PowerPoint 簡報

Size: px

Start display at page:

Download "PowerPoint 簡報"

铭解
7 years ago
Views:

1 疑義處方判讀蘇蜂琪藥師

2 優良藥品調劑作業規範 (GDP;Good Dispensary Practice) 確認處方的合法性完整性與處方期限有效性一病患的姓名年齡性別診斷二處方醫師姓名執業執照或管制藥品使用執照號碼及簽名或蓋章, 醫療院所名稱地址電話三藥品之名稱劑型單位含量四藥品數量五劑量與用藥指示六開立處方日期七連續處方指示, 包括連續處方的調劑次數及時間間隔

4 優良藥品調劑作業規範 (GDP;Good Dispensary Practice) 藥事人員於調劑前應對處方用藥做適當性評估前項用藥適當性評估, 包括下列各項 : 一病患是否會對處方上的藥品過敏二用藥目的三劑量頻次四劑型與給藥途徑五療程六目前所有用藥是否有重複給藥現象七目前所有用藥是否有交互作用情形八其他藥事人員經依前條用藥適當性評估後, 認為對病患有相關用藥治療問題之虞時, 應該主動與開立處方的醫師聯絡, 請其確認或重新開立處方前項過程皆應記錄在處方或加註於藥品治療問題專用紀錄表上, 並註明與醫師討論的時間

6 鈴鐺標示者 : 當日看診兩科以上紙張 : 三高病人可列印用藥紀錄卡旗子 : 交互作用相同藥理重複用藥一病患是否會對處方上的藥品過敏二用藥目的三劑量頻次四劑型與給藥途徑五療程六目前所有用藥是否有重複給藥現象七目前所有用藥是否有交互作用情形八其他

7 腎兒 RUT 勿磨粉紅色 : 高警訊藥品黃色 : 相同藥理藍色 : 與其他藥物有交互作用綠色 : 重複用藥警語 ( 旗子 ) 查詢

8 異常原因分類

9 異常原因分類

10 異常原因分類藥物錯誤劑量錯誤藥物與藥物交互作用特殊性病人用藥不安全給藥方式錯誤電腦批輸錯誤其他醫師維持原處方

11 規格錯誤相同藥品規格不同 ( 適應症相同 ) 之異常處方 Methylprednisolone 500mg IVF Methylprednisolone 40mg IV 劑型錯誤相同藥品劑型不同 ( 適應症相同 ) 之異常處方 Scanol Tab 3 # TID Scanol syrup 3cc TID 重複用藥學名相同劑型規格不同而同時併用之異常處方, 或不同科別醫師開立相同藥品劑型使用 Furosemide tab + Furosemide amp

12 無適應症針對病人的適應症不須投予該藥物 Acetazolamide Acetaminophen 須增加藥物針對病人的適應症須增加藥物投予者 Isoniazid+pyridoxine 治療禁忌針對病人疾病狀態不可投予該藥物者 cefazolin cefadroxil

13 配伍禁忌藥品因物理性或化學性交互作用而不建議混和使用者 Amphotericin B 不建議以食鹽水稀釋其他屬開錯藥物, 但無法歸類於上述分類

14 異常原因分類藥物錯誤劑量錯誤藥物與藥物交互作用特殊性病人用藥不安全給藥方式錯誤電腦批輸錯誤其他醫師維持原處方

15 劑量過高該藥品投予之劑量過大劑量過低該藥品投予之劑量太少給藥間隔太長該藥品之給藥頻率過低給藥間隔太短該藥品之給藥頻率過高治療期間過長針對病人的適應症投予藥品之療程過長治療期間不足針對病人的適應症投予藥品之療程過短肝功能不佳因肝功能不良須調整劑量者腎功能不佳因腎功能不良須調整劑量者

16 異常原因分類藥物錯誤劑量錯誤藥物與藥物交互作用特殊性病人用藥不安全給藥方式錯誤電腦批輸錯誤其他醫師維持原處方

17 拮抗藥理作用互相拮抗或互相牴觸者 Sennoside 與 Kaopectin 併用相似藥理作用相似者 cephradine 與 Cefazolin 併用吸收因藥物併用而影響該藥物的吸收者 Ciprofloxacin 與 Antacid 併用

