Ngā Tauhohenga Kino ki te Rongoā i roto i te Rongoā Hauora
Pendahuluan
He take nui ngā tauhohenga rongoā kino (ADR) i roto i te rongoā haumanu nā te mea ka pā tika ki te haumaru o te tūroro. Ko te ADR he tauhohenga kāore i te whakaarohia, he urupare kino hoki ki tētahi rongoā e puta ana i ngā horopeta e whakamahia ana mō te ārai, te tātaritanga, te rongoā rānei i te mate, mō te whakarerekētanga rānei i te mahi ā-tinana. I roto i te mahi haumanu, ka taea e ngā ADR te whakaroa i te noho hōhipera, te whakanui ake i ngā utu hauora, te whakaiti i te kounga o te oranga o ngā tūroro, tae atu ki te mate. Nō reira, ko te māramatanga pai ki ngā ADR, ō rātou āhuatanga mōrearea, me ngā rautaki ārai me te whakahaere he pūkenga matua mō ngā kaiwhakaora rongoā haumanu.
Te Ariā me te Whānuitanga o te ROM
He rerekē te ROM i ngā pānga taha noa, e tūmanakohia ana, ā, he iti noa iho. Ko te arotahi nui a te ROM ki ngā pānga kino nui, kāore rānei i te tūmanakohia. He mea nui anō hoki kia wehewehea te ROM mai i ngā hapa rongoā. Ka puta ngā hapa rongoā nā ngā tukanga hē (hei tauira, he rongoā hē, he horopeta hē, he tūroro hē), engari ka puta pea te ROM ahakoa te whakamahinga tika o te rongoā. Heoi, ka taea te hono atu ki tētahi ki tētahi, nā te mea ka taea e ngā hapa rongoā te whakaoho i ngā pānga kino e āhua ana ko te ROM.
I roto i te rongoā haumanu, ehara i te mea ko te tautuhi i te ROM anake te mahi a te kaiwhakaora rongoā engari ko te aromatawai hoki i tōna whanaungatanga ki ngā rongoā, te kaha, me te ārai pea. Ka tutuki tēnei mā te aromatawai haumanu, te arotake i ngā pūkete hauora, te aroturuki taiwhanga, me te whakawhitiwhiti kōrero kaha ki te tīma hauora me te tūroro.
Te Whakarōpūtanga o ngā Tauhohenga Kino o te Rongoā
I te nuinga o te wā, ka whakarōpūtia te ROM mā te momo A me te momo B, ahakoa he whānui ake ngā whakarōpūtanga.
1. Momo A (Whakanuia)
Ko ngā tauhohenga kino o te rongoā Momo A (ROM) e pā ana ki te tikanga rongoā o te rongoā, ka taea te matapae, ā, he maha ngā wā ka whakawhirinaki ki te horopeta. Ko ētahi tauira ko te hypoglycemia i puta mai i te insulin, i te sulfonylurea rānei, te toto i puta mai i te anticoagulant, me te hypotension i puta mai i te antihypertensive. Nā te mea ka taea te matapae, he ngāwari noa te ārai i te momo A ROM mā te whakarerekētanga horopeta, te aroturukitanga rongoā, me te whakaakoranga tūroro.
2. Momo B (Pērā)
Kāore e taea te matapae i te momo ROM B, kāore e whakawhirinaki ki te horopeta, ā, he maha ngā wā e pā ana ki ngā tauhohenga mate pāwera, ngā tauhohenga motuhake rānei. Ko ngā tauira tawhito ko te anaphylaxis ki te penicillin, te mate Stevens-Johnson rānei ki ētahi rongoā pēnei i te lamotrigine, te sulfonamides rānei. He nui ake te morearea o tēnei momo ROM, ā, he uaua ki te ārai nā te mea ka puta pea i ngā horopeta iti, ā, i roto i ngā tūroro kāore anō kia pāngia e ēnei tauhohenga.
Haunga ngā momo A me B, e mōhiotia ana ētahi atu momo e ētahi tuhinga pēnei i:
– Momo C (Mau tonu): ka puta mai i muri i te whakamahinga roa, hei tauira, te pehitanga o te adrenal nā te corticosteroids mau tonu.
– Momo D (Whakaroa): ka puta mai i muri mai, hei tauira, ngā pānga whakamate, ngā pānga mate pukupuku rānei.
