药物相互作用汇总.pptVIP

临床上药物联用情况非常普遍一种症状需多种药物联合治疗（70%高血压联合药物治疗。 　 多种症状涉及多种药物, 230例老年住院患者平均用药14.404 ± 5.982种 5种以内者占8.26% 5-20种者占77.83% 20种以上者占13.91%。 -----《现代护理》2007 ,13 (15) 　 345 例住院死亡患者人均用药品32种 95（28%）例患者用药存在缺陷。 不良用药事件273起。 21(约6%)个不良药物事件源于药物相互作用。 -----《广东医学》2007，28(7） 药物相互作用是临床药物治疗中的重要课题 Induction of Intestinal P-gp by rifampin (Greiner et al., J. Clin. Inv. 104: 147-53, 1999). 外排转运加强 P-gp in Drug Absorption AND PK P-gp Based Drug Interactions Drugs (including herbal medications) capable of modulating P-gp can alter absorption, distribution and excretion of P-gp substrates. Intestinal drug absorprtion and secretion (exsorption) Inhibition: e.g. digoxin-clarithromycin, digoxin-itraconazole, digoxin-atorvastatin Induction: e.g. decrease in absorption of digoxin by rifampin and St. Johns wort extract Decrease in renal and biliary drug clearance Decrease in efflux of drugs from the CNS P-gp抑制剂减少长春新碱外排，提高对脑内肿瘤治疗浓度 对于孕妇尽可能不使用P-gp抑制剂，保护胎盘P-gp对有毒物质的外排作用，从而减少有毒物质对胎儿的损害。 Phases of Drug Metabolism Phase I Oxidation/Reduction/Hydrolysis Phase II Conjugation Can you remember how this happen? Adverse drug reactions Drug fever Drug withdraw syndrome Mental confusion and seizures Anaphylaxis or anaphylactoid reactions Cardiovascular reactions Respiratory reactions Hematologic reactions Dermatologic reactions Gastrointestinal tract reactions Renal reaction Naranjo ADR Probability Scale Naranjo CA. Clin Pharmacol Ther 1981;30:239-45 Do you remember Thank your attention! wang_liansheng@ 骨质疏松症和预防癌症骨转移药氯屈膦酸二钠 ，甲氧氯普胺 螺内酯，固醇类利尿药 合理，不需要的有害反应。 药源性的有害反应进行聚类分析， 杜零丁对人与狗，反应停大白鼠与人，阿司匹林对大白鼠与人 Case presentation Treatment: Discontinue verapamil and erythromycin IV Ca IV Dopamine AVOIDING DRUG INTERACTIONS Periodic evaluation of symptoms, signs, and laboratory measures Scrupulous medication records with frequent review by the health care team to identify known potential drug interactions Individualize drug therapy using the least number and most appropriat