• Nghien CIFU - Ky thuat
Danh gia tirong tac thuoc bat lgi trong don thuoc xuat vien va dieu tri ngoai trii
tai benh vien da khoa hang I
Nguyen Hodng Anh, Nguyen Thanh Sffn, Hofing VSn Hd, NguySn Mai Hoa Trung tdm DI&ADR Quoc gia, Tnrang DH DUQC Hd Npi
D a t v a n d e
T u o n g tac thudc Id mpt van d l kha phd b i l n trong thyc hdnh lam sang. Theo mgt tdng quan y van cdng bd nam 2007, u d c tinh khoang 0,6% sd benh nhan nhdp vien va khoang 0 , 1 % sd bfinh nhdn tdi nhap vipn vdi ly do ggp cac tdc dyng khdng mong mudn lien quan den tuong tdc thudc
"'. D i l u nay dgc biet cd y nghTa vdi benh nhan x u i t vipn vd d i l u trj ngoai tnj, khi rdi khdi moi tordng cham sdc d benh vien, vipc difiu tri theo don thudc tgi nha ma khdng cd s y gidm sdt ciia can bd y lam tang nguy c o xuat hien cac b i l n c6 b i t Ipi lien quan d i n thudc, nhieu tnrdng hop de lai hau qua nang n l cho bfinh nhdn '^'. 6" giai dogn nay, hudng d i n khi ke don va t u v i n sir dyng thudc vdi mgc tifiu dam bdo hieu qua d i l u tri vd giam t h i l u cac tdc dung b i t Ipi do thudc (trong dd cd tuong tdc thudc) can dup'c chu trgng trong t h y c hanh. Nghifin cdu nay d u p c thyc hien nham xdc djnh t i n s u i t xuat hien tuong tac thudc tren bfinh nhan x u i t vifin va dieu trj ngogi tru vd danh gid cac tuong tac xuat hien khi xuat vidn do s y thay ddi thuoc so vdi don dieu trj npi trii tgi mpt bfinh vien da khoa hgng I.
D o i t i p p ' n g v a p h i r a n g p h a p n g h i e n c i > u
Doi tu'gng nghien ci>u
T i t ca cac don thudc xuat vign va dun thudc difiu tri ngogi trii cua cdc Khoa dieu tri trong Vien d u g c thu thgp tgi Nhd thudc Benh vign Da khoa Hd Ddng trong thdi gian 1 thdng, tir ngay 1/3/2011 d i n h i t ngay 31/3/2011.
P h m j n g phdp nghien CIFU
NghiSn cuv quan sat mo ta dt ngang Thu thap, ghi nhan cac don thudc x u i t vifin vd don thudc khdm ngogi tru, thdng tin cOa don
thudc d u p c ghl vdo p h i l u thu thdp so lifiu. Phdt hien tuong tdc trong don bang phan m i m DRUG-RE/\X Micromedex 2.0 (Thomson Reuters), p h i n mem d u p c sip dyng rpng rai n h i t vd d u g c coi la c h u i n m y c trong tra c d u tuong tdc thudc. Phan logi dp nghifim trpng ciia tuong tdc theo 5 mipc: chong chi dinh, nghiem trgng, trung blnh, nhe vd chua rd trong do, tuong tdc chdng chf djnh va nghiem trgng d u p c xep logi Id t u o n g tac cd y nghTa lam sdng (YNLS). Vdi nhu'ng don thudc xuat vien ma x u i t hien t u o n g tac, t i l n hdnh hdi cuu lai benh an luu de ghi nhgn thong tin trong giai dogn d i l u trj ndi trii.
Tieu chi danh gia
Danh gia cac tuong tdc xuat hi$n tren dem thudc: Ty le sd don thudc cd tuong tdc, sd tuong tdc trung binh/don, ty le don cd 1 t u o n g tac, 2 tuong tdc, £ 3 tuong tac; cac cap t u o n g tac thudng ggp; sd don cd tuong tdc cd YNLS;
sd tuong tdc cd y nghTa lam YNLS/don; cdc cgp t u o n g tdc cd YNLS.
