藥物上良反應的潛在危險與預防

Size: px

Start display at page:

Download "藥物上良反應的潛在危險與預防"

恬樱卜
5 years ago
Views:

1 Preventable Adverse Drug Reactions: A Focus on Drug Interactions 財團法人奇美醫院王慧瑜總藥師

2 Why Learn about Adverse Drug Reactions (ADR)? Over 2 MILLION serious ADRs yearly 100,000 DEATHS yearly ADRs 4th leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents and automobile deaths Ambulatory patients ADR rate nknown Nursing home patients ADR rate 350,000 yearly Institute of Medicine, National Academy Press, 2000 Lazarou J et al. JAMA 1998;279(15):1200?205 Gurwitz JH et al. Am J Med 2000;109(2):87?4

3 Costs Associated with ADRs $136 BILLION yearly Greater than total costs of cardiovascular or diabetic care ADRs cause 1 out of 5 injuries or deaths per year to hospitalized patients Mean length of stay, cost and mortality for ADR patients are DOUBLE that for control patients Johnson JA et al. Arch Intern Med 1995;155(18):1949?956 Leape LL et al. N Engl J Med 1991;324(6):377?84 Classen DC et al. JAMA 1997;277(4):301?06

4 Drugs Removed from or Restricted in the U.S. Market Because of Drug Interactions Terfenadine (Seldane ) February 1998 Mibefradil (Posicor ) June 1998 Astemizole (Hismanal ) July 1999 Cisapride (Propulsid ) January 2000

5 Contribution of Drug Interactions to the Overall Burden of Preventable ADRs Drug interactions represent 3-5% of preventable in-hospital ADRs Drug interactions are an important contributor to number of ER visits and hospital admissions Leape LL et al. JAMA 1995;274(1):35-43 Raschetti R et al. Eur J Clin Pharmacol 1999;54(12):

6 Sources of Error in Drug Interactions: The Swiss Cheese Model James Reason, British psychology professor

8 Pharmacy Times - New Drugs of 2003 Sources of Error in Drug Interactions: The Swiss Cheese Model

9 Pharmacists can Provide information for prescribers. Help improve computer system. Assess whether specific patients have risk factors. Determine whether the pt s pharmacogenetics increases or decreases the risk (when pharmacogenetic profiles if patients become routine). Assess whether the drug is to be administered in a way that would mitigate the interaction or make it more dangerous. Help monitor for signs and symptoms that may represent evidence of an adverse drug interaction.

10 92-96 年某醫學中心藥物不良反應通報統計 ADR 藥理分類 Preventable 案例數 % 9.1% 0 Type A Type B

11 可預防之 ADR 發生症狀其他腎臟相關精神症狀神經相關胃腸道症狀高血鉀心血管相關血液相關 ADR 發生症狀案例數

12 ADR 藥品分類 Miscellaneous Anti-psychotics ( 含 Lithium) Anti-epileptics Gastrointestinal Endocrine Antibiotics Respiratory Anticoagulants Cardiovascular 案例數 38

13 可預防之 ADR 發生原因 ADR 發生原因案例數劑量交互作用藥理作用用藥時間其他

14 預防措施實例分享電腦醫囑輸入系統建立藥物疏失防範措施

15 用藥品質指標監測之應用抗生素劑量適當性監測藥物導致血液檢查值異常監測用藥異常監測ㄧ級藥物交互作用監測重複用藥指標監測藥物每日最大劑量管控 / 監測

16 一級交互作用醫囑警示警示畫面會出現藥物交互作用對臨床反應之影響並提供相關建議事項

17 一級藥物交互作用監測一級藥物交互作用之藥物配對共 397 項 DDIs alert overrode 監測 : 掃描跳開警示之藥物交互作用醫囑方法 : 專責藥師每日列表監測追蹤因交互作用致 ADR 的可能性建議醫師修改處方或繼續追蹤記錄交互作用不存在醫囑開立具一級藥物交互作用藥物電腦畫面出現交互作用警示臨床影響建議醫囑處方修改交互作用存在醫囑未處方修改藥師電腦監測掃描追蹤監測建議記錄

18 交互作用監測結果 : 電腦搜尋建議數發生數接受建議 % 接受度 0 92 年 93 年 94 年 95 年月 0

19 發生數接受率 % 常見交互作用建議數與接受度 Suggests Accepts Accept Rate DDI 代碼 64 代碼 Drug 1 Drug 2 r/oadr 代碼 Drug 1 Drug 2 r/oadr 1 AMG Furosemide 1 6 Warfarin Amiodaron 12 2 Spironolactom AII -blocker 4 7 Warfarin ASA 11 3 Digoxin Aminodaron 2 8 Moduretic ACEI 3 4 Digoxin Furosemide 1 9 Moduretic KCL 2 5 Spironolactom ACEI Spironolactom KCL 4

20 Systems Interventions and Their Limitations Systems interventions Electronic prescription entry and bar-coding Computerized medication records Drug interaction software Limitations Fragmented healthcare delivery and prescription filling Information not uniformly translated into practice Message Can t rely completely on technology Need basic knowledge of clinical pharmacology of drug interactions Bates DW et al. JAMA 1998;280:1311?316. Evans RS et al. Ann Pharmacother 1994;28(4):523?277 Gebhart F. Drug Topics 1999;1:44. Smalley W et al.

21 結語預防交互作用引起的藥物不良事件須由醫藥護共同把關醫療不良事件大部分來自於疏失, 透過管理機制可改善疏失的發生利用電腦醫囑管控系統雖可有效降低用藥相關之藥物不良事件, 但不能完全避免醫療人員並包括病人必須充分討論有效溝通互動配合才能改善用藥安全

22 Thanks for Your Atention

标题

医药导报 2016 年 8 月第 35 卷第 8 期 803 特约稿鱼腥草制剂上市后安全性再评价吴健鸿 1 ꎬ 杨晓燕 2 ꎬ 柳强妮 2 ꎬ 尹平 2 2 ꎬ 曾繁典 (1. 武汉药品医疗器械检验所 ꎬ 武汉 430075ꎻ2. 华中科技大学同济医学院 ꎬ 武汉 430030) 摘要目的