2011屏基藥訊第一季

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1 PINGTUNG CHRISTIAN HOSPITAL 2011 No 13 PharmacyTime B

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3 B B B 300 (15-20%) B B B B ealt 2 e (deoxyribonucleic acid, DNA) ALT 2 B B B HBeAg e95% B 85% 7.8% e6-8% 80% B 90% % 5% B 1. HBsAg HBeAg ALT ALT 5X 2. HBsAg HBeAg ALT 2X ALT 5X HBV- DNA 20,000IU/ML HBcAgD C 3. HBsAg HBeAg ALT ALT 2X HBV-DNA 2,000IU/ MLH cag DC B B 1. Lamivudine AdefovirEntecavir Telbivudine 2. α 3. α (Thymosinα) 3

4 4 B Lamivudine B 100 e e 3~6 6 HBV DNA300 copies/ml 2~4 15~20% B 2 40% 366% B Adefovir BDNA 酶 B B3 5 50% 30mg/d 10 Entecavir B 酶 B

5 Telbivudine (thymidine nucleoside analogue) B DNA 酶 (polymerase) e e GOT/GPT 100mg e B B (BC ) 2 10% 20% % ( Interferon, IFN ) B α β γ α 3 ( B S ) α GPT 2~5α α

6 α α 20~40% α 30~40% 25% GPT HBV DNA α 參 MICROMEDEX α α 6

7 M2 M3 α1 β3 (α-agonists β-agonists) benzodiazepines (BZDs) selective serotonin reuptake inhibitors (SSRIs) nonsteroidalanti-inflammatory drugs (NSAIDs) calcium channel blockers (CCBs) 濳 methylnaltrexone methylnaltrexone anticholinergics antispasmodics musclerelaxants tricylic antidepressants ( ) Beersʼ criteria Beersʼ criteria chlorpheniramine diphenhydramine α-agonists αagonists α1b α1a/d α-agonists α-agonists ( pseudoephedrine phenylephrine ) α-agonists αagonists β-agonists ( isoproterenol terbutaline ) β-agonists β β-agonists β-agonists 7

8 Benzodiazepines (BZDs) BZDs BZDs ( clonazepam diazepam) BZDs ( )BZDs Selective Serotonin Reuptake Inhibitors (SSRIs) 1993Garnier 299 fluvoxamine 2007 Chung fluoxetine mg fluoxetine fluoxetine 70 mg SSRIs serotonin serotonin 5-HT2 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Prostaglandin E2 (PGE2) cyclooxygenase(cox)-2 prostaglandin PGE2 tachykinins neurokinin ( :) NSAIDs COX( COX-2)PGE2 Verhamme NSAIDs 2.2 (95%: ) 1 COX-2 NSAIDs COX-2 PGE2 NSAIDs Calcium Channel Blockers (CCBs) 1999Meigs CCBs 2.2(95% : ) nicardipine CCBs CCBs BZDs SSRIs NSAIDs CCBs 參 1. Verhamme KM, et al. Drug-induced urinary retention: incidence, management andprevention. Drug Saf 2008; 31: Fick DM, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus 8

9 panel of experts. Arch Intern Med 2003; 163: Meigs JB, et al. Incidence rates and risk factors for acute urinary retention: the healthprofessionals followup study. J Urol 1999; 162: Rosow CE, et al. Reversal of opioidinduced bladder dysfunction by intravenousnaloxone and methylnaltrexone. Clin Pharmacol Ther 2007; 82: Drake MJ, et al. Drug-induced bladder and urinary disorders. Incidence, prevention andmanagement. Drug Saf 1998; 19: Caksen H, Odabas D. Urinary retention due to clonazepam in a child with dyskinetic cerebral palsy. J Emerg Med 2004; 26: Garnier R, et al. Acute fluvoxamine poisoning. J Int Med Res 1993; 21: Chung AK, Chua SE. Acute urinary retention associated with selective serotonin reuptake inhibitors and ziprasidone. J Clin Psychopharmacol 2007; 27: Thor KB. Serotonin and norepinephrine involvement in efferent pathways to the urethral rhabdosphincter: implications for treating stress urinary incontinence. Urology 2003; 62: Verhamme KM, et al. Nonsteroidal antiinflammatory drugs and increased risk of acute urinary retention. Arch Intern Med 2005; 165:

10 Brand name Lendormin 250mcg/tab Indication Dosage 0.25 qd Contraindication CNS depression Side effect CNS depression Brotizolam C OLEND Pemetrexed Brand name Alimta 100mg/vial IALIM1 Indication cisplatin Dosage mg/m cisplatin 75mg/m2 2 cisplatin Side effect / Precaution 2. corticteroid D 10

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老年人藥物不良反應

老年人藥物不良反應老年人藥物不良反應林志學醫師, 劉秋松醫師中國醫藥學院附設醫院家庭醫學科前言 : 老年人的藥物不良反應 (Adverse drug reactions;adr) 是臨床上極為令人關心的課題根據統計, 全世界老年人 ( 指 65 歲以上 ) 大概佔總人口 12%,