PhSn tich c^c ySu tS li§n quan den vi$c xuat hien tLeang tac thuoc: cdc thudc hay d u p c ke don; cdc nhdm thudc hay ggp tuong tac, cac thudc hay gap t u o n g tac; mdi lien quan giira sd thudc d u g c kfi trong don, tudi, logi hinh b^nh tgt, khoa lam sang, sd bpnh m i c kem den kha nang ggp t u o n g tac trong don.
Ddi v&i dan thuSc xuit vi$n cd tirong tac thudc, hdi CUV l^i benh dn cd xuit hi$n tuvmg tdc de xdc dinh: ty lp tuong tac trfin don thudc khi x u i t vign vd tuong tdc trong bpnh an d i l u trj npi trii; sd t u o n g tdc va cdc cap t u o n g tac phat sinh do thfim thudc hogc thay thudc khi bgnh nhan xuat vifin; cac cap t u o n g tdc cd YNLS phat sinh trong don thudc khi xuat vidn.
T ^ CHi DiraO HOrv-OS/aoa^^CWaa MAM •i'>\
• Nghien CIFU - Ky thuat
Xu' ly s6 ll^u
Sd li$u dugc iuu tru- vd phdn tich bing phin mim SPSS 15.0. B0nh tdt vd thudc sir dyng dugc md hda tuong u'ng theo phdn logi ICD-10 vd phdn logi ATC. Su- dgng kilm djnh t-Student d l so sdnh gid trj tmng binh nlu miu tudn theo phdn bd chuin. kilm djnh Mann Whitney nlu miu khdng tudn theo phdn bd chuin, kilm dinh
* d l so sdnh cdc tj' Id. Si> dyng hdi qui tuyin tinh don gidn d l phdn tich mdi Nfin h$ giO'a sd thudc vd sd tuong tdc trong don, kilm djnh ' vdi t^ suit chinh (odd ratio, OR) d l phdn tich mdi Nfin quan glCra tudi vdi sd tuong tdc trong don.
K^t qud
D$c dilm bgnh nhdn trong miu nghidn ci>u
Bdng 1: D$c diim miu nghidn cuv
Thdng s6ruof (X ± SD; th^p nhil-cao nhit)
GI6i: nam; nip: n (%) Kh6i dieu tri
KhSm benh Ngoai/san
Noi CSp Ci>u/h6i sijc Chuygn khoa le
Nhi
5 ntidm b^n/i ctiinb thwdng g$p (ma ICD-10) B§nh h§ ho hap (J) Thai ngh^n, sinh de va h$u sSn (0)
B#nh h$ tieu hoa (K) 8|nh nhiim thjng vd l<y sinh
thing (A-B) B$nh h# tuin hodn (1) 5 ^ lu^g bfnti miic kdm
0 1-2 2 3
35,8 ± 23,8 (1 thdng - 100 tu6i)
701 (46,7%);
801 (53,3%) 508 (33,9%) 324(22,1%) 187(12,5%) 171 (11,4%) 232(15,4%)
71 (7,4%)
452(30,1%) 160 (10,7%) 150(10,0%) 137(9.1%) 136(9,1%) 1307(87%) 194 (12,9%)
1 (0,1%)
khodng biln thifin khd rdng. Don thudc trong miu nghifin ciru dupc kfi tir tit cd cdc khoa lam sdng trong bdnh vidn, trong dd Khoa Khdm bdnh chilm ty 1$ cao nhit (33,9%) chd ylu Id don thudc ngogi trii. Bdnh ly chinh dugc chin dodn rit da dgng trong dd 5 nhdm bdnh chinh thudng g$p Id b$nh hd hd hip; thai nghfin, sinh dd vd h$u sdn; b$nh hfi tilu hda, bdnh nhiem triing, bdnh h | tuin hodn. Da sd bdnh nhdn (87,0%) trong miu nghifin ciru khdng cd bgnh mic kfim. 13% cdn Igi sd bdnh nhdn cd tir 1 bdnh mic kfim trd Ifin trong dd chd ylu Id cdc bdnh nhdn cd bdnh ly chinh Id bdnh tuin hodn, bdnh ndi tilt, dinh dudng vd chuyin hda.
