XAY DU^G DANH SACK TU'ONG TAC GIUA MOT SO THUOC DIEU TRI BA BENH THU'OfNG GAP 6 NGUtn CAO TU6l
TAI BENH VIEN DA KHOA TINH TRA VINH
Developing a list of important drug interactions in medication of the three most common chronic diseases in elderly patients at Tra Vinh general hospital
Nguyen Nggc Anh Dao' Tdm Tat
Nghien cicu duge tien hdnh v&i mite tieu x^ dung danh sdch vd de xudt biin phdp xu ly tuang tdc giica cdc thudc dugc diing pho bien di dieu trf ba benh man tinh thudng gap & ngudi cao tudi tgi B^nh viin Da khoa tinh Trd Vinh. Danh sdch ticcmg tdc ndy dugc xdy dung dua tren su ddng thudn ciia bdn ca sa die lieu: (1) Tuang tdc thudc vd cha y khi ehi dinh, (2) British National Formulary, (3) Drug interactions checker (www.
drugs.com), (4) Drug interactions checker (www.
medscape.eom). Nghiin eieu dd xdy dimg dugc danh sdch 20 tuang tdc cdn chit y khi diiu tri ba benh mdn tinh: tdng huyit dp, ddi thdo duang type II, thodi hda cot sdng khdng xdc dinh. Danh sdch ndy cd trien vgng dp dung tgi cde khoa ldm sdng nhdm gidm thieu tuang tdc trong dan thudc.
Tic khda: Tuang tdc thudc, nguai cao tudi, benh mdn tinh, bien ed bdt lai eiia thude.
1. Md dau
Tuang tac thudc (TTT) la mdt trong nhiJng nguyen nhan gay ra cac bien cd bat Igi cua thudc, bao gdm xuat hien dgc tinh hoac phan ung cd hai, didu tri kem hidu qua hoac that bai, keo dai thdi gian dieu trj, tang chi phi didu Uj va tham chi tang nguy ca tu vong cua b?nh nhan. Ddi tugng benh nhan Idn tudi lai cang dugc chii y do chdc nang cac ca quan bj suy giam d^c bidt la gan, thdn. Hg thudng ddng thdi mac nhidu benh ly man tinh ddi hdi phai su dung phoi hgp thudc trong thai gian dai. Mdt sd thuoc cd pham vi didu Uj hep, tiem tang nhidu ddc tinh, c6 nguy ca tuong tac cao khi phdi hgp.
De hd \xa tra cuu TTT, bac sT, dugc sT thudng dimg ddn cac sach chuyen khao, phan mem hoac fra cuu thdng tin true tuydn. Tuy nhidn, thyc tidn con gap nhidu kho khan. Thu nhat, cac ca sd dii
Abstract
The objective of this study is to develop a list of significant drug interactions in medication of the three most common chronic diseases in elderly patients in Tra Vinh General Hospital and provide with guidelines to minimize the interactions. The construction of the list was based on the agreement among four drug interaction compendia: (1) Drug interactions and caution when prescribing, (2) British National Formulary, (3) Drug interactions checker (www.drugs.com), (4) Drug interactions checker (www.medscape.com). The result has listed 20 clinically important drug interactions in medication of hypertension, diabetes Type II, spondylosis. This list is potentially used in clinical practice in order to minimize the risk of drug interactions.
Key words; Drug interactions, elderly patients, chronic diseases, adverse drug events.
lieu (CSDL) fra cuu khdng thdng nhat trong nhan dinh va danh gia muc do nghidm trgng ciia tuong tac'. Thu hai, co nhiing tucmg tac xay ra in viUo, in vivo nhung lai khong xay ra Udn lam sang. Ti Id canh bao gia Uen he thdng phat hien TTT c6 thd tir 17 - 40%^, ^ Vide CO qua nhidu canh bao, dac bidt la nhirng canh bao gia, dan den vide cac bac sT, dugc si bd qua mgt s6 tuong tac trong dieu tri *. Dieu nay
1 Giang vifin, BO n hgc Tri Vinh
n Dir<?c, Khoa Y - Dugc, Tni6ng Dai
1 Abarca, Jacob. 2004. Concordance of Severity Ratings Provided in Four Drug Interaction Compendia.
Joumal of the American Pharmacists Association. 44.
pp. 136-141.
2 Yang, Hsuan-Chia. 2010. Proactive Identification of False Alert for Drug-Drug Interaction. World Academy of Science Engineering and Technology. 44. pp. 1417-1420.
