Kukanganisa Kwakashata Kwemishonga Mukiriniki yeMishonga
Pendauluan
Kusawirirana nemishonga (ADRs) inyaya yakakosha mukiriniki yemishonga nekuti inokanganisa zvakananga kuchengetedzeka kwemurwere. ADR inotsanangurwa semhinduro isingatarisirwi uye inokuvadza kumushonga unowanikwa pamishonga inowanzo shandiswa kudzivirira, kuongorora, kana kurapa chirwere, kana kugadzirisa mashandiro emuviri. Mukurapa, ADRs dzinogona kuwedzera nguva yekugara muchipatara, kuwedzera mari yehutano, kuderedza hupenyu hwevarwere, uye kutokonzera rufu. Nokudaro, kunzwisisa kwakanaka kweADRs, njodzi dzadzo, uye nzira dzekudzivirira nekutarisira inyanzvi huru yevanorapa mishonga.
Pfungwa uye Kukura kweROM
ROM yakasiyana nemigumisiro inowanzoonekwa, iyo inotarisirwa uye iri nyore. ROM inonyanya kutarisisa migumisiro yakaipa yakakura kana isingatarisirwi. Zvakakoshawo kusiyanisa ROM kubva kuzvikanganiso zvemishonga. Kukanganisa kwemishonga kunoitika nekuda kwekusashanda zvakanaka (semuenzaniso, mushonga usiri iwo, uwandu husina kunaka, murwere usiri iwo), nepo ROM inogona kuitika kunyangwe mushonga ukashandiswa nemazvo. Zvisinei, zviviri izvi zvinogona kunge zvakabatana, sezvo zvikanganiso zvemishonga zvinogona kukonzera zviitiko zvakaipa zvinoita seROM.
Mu pharmacy yekiriniki, basa remufarisi harisi rekuona ROM chete asiwo kuongorora hukama hwayo nemishonga, kuoma kwayo, uye dziviriro inogona kuitika. Izvi zvinoitwa kuburikidza nekuongorora kliniki, kuongorora zvinyorwa zvekurapa, kutarisa murabhoritari, uye kutaurirana nechikwata chekurapa nemurwere.
Kurongwa kweMaitiro Emishonga Asina Kunaka
Kazhinji, ROM inowanzoiswa muzvikamu uchishandisa nzira yerudzi rweA nerudzi rweB, kunyangwe paine kupatsanura kwakakura.
1. Rudzi A (Yakawedzerwa)
Rudzi rweA additional drug reactions (ROM) rune chekuita nemaitiro emishonga emushonga, runogona kufanotaurwa, uye runowanzoenderana nedosi. Mienzaniso inosanganisira insulin- kana sulfonylurea-induced hypoglycemia, anticoagulant-induced bleeding, uye antihypertension-induced BP. Nekuti zvinogoneka kufanotaurwa, rudzi rweA ROM ruri nyore kudzivirira kuburikidza nekugadzirisa dosi, kutarisa kurapwa, uye kudzidzisa varwere.
2. Rudzi B (Runoshamisa)
Rudzi rweB ROM haruna kutarisirwa, harutsamiri pahuwandu hwemushonga, uye runowanzobatanidzwa neallergy kana idiosyncratic reactions. Mienzaniso yekare inosanganisira anaphylaxis kune penicillin kana Stevens-Johnson syndrome kune mimwe mishonga yakaita selamotrigine kana sulfonamides. Rudzi urwu rweROM runowanzova nengozi uye rwakaoma kudzivirira nekuti runogona kuitika pamishonga yakaderera uye kune varwere vasina nhoroondo yeallergy yakadaro.
Kunze kwemarudzi A neB, mamwe mabhuku anoona mamwe marudzi akadai se:
– Rudzi C (Rusingaperi): runoonekwa mushure mekushandiswa kwenguva refu, semuenzaniso kudzvinyirirwa kweadrenal nekuda kwemishonga inogara kwenguva refu yecorticosteroids.
– Rudzi D (Ranonoka): rinoonekwa kunonoka, semuenzaniso migumisiro yeteratogenic kana carcinogenic.
– Rudzi E (Kuguma kwekushandisa): zvine chekuita nekurega kushandisa mushonga, semuenzaniso zviratidzo zvekurega kushandisa benzodiazepine.