D$c dilm v l thudc dirgv ke don trong miu nghiin ciru
Bdng 2: Mwdri nhdm thudc dugc k§ don
nhiiu nhitS6 lif^ difij/c ki don (%) Nhdm thudc
Vitamin/kho^ng chit/che phim b l sung
KhSng sinh nh6m cephaiosponn t h i h? 3 (du&ng uong) 3(11,9) 3 Gidm dau, hg sot 306 (5,2) 4 Chdng vifimc6 ngudn goc enzym 2 8 6 ( 4 , ^ i
Khdng histamin H1 dung dudng
todn thdn 221 (3,7)
^111
6 Corticoid dung duong toan than 204 (3,5) 7 Khang sinh nh6m macrolid 195 (3,3)
8 Long Cinm 166 (2,8)
9 Khdng sinh nhdm fluoroquinolon 111 (1,9) 10 Khdng sinh nhdm penicillin 109(1,8)
Tdng 5893 (100)
Tdng cdng 1502 don thudc da dugc thu thdp trong dd cd 971 (64,6%) Id don khdm ngogi tni va 531 (35,4%) Id don xuit vidn. Dg tuii tmng binh trong miu nghifin ciru Id 35,8 tudi vdi
T^ 1$ don cd tuong tdc thudc vd cd tuong tdc c6 YNLS
Bdng 3: Ty /p don c6 tuong tac i/d twong tic c6 YNLS trong miu nghi§n cuv
Trong 1502 don thudc da cd tdng cgng 5893 lugt thudc dugc kfi don. So thudc tmng binh trong 1 don Id 3,92±1,49 (thip nhat 2 thudc, cao nhit 10 thudc). Trong sd dd, vitamin/khodng chat/ chl phim bd sung; cdc khdng sinh nhdm cephalospoiin thi hg 3 dudng udng; thudc gidm dau hg sdt; thuoc chdng vifim cd ngudn goc aizym; thudc khang histamin HI diing dudng toan thdn Id 5 nhdm thuoc dugc ke don nhilu nhit.
S6 lu-p-ng clan co tuang lAc (n = 1502) Dan kham ngogi tni (n = 971)
SdliF^ng 268 186
%(n=1S02) % so v6imSutirang ung ^
17,8 1
12,4 19,2 I I "T ^ CHl Dl/gic HOC - nsrani i (siS j i i i«jc in sm
• NgPiien CIFU - Ky tiiuat
Dan xuat vien (n = 531) So lu-ong dan co tuang tac co YNLS (n= 1502)
Don kham ngoai tnj (n = 971) Dan xuat vi|n(n = 531)
SolWQVig 82 44 20 24
% (n= 1502) 5,4 2,9 1,3 1,6
%
50 vm miu twong (mg 15,42,1 4,5 Trong 1502 don thudc cd 268 dan thudc cd
t u o n g tac (17,8%) lien quan d i n 88 cgp t u o n g tac thudc-thudc khac nhau, trong do 82 don Id don xuat vign vd 186 dan Id don khdm ngogi trii. Ty ifi ggp tuong tdc d don khdm ngogi trii va dan x u i t vign t u o n g irng Id 19,2% vd 15,4%.
Sd t u o n g tac trung blnh/dan Id 0,25±0,68 ( t h i p nhat 0, cao nhat 7). So luong tuang tdc cd YNLS chiem 2,9% tdng sd dan lien quan d i n 18 cap t u a n g tac thudc-thudc khdc nhau, trong dd ty lg d don kham ngogi trii vd don x u i t vien t u a n g irng la 2 , 1 % va 4,5%. Sd tuong tac co YNLS trung binh/don Id 0,04± 0.28 ( t h i p n h i t 0, cao n h i t 5). Da sd cdc don thuoc khdng cd t u a n g tdc (82,2%). So don thudc cd 1 tuang tdc c h i l m ty le 13,5%, cd tip 3 tuang tac trd len chiem ty lg thap 1,8%. Neu tinh den cdc tuang tac cd YNLS thi sd tuong tac cdn t h i p hon r i t nhieu: cd 2 , 1 % sd don cd 1 t u o n g tac cd YNLS, sd d a n cd tir 3 t u o n g tac cd YNLS trd len chf chiem 0,3% (hinh 1).