18 代謝因藥物併用而影響該藥物的代謝者 Cimetidine 與 Warfarin 併用藥理不良反應因藥物併用所引起之藥物不良反應 Moxifloxacin 與 Amiodarone 併用, 易造成 Q-T interval 的延長 Paroxetine 與 Tramadol, 易造成 serotonin syndrome

19 異常原因分類藥物錯誤劑量錯誤藥物與藥物交互作用特殊性病人用藥不安全給藥方式錯誤電腦批輸錯誤其他醫師維持原處方

20 針對孕婦哺乳老人幼兒用藥不安全或有治療禁忌者屬此一分類, 但因老人幼兒身份對劑量有所調整皆屬劑量錯誤, 而凡因腎功能不良而須調整劑量仍屬腎功能不佳孕婦哺乳 D X 級藥品用於已懷孕婦女 Hyperthyroidism 之哺乳者建議用 PTU 優於 methimazole 老人過 2mg 幼兒 Alprazolam 用於 65 y/o 病患一天劑量不建議超 Ciproxin 不建用於 18 y/o 以下之病患

21 異常原因分類藥物錯誤劑量錯誤藥物與藥物交互作用特殊性病人用藥不安全給藥方式錯誤電腦批輸錯誤其他醫師維持原處方

22 給藥途徑該藥物須依特定之方式投予如 :Prochlorperazine 僅可以 IM 投與, 以 IV 給予可能導致不良副作用發生 (EPS) 使用部位該藥物須投予於特定的部位如 :Oestrogel gel 盡可能塗於前臂, 手臂, 兩肩, 勿抹於乳房, 陰部之粘膜給藥時間用法用量相同的情況下, 該藥物須投予於特定的時間如 :Glipizide 須飯前服用, 不可飯後投與其他如 : 不可剝半或研磨之藥品 (pantoprazole tab)

23 電腦批輸錯誤明顯為批輸時輸入之錯誤, 如 100mg 批成 100PC, 或用法用量皆對, 但在總量處卻不足或過多其他屬處方箋錯誤, 但無法歸類於藥物錯誤劑量錯誤藥物與藥物交互作用特殊性病人用藥不安全及給藥方式錯誤者選擇其他醫師維持原處方經發現爭議之處方, 與醫師確認討論過後, 醫師仍決定維持原處方

25 月經疾患及其他女性生殖道之異常出血子宮平滑肌瘤血液流失引起之缺鐵性貧血子宮體之子宮內膜異位症署胃及十二指腸潰瘍 TCR myomectomy

Misoprostol 200mcg/tab TCR myomectomy 經由子宮頸電刀作切除肌瘤手術 TCR- M(Transcervical resection- Myomectomy) For patients who do require cervical dilation, cervical preparation with a prostaglandin (eg,

26 Misoprostol 200mcg/tab TCR myomectomy 經由子宮頸電刀作切除肌瘤手術 TCR- M(Transcervical resection- Myomectomy) For patients who do require cervical dilation, cervical preparation with a prostaglandin (eg, misoprostol) may be sufficient on its own or can facilitate mechanical dilation. The vaginal route for misoprostol may be more effective than oral. Given these data, we ask patients to self-administer oral or vaginal misoprostol (200 to 400 mcg) the night before the procedure.

27 賁門鬆弛不能及賁門痙攣吞嚥困難其他焦慮狀態署狹心症高血壓

Nifedipine 10mg/cap Achalasia and cardiospasm NIFEDIPINE reduces lower esophageal sphincter pressure by up to 65% both acutely and chronically, and may be effective in reducing frequency or severity

28 Nifedipine 10mg/cap Achalasia and cardiospasm NIFEDIPINE reduces lower esophageal sphincter pressure by up to 65% both acutely and chronically, and may be effective in reducing frequency or severity of symptoms associated with diffuse esophageal spasm from a variety of causes including radiation esophagitis, cutaneous leiomyoma, or dysphagia of achalasia (Bartolotti, 1999; Thomas et al, 1986) A review of medical therapy of achalasia reported an overall efficacy rate of 50% to 90% for nifedipine at dosages from 10 to 30 milligrams three times daily orally or sublingually.