3 Mille, Frederic. 2t)Gi. Analysis of overridden alerts in a drug-drug interaction detection system. Intemational Joumal for Quality in Health Care. 20 (6), pp. 400-405.
4 Weingart, Saul N. 2003. Physicians' Decisions to Override Computerized Drug Alerts in Primary Care American Medical Association. 163. pp. 2625-2631.
So 16, thdng 12/2014 B i i
ma
anh hudng xiu tdi bdnh nhan khi hg bd qua nhung canh bao vd cac tuong tac nghiem frgng.
Tai Viet Nam, ung dung cdng nghe thong tin phyc vu cho bdnh vidn chi mdi dimg lai d cdng tac quan ly hanh chinh. Chi tai cac benh vidn tuydn trung uong, phin mdm chuydn nganh y dugc va phin mdm quan 1^ thudc mdi dugc sd dung. Tuy nhien, cac phin mem nay vdn chua tich hgp chuc nang quan ly tuong tac trong dcm thudc ciia bdnh nhan. Thay vao d6, cac phan mdm duyet TTT mdi chi dugc su dung nhu mdt cdng cy tham khao khong chinh thiic *. Ngoai ra, ngudi daii ty y mua v^ su dung thudc van con diln ra rat pho bidn. Tai cac nha thudc tu nhan hidn nay, bien phap quan ly TTT van cdn rat Idng leo.
Xuit phat thyc td neu Udn, viec xay dyng mdt danh sach ngin ggn, bao gdm cdc tuang tac nghidm trgng, can chii y nhat giira cac thudc didu tri ba bdnh thudng gap d ngudi cao tudi tai Benh vien da khoa tinh Tra Vinh la mgt van dd cin thiet.
2. Noi dung
2.1. Phirung phap nghien cuu 2.1.1. Xdc dfnh ba b?nh ly mdn tinh cd tl le mdc cao nhdt & nguai cao tudi din khdm vd dieu tri tgi Benh viin Da khoa tinh Trd Vinh ndm 2012 Bai viet thu thap thdng tin tu tit ca don thudc ngoai tni va benh an ndi Uii ciia bdnh nhan tit 60 - 69 tudi den kham va didu tri tai Benh vidn Da khoa tinh Tra Vinh trong thdi gian 01/01/2012 - 31/12/2012 luu tru Uong phan mdm quan ly cua benh vien. Thdng ke sd iugng benh nhan Uong mdi nhom b?nh da dugc chan doan va phan loai theo He thdng phan loai benh tat quoc td (ICD 10). Tinh ti Id phan tram mdi nhom bdnh fren tdng sd. Xac dinh ba nhom bdnh ly chidm ti le cao nhat. Ung vdi mdi nhdm, xac djnh bdnh man tinh dugc chan doan vdi ti le cao nhit 6e tidp tuc khao sat.
2.1.2. Xdc dinh cdc thudc sic dungpho bien a Benh viin Da khoa linh Trd Vinh di dieu tri ba benh ly dugc lua chgn
Tu nhiing thudc dugc sd dyng trong don thudc ngoai tni va bdnh an ndi Uii didu tri ba benh chiem tl Id cao lya chgn cac boat chat dira vao nghidn ciru thoa man cac tidu chuin sau:
Tieu chudn lua chon:
' Thudc cd tac dung toan than.
• Thudc sir dyng phd bidn dya tren tong lidu sir dyng trung binh hang ngay (DDD)/100 benh 5 Hoang, Thi Kim HuySn. 2011. KiSm scat tuang tac thudc Uong diau tri. Bg Y te, Chdm sdc duac. Nh^ xuit ban Y hgc. Ha Noi.
nhan cao nhit va bao phu cac hg dugc ly ca bin Uong didu tri ba bdnh ly dugc lya chgn.
Tieu chudn logi trie:
• Thudc sd dung tai chd, djch truyen, thuoc pha che.
• Thudc thanh phim cd nguon goc tu dui?c lidu, cac vj thudc y hgc cd truyen.