Cdc tuvrng tac va t u o n g tac cd YNLS t h u d n g gap
10 cap t u o n g tac va 10 cgp tuang tdc cd YNLS t h u d n g gap n h i t d u g c phat hlgn khi duyfit d o n d u g c trinh bdy trong bang 4 va 5.
Cdc tuong tdc thudng gdp bao gdm; phdi hgp khdng sinh (cefpodoxim, fluoroquinolon) vdi cac c h l p h i m cd chira ion kim logi (5,2%), tuong tdc Idm tang ddc tinh cOa digoxin (2,3%), tuong tac lien quan d i n thudc ire c h l men chuyln-kali (0,9%) va tuong tdc giua fluoroquinoion- corticoid (0,9%). Cdc tuong tdc cd YNLS chii yeu tdp trung vdo tuang tdc giira thudc ire che men chuyen vdi kali/thudc loi tieu giir kali (1,2%), tuong tdc thdng qua trung gian CYP3A4 (ipc che hoac cdm ung) (0,79%), tuang tdc lam tang ddc tinh ciia digoxin (1,59%).
Hinh 1 : So iuxmg tuong tac vi tuong tic co YNLS trong dan
Bdng 4: Cic tuxyng tac thuoc thwo STT Cap twong tac
1 Cefpodoxim - canxi 2 Fluoroquinolon - Mg/Zn/Fe/Ca 3 Cefpodoxim - famotidin 4 Fluoroquinolon-methylprednisolon 5 Enalapn) - splronolacton 6 Acid folic - phenobarbital 7 Digoxin - furosemid 8 Digoxin - splronolacton 9 Chgn kenh canxi - magie 10 Digoxin - canxi
mg g$p trong miu nghien cuv Hau qua cua tteang tac Giam hi$u qua cOa khdng sinh Giam hi$u qua ciia khang sinh Gidm hi^u qua cua khdng sinh
Tang nguy ca dirt gSn Tdng kali mdu Giam hi$u qua ciia barbiturat Tang nguy co ngo ddc digoxin Tang nguy co ngp d$c digoxin
Hg huyet dp Tang nguy co logn nhjp tim nghifim trpng
MiKdg tifvng tac Trung binh Trung binh Trung binh Trung binh Ngng Trung binh Trung binh Ngng Trung binh
Ngng
S6 tuvng tac (%,N = 1502)
50 (3.3) 28(1.9) 18(1,2) 14 (0,9) 14 (0,9) 12 (0.8) 12(0,8) 12 (0.8) 11 (0,7) 10(0,7)
T A P C H i D U J S & H O G - 0«fl01*«B£M11 IMAM 571
• Nghien CLPU - Ky thuat
Bdng 5: Cdc tuxyng tic c6 YNLS g$p trong miu nghiin cOv STT
1 2 3 4 5 6 7 6 9 10
Cftp tuvng tic Nifedipin-phenobarbital
/^ithromycin-suipirid Colchicin-clarithromycin
Enalapril-spironolaclon Digoxin-spironolacton
Digoxin-canxi Uc c h l men chuyln-kali Erythromycin-atorvastatin Digoxin-indapamid Amiodaron-chgn kdnh canxi
H$u qui cua tuvmg tic Gidm hifiu qud cua nifedlpin TSng dOc tinh trfin tim TSng d$c t(nh ciia colchicin
Tdng kali mdu Tdng nguy ca ng$ d$c digoxin
Tdng nguy ca logn nhjp Tdng kali mdu Tdng nguy ca bfinh ca
ho$c tifiu CO v3n Tdng nguy ca ngp dOc digoxin
Ch$m nhjp tim. block nhT thit vd/hodc ngirng nhjp xoang
Muvd^
tutmg tic COD COD
ceo
Ndng N$ng N^ng Ndng N$ng N|ng Ndng
CvchS Duoc d^ng hpc Duoc d$ng hgc Duoc d$ng hgc Ducc luc hpc Dupc luc hpc Dupc luc hpc Duoc luc hpc Dup'c ddng hpc Dupc luc hpc Dupc dOng hpc
S6 Iwqrtg (%. n = 1502)
4 (0.26) 2 (0,13) 1 (0.07) 12 (0,80) 12(0.80) 10 (0,66) 6 (0,40) 3 (0,20) 2(0,13) 2(0.13) Cdc ylu td lien quan din vigc xuit hidn
tuvnyg tdc thudc trong don
Anh hwdmg ctia sd thudc trong don: Phdn tich hdi qui t u y i n tinh don gidn cho thay cd mdi Hfin hd giua sd thudc va sd t u o n g tac trong don (Fi.i5oo= 313,7; p<0,001). Khi tdng mgt thudc trong don thi sd t u o n g tdc trong don se tang tuang irng la 0,19 (khoang tin cdy 95% dao dgng tip 0,18-0,20).
