重视老年人药源性肾损伤的预防

老年人因年龄相关的特殊肾脏生理改变,且常多病共存及多药并用,易受肾毒性药物影响,是发生药源性肾损伤（DIKI）的高风险人群。目前,对于DIKI尚缺乏有效治疗方法,因此重在预防。近年研究提示与DIKI发生密切相关的危险因素主要包括药物因素、患者因素和肾脏因素。对上述危险因素进行综合评估,有助于早期识别DIKI高危老年患者...     

中枢神经系统用药与老年人跌倒风险的相关性研究

目的研究服用中枢神经系统药物与老年人跌倒风险的相关性。方法在本社区60~75岁人群中随机分发问卷,调查在过去1年中服用中枢神经系统药物同时有跌倒史的人群样本。通过回归分析研究在老年人群中服用中枢神经系统药物和跌倒风险的相关性。结果调查4 696人,男2 546人,女2 150人,平均年龄66.3岁,21.7%的被调查者有跌倒史。与老年人跌倒风险相关(OR,95%CI)的中枢神经性药物有:阿片类药(2.4,1.5~3.7)、非阿片类止痛药(1.7,1.4~2.1)、抗癫疒间药(2.8,1.5~5.1)、抗抑郁药(2.8,1.9~4.1)、抗焦虑药(1.5,0.9~2.6)。其中阿片类药与老年人的跌倒风险明显相关,抗精神病药与跌倒没有明显的相关性。结论多数中枢神经系统药物与老年人跌倒风险相关,并能使跌倒风险增加2~3倍。     

药源性精神障碍

药物引起的精神障碍较为普遍.1997年在英国药物安全委员会收到的"黄卡"报告中,8.6%的病例涉及精神健康障碍.在这些反应中,大多数是A型,即剂量依赖型反应,以药物的药理作用为基础.少数是B型反应.在药物使用期间,既存在精神疾病逐渐加重的情况,又可能突然发生精神障碍.精神障碍也是一种常见的撤药反应,即停用某些药物后而出现精神障碍,尤其是在突然停止治疗时.以下讨论最常见药源性精神障碍以及最常见可能引起精神障碍的药物.     

药源性皮肤病

在药物不良反应(ADR)中,皮肤是最易受到影响的器官。1997年英国药物安全委员会收到的ADR报告中,皮肤和皮下组织的过敏反应约占27％。尽管很多药物引起的皮肤过敏反应有一定的变应性或毒性基础,但其原因仍然不清遗传可能是一个比较重要的影响因素;患肝病、肾病、AIDS病、SIE患者和老年人等发生皮肤反应的危险性较高。在住院病人中,药物引起的过敏反应高达3％。事实上,所有的药物都可能引起皮肤反应,虽然大多比较轻微,但有些反应很严重,甚至危及生命。如Stevens-Johnson综合征、中毒性表皮坏死松解症(TEN)等。ADR的诊断较困难。一般的皮肤反应是在药物使用后的短期内发生,但也有几星期内,甚至数月发生的情况。     

112例药源性皮疹病例分析

目的: 探讨药源性皮疹近年来的发生率和变化.方法: 对我院1996～1998年112例药源性皮疹病例进行总结分析.结果: 引起药疹的药物中, 抗菌药物占49.02%, 其次是心血管类药和解热镇痛药.药疹类型主要是麻疹型, 其次为荨麻疹或多型红斑.结论: 目前引起药疹主要是新一代抗菌药物.     

药源性尿频

药物因素导致的尿频报道比较少,本文对一些零散的报道综述如下,旨在临床治疗过程中,应用时引起注意.     

药源性大疱性表皮松解症中文文献分析

目的：了解药源性大疱性表皮松解症的发生情况、致死原因及治疗方法。方法：查阅１９７０～１９９９年国内公开出版的医药学期刊,对药源性大疱性表皮松解症的药物分布情况、临床表现、致病死例及治疗方法进行统计分析。结果：共查得８１例药物引起的大疱性表皮松解症１５５例,诱发药物以抗微生物药和中枢神经系统药占绝大多数,致死病例２８例,致死药物以解热镇痛药居首位。结论：药源性大疱性表皮松解症起病急骤、预后不良、病死率高,及早使用糖皮质激素是治疗的关键。     

药源性血尿及其治疗

目的根据相关报道综述引起血尿的药物及药源性血尿的治疗。方法收集近8年来药源性血尿相关文献资料,进行分析总结。结果引起血尿的药物品种较多,药源性血尿在临床比较常见,但经过处理和治疗均可痊愈。结论药物引起血尿后首先应停用该药,多饮水,多休息,必要时做对症治疗,血尿便会消失。     

药源性内分泌系统疾病

内分泌疾病大多为自身免疫性或继发于内分泌腺体肿瘤,但许多药物能对内分泌腺体合成和释放激素产生干扰,从而对其功能产生影响.此外,药物还可能干扰内分泌疾病诊断试验的结果,影响内分泌疾病的诊断,而诊断错误可能导致不恰当的治疗.以下对常见的药源性内分泌系统疾病的临床特征、引起内分泌系统疾病最常见的药物、机制和防治进行介绍.     