Tdng lidu DDD/100 bdnh nhan cua cac thudc dugc tinh theo cdng thuc:
2.1.3. Xdy dung danh muc tuang tdc cdn chuy
Thdng tin tuong tac dugc tra cuu Uong bon CSDL uy tin, sit dung rgng rai, phd bien va dd tiep can tai Vidt Nam:
" Tuong tac thudc va chii y khi chi dinh - BQ Ytd^
- Phu lye 1 - Dugc thu Anh 61 (British National Formulary 6 1 ) '
• Drug Interactions Checker (vi'ww.drugs.
com)'
Drug Interactions Checker (www.
medscape.eom)'
Danh sach cudi cung cac TTT can chii y dugc dua ra dya fren sy ddng thuan cua cac CSDL theo hai muc dd:
Tuang tac chdng chi dinh:
Tuong tac dugc it nhat 3/4 CSDL ghi nh(in d mirc do 1. Trudng hgp mgt Uong hai thudc chi xuit hidn trong ba hay hai CSDL thi cap tuang tic do phai dugc ghi nhan frong it nhat 2/3 hoac 2/2 CSDL d mdc do 1.
Tuang tac can theo doi:
Tuang tac khdng dat d muc do 1 nhung dugc It nhat 3/4 CSDL ghi nhan d miic do 1 hoac m6c do 2, trong do it nhit phai c6 mgt CSDL ghi nh$n d mdc do 1. Trudng hgrp mdt frong hai thudc chi xuat hien trong ba hoac hai CSDL thi cap tucmg tac do phai dugc it nhit 2/3 hoac 2/2 CSDL ghi nhan d mdc do 1 hoac muc do 2, frong do it nhat phai co mdt CSDL ghi nhan d muc do 1 '".
6 B6 Y te. 2006. Tucmg tdc thudc vd chuy khi chi dinh.
Nhd Xuit ban Y hoc. Ha Noi.
7 Joint Formulary Committee. 2011. British National Formulary 61. British Medical Association and Royal Pharmaceutical Society of Great Britain, London.
8 Drug interactions checker. 2014. Xem 15/02/2014
<htTp://www.drugs-com/drug interaction s.hrml>
9 Drug interactions checiier. 2014. Xem 15/02/2014 <http://reference.medscape.com/drug- interactionchecker>
10 Nguyin, Dire Phuang. 2012. NghiSn ciiu xSy dimg danh myc tirong tAc thu6c cln chil y trong thirc h^nh t^i khoa cO - xuong - khdp b?nh vi?n Bach Mai. Khoa luSn l6t nghift) Dir<?c sT dai hgc, Trudng D^i hgc Dirpc HaN§i. HEI Npi.
So 16, thdng 12/2014 WA
KEl 2.1.4. Xdy dung hic&ng ddn xic tri cho cde
TTT cdn chuy
Tac gia tap hgp hudng dan xu tri cho cac TTT frong danh sach tu cac CSDL nghien ciiu, tii do so sanh, chgn ra nhung y kidn ve kidm soat tuang tdc dugc ghi nhan d nhidu CSDL nhit va xay dyng phan kiem soat tuong tac chi tiet, cu thd, CO kha nang ap dyng vao thuc td.
2.2. Ket qua va ban ludn
2.2.1. Ba benh cd ti le mdc cao nhdt cua ngudi cao tudi tgi benh vien Trd Vinh
Nam 2012 c6 tdng sd 28.294 benh nhan tu 60 ~ 69 tudi ddn kham va didu Ui tai Bdnh vien Da khoa tinh Tra Vinh. Bdnh nhan ndi tni chidm 14,43%, bdnh nhan ngoai tru chiem 85,57%. Ti Id nam gidi la 55,7%, nir gidi la 44,3%. Tudi trung binh cua cac bdnh nhan la 63,50 ± 2,76 tudi.
Thdng ke ti le cac nhdm benh frong don thuoc va benh dn. Kdt qua trinh bay d Hinh 1.
H hfioi
/ j J #
^ / .
i ? •
Hinh 1. Tile cdc nhdm benh duac chdn dodn vd xae dinh theo ICD 10 Nhu vay, frong nam 2012, ba nhdm benh cd ti le cao nhat d cac bdnh nhan tu 60 - 69 tudi den kham va dieu trj tai Bdnh vidn Da khoa tinh Tra Vinh theo thu ty: Benh he tuan hoan (25,77%), benh ngi tidt dinh duang va chuydn hoa (14,3 6%), benh he ca xuang khdp va md lien kdt (12,19%).
LTng vdi moi nhom benh, xac dinh benh dugc chan doan vdi ti le cao nhit dd khao sat.
