临床药师基于药物相互作用软件筛选心脏病加护病房药物相互作用的药学服务研究
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摘要
目的药物相互作用可导致药物毒性增加或疗效降低。临床药师借助药物相互软件分析评估药物相互作用,关注药物相互作用,为临床提供药学服务。方法研究共纳入543名患者(403名男性和140名女性),平均年龄为(64±12.4)岁(17～92岁)。临床药师通过Lexi-Interact软件分析评估药物相互作用的发生率及发生类型。结果总计处方药物121种,处方药物较多的是:阿司匹林、氯吡格雷和阿托伐他汀。Lexi-Interact共鉴定了3305个药物相互作用,其中D级药物相互作用511个(15.46%),X级药物相互作用33个(1.00%)。最严重(X级)的相互作用是氯吡格雷+埃索美拉唑、胺碘酮+左氧氟沙星、胺碘酮+莫西沙星以及硝苯地平+卡马西平。结论临床药师以药物相互作用为药学服务切入点,通过软件高效的筛选出潜在的药物相互作用,实行快速、有效的干预,协助临床药物治疗方案,保证药物使用疗效,提高临床用药安全性。
Objective To analyze and evaluate drug-drug interactions(DDI) with mutual drug software,and provide pharmaceutical service in clinical practice. Methods A total of 543 patients(403 men and 140 women) were enrolled in the study, with an average age of(64±12.4) years(17-92). Clinical pharmacists analyzed and evaluated the incidence and types of DDI through Lexi-Interact software. Results There were121 kinds of prescription drugs. Aspirin, clopidogrel and atorvastatin were the most common prescriptions.Lexi-Interact identified 3305 drug interactions, of which 511 were class D drug interactions(15.46%), and 33 were class X(1.00%). The most serious(X) interactions were clopidogrel + esomeprazole, amiodarone +levofloxacin, amiodarone + moxifloxacin, and nifedipine + carbamazepine. Conclusion Clinical pharmacists use drug interactions as the breakthrough point of pharmaceutical care. The drug interaction software is used to effectively screen the potential drug interactions, to implement rapid and effective intervention in the drug treatment scheme, to ensure the safety and efficacy of drug use.
Objective To analyze and evaluate drug-drug interactions(DDI) with mutual drug software,and provide pharmaceutical service in clinical practice. Methods A total of 543 patients(403 men and 140 women) were enrolled in the study, with an average age of(64±12.4) years(17-92). Clinical pharmacists analyzed and evaluated the incidence and types of DDI through Lexi-Interact software. Results There were121 kinds of prescription drugs. Aspirin, clopidogrel and atorvastatin were the most common prescriptions.Lexi-Interact identified 3305 drug interactions, of which 511 were class D drug interactions(15.46%), and 33 were class X(1.00%). The most serious(X) interactions were clopidogrel + esomeprazole, amiodarone +levofloxacin, amiodarone + moxifloxacin, and nifedipine + carbamazepine. Conclusion Clinical pharmacists use drug interactions as the breakthrough point of pharmaceutical care. The drug interaction software is used to effectively screen the potential drug interactions, to implement rapid and effective intervention in the drug treatment scheme, to ensure the safety and efficacy of drug use.
引文
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[11]Ponte MI,Keller GA,Di Girolamo G.Mechanisms of drug induced QT interval prolongation[J].Curr Drug Safety,2010,5(1):44-53.
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[13]Fenster PE,White NW Jr,Hanson CD.Pharmacokinetic evaluation of the digoxin-amiodarone interaction[J].J Am Coil Cardiol,l985,5(1):108-112.
[14]Laer S,Scholz H,Buschmann I,et a1.Digitoxin intoxication during concomitant use of amiodarone[J].Eur J Clin Pharmacol,1998,54(1):95-96.
[15]Barry M.Rosuvastatin-warfarin drug interaction[J].Lancet,2004,363(9405):328.
[2]Abbasi Nazari M,Khanzadeh-Moqhadam N.Evaluation of pharmacokinetic drug interactions in prescriptions of intensive care unit(ICU)in a teaching hospital[J].Iranian JPharm Res,2006,14(5):3215-3218.
[3]Goldberg RM,Mabee J,Chan L,et al.Drug-drug and drug-disease interactions in the ED:analysis of a highrisk population[J].Am J Emerg Med,1996,14(5):447-450.
[4]吴桂月,伏晓,代大顺.华法林引起严重出血的原因分析及药学监护[J].中南药学,2016,14(5):555-557.
[5]Frelinger AL,Lee RD,Mulford DJ,et al.A randomized,2-period,crossover design study to assess the effects of dexlansoprazole,lansoprazole,esomeprazole,and omeprazole on the steady-state pharmacokinetics and pharmacodynamics of clopidogrel in healthy volunteers[J].JAm Coll Cardiol,2012,59(14):1304-1311.
[6]Kreutz RP,Stanek EJ,Aubert R,et al.Impact of proton pump inhibitors on the effectiveness of clopidogrel after coronary stent placement:the clopidogrel medco outcomes study[J].Pharmacotherapy,2010,30(8):787-796.
[7]Evanchan J,Donnally MR,Binkley P,et al.Recurrence of acute myocardial infarction in patients discharged on clopidogrel and a proton pump inhibitor after stent placement for acute myocardial infarction[J].Clin Cardiol,2010,33(3):168-171.
[8]Stockl KM,Le L,Zakharyan A,et al.Risk of rehospitalization for patients using clopidogrel with a proton pump inhibitor[J].Arch Intern Med,2010,170(8):704-710.
[9]Sherwood MW,Melloni C,Jones WS,et al.Individual proton pump inhibitors and outcomes in patients with coronary artery disease on dual antiplatelet therapy:a systematic review[J].J Am Heart Assoc,2015,4(11):225-230.
[10]Frelinger AL,Lee RD,Mulford DJ,et al.A randomized,2-period,crossover design study to assess the effects of dexlansoprazole,lansoprazole,esomeprazole,and omeprazole on the steady-state pharmacokinetics and pharmacodynamics of clopidogrel in healthy volunteers[J].JAm Coll Cardiol,2012,59(14):1304-1311.
[11]Ponte MI,Keller GA,Di Girolamo G.Mechanisms of drug induced QT interval prolongation[J].Curr Drug Safety,2010,5(1):44-53.
[12]Boyd RA,Stern RH,Stewart BH,et al.Atorvastatin coad-ministration may increase digoxin concentrations by inhibition of intestinal P-glyeoprotein-mediated secretion[J].J Clin Pharmacol,2000,40(1):91-98.
[13]Fenster PE,White NW Jr,Hanson CD.Pharmacokinetic evaluation of the digoxin-amiodarone interaction[J].J Am Coil Cardiol,l985,5(1):108-112.
[14]Laer S,Scholz H,Buschmann I,et a1.Digitoxin intoxication during concomitant use of amiodarone[J].Eur J Clin Pharmacol,1998,54(1):95-96.
[15]Barry M.Rosuvastatin-warfarin drug interaction[J].Lancet,2004,363(9405):328.
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