Anh huong cda tudi: Bfinh nhan ^ 65 tudi cd nguy co ggp t u o n g tac cao hon g i p 3,3 lan so vdi cdc bgnh nhdn < 65 tuoi (khoang tin cdy 9 5 % : 2 , 4 - 4 , 8 ) ( p < 0 , 0 0 1 ) .
Anh hw&ng cua b$nh /y chinh: Bfinh nhan m i c bgnh ciia hd tuan hodn cd kha nang ggp t u o n g tdc cao hon cdc nhdm bfinh khac (p<0,001).
Anh hw&ng cua b$nh mic l<em: Bdnh nhan cd bgnh mac kdm cd khd ndng xuat hidn t u o n g tdc thudc cao ban cd y nghTa so vdi bgnh nhdn khdng cd b$nh mac kfim (p<0,001).
Anh hi/dng cua khdi didu tri: D a n thudc tir khdi hdi su-c/cip c u u va khdi ngi cd khd nang x u i t hign t u o n g tdc thudc cao hon ro rgt so vdi cdc khoi d i l u tn khdc (p<0,001).
So s d n h tu>ong tdc x u i t hl$n t r o n g giai d o g n d i l u trj ngi t r u vd trong d o n x u i t vl$n
Trong 1502 don thudc cd 82 don x u i t vidn cd tuang tdc thudc, chung tdi t l l n hdnh hdi ciru bgnh dn trfin 82 bdnh nhdn ndy d l so sanh tuong tdc thudc x u i t hign trong giai dogn d i l u tn ngi tni vd khi x u i t vign. Cdc bdnh nhdn cd tuong tac thudc trong don xuat vidn chii yeu da dupc dieu trj tgi cdc khoa lam sdng thudc khdi Ndi vd khdi Ngogi/sdn. So thudc tnjng binh trong don x u i t vifin (5,22) t h i p hon cd y nghTa so vdi s6 thudc trong giai dogn d i l u trj ndi tni (9,56) nhung sd lug-ng t u o n g tdc vd sd lugng tuong tdc cd YNLS cung nhu t j Id bgnh nhdn cd 5 1 tuong tac cd YNLS Igi khdng cd s y khdc bidt giu-a 2 giai dogn ndy. Trong sd 147 t u o n g tdc phdt hi0n d u g c trong 82 don x u i t vidn cd 129 Id tuong tdc mdi phdt sinh lien quan d i n 50 cgp tuong tdc phdt sinh (tmng binh cd 1,57 tuong tdc mdi phdt sinh cho mdi don x u i t vidn). Trong s6 ndy, 39 tuong tdc Id cd YNLS lidn quan 9 c^p tuong tdc phdt sinh, chii y l u Id t u o n g tdc cua digoxin (24,4%), t u o n g tdc Idm tdng kali mdu do phoi hgp iPc c h l men chuyln/spiranolacton hogc muoi kali (18,3%) (bdng 6-8).
