肥胖病人之抗生素使用准则-cgmhorgtw.PDFVIP

肥胖病人之抗生素使用準則肥胖病人之抗生素使用準則 肥胖病人之抗生素使用準則肥胖病人之抗生素使用準則 蜂琪藥師 肥胖定義肥胖定義 肥胖定義肥胖定義 定義定義 世界衛生組織世界衛生組織歐美歐美( )東方人標準東方人標準 健康危險性健康危險性 定義定義 世界衛生組織世界衛生組織歐美歐美 東方人標準東方人標準 健康危險性健康危險性 過輕 小於18.5 小於18.5 正常 18.5-24.9 18.5-23.9 過重 25.0-29.9 24.0-26.9 輕度增加 肥胖第一度( ) 30.0-34.9 27.0-29.9 中度增加 肥胖第二度( ) 35.0-39.9 30.0-34.9 嚴重增加 morbid 肥胖第三度( ) 40.0 以上 35.0以上 極嚴重增加 obesity Super obesity 50.0以上 Formulae of body weight • ABW, actual body weight; TBW, total body weight • Body mass index (BMI) • Lean body weight (LBW) • Ideal body weight (IBW) Males: IBW = 50 + 2.3 (height /2.54-60) Females: IBW = 45.5 + 2.3 (height /2.54-60) • Adjusted body weight (AdjBW) AdjBW =IBW+[(C)X(TBW – IBW)] C=correction factor, for hydrophilic drugs (0.37–0.58), average 0.4 Obesity pharmacokinetics and pharmacodynamics Physiological and pharmacokinetic factors altered in obese patients Absorption Changes in gastric motility can alter oral absorption Changes in body composition • Subcutaneous absorption delayed or incomplete with increased adipose tissue • Intramuscular injections mistakenly given as deep subcutaneous injections Physiological and pharmacokinetic factors altered in obese patients Distribution Little/no change in volume of distribution expected if • Large molecular size • Highly ionized • Highly protein bound • Poorly crosses biological membranes Increase in volume of distribution expected if • Small molecular size • Minimally ionized • Minimally protein bound • Easily crosses biological membranes Physiologi