Bdng I. Benh chiem ti le cao nhat trong mdi nhdm benh TT
I 2 3
NHOM BENH Benh he tuan hoan Benh^ npi tiet, dinh dutmg va chuyen hoa
Benh he co xuong kh6p va mo lien ket
BENH CHIEM Ti L | CAO NHAT Tang huyet ap vo can (nguyen phat) Benh dai thao duong khong phu thuoc insuhn
Thoai hoa cot song khong xac dinh ICD
110 Ell M47.9
TILE
( % ) •
63.74 80.14 20.38 2.2.2. Nhung thudc su dung pho biin tgi Benh vien Da khoa tinh Trd Vinh de dieu tri ba binh chiem ti li cao nhdt
Ngoai chan doan benh chinh, ngudi cao tuoi thudng mac kem mgt sd benh. Tren ddi tugng benh nhan ngi Uii, trung binh mgt bdnh nhan mac 1,69 ± 0,55 bdnh. Nhu vay, cd the thay rang da sd ngudi cao tudi didu tri ngi trii tai Bdnh vidn Da khoa Tra Vinh CO tir mgt benh mac kem trd len. Day la mgt trong nhung nguydn nhan dua ddn kha nang xay ra TTT do hg phai su dung phdi hgp nhieu thudc dd chOa tri nhiing bdnh mac cimg liic.
Bdng 2. Cde thuoc thudng dung trong dieu tri ba benh khao sdt tgi Binh vien Da khoa tinh Trd Vinh phdn logi theo cdc hg duac ly
Cac thudc cd tan suat su dung cao nhat (lieu DDD/100 benh nhan cao nhat) ddng thdi bao phii cac hg dugc ly ca ban trong didu Uj ba benh ly khao sat dugc frinh bay d Bang 2.
NHOM THUOC
NGOAI TRU
HOATCHAT DDD/
lOOBN
NOI TRU
HOAT CHAT DDD/
100 BN
• ' THUOC DIEU TRI TANG HUYET AP Uc che than kinh giao cam
Gian mach true tiep Khang angiotensin receptor II
trimetazidin nitroglycerin valsartan
1226 410 313
trimetazidin nitroglycerin irbesartan
505 456 31 So 16, thdng 12/2014 B 3
Uc che men chuyen Chen receptor beta - adrenergic Chen kenh calci
Lai tieu
perindopril bisoprolol nifedipin hypothiazid
261 161 129 13
perindopril atenolol nifedipin furosemid THUOC DIEU TRJ DAI THAO DUdNG Dan chit biguanid metformin 3896 metformin Sulfamid ha dudng huyet
Hormon tuydn tuy chinh U'c che alpha glucosidase
gliclazide insulin acarbose
821 215 59
gliclazide Insulin
-
THUOC DIEU TRI THOAI HOA CQT SONG Gian ca
NSAID uc chd chgn lgc COX - 2 NSAID
Khoang chat Corticoid
Phdng va tri benh khdp U'c che bom proton (Thudc hd trg) Opiate
Chdng tram cam ba vdng
mephenesin celecoxib meloxicam calcium betamethason glucosamin omeprazol codein amifriptylin
573 132 109 98 96 96 94 46 6
eperison celecoxib diclofenac
-
methyl prednisolon
-
esomeprazol codein-
1157 24 17 25 212 418 358
i
667 1000 375
-
533 1333
-
2300
-
Sd lugng thudc su dung trung binh ciia benh nhan ndi trii la 5,62 ± 2,10 thuoc, trong khi so lugng thudc su dung trung binh cua bdnh nhan ngoai trii la 4,09 ± 1,46 thuoc. Nhidu benh mac kem, nhieu thudc su dung ddng thai, ghi nhan trong mgt frudng hgp dien hinh benh nhan ngi tni dugc cho su dung 13 thudc cimg luc, la nhiing ydu to nguy ca dan tdi TTT.
2.2.3. Di xudt danh sdch cdc tucmg tdc nghiem trgng
Tidn hanh tra cdu trdn cac CSDL va lya chgn TTT dugc ddng thuSn trong cac CSDL, ket qua CO 21 TTT thoa man didu kien. Tuong tac giira furosemid va hypothiazid dugc loai ra vi it cd kha nang gap tren Iam sang tinh hudng hai thudc Igi tieu dugc phdi hgp vai nhau. Ket qua co 20 tucmg tac can luu y trong do khdng c6 tuong tac d mirc do 1 (chdng chi dinh), 20 cap tucmg tac ddu d mirc do 2.