Bdng 6: So sinh tuxyng tic xuit hi^n trong giai do^n diiu trj ndi tni vi trong don xuit vi$n Tieu chi
S6 tliu6c trong don S6 tuang tSc/dan So tuang t^c c6 YNLS /dan Ty 1^ b#nh nh§n c6 & 1 tuang t^c co YNLS
Diiu trj n^i trii 9,56 ± 3,78 1,96 ±2,50 0,45 ± 0,89 25 (30,5%)
Xuitvl$n 5,22 ±1,76 1,79±1,34 0,51 ± 0,98 24 (29,3%)
P
< 0,001 0,875 0,553 1,000
TAP CHi Dl/OC HD£l_jllS/ini? rsiS 411 luXiu fiaj
• Nghien CIFU - Ky thuat
Bang 7:
: Tuxyng tac thudc phat sinh trong dan xuit vi$n
S6 twong tic
Bdng 8 STT
1
Tong so tuang tdc phat hign dupc/82 dan xuit vifir So tuang tdc phat sinh So cdp tuang tdc phdt sinh So tuang tdc phdt sinh c6 ^ ngh Ta Idm sdng S6 cap tuang tdc phdt sinh cd y nghTa ISm sdng
S6 tuang tdc phdt sinh trung binh/dan : Cic cap tu^yng tic cd YNLS phit sinh trong dan
Cap twong tic Muc cfp twong tic Colchicin-clarithromycin
2 Cfc c h l men chuyln-spironolacton 3
4 5 6 7 8 9
Digoxin-spironolacton DigoxJn-calcl Cfc c h l men chuyln-kali
Digoxin-indapamid Amiodaron-acenocoumarol Amiodaron-chpn kfinh caici
Spironolacton-kali
COO Ndng Ngng Ndng Ndng Ngng Nang Nang Ndng
1
xuit vi$n Cvchi Dupc dOng hpc
Dupc Iyc hpc Dupc Iyc hpc Dupc luc hpc Dupc luc hpc Dupc luc hpc Dupc dpng hpc Duac d$ng hpc Dupc Iyc hpc
147 129 50 39 9 1,57
S6 Iwqmg {% so viri tdng 82 dtm xuit vl$n)
1 (1,2) 10(12,2) 11 (13,4) 8 (9,8) 4 (4,9) 1 (1.2) 1 (1.2) 1 (1,2) 1 (1,2) B a n l u a n
K i t qua cho t h i y ty lg t u o n g tac thudc gap trong don x u i t vien vd d i l u trj ngogi tru trong mau nghifin ciru t u o n g ddi cao (17,8% sd don cd ferong tdc, trung binh co 0,25 tuong tac/dan), trong dd sd don cd t u o n g tac cd YNLS (mire dd chdng chf djnh hoac ngng) chidm ty le 2,9%.
t u o n g Cl'ng vdi 0.04 t u o n g tac cd YNLS/don.
K i t qua nay mdt lan nu-a khang djnh t i m quan trong cua t u o n g tdc thudc ndi len nhu mgt v i n dfi ndi cdm trong dan x u i t vifin va ^ l u trj ngoai trii vdi t? le dan cd t u o n g tac dao dpng trong khoang 40%-70% trong do sd t u o n g tac cd YNLS dao ddng trong khoang tip 2-18%^^"^. TJ lfi sd dan cd t u a n g tac hoac tuong tdc cd YNLS trong nghifin cuu cua chiing tdi thap hon mgt sd nghien c u u da cdng bd cd t h i do mau nghien ciru bao gdm ca don x u i t vign va dieu trj ngogi tru, do s y da dgng ve loai hinh benh tat cua benh nhdn ciia mdt bfinh vifin da khoa trong m i u nghien cii'u va cudi ciing cd t h i do kha nang nhgn djnh va phdt hifin t u o n g tdc thudc khac nhau giua cac p h i n m i m sii' dung duydt t u o n g tdc trong cac nghien ciru"®'. Cdng bd trong y van cho t h i y ty le tuong tdc trong don x u i t vign dgc biet trfin nhdm bfinh nhdn tim mgch vd lao khoa cd xu hudng cao hon rd rgt '^' ^°\ K i t
qua cdng bd g i n day ciia Tran Nhan T h i n g vd Can Tuyet Nga khdo sdt tren bfinh an cda bfinh nhdn tim mach d i l u trj ndi trii tgi Bgnh vign Bgch Mai sir dyng p h i n mem Drug Interaction Facts vd MIMS Interactive de duyet t u o n g tdc cung cho t h i y ty lg sd bgnh an cd t u o n g tac r i t cao (80%-91%)'''^'. Benh nhan cao tudi, bfinh nhan m i c benh tim mgch la nhu'ng ddi t u o n g cd n h i l u benh ly mdc kem vd d u o c kfi n h i l u thudc trong don Id nhirng yeu td nguy co chinh lam tang kha nang x u i t hien t u o n g tdc thudc trong don da d u g c md ta trong nghifin cipu cua Chung tdi.