30 Patients with allergy to lansoprazole that develop cross-reactivity with rabeprazole, but tolerate omeprazole, pantoprazole, and esomeprazole. Patients with allergy to omeprazole that develop cross-reactivity with pantoprazole, but tolerate lansoprazole (and perhaps rabeprazole). PPI cross-reactivity

31 消化性潰瘍, 未提及出血穿孔或阻塞回流性食道炎腸功能性疾患血管瘤未明示為原發性或續發性之肝惡性腫瘤

32 First-line therapy Standard triple therapy Sequential therapy 序列性治療 (2+3) A PPI (standard dose, b.i.d.), clarithromycin (500 mg, b.i.d.) and amoxicillin (1 g, b.i.d.)( or metronidazole (500 mg, b.i.d.) for 7-14 d A 5-d dual therapy with a PPI (standard dose, b.i.d.) and amoxicillin (1 g, b.i.d.) followed by a 5-d triple therapy with a PPI (standard dose, b.i.d.), clarithromycin (500 mg, b.i.d.) and metronidazole (500 mg, b.i.d.) Concomitant therapy 同步治療 Hybrid therapy (2+4) REVERSE A PPI (standard dose, b.i.d.), clarithromycin (500 mg, b.i.d.), amoxicillin (1 g, b.i.d.) and metronidazole (500 mg, b.i.d.) for 7-10 d A 7-d dual therapy with a PPI (standard dose, b.i.d.) and amoxicillin (1 g, b.i.d.) followed by a 7-d quadruple therapy with a PPI (standard dose, b.i.d.), amoxicillin (1 g, b.i.d.), Clarithromycin (500 mg, b.i.d.) and metronidazole (500 mg, b.i.d.)

33 腸之疾患損傷內痔, 未提及併發症脊髓空洞病及延髓空洞病署重症肌無力

34 pyridostigmine Base on small randomized trial 30 patients aged(18-70 years) with diabetes mellitus (60% with type 1) and chronic constipation without defaecatory disorder were randomised to oral placebo or pyridostigmine, 60 mg starting dose titrated to maximum tolerated dose or 120 mg three times daily vs placebo for 17 days. Treatment effects on stool frequency, consistency and ease of passage were significant.

35 男 80 歲 NEWD Sennoside B 7.5mg/tab 2PC HS PC PO 16 天 NEWD Tamsulosin D 0.2mg/tab 1PC QD PC PO 16 天 NEWD Prednisolone 5mg/tab 2PC BID PC PO 16 天 NEWD KetoCONAzole 200mg/tab 2PC TID PC PO 16 天 NEWD Gliclazide MR 30mg/tab 1PC QD AC PO 16 天 1.Bilateral legs edema, favor fluid overload, r/o deep vein thrombosis 2.Hypokalemia, suepcted diuretics related 3.Diabetes mellitus 4.shortness of breath with elevated D-dimer, suspect pulmonart embolism 5.Prostate adenocarcinoma, stage IV 署 ( 口服 ) 髮癬 (Tinea Capitis) 汗斑

36 KetoCONAzole Single-agent ketoconazole has demonstrated some efficacy in patients with prostate cancer. Ketoconazole in high doses (400 mg orally every 8 hours) has been effective in the treatment of metastatic prostate cancer in patients who have not received orchiectomy. All patients had previously been castrated or had castrate levels of testosterone as a result of LH-releasing hormone treatment. Ketoconazole therapy resulted in further reduction in testosterone levels and suppression of adrenal androgen production. Adverse effects consisted mainly of nausea and vomiting, which tended to be severe.

39 醫藥問題諮詢當無法立即答覆時利用參考書籍或圖書館資料庫上網搜尋資料 1. 參考書籍 : 處方集 PDR Matindale USPDI AHFS Drug facts and Comparison Handbook on Injectable Drugs Drugs in Pregnancy & Lactation Applied Therapeutics 2. 圖書館資料庫 :CCIS UpToDate Access pharmacy, 搜尋實證資料進行答覆 3. 詢問藥廠相關資訊

鼠　疫（Plague）

鼠　疫（Plague）鼠疫 (Plague) 一疾病概述 (Disease description) 存在囓齒類及其跳蚤的一種人畜共通傳染病, 並藉跳蚤傳染給各種動物及人類, 其最初反應為跳蚤咬傷部位臨近的淋巴腺發炎, 這就是腺鼠疫, 經常發生於鼠蹊部, 少發生於腋下或頸部,