong>Ne oluyor?<\/strong><br>Bir sakinle\u015ftirici (\u00f6r. benzodiazepin) \u2013 \u00f6rne\u011fin i\u00e7 huzursuzluk veya hal\u00fcsinasyonlar gibi \u2013 paradoksal tepkilere yol a\u00e7ar. Bunlar daha sonra bir ba\u015fka g\u00fc\u00e7l\u00fc ila\u00e7la tedavi edilir.<\/p>\n\n\n\n<p><strong>Takip:<\/strong><br>Yorgunluk, y\u00fcr\u00fcme bozuklu\u011fu, konsantrasyon sorunlar\u0131.<\/p>\n\n\n\n<p><strong>Neler yapabilirsiniz<\/strong><\/p>\n\n\n\n<p><strong>\u015eikayetlerinizi a\u00e7\u0131k\u00e7a dile getirin.<\/strong><br>Yeni belirtiler fark ederseniz, doktorunuzla konu\u015fun.<br>\u015eu \u015fekilde do\u011frudan sorun: \u201eBu ilac\u0131n bir yan etkisi olabilir mi?\u201c<\/p>\n\n\n\n<p><strong>Emin olmad\u0131\u011f\u0131n\u0131z durumlarda ikinci bir g\u00f6r\u00fc\u015f al\u0131n.<\/strong><br>\u00d6rne\u011fin eczanede!<\/p>\n\n\n\n<p><strong>Ba\u015f d\u00f6nmesi veya denge bozukluklar\u0131 durumunda:<\/strong><br>\u015eikayetler ila\u00e7lardan kaynaklanm\u0131yorsa, alt\u0131nda yatan neden vestib\u00fcler bir k\u00f6ken de olabilir.<\/p>\n\n\n\n<p>\ud83c\udfaf Sertifikal\u0131lar\u0131m\u0131z&nbsp;<strong>IVRT\u00ae-Ba\u015f D\u00f6nmesi ve Vestib\u00fcler Terapistleri<\/strong>&nbsp;size ki\u015fisel olarak yard\u0131mc\u0131 oluyoruz: <strong><a href=\"https:\/\/ivrt.de\/tr\/etkilenenler-icin\/terapist-arama\/\" target=\"_blank\" rel=\"noreferrer noopener\">IVRT Terapist Arama<\/a><\/strong><\/p>\n\n\n\n<p><a id=\"_msocom_1\"><\/a><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/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":""},"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:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/posts\/13979","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/comments?post=13979"}],"version-history":[{"count":1,"href":"https:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/posts\/13979\/revisions"}],"predecessor-version":[{"id":17490,"href":"https:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/posts\/13979\/revisions\/17490"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/media\/17994"}],"wp:attachment":[{"href":"https:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/media?parent=13979"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/categories?post=13979"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ivrt.de\/tr\/wp-json\/wp\/v2\/tags?post=13979"}],"curies":[{"name":"Naber","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}