藥物不良反應(yīng)之評估與通報(bào)作-在線瀏覽
2025-07-15 01:59本頁面
【正文】 sceptibility 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 took more than 10 tablets per day ? About one week ago, nausea, vomiting and diarrhea attacked her for 1 day , then subsided ? But the condition became serious, she was send to ER ? GOT/GPT： 6058/ 8732 ? HBS Ag, anti HBCIgM, anti HCV, anti HAVIgM：（ ） ? Abdominal echo： fatty liver, hepatomegaly ? Concurrent medication： unknown Case 3： metronidazoleperipheral neuropathy ? 50 y/o man , brain CT revealed brain abscess, treated with ceftriaxone, penicillin G, metronidazole ? Metronidazole 2g/d was stopped after a total of 43 days ? 15 days later, patient plained numbness of limbs, no headache , no nausea/ vomiting, no diplopia, no definite neurologic sign ? Numbness of the hands improved 10 months later, but shortstocking like numbness of the feet persisted ? No other causes of peripheral neuropathy were found: alcoholism, amyloidosis, cancer, DM, heavy metal toxicity, hypothyroidism, malnutrition, medicines（ amiodarone, cisplatin, ethambutol, hydralazine, isoniazid, nitrofuratoin, phenytoin,… ） Ketoconazole ＆ hepatitis Case 4: 女性， 36 歲，曾於 89 年 5月因急性肝炎入院，當(dāng)時(shí)致病因子不明?；仡櫰溆盟幨钒l(fā)現(xiàn)，兩次肝炎事件發(fā)生之前，病人皆因念珠菌陰道炎，而有口服 ketoconazole。 Case 5: 女性， 45 歲，因灰指甲而口服 ketoconazole。住院期間有排除 A型肝炎、 B型肝炎及 C型肝炎病毒之感染。停用 ketoconazole後約 34 個月，患者之肝功能恢復(fù)至正常。患 者於 91年 4月，再度因急性肝炎住院，期間有排除 A型肝炎、 B型肝炎及 C型肝炎病毒之感染，另排除自體免疫性 疾病。停用 ketoconazole後約 12個月，肝功能恢復(fù)至正常。於 91年 4月因念珠菌陰 道炎口服 ketoconazole共 3天，之後，出現(xiàn)全身無力、噁心、茶色尿，及肝功能異常等而入院治療。住院期間有排除 A型肝炎、 B型肝炎及 C型肝炎病毒之感染。 如何辨識可疑之 ADR ? 病患的陳述是重要的資訊 , 要重視任何的抱怨 ? 要有病人完整的用藥史 , 包括是否服用成藥 , 中草藥 , 營養(yǎng)補(bǔ)充劑 . (Acetaminophen induced allergy、 chronic use of OTC medication ) ? 不良反應(yīng)之辨識通常是主觀的 ,要靠文獻(xiàn)之驗(yàn)證 , 而且經(jīng)常無法絕對確認(rèn)因果關(guān)係 ,只能呈現(xiàn)相關(guān)性之大小 . 如何辨識可疑之 ADR ? 系統(tǒng)性的追蹤使用高危險(xiǎn)性藥物的病人 ? 回溯性查訪使用解毒劑的病例 ? 發(fā)展內(nèi)部電腦偵測系統(tǒng) ? 最直接的方法是鼓勵醫(yī)療人員參與通報(bào) ? 一旦懷疑 , 必頇知會開處方之醫(yī)師 , 病例上務(wù)必詳細(xì)記載 , 完整的發(fā)生癥狀、處理過程及預(yù)後 那些 ADR病例需要通報(bào) 嚴(yán)重 ADR（即使不確定因果關(guān)係，仍需通報(bào)） 1.
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