藥物不良反應 Adverse Drug Reactions Leukocytosis CRP Tatumcef anti-tb WBC RBC Hb Ht famotidine albumin 3.1 mg/dl CRP 53.0 mg/dl

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1 疑似 Herpes Zoster Virus 引起多形性紅斑之個案報告台北市立聯合醫院中興院區藥劑科藥師張麗雯朱婉兒台北市立聯合醫院松德院區藥劑科藥師李桂花台北市立聯合醫院藥劑部藥師陳立奇台北醫學大學藥學系教授許秀蘊摘要 rifampicin famotidine Stevens-Johnson syndrome Naranjo scale adverse drug reaction; ADR - 疱疱 72 疱 Stevens-Johnson syndrome Naranjo scale adverse drug reaction 壹前言 erythema multiforme 疱 1 87 rifampicin famotidine Naranjo scale - varicellazoster virus; VZV 貳案例報告 Dec 藥學雜誌第 105 冊 131

2 藥物不良反應 Adverse Drug Reactions Leukocytosis CRP Tatumcef anti-tb WBC RBC Hb Ht famotidine albumin 3.1 mg/dl CRP 53.0 mg/dl Rifater rifampicin Fadin famotidine Naranjo scale 10 8 albumin 2.7 mg/dl CRP 19.0 mg/dl WBC L herpes zoster left CNV-1 dermatome Famvir 10 9 疱 Famvir 250 mg 2 # q8h 參討論一病因學與流行病學 Stevens - Johnson syndrome % 3 Herpes zoster VZV 疱 DNA 70% 80% VZV thymidine kinase VZV 10 20% VZV herpes zoster 50 4 二症狀表現 5 WBC count antinuclear antibodies viral culture and serology skin biopsy 5 疱 SJS 6 Naranjo 132 THE JOURNAL OF TAIWAN PHARMACY Vol.26 No.4 Dec

3 Herpes Zoster Virus 7,8 Micromedex ADR rifampicin SJS rifampicin SJS SJS Naranjo famotidine Micromedex 2 symptomatic dermatographism SJS famotidine SJS Naranjo SJS 表一住院期間血液生化值記錄 26 4 Dec 藥學雜誌第 105 冊 133

4 藥物不良反應 Adverse Drug Reactions 表二住院期間用藥記錄表三不良反應相關性分析之 rifampin & famotidine of Naranjo 評估表在 "Stevens - Johnson syndrome" 的分數 134 THE JOURNAL OF TAIWAN PHARMACY Vol.26 No.4 Dec

5 Herpes Zoster Virus CRP CRP 53.0 mg/dl 10 8 CRP 19.0 mg/ dl 4.0 mg/dl VZV VZV post-herpetic neuralgia PHN % 50% 4 三診斷 h e r p e s zoster VZV DNA 4,6,9 1 Tzanck smear 疱 VZV 疱 2 疱 3 VZV 4 PCR 疱 VZV DNA 5 VZV herpes zoster 四治療 ( 一 ) 抗病毒治療 IV acyclovir 500 mg/m 2 10 mg/kg q8h 7 60 acyclovir 4,9 acyclovir 800 mg 5 times daily for 7 to 10 days famciclovir 500 mg q8h for 7 days valacyclovir 1,000 mg q8h for 7 days immunocompetent famciclovir acyclovir famciclovir valacyclovir 6,10,11 Valacyclovir acyclovir PHN 11 famciclovir 疱 acyclovir 12 famciclovir acyclovir 12 Famciclovir valacyclovir PHN 12 Famciclovir acyclovir 11 ( 二 ) 疼痛的緩解 H e r p e s z o s t e r acetaminophen 4 PHN amitriptyline carbamazepine sodium valproate gabapentin capsaicin cream opioids oxycodone P H N methylprednisolone 9 72 acyclovir Dec 藥學雜誌第 105 冊 135

6 藥物不良反應 Adverse Drug Reactions PHN ( 三 ) 其他治療 antihistamines povidone iodine calamine lotion flucloxacillin erythromycin 6 topsym cream bid chlorpheniramine 4 mg 1 # qid diphenhydramine 30 mg st 1 amp VZV famciclovir 1 # tid acyclovir oph. oint. bid famciclovir 2 # q8h acetaminophen 500 mg 1 # qid allergopos eye drop tid sinomin oph. sol'n tid engene eye drop tid tertracycline oph.oint. bid vidisic oph. gel duratears oph.oint. bid 表四 U. S. Food and Drug Adminisration (FDA)-Indicated Drugs for Various Viral Infections Applied Therapeutics Ninth Edition 136 THE JOURNAL OF TAIWAN PHARMACY Vol.26 No.4 Dec

7 Herpes Zoster Virus 肆結論 Herpes zoster PHN VZV CRP 0.8 mg/dl 4 mg/dl VZV 參考資料 : 1. et al: : : Cabamazepine Stevens-Johnson syndrome (2008) 97, 疱 2002: Erythema multiforme Medical Topics First Consult Last updated: 24 Aug et al: 疱疱 2009; 24(2): Naranjo CA, Sellers EM, Sandor P et al: A method for estimating the probability of adverse drug reactions, Clinical Pharmacology & Therapeutics 1981;30(2): ADR 2007; 17(2): 2-3, Gershon AA: Varicella-zoster virus. In : Feigin RD,Cherry JD,eds. Texbook of Pediatric Infectuons Diseases 4thed Philadelphia. W.B.Saunders 1998; Mary Anne Koda-Kimble Lloyd Y. Young, Wayne A. Kradjan et al:applied Therapeutics, Ninth Edition. USA Lippincott Williams & Wilkins, 2008: Treatment of herpes zoster updated 12. Famciclovir, Comparative Efficacy/Evaluation With other Therapies, updated. 愛心泡泡 26 4 Dec 藥學雜誌第 105 冊 137

8 藥物不良反應 Adverse Drug Reactions Suspected Herpes Zoster Virus Inducing Erythema Multiforme - A Case Report Li-Wen Chang 1, Wan-O Chu 1, Kuei-Hua Lee 2, Lih-Chi Chen 3, Shiow-Yunn Sheu 4 Department of Pharmacy, Taipei City Hospital,Zhongxing Branch 1 Department of Pharmacy, Taipei City Hospital, Songdy Branch 2 Department of Pharmacy,Taipei City Hospital 3 School of Pharmacy,Taipei Medical University 4 Abstract Accurate identification of the pathogenic sources is essential for efficient treatment of erythema multiforme. We reported a strategy that successfully identified the Stevens-Johnson syndrome that was originally diagnosed and suggested to be induced by rifampicin and famotidine. The study involving a combination of adverse drug reactions evaluated with Naranjo scale, the biochemical data, and medical history before herpes zoster virus verified and concluded as the source that causing the erythema multiforme. It was further found that treating with antiviral drugs within seventytwo hours after the onset of clinical manifestation of erythema multiforme significantly reduced the disease progression and it relieved the post-herpetic neuralgia. 泡破瞬間 138 THE JOURNAL OF TAIWAN PHARMACY Vol.26 No.4 Dec

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公 Hygiene Pharmacy and Pharmacy Administration carbamazepine carbamazepine HLA-B*1502 SJS/TEN IC carbamazepine HLA-B*1502 carbamaz Carbamazepine Carbamazepine 敏基因檢測提示機制公林口長庚紀念醫院劑部師盧柏先鄭吉元陳琦華林口長庚紀念醫院檢驗醫科醫檢師甯孝真基隆長庚紀念醫院劑科師陳玉瑩摘要 2011 7 HLA-B HLA-B*1502 carbamazepine SJS/TEN