Bdng 3. Danh sdch tuang tdc thuoc duac ghi nhdn tit ea sd dir lieu A Tutfng tac chong chi djnh
Chua ghi nhan tuong tac chdng chi djnh theo cac tidu chi da dd ra.
B STT
1
2
3 4
Tutnig tac can theo doi chat che Cap tuong tac
atenolol - furosemid
atenolol - nifedipin
betamethason - insulin betamethason - metformin
Hau qua tuong tac
Mac du thudng dugc kdt hgp frong thyc hanh lam sang, thudc loi tidu va thudc chen beta cd thd iam tang glucose huydt, tang nguy ca tut huydt ap, loan nhip that do tinh trang giam K gay ra bcfi thuoc lai tidu.
Mac dii phoi hgp giira beta blocker va thudc chen kenh calci thuang cd hidu qua. Tuy nhien, sii dung beta blocker va nifedipin dugc \>ko cao cd kha nang gav ha huydt ap nghidm trgng, suy tim.
Corticoid lam giam tac dung cua thudc fri dai thao duang vi chiing cd thd gay tang duon^ huydt.
Giam tac dung ciia metformin
So 16, thdng 12/2014 B £ l
. l a
5 6 7 8 9 10 11 12 13
14
15 16
17
18 19 20
bisoprolol - furosemid bisoprolol - hypothiazid bisoprolol - nifedipin celecoxib — furosemid celecoxib - hypothiazid celecoxib - diclofenac celecoxib - meloxicam diclofenac - furosemid diclofenac - hypothiazid furosemid - irbesartan
furosemid - valsartan furosemid - meloxicam furosemid - perindopril
hypothiazid - perindopril perindopril - irbesartan perindopril - valsartan
Tang nguy ca tyt huyet ap va lam cham nhip tim Tang nguy ca tut huydt ap va cham nhip tim.
C6 thd gay ha huydt ap nghiem frgng, suy tim.
Lam giam tac dyng Igi tidu va tac dyng ha huydt ap, tang nguy ca suy than, suy tim xung huydt.
Lam giam tac dung ciia thudc igi tidu, tang nguy ca suy than, suy tim xung huydt.
Gia tang ddc tinh ciia NSAIDs, tang nguy ca xuat huyet tidu hoa, suy than.
Gia tang ddc tinh ciia NSAIDs, tang nguy ca xuit huydt tieu hda, suy than.
Lam giam tac dung ciia thudc Igi tidu, tang nguy ca suy than, suy tim xung huyet.
Lam giam tac dung ciia thudc Igi tidu, tang nguy ca suy than, suy tim xung huydt.
Phoi hgp nay thudng co hieu qua. Tuy nhien van co nguy ca gay tut huydt ap dac bidt la sau lieu phoi hgp dau tien.
Thudc lie che angiotensin 11 receptor giir kali trong khi furosemid thai kali nen nong do kali huyet co the tang, giam hoac khdng ddi.
Phdi hgp nay thuong co hieu qua. Tuy nhidn van cd nguy ca gay tut huydt ap dac bidt la sau lieu phoi hgp dau tien.
Nong do kali huyet thay ddi kho du doan.
Lam giam tac dung ciia thudc Igi tidu, tang nguy ca suy than, suy tim xung huydt.
Sy kdt hgp cua thudc lie che men chuyen vai thudc Igi tieu thudng an toan va hieu qua, nhung cac dau hieu ha huyet ap (chdng mat, choang, ngit xiu) c6 thd xay ra a lidu phdi hgp diu tidn, dac bidt neu lidu thudc Igi tieu cao.
Tang kali huyet, suy than va tham chi suy than cSp.
Cac dau hieu ha huyet ap (chong mat, choang, ngat xiu) c6 the xay ra a lieu phdi hgp dau tien, dac bidt neu lieu thudc Igi tieu cao.
Tang kali huyet, suy than va tham chi suy than cap.
Gia tang nguy ca ha huydt ap, suy than, tang kali huydt dac biet trdn bdnh nhan suy tim
Gia tang nguy ca ha huydt ap, suy than, tang kali huydt dac bidt tren bdnh nhan suy tim.