Cac t u o n g tdc thudng gap (ty le >1%) trong nghien ciru ndy bao gdm t u o n g tac Idm gidm hap thu cila khdng sinh khi k i t hop vol cdc ion kim logi, tuong tdc Idm tang kali mdu khi phdi hop thudc ire c h l men chuyen/thudc chgn thg t b l ATi vdi mudi kali hoac thudc Igi t i l u t i l t kigm kali (splronolacton), tuong tac Idm tang ddc tinh cua digoxin do thay ddi ndng do Ca**
hogc K* trong mdu. N l u khdng d u g c t u v i n day du ve thdi gian dimg thudc (vdi t u o n g tdc khang sinh-ion kim logi) hoac theo doi djnh ky dien giai dd (vdi tuang tdc lam tang kali mau) hoac t u v i n v l cdc d i u hieu qua lieu hogc ngg ddc digoxin (vdi tuang tdc Idm tang ddc linh cua T4.P CHI niJiJC-HOr—flfi/MlXiS^-43-* MAM 'iJ\
• Nghien ciru - Ky thuat
digoxin) trong d i l u kidn d i l u trj ngogi tru, cdc t u a n g tdc ndy cd t h i Idm tdng nguy co x u i t hidn cdc tdc dgng b i t Igi (gidm hi§u qud d i l u trj hodc tdng ddc tinh ciia thudc) trfin bdnh nhdn.
Vdi cdc t u o n g tdc cd YNLS (mire dd ndng hodc chdng cht djnh) thudng gdp trong m i u nghifin c u u , ngodi cdc tuang tdc Idm tdng n i n g dd kali mdu, t u o n g tdc Idm tdng ddc tinh ciia digoxin cdn x u i t hidn t u o n g tdc d giai dogn c h u y i n hda thdng qua trung gian cdm irng hodc ire c h l CYP450 (nifedipin-phenobarbital, erythromycin- atorvastatin, amiodaron-thudc chgn kfinh caici).
Ddy Id cde t u o n g tdc cd YNLS quan trgng da d u g c md td trong n h i l u nghifin ciru trfin nhdm bgnh nhdn x u i t vign/dilu trj ngogi trii ndi chung ho^c bdnh nhdn tim mgch ndi rifing '^^'.