– Momo E (Mutu o te whakamahinga): e pā ana ki te whakamutu i te rongoā, hei tauira, ngā tohumate tango benzodiazepine.
– Momo F (Rahunga): te korenga o te rongoā nā ngā taunekeneke rongoā, te ātete rānei, hei tauira, te korenga o te ārai hapūtanga nā te whakaoho whākōkī e te rifampicin.
Mā tēnei whakarōpūtanga ka āwhina i ngā kaiwhakaora rongoā haumanu ki te matapae i ngā tauira o te putanga mai, ki te whakawhanake i ngā rautaki ārai, me te whakatau i ngā wawaotanga e tika ana.
Ngā Take Mōrearea mō te ROM
He maha ngā āhuatanga o te ROM. Ko ētahi o ngā āhuatanga ka whakapiki ake i te mōrearea ko:
1. Ngā āhuatanga o te tūroro
He rerekētanga pharmacokinetic me pharmacodynamic tō ngā kaumātua me ngā tamariki, ā, ka piki ake te ngāwari ki te ROM. Hei tauira, he nui ake te tūponotanga o ngā tūroro kaumātua ki te pāngia e te ngoikore o te mahi a ngā whatukuhu me te ate, ka puhoi ake te whakakorenga o te rongoā, ka nui ake hoki te tūponotanga o te paitini. He pānga anō tō te hītori mate pāwera, te āhua kai, te hāputanga, me ngā āhuatanga ira (pēnei i ngā rerekētanga o ngā whākōkī pākia).
2. Ngā mate pāwera me ngā āhuatanga haumanu
Ka taea e te ngoikore o te whatukuhu, te ngoikore o te ate, te mate ngakau, me ngā raruraru electrolyte te whakanui ake i te mōrearea o te ROM. Hei tauira, ko ngā tūroro he ngoikore te whatukuhu ka ngawari ake ki te kohikohi aminoglycoside, ka arahi pea ki te nephrotoxicity, ki te ototoxicity rānei.
3. Te maha o ngā rongoā me ngā taunekeneke rongoā
Mā te whakamahinga o ngā rongoā maha i te wā kotahi ka nui ake te tūponotanga o ngā taunekeneke i waenga i te rongoā me te rongoā me te mate. Ka taea e ngā taunekeneke te whakanui ake i ngā taumata rongoā (hei tauira, mā te taunekeneke a te warfarin me ētahi paturopi ka nui ake te INR) ka whakaiti rānei i te whai huatanga o te rongoā. Ka nui ake hoki te uaua o te maimoatanga e te polypharmacy, ka iti ake te ngohengohe o te tūroro me te nui ake o te tūponotanga o ngā pānga kino.
4. Te horopeta me te roa o te rongoā
Ka taea e te horopeta nui rawa, te tere rawa o te titration, te whakamahinga roa rānei me te kore aromatawai te whakaoho i te ROM. Me aroturukitia pai ngā rongoā he whāiti te taupū rongoā (hei tauira, digoxin, lithium, phenytoin).
Te Kimi me te Aromatawai i te ROM i roto i te Mahi Hauora
Ko te kimi i te ROM me mātua mataara ki ngā mate pukupuku me te pūnaha pūrongo pakari. Ko ngā tohu o te ROM ka uru atu ki ngā tohu hou, te kino haere o ngā tohu, ngā panonitanga o ngā hua taiwhanga, ngā tauhohenga kiri rānei. He maha ngā wā ka whakamahia e ngā kaiwhakaora rongoā haumanu he huarahi hanganga hei aromatawai i te ROM, pēnei i:
– Aromatawai take: te aromatawai i te tūponotanga ka puta he tauhohenga mai i tētahi rongoā, hei tauira mā te whakamahi i te raupaparorohiko Naranjo.
– Aromatawai i te kaha o te tauhohenga: mēnā he ngawari, he āhua ōrite, he kino, he mōrearea ki te ora, he mate rānei.
– Aromatawai ārai: mēnā ka taea te ārai i te ROM mā te whiriwhiri rongoā haumaru ake, te whakarerekētanga horopeta, te aroturuki tata rānei.
He mea nui te aroturuki i te taiwhanga mō ētahi rongoā, pērā i te mahi a te whatukuhu mō ngā aminoglycosides, ngā electrolytes mō ngā diuretics, ngā whākōkī ate mō ngā rongoā hepatotoxic, te INR rānei mō te rongoā warfarin.