Nhu vay, cac tuong tac lien quan tdi thudc trj tang huydt ap chiem ti le cao nhat trong danh sach gdm 12 tuong tac ciia nhdm Igi tieu, nam tuang tac cua nhom chen beta, bdn tuong tac cua nhom lie chd men chuyen, bon tuang tac ciia nhom lie chd angiotensin II receptor, hai tuang tac ciia nhdm lic chd kenh Ca. Cac tuong tac lidn quan tai thudc didu tri thoai hda cdt song gdm bay tuang tac ciia nhom NSAIDs, hai tuong tac ciia nhom corticoid. Cac tuong tac lidn quan tai thuoc tri dai thao duang type 2 chidm ti Id thip nhit gdm mgt tuang tac ciia insulm va mdt tuang tac cua nhdm biguanid.
Danh sach cac TTT can lim y dugc dd xuat tai Bdnh vidn Da khoa tinh Tra Vinh hidn chua ghi nhan tuong tac thudc a mirc do chdng chi djnh theo cac tieu chi da dd ra. Dieu nay chiing to vide phdi hgp thudc trong didu Uj la hgp ly, tinh nii ro khdng cao.
2.2.4. Di xudt bien phdp xic tri Huang xii tri cho cac TTT cin chu y dugc frinh bay trong Bang 4.
Bdng 4. Hu&ng xir tri cho cdc tuang tae thudc
Sd 16, thdng 12/2014 E 3
^ _
STT 1
2
3
4
5
6
7
Cap tuffng tac atenolol - furosemid bisoprolol - fiirosemid
atenolol - nifedipin bisoprolol - nifedipin
bisoprolol - hypothiazid
betamethason - insulin betamethason - metformin
celecoxib - furosemid celecoxib - hypothiazid diclofenac - furosemid diclofenac - hypothiazid furosemid - meloxicam
celecoxib - diclofenac celecoxib- meloxicam
furosemid - perindopril hypothiazid - perindopril
Hircmg xu tri
-Theo doi chat che cac chi sd huyet ap, dudng huydt, ndng do kali huyet cua bdnh nhan.
-Khuydn cao benh nhan thdng bao ngay cho bac sT ndu xuat hidn cac Uieu chiing chdng mat, suy nhuge, ngat, tim dap nhanh hoac khdng ddu, hay mit kidm soat dudng huydt vai benh rihan dai thao dudng.
-Can nhic sic dung cac thuoc chen kenh calci khac ciing loai nhung it gay tuang tac nhu felodipin, isradipin, lacidipin, nicardipin, nimodipin.
-Can nhic giam lieu ciia mgt hoac ca hai thudc.
-Theo ddi chiic nang tim mach cua bdnh nhan.
-Chii y theo doi ca benh nhan diing beta blocker dang nho mat do vin c6 kha nang cho tac dyng toan than.
-Khuydn cao bdnh nhan thdng bao ngay cho bac sTndu xuat hidn cac Uieu chiing chong mat, suy nhuge, ngat, tim dap nhanh hoac khdng ddu, hay mit kiem soat ducmg huyet vdi benh nhan dai thao dudng.
-Can nhac hieu chinh lidu.
-Theo doi huyet ap thuong xuydn.
-Theo doi chat che dudng huydt ciia benh nhan trong qua frinh didu tri ciing nhu khi rut corticoid khoi phac do dieu frj.
-Can nhic didu chinh lieu lugng cita thudc Uj dai thao dudng khi can thidt.
-Chii^ theo ddi ca corticoid diing ngoai da hoac dang phun xit vi cd the gay ra tac dung toan than.
-Can nhac sit dung nhom thudc giam dau khac ndu co the.
-Trong trudng hgp bat buoc phdi hgp thuang phai tang lidu thudc Igi tidu tiiy vao dap ling ISm sang.
-Theo doi chat che chiic nang than, ndng do cac chat didn giai, franh franh mit nude cho benh nhSn.
-Ndu phat hien bat thudng d chiic nang than hoac tang kali mau, ca hai loai thuoc nen ngung cho ddn khi tinh frang dugc cai thidn.
-Cac NSAID khdng ndn dugc diing ddng thd'i do gia tang dgc tinh nhung khdng gia tang dang ke tac dung frj lidu.
- Giam bat mgt NSAID hoac thay the bang paracetarnol, ndu tinh Uang dau khdng cai thidn can nhac sir dung cac thuoc giam dau gay nghidn.
-Ndu benh nhan diin^ furosemid lidu cao ban 80 mg/ngay xem xet tarn thdi ngirng thudc Igi tidu hoac giam lidu lugng mgt vai ngay fruac khi diing chit lic chd men chuydn.