Drug-related hospital admissions in a generic pharmaceutical system

1. Generically based pharmaceutical systems exist in a few countries of the world, such as Iran. Most developed countries have free market pharmaceutical systems. Drug-related problems (DRP) have been reported mostly in the Western world but few data are available for generic systems. In this study, we tried to measure the prevalence of drug-related problems leading to hospital admissions in Isfahan, Iran. 2. One thousand consecutive hospital admissions in three major teaching hospitals were studied for a period of 6 months for the presence of DRP as a cause of hospital admissions. Two subcategories of DRP were considered: (i) drug therapy failure; and (ii) adverse drug reactions. Preventability and outcome measures were also assessed. Medications responsible for DRP were classified according to the Anatomic Therapeutic Chemical (ATC) classification of the World Health Organization. 3. Of the 1000 admissions studied, 115 (11.5%) were owing to DRP, 81% as a result of drug therapy failure and 19% as adverse drug reactions. A total of 106 out of the 115 DRP cases (92%) were either preventable or probably preventable, most of which had to do with either prescriber or patient error. An overview of DRP showed that 58.3% resulted in complete recovery, 33.9% in relative recovery and 7.8% in death. Close to 1% of hospital admissions resulted in DRP-related deaths. 4. The overall prevalence of hospital admissions caused by DRP is similar to that in free market pharmaceutical systems. The high preventability rate of these problems should alert clinicians and policy makers to design strategies to curtail this. Also, reasons for differences in subtypes of DRP between the results of this study and those of the literature from free market systems needs to be investigated further.     

我院286例老年患者药品不良反应回顾性分析

目的了解医院老年患者用药发生药品不良反应（ADR）的特点。方法回顾性分析2005年至2009年的286例老年患者ADR报告。结果总计1 175例ADR中,老年患者ADR发生率为24.34%,男性略少于女性,静脉给药方式导致ADR最多（83.92%）,引发ADR最多的为抗感染药物（45.80%）,ADR临床表现以皮肤及其附件损害最常见（30.42%）。结论老年患者因身体机能减退,同时患有多种疾病等原因,服药种类多,潜在的不良反应发生率较高。因此,医务工作者要有以患者为中心的服务意识,充分利用处方审查系统提供的用药指南指导患者用药,确保用药安全。     

211例药源性急性肾功能衰竭中国期刊文献分析

目的：研究药源性急性肾功能衰竭的相关因素.方法：对〈中国期刊全文数据库〉1994年1月-2005年5月收录的一般资料描述完整的63篇共211例药源性急性肾功能衰竭病例进行分析.结果：211例药源性急性肾功能衰竭中,男性140例,女性71例,平均年龄52.3岁,静脉给药176例,占83.41%,211例中死亡病例47例,占22.27%.结论：合理用药,预防药源性急性肾功能衰竭的发生.     

Adverse drug reactions in adult medical inpatients in a South African hospital serving a community with a high HIV/AIDS prevalence: prospective observational study

Aims

To describe the frequency, nature and preventability of community-acquired and hospital-acquired adverse drug reactions (ADRs) in a South African hospital serving a community with a high prevalence of human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome.

Methods

A 3-month prospective observational study of 665 adults admitted to two medical wards.

Results

Forty-one (6.3%) patients were admitted as a result of an ADR and 41 (6.3%) developed an ADR in hospital. Many of the ADRs (46.2%) were considered preventable, although less likely to be preventable in HIV-infected patients than in those with negative or unknown HIV status (community-acquired ADRs 2/24 vs. 35/42; P < 0.0001; hospital-acquired ADRs 3/25 vs. 14/26; P = 0.003). Patients admitted with ADRs were older than patients not admitted with an ADR (median 53 vs. 42 years, P = 0.003), but 60% of community-acquired ADRs at hospital admission were in patients <60 years old. Among patients <60 years old, those HIV infected were more likely to be admitted with an ADR [odds ratio (OR) 2.32, 95% confidence interval (CI) 1.17, 4.61; P = 0.017]. Among HIV-infected patients, those receiving antiretroviral therapy (ART) were more likely to be admitted with an ADR than those not receiving ART (OR 10.34, 95% CI 4.50, 23.77; P < 0.0001). No ART-related ADRs were fatal. Antibiotics and drugs used for opportunistic infections were implicated in two-thirds of hospital-acquired ADRs.

Conclusions

ADRs are an important, often preventable cause of hospitalizations and inpatient morbidity in South Africa, particularly among the elderly and HIV-infected. Although ART-related injury contributed to hospital admissions, many HIV-related admissions were among patients not receiving ART, and many ADRs were associated with medicines used for managing opportunistic infections.

What is already known about this subject

• Studies conducted primarily in developed countries have shown that adverse drug reactions (ADRs) are a significant cause of hospital admission, prolong hospital stay and consequently increase the cost of disease management in patients.
• Cardiovascular medicines, hypoglycaemic agents, nonsteroidal anti-inflammatory drugs and antibiotics are the most frequently implicated medicines in these studies.
• A large proportion of these ADRs have been shown to be preventable through improved drug prescribing, administration and monitoring for adverse effects.