Giai dogn x u i t vifin d u g c ddnh gid Id giai dogn nhgy cdm khi bfinh nhdn rdi mdi trudng d u g c chdm sdc vd theo ddi ch|it che, cdng thdm sg- thay ddi thudc trong don x u i t vign. Id y i u td nguy c o gia tang cdc b i l n cd b i t lgi lifin quan den thudc xay ra sau khi x u i t vidn, trong dd cd t u o n g tdc thudc ^\ K i t qud cua chung tdi eho thay, mgc dii sd thudc trong don xuat vign t h i p hon rd ret so vol sd luang thudc trong thdi gian d i l u trj ndi tnJ nhung ty Id sd t u o n g tac va sd t u o n g tdc cd YNLS trong don x u i t vifin khdng he giam. Them vao dd, 129 t u o n g tac mdi (lifin quan d i n 50 cgp t u o n g tdc mdi), trong dd cd 39 t u o n g tac cd YNLS da phdt sinh trong dan xuat vifin do thay ddi thudc hogc thfim thudc mdi trong d o n . Vonbach vd cdng s g eung da phdt hien 49% t u o n g tdc d mdc dd trung binh vd nghiem trgng phdt sinh trong don x u i t vign do thay ddi thudc ^^. Con sd ndy Id 53,8% trong nghifin ciru ciia E g g e r v d cdng s\/^. Cdc t u o n g tac phdt sinh trong don x u i t vidn ehii yeu Id cdc t u a n g tdc lam tang dgc tinh cua digoxin hodc tang ndng dg kali mdu lifin quan d i n thudc ire che men c h u y i n . Nhung t u o n g tdc ddi hdi t u v i n vd theo ddi djnh ky bdnh nhan nay cung Id nguyfin nhdn chinh budc bdnh nhdn phai nhdp vifin lgi do tdc dgng khdng mong mudn lifin quan d i n t u o n g tac thudc'®'.
K^t lu^n
Ty lg t u o n g tac thudc trong don x u i t vign vd dieu trj ngoai trii la kha cao, trong dd bao gdm ed t u o n g tdc cd YNLS. Tudi cao, bdnh nhdn tlm mach, s6 thudc trong don n h i l u Id cdc yeu td
nguy c o chinh Idm tdng khd ndng x u i t hidn t u a n g tdc thudc trong d o n . S g thay ddi thudc ho^c thdm thudc mdi trong don x u i t vidn Idm phdt sinh cdc t u o n g tdc thudc mdi trong dd cd edc t u o n g tdc cd YNLS. K i t qud ndy phdn dnh t i m quan trgng ciia s y phdi h g p giua bdc sT va d u g c sT Idm sdng/dugc sT tgi nhd thudc trong phdt hidn, qudn ly t u o n g tdc thudc vd t u v i n eho bdnh nhdn d giai dogn x u i t vidn vd d i l u trj ngogi trii d l gidm t h i l u edc tdc dyng b i t Igi do t u o n g tdc gdy ra.
Summary
Drug interactions in prescfiptions for 1502 outpatients and patients at hospital discharge in a community hospital were assessed by Micromedex Drug Interaction Checking software. The study revealed a relatively high prevalence of prescriptions committing drug interactions and even potential ones (17.8 % and 2.9%, respectively). Erdedy patients, and cardiovascular ones and the higher number of drugs/prescription were the common risk factors for drug interactions. Interactions resulting in kyperkaiemia and digoxin toxicity were the two of most common potential and occurrence.
Changes in medication at discharge resulted in other drug interactions, including potential ones.
Efforts should be needed to minimize harms associated with drug interactions occurring at discharge and in outpatients.
Tai lifu tham khao 1. Becker ML., Kallewaard M.. Gaspers PW. etal.
Hospitalisations and emergency department visits due to drug-drug interactions; A literature review, PharmacoeptdBmiol Drug Saf, {2007),16, p. 641-651.
2. Ellitt GR., Engblom E., Aslanl P. et al: Drag related pnDblems after discharge from an Autraiian teaching hospital, Pharm World ScL. (2010), 32, p.
622-630.
3. Bertoli R., Bissig M., Caronzolo D., Odorico M et al: Assessment of potential dnjg-dmg interactions at hospital discharge. Swiss Med Weekly, (2010), 140, w13043.
4. Aparasu R., Baer R., Aparasu A : Clinical important potential drug-drug interactions in outpatient setting. Res Soc Admin Pharm, (2007), 3.
p. 426-437.
5. Vonbach P , Dubied A . Krahenbijhl S. et al:
Prevalence of drug-dmg interactions at hospital entry and during hospital stay of patients in internal medicine, Eur J Intern Med, (2008), 19, p. 413-420. %
12 T A P C H I DlTOC H O C - 05/2012 (fi^ A%% MAM ?
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