– Rudzi F (Kukundikana): kutadza kurapwa nekuda kwekusawirirana kwemishonga kana kusakwanisa kuitora, semuenzaniso kutadza kubata pamuviri nekuda kwekushandiswa kwema enzyme ne rifampicin.
Kurongwa uku kunobatsira varapi vemishonga kufanotaura maitiro ezviitiko, kugadzira nzira dzekudzivirira, uye kusarudza nzira dzakakodzera dzekurapa.
Zvinhu Zvinokonzera Njodzi dzeROM
ROM inokonzerwa nezvinhu zvakawanda. Zvimwe zvinhu zvinowedzera njodzi zvinosanganisira:
1. Zvinhu Zvinokonzera Varwere
Vakwegura nevana vane mutsauko wemishonga uye wemishonga unogona kuwedzera mukana wekuva neROM. Semuenzaniso, varwere vakwegura vane mukana wekudzikira kwekushanda kweitsvo nechiropa, zvichikonzera kunonoka kubviswa kwemishonga uye kuwedzera njodzi yekukuvadzwa. Nhoroondo yeallergy, mamiriro ekudya, pamuviri, uye majini (akadai sekusiyana kwema enzymes e metabolic) zvinewo basa.
2. Kurwara nezvirwere zvepfungwa uye mamiriro ekurapa
Kukundikana kweitsvo, kutadza kwechiropa, chirwere chemwoyo, uye kusagadzikana kwema electrolyte zvinogona kuwedzera njodzi yeROM. Semuenzaniso, varwere vane dambudziko reitsvo vanonyanya kuunganidzwa kweaminoglycoside, izvo zvinogona kukonzera nephrotoxicity kana ototoxicity.
3. Kudyidzana kwemishonga yakawanda nemishonga
Kushandisa mishonga yakawanda panguva imwe chete kunowedzera njodzi yekudyidzana kwemishonga nemishonga uye zvirwere. Kudyidzana kunogona kuwedzera huwandu hwemishonga (semuenzaniso, warfarin ichishanda nemamwe maantibiotics inowedzera INR) kana kuderedza kushanda kwekurapa. Polypharmacy inowedzerawo kuoma kwemishonga, zvichikonzera kudzikira kwekutevedzera mitemo yemurwere uye kuwedzera njodzi yezviitiko zvakaipa.
4. Chipimo uye nguva yekurapwa
Kunwa mushonga wakawandisa, kukurumidza kutorwa kwemushonga, kana kushandiswa kwenguva refu pasina kuongororwa kunogona kukonzera ROM. Mishonga ine hunyanzvi hwakati wandei (semuenzaniso, digoxin, lithium, phenytoin) inoda kutariswa zvakanyanya.
Kuonekwa uye Kuongororwa kweROM muKudzidzira Kwekiriniki
Kuona ROM kunoda kungwarira kwekiriniki uye hurongwa hwakasimba hwekuzivisa. Zviratidzo zveROM zvinogona kusanganisira zviratidzo zvitsva, zviratidzo zvinowedzera kuipa, shanduko mumhedzisiro yerabhoritari, kana maitiro eganda. Varapi vemishonga vanowanzo shandisa nzira yakarongeka yekuongorora ROM, yakaita se:
- Kuongororwa kwezvikonzero: kuongorora kuti mushonga ungangokonzera sei chiitiko, semuenzaniso uchishandisa Naranjo algorithm.
– Kuongororwa kwehukosha: kana mhinduro yacho iri diki, iri pakati nepakati, yakanyanya, inotyisidzira hupenyu, kana kuti inouraya.
– Kuongorora kudzivirira: kana ROM inogona kudzivirirwa kuburikidza nekusarudza mishonga yakachengeteka, kugadzirisa dose, kana kunyatsotarisa.
Kuongororwa kwemishonga murabhoritari kwakakosha kune mimwe mishonga, yakadai sekushanda kweitsvo pakutsvaga aminoglycosides, maelectrolyte ekuderedza ropa, maenzymes echiropa ekushandisa mishonga ine chepfu muropa, kana INR yekurapa warfarin.