What this paper adds

• This is the first Sub-Saharan African study in the HIV/AIDS era that describes the contribution of ADRs to patient morbidity, hospitalisation and mortality.
• Cardiovascular medicines and antiretroviral therapy contributed the most to community-acquired ADRs at the time of hospital admission while medicines used for opportunistic infections (such as antifungals, antibiotics and antituberculosis medicines were most frequently implicated in hospital acquired ADRs.
• ADRs in HIV-infected patients were less likely to be preventable.

     

内科病区老年患者潜在的药物相互作用

目的 探讨内科病区老年患者用药中的药物相互作用情况。方法 查阅电子病历,将2014年10月—2015年6月宁波市妇女儿童医院内科病区收治入院的老年(年龄≥65周岁)患者纳入研究对象,并对其用药情况进行回顾性调查研究,以药品说明书为依据,评判其是否存在药物相互作用,并对可能由其导致的药物不良事件进行统计分析。结果 共163例老年患者纳入研究,医嘱用药中位数是7,潜在的药物相互作用中位数是3,94例患者存在有临床意义的潜在的药物相互作用,占57.7%;临床发生实际药物相互作用有10例,占6.1%,其中8例发生药物不良反应,2例发生药物疗效欠佳。结论 为了保障老年患者用药安全,医师应关注药物的相互作用,尽量减少用药品种数和避免选择相互作用有害的药物以降低药物不良事件的发生率。     

老年患者应用利奈唑胺的合理性和安全性评价

目的：对复旦大学附属中山医院老年患者临床应用利奈唑胺的合理性进行分析,并统计不良反应的发生情况,为老年患者安全合理用药提供参考。方法：运用回顾性研究方法,选取2018年8月至2020年8月在复旦大学附属中山医院使用利奈唑胺治疗的老年患者,收集患者的基本信息、感染部位、病原菌的种类、实验室检查指标、合并疾病和合并用药等情况,根据药品的说明书和相关指南设计调查表,对老年患者中利奈唑胺的使用情况进行合理性评价,评估其疗效和不良反应,并对血药浓度监测情况进行统计分析。结果：共纳入有效病例329例,利奈唑胺临床应用的合理率为81.8%,不合理原因主要有无指征用药、疗程不当、选药起点过高以及联用药物不适宜等。临床治疗有效率为69.3%,病原菌清除率为59.6%。利奈唑胺用药期间主要的不良反应为血小板减少（20.4%）和血红蛋白减少（11.9%）。31名老年患者进行利奈唑胺的血药浓度监测,血药浓度的监测率为9.4%,谷浓度维持在2~8 mg·L^-1的有11例（35.5%）,谷浓度＞8 mg·L^-1的有18例（58.1%）,谷浓度<2 mg·L^-1的有2例（6.4%）。结论：利奈唑胺临床应用的合理性有待提高,临床医师应严格把握用药适应证及合并用药的合理性来促进其临床使用。此外,临床用药期间还应加强利奈唑胺的血药浓度监测来提高老年患者用药的安全性。     

Frequency and cost of serious adverse drug reactions in a department of general medicine

Aims To assess the frequency and cost of drug reactions causing or prolonging hospitalization.
Methods All patients admitted to an internal medicine ward over 6 months were evaluated to identify serious adverse reactions. The number of drug classes on admission or at the time of the adverse drug reaction (ADR) was counted. Excess ADR-related hospital stay was computed using a) raw excess duration of hospital stay, b) correction of duration of hospital stay by age, sex, and number of drug classes, and c) estimation by investigator of excess hospital stay.
Results Three hundred and twenty-nine patients were evaluated: 212 male, 117 female, mean age 57.2 (males: 52.2, females: 66.2 ( P <0.05)), range 17–95 years. They stayed a total of 3720 hospital days (mean stay 11.3 days). 298 had no ADR (mean age 55.8, taking a mean of 2.7 drug classes, 10.7 days hospital stay); 31 had ADRs: in 10, the ADR caused admission in patients with a mean age of 84 ( P <0.01 vs the two other groups), taking 6.3 drug classes, who stayed a mean of 15.1 days; 21 occurred in hospital in patients with a mean age of 63.6, taking 4.2 drug classes ( P <0.01), who stayed a mean of 19.2 days ( P <0.01 vs patients without ADRs). In four the ADR was fatal (13% of ADRs, 40% of deaths). Raw ADR-related excess hospital stay was 318 days (8.6% of all hospital days), after multivariate correction 282 days (7.6% of all hospital days), and with investigator estimation 197 days (5.3% of all hospital days). Point prevalence of ADRs at admission was 3%, incidence rate in hospital was 5.6/1000 patient-days.
Conclusions 3% of the admissions were related to ADRs. In addition, 6.6% of hospitalized patients had significant ADRs. Between 5 and 9% of hospital costs were related to ADRs. In 24 of the 31 patients with ADRs (77%), these were related to the pharmacological properties of the involved drugs, and may possibly have been avoidable.