-Ndu vide giam liduthudc lai tidu khdng thich hgp trdn lam sang, lieu dau tien cua chat lic chd men_ chuyen nen dugc giam sat chat che, bat dau tu lieu thap va nen udng tnrdc khi di ngii.
-Tu van cho bdnh nhan cac van dd co the gap phai, khi thay cac dau hidu ha huydt ap (chdng mat, choang...) ndn cho bdnh nhan nam xuong.
-Ndu tinh trang ha huyet ap van tidp dien ndn tam thdfi giam lieu thudc Igi tidu.
^Cac san pham kdt hgp san giiia chat lic chd men chuydn vdi thudc Igi tieu chi ndn dimg of nhiing bdnh nhan co tinh frang bdnh dn djnh.
-Theo doi kali huyet, chiic nang than. Khi tinh trang tang ure va creatinin huydt xay ra, giam lieu hoac ngimg diudc Igi tidu hoac lic chd men chuydn hoac ca hai, dieu trj phyc hoi thd tich djch va didn giai.
So 16, thdng 12/2014 E 3
_ia
8
9
furosemid ~ valsartan furosemid - irbesartan
perindopril - valsartan perindopril - irbesartan
-Giam lidu thudc Igi tidu va / hoac sir dung mgt lidu khai dau thap hem chat uc chd angiotensin II receptor.
-Theo doi kali huydt thucmg xuyen df benh nhan suy tim, suy than, cao tudi.
-Theo ddi chirc nang than va kali huydt chat che.
3. Kdt luan
Nhom nghien curu da xay dyng danh sach 20 tuang tac can chii y Uong thyc hanh lam sang tai Bdnh vidn Da khoa tinh Tra Vinh dya trdn ca sa su dung cac CSDL co uy tin va bing chiing ghi nhan trong y van ddng thd'i dua ra dd xuit huang xic tri khi bit buOc phai sii dung cac cap phdi hgp nay.
Bang canh bao vd cac TTT can luu y co the dugc thiet kd dd dan tai cac khoa Iam sang, hoac tich hgp vao phan mdm kd don tai benh vidn giiip bac sT tham khao. Nhiing nghien ciiu tidp theo de nghj mdf rgng fra ciiu tucmg tac thuoc trdn cac ddi tugng khac, ddng thdi phdi hgp ddi chidu thyc te lam sang va y kien chuyen mdn ciia cac bac sT tham gia dieu tri.
Tai lieu tham khao
Abarca, Jacob. 2004. "Concordance of Severity Ratings Provided in Four Drug Interaction Compendia". Joumal of the American Pharmacists Association. 44. pp. 136-141.
Bg Y td. 2006. Tuang tdc thuoc vd chuy khi chi dinh. Nha xuit ban Y hgc. Ha Ndi.
Drug interactions checker. 2014. Xem 15/02/2014, <http://reference.medscape.com/drug- interactionchecker>
Drug interactions checker. 2014. Xem 15/02/2014, <http://wvra'.drugs.com/drug_interactions.
html>
Hoang, Thi Kim Huyen. 2011. Kiim sodt tuang tdc thudc trong dieu tri: Chdm sdc dugc. Nha xuit ban Y hgc. Ha Ngi.
Joint Formulary Committee. 2011. British National Formulary 61. British Medical Association and Royal Pharmaceutical Society of Great Britain, London.
Mille, Frederic. 2008. "Analysis of overridden alerts in a drug-drug interaction detection system".
Intemational Journal for Quality in Health Care. 20 (6), pp. 400-405.
Nguydn, Dire Phuang. 2012. "Nghien ciiu xay dyng danh myc tuang tac thudc cin chii y trong thuc hanh tai khoa ca - xuong - khap b^nh vidn Bach Mai". Khoa luan tdt nghiep Dugc sT dai hgc, Truong Dai hgc Dugc Ha Ngi. Ha Ndi.
Weingart, Saul N. 2003. Physicians 'Decisions to Override Computerized Drug Alerts in Primary Care. American Medical Association. 163. pp. 2625-2631.
Yang, Hsuan-Chia. 2010. Proactive Identification of False Alert for Drug-Drug Interaction.
World Academy of Science Engineering and Technology. 44. pp. 1417-1420.
Sdl6. thdng 12/2014 J C T
