藥物不良反應(yīng)之評(píng)估與通報(bào)作(完整版)
【正文】 pam cons disturbance suicide tendency carbamazepine skin rash over whole body CD4/CD8 ratio phenytoin anticonvulsant hypersensitivity syndrome rash, high fever,WBC↑, abn LFT, hepatomegaly, vanycin thrombocytopenia acetaminophen acute hepatitis(6058/8732） chronic use ADR reporting ticlopidine leukopenia； septic shock delayed type metronidazole peripheral neuropathy delayed type zolpidem visual hallucination administering error iopromide anaphylactoid reaction metoclopramide cons disturbance imipramine visual hallucination corticosteroids bronchospasm， cyanosis oxacillin Abn LFT, general urticaria ADR reporting sulfasalazine hypersensitivity syndrome cisapride long QT syndrome； Torsades de points drug interaction methimazole agranulocytosis flumarizine EPS oxacillin agranulocytosis warfarin hemoptysis： pul hemorrhage drug interaction losartan acute hepatitis， shock， ARF carbamazepine 2176。停用 ketoconazole後約 34個(gè)月，患 者之肝功能恢復(fù)至正常。 Case 6: 女性， 42 歲，曾於 90年 11 月因急性肝炎入院，當(dāng)時(shí)有排除 C型肝炎病毒、 EpsteinBarr氏病毒之感染?；颊哽? 90年 11 月再度因急性肝炎住院治療，排除病毒性肝炎之可能，佐以肝臟切片檢查，結(jié)果符合藥物引起肝炎之診斷。 carcinogenic/teratogenic reactions ? seem to be a function of patient susceptibility ? Rarely predictable ? usually not dosedependent ? seem to concentrate in certain body systems such as liver, blood, skin, kidney, nervous system, and others ? unmon, generally very serious, can be lifethreatening Type B reactions ? except for immediate hypersensitivity reactions, they usually take 5 days before the patient demonstrates hypersensitivity to a drug ? there is no maximum time for the occurrence of a reaction, but most occur within 12 weeks of therapy Allergic vs idiosyncratic reaction ? Allergic reaction: an immunologic hypersensitivity, occurring as the results of unusual sensitivity to a drug ? idiosyncratic reaction: abnormal susceptibility to a drug that is peculiar to the individual Type of reaction mnemonic examples A： doserelated augmented digoxin toxicity、 serotonin syndrome with SSRI B： nondoserelated bizarre penicillin hypersensitivity、 acute porphyria、 malignant hyperthermia C： doserelated ＆ timerelated chronic HPAaxis suppression by steroid、benzodiazepine dependence、analgesic nephropathy D： timerelated delayed teratogenesis、 carcinogenesis E： withdrawal end of use opiate withdrawal syndrome F： unexpected failure of therapy failure inadequate dosage of oral contraceptives used with specific enzyme inducers Case 1: Imipramine ? 15 monthold boy, suffered from cons disturbance ＆frequent seizurelike movement ? Brain CT was performed, mannitol IV was used under the impression of brain edema ? Cons disturbance was not improved ? Transferred to our ER, admitted to NCU ? Fell down from 3040cm height chair 4 days ago ( no seizure, no cons disturbance, no vomiting or irritable crying ) ? EKG: QRS prolongation, QTc widening ? Imipramine level: 1389μg/l （ therapeutic range: 150250, toxic level:＞ 500） Case 2: acetaminophen ? 22 y/o lady, suffered from migraine since her childhood, it became worse 56 years ago, acetaminophen was given since then at LMD ? She stated that she t
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