Te Whakahaere i ngā Tauhohenga Kino o te Rongoā
Ko te maimoatanga o te ROM e whakawhirinaki ana ki te momo me te kaha, engari ko ngā mātāpono whānui ko:
1. Te tautuhi me te whakamutu i ngā rongoā whakapae
Mena he kino rawa te ROM, he mōrearea rānei ki te ora, ko te whakamutu i te rongoā te taahiraa tuatahi. Heoi, i ētahi wā, me paunatia e tēnei whakatau ngā painga o te rongoā me te wātea o ngā huarahi kē atu.
2. Te rongoā tautoko me te rongoā tohumate
Hei tauira, ka taea te hoatu i ngā rongoā antihistamine mō ngā mate pāwera ngawari, ngā wai werohanga mō te whakaheke toto, ngā rongoā bronchodilator rānei mō te bronchospasm. I roto i te anaphylaxis, he mea nui te maimoatanga ohorere pēnei i te epinephrine.
3. Te whakamahinga o ngā rongoā ārai mate, o ngā rongoā motuhake rānei
Hei tauira: naloxone mō te nui rawa o te opioid, huaora K mō te toto i puta mai i te warfarin, N-acetylcysteine rānei mō te paitini o te paracetamol.
4. Te aroturuki me te tuhi i ngā mahi whai muri
Me mārama te tuhi i te ROM ki roto i ngā tuhinga hauora hei ārai i te pānga anō. He mea nui anō hoki te whakaako i te tūroro kia mōhio ai ngā tūroro ko ēhea ngā rongoā hei karo.
Te Ārai i te ROM: Te Tūranga Matua o te Rongoā Hauora
Ko te ārai te rautaki pai rawa atu nā te mea he maha ngā pānga kino o te ROM. Ko ngā mahi a ngā kaiwhakaora rongoā haumanu ko:
– Arotake i ngā rongoā me te whakataurite i ngā rongoā hei whakaiti i te tāruarua o te rongoā, te horopeta kāore i te tika, me ngā taunekeneke.
– Ka whakarerekētia te horopeta i runga i te mahi a te whatukuhu/ate me te āhua o te tūroro.
– Te aroturuki i ngā rongoā whakaora (TDM) mō ngā rongoā he whāiti te taupū whakaora.
– Te whakaakoranga ki te tūroro mō te whakamahinga o ngā rongoā, ngā tohu whakatūpato mō te ROM, me te hiranga o te whakarongo ki ngā ture e pā ana ki te whakamahinga o ngā rongoā.
– Te aro turuki i te rongoā mā te tuku pūrongo mō te ROM ki te pūnaha e tika ana i te whare hauora, i te mana whakahaere rānei, kia taea ai te aro turuki tonu i ngā tauira haumaru rongoā.
Me tautoko hoki e te pūnaha hōhipera te ahurea o te haumaru tūroro, tae atu ki ngā aratohu haumanu, te whakamahinga o ngā pūnaha tautoko whakatau haumanu, me te mahi tahi a ngā ngaio.
Whakamutunga
He wero nui ngā tauhohenga rongoā kino (ADD) i roto i te rongoā haumanu, he pānga nui ki te haumaru o te tūroro me ngā putanga rongoā. Ka puta pea ngā tauhohenga rongoā kino (ADD) nā ngā pānga rongoā ka taea te matapae, nā ngā tauhohenga ohorere rānei, me ngā āhuatanga mōrearea tae atu ki te pakeketanga, ngā mate tāpiri, te maha o ngā rongoā, me te ngoikore o ngā okana. He mahi nui tā ngā kaiwhakaora rongoā haumanu ki te kimi, ki te aromatawai, ki te whakahaere, me te aukati i ngā ADD mā te aroturukitanga rongoā, ngā wawaotanga e ahu mai ana i ngā taunakitanga, te mātauranga tūroro, me te pūrongo pharmacovigilance. Mā te huarahi pūnaha me te mahi tahi, ka taea te whakaiti i te maha o ngā ADD, ka hua ake he rongoā haumaru ake, he rongoā whai hua ake.
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Ki te hiahia koe, ka taea e au te whakarerekē i tēnei tuhinga kia nui ake te mātauranga (me ngā tohutoro me te rārangi pukapuka), ka taea rānei te tāpiri i ngā tauira o ngā take ROM e puta pinepine ana i ngā hōhipera me te āhua o te whakahaere i ngā wawaotanga haumanu a te kaiwhakaora rongoā.
