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。     

老年人预防跌倒意识与行为研究

目的：描述老年人跌倒状况,比较有无跌倒史老人的预防跌倒意识及行为差异,研究预防跌倒意识与行为的关系。方法：入选160例60岁以上老人,通过访谈,调查其跌倒状况、预防跌倒意识与行为关系。结果：老年人跌倒发生率为27．0％,且随着年龄的增高而上升;跌倒大多发生在室内,占51．5％,主要由腿脚无力和障碍物绊倒所致;跌倒主要造成软组织损伤者占60．0％;无跌倒史老人的预防跌倒意识和行为均优于有跌倒史老人。预防跌倒意识与行为呈正相关。结论：提高老年人预防跌倒意识可促进其预防跌倒行为,从而降低跌倒的发生率。     

Adverse drug reactions in elderly patients

Many studies from around the world show a correlation between increasing age and adverse drug reaction (ADR) rate, at least for some medical conditions. More than 80% of ADRs causing admission or occurring in hospital are type A (dose-related) in nature, and thus predictable from the known pharmacology of the drug and therefore potentially avoidable. Frail elderly patients appear to be particularly at risk of ADRs and this group is also likely to be receiving several medicines. The toxicity of some drug combinations may sometimes be synergistic and be greater than the sum of the risks of toxicity of either agent used alone. In order to recognize and to prevent ADRs (including drug interactions), good communication is crucial, and prescribers should develop an effective therapeutic partnership with the patient and with fellow health professionals. Undergraduate and postgraduate education in evidence-based therapeutics is also vitally important. The use of computer-based decision support systems (CDSS) and electronic prescribing should be encouraged, and when problems do occur, health professionals need to be aware of their professional responsibility to report suspected adverse drug events (ADEs) and ADRs. "Rational" or "obligatory" polypharmacy is becoming a legitimate practice as increasing numbers of individuals live longer and the range of available therapeutic options for many medical conditions increases. The clear risk of ADRs in this situation should be considered in the context that dose-related failure of existing therapy to manage the condition adequately may be one of the most important reasons for admission of the elderly to hospital. Thus, age itself should not be used as a reason for withholding adequate doses of effective therapies.     

Spontaneous reports of hypersensitivity adverse drug reactions in Portugal: a retrospective analysis

ABSTRACT

Background

Hypersensitivity adverse drug reactions (ADRs) are usually serious, unpredictable, and associated with high morbidity and mortality. This study describes cases of hypersensitivity ADRs spontaneously reported in Central Portugal.     

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。     

DNA甲基化在药物效应和新药研发中的研究进展

DNA甲基化对药物作用的影响日渐受到关注。许多编码药物代谢酶、药物转运体、核受体及药物靶点的基因受DNA甲基化调控。DNA甲基化在影响细胞色素P450酶(CYP450)的表达水平上起着重要的作用,而CYP450酶系催化多种药物代谢反应,能显著影响药物疗效。目前的研究也发现DNA甲基化水平在个体间的差异与药物疗效和不良反应在个体间的差异是紧密相关的。DNA甲基化状态会受药物作用影响,进而引起不同程度的药物不良反应。近年来,以DNA甲基化为靶向的药物研发呈增长态势,DNA甲基转移酶抑制剂对肿瘤等重大疾病治疗具决定性作用。临床试验结果显示,DNA甲基化药物治疗已在改善药物疗效、稳定药理作用及减少药物不良反应上初见成效。DNA甲基化可能成为早期预测药物效应的潜在生物标记,将成为实现临床个体化用药的有力工具。     

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.     

艾司奥美拉唑不良反应418例报告分析

目的：了解艾司奥美拉唑发生药品不良反应（adverse drug reaction,ADR）的特点及相关因素,探讨其安全性,为临床合理用药提供参考。方法：调取江苏省药品不良反应监测中心数据库收集的2013-2016年379 801例报告,提取其中418例艾司奥美拉唑ADR报告进行描述性统计分析。结果：418份ADR报表中,类型为一般的有378例,其中新的有262例,严重的40例;注射剂29例,胶囊片剂389例;不良反应发生较多的是中老年人（83.47%）;ADR可累及多个器官或系统,主要为消化系统（37.80%）、皮肤系统（11.00%）和神经系统（10.53%）。临床症状范围较广。只有124例（29.67%）因果关系为肯定,可能,很可能或可能无关,294例（70.33%）是待评价和无法评价。合并用药有188例（44.97%）。结论：虽然严重的艾司奥美拉唑不良反应不多,但新的不良反应依然很多,临床上应重视其所致的ADR,并加强合理用药,确保用药安全。     

托珠单抗致不良反应文献分析

目的:分析托珠单抗致不良反应(adverse drug reactions,ADRs)发生情况及临床特点,为临床安全用药提供参考.方法:检索Web of Science、PubMed、维普数据库、中国知网数据库和万方数据库关于托珠单抗不良反应的文献并进行分析.结果:托珠单抗致ADRs的个案报道共51例,患者年龄分布以5...     

191例氟喹诺酮类药物不良反应分析

目的:调查我院氟喹诺酮类抗菌药物不良反应发生的情况和特点.方法:收集我院上报的191例氟喹诺酮类药物的不良反应报告,按患者的一般情况、涉及药物、给药方式、不良反应涉及器官及临床表现等方面进行汇总和分析.结果:不良反应主要发生在60岁以上患者中(45.02% );女性不良反应的发生比例明显高于男性;共涉及3种氟喹诺酮类药物,主要以左氧氟沙星为主;严重不良反应事件为3例(1.57%),皆为过敏性休克;引起不良反应的主要给药途径为静脉给药(164例,85.90% ) ;不良反应主要损害类型为皮肤及其附件损害、消化系统损害.结论:加强氟喹诺酮类药物不良反应的监测工作,以减少氟喹诺酮类药物不良反应、提高临床合理用药水平.     

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.     

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.