Kutarisira Maitiro Asina Kunaka Mumishonga
Kurapwa kweROM kunoenderana nerudzi uye kuoma, asi misimboti yakawanda inosanganisira:
1. Kuzivikanwa uye kuregwa kwemishonga inofungidzirwa kuti iri kushandiswa
Kana ROM yakanyanya kana kuti ichiisa upenyu panjodzi, kurega mushonga kazhinji ndiyo danho rekutanga. Zvisinei, mune mamwe mamiriro ezvinhu, sarudzo iyi inofanira kuyera zvakanakira kurapwa uye kuwanikwa kwemamwe marapirwo.
2. Kurapa kunotsigira uye kunoratidza zviratidzo
Semuenzaniso, mishonga inorwisa mabhakitiriya inogona kupihwa kana paine allergy shoma, mvura inopinzwa mutsinga yeropa kana paine hypotension, kana kuti bronchodilators kana paine bronchospasm. Mu anaphylaxis, kurapwa kwekukurumidzira kwakadai se epinephrine kwakakosha.
3. Kushandisa mishonga inorwisa mabhakitiriya kana kurapa kwakananga
Mienzaniso: naloxone inoshandiswa pakushandisa opioid yakawanda, vhitamini K inoshandiswa pakubvisa ropa rinokonzerwa newarfarin, kana N-acetylcysteine yekushandisa paracetamol.
4. Kutarisa nekutevera uye magwaro
ROM inofanira kunyorwa zvakajeka muzvinyorwa zvekurapa kudzivirira kudzoka kwechirwere. Kudzidziswa kwevarwere kwakakoshawo kuitira kuti varwere vazive mishonga yekudzivisa.
Kudzivirira ROM: Basa Guru reKliniki Pharmacy
Kudzivirira ndiyo nzira yakanakisisa nekuti ROM inowanzova nemigumisiro yakaipa. Varapi vemishonga vanobatsira ne:
- Kuongororwa kwemishonga inorapwa nechiremba uye kugadziriswa kwemishonga kuti kuderedze kudzokororwa kwemishonga, kupihwa mishonga isina kukodzera, uye kudyidzana kwayo.
- Kugadziriswa kwemushonga kunoenderana nekushanda kweitsvo/chiropa uye mamiriro emurwere.
- Kuongororwa kwemishonga yekurapa (TDM) pamishonga ine chiyero chidiki chekurapa.
- Dzidziso yevarwere maererano nekushandiswa kwemishonga, zviratidzo zvekunyevera zveROM, uye kukosha kwekutevedzera mitemo.
- Kuongororwa kwemishonga kuburikidza nekuzivisa ROM kune system inoshanda panzvimbo yehutano kana kune vane masimba akakodzera, kuitira kuti maitiro ekuchengetedza mishonga agone kutariswa nguva dzose.
Tsika yekuchengetedzeka kwevarwere inofanirawo kutsigirwa nehurongwa hwezvipatara, kusanganisira nhungamiro dzekiriniki, kushandiswa kwenzira dzekutsigira sarudzo dzekiriniki, uye kushandira pamwe kwevashandi pamwe chete.
Mhedziso
Kusawirirana nemishonga (ADDs) idambudziko guru mu pharmacy yekiriniki, zvichikanganisa zvakanyanya kuchengetedzeka kwemurwere uye mhedzisiro yekurapa. Kusawirirana nemishonga (ADDs) kunogona kuitika nekuda kwemigumisiro yemishonga inofungidzirwa kana kusawirirana kusingatarisirwi, nezvinhu zvine njodzi zvinosanganisira zera, zvimwe zvirwere, polypharmacy, uye kusashanda zvakanaka kwenhengo dzemuviri. Varapi vemishonga vekiriniki vanoita basa guru mukuona, kuongorora, kutarisira, uye kudzivirira ADDs kuburikidza nekutarisa kurapwa, kupindira kwakavakirwa pauchapupu, kudzidzisa varwere, uye mishumo yemishonga. Nenzira yakarongeka uye yekushandira pamwe, kuwanda kweADDs kunogona kuderedzwa, zvichikonzera kurapwa kwemishonga kwakachengeteka uye kunoshanda zviri nani.
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Kana muchida, ndinogona kugadzirisa chinyorwa chino kuti chive chedzidzo yepamusoro (nemashoko akanyorwa uye bhuku remabhuku), kana kuwedzera mienzaniso yezviitiko zveROM zvinowanzoitika muzvipatara uye mashandisirwo anoitwa mishonga yekurapa.
