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頁籤選單縮合
題名 | 注意力不足過動症治療藥物對心臟功能的影響=Attention Deficit-Hyperactivity Disorder Drugs and Cardiovascular Risk |
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作者 | 張一如; 陳泰宇; 李怡靜; 陳慧玲; 史明偉; | 書刊名 | 藥學雜誌 |
卷期 | 26:3=104 2010.09[民99.09] |
頁次 | 頁74-78 |
分類號 | 418.21 |
關鍵詞 | 注意力不足過動症; 中樞性興奮劑; 心血管危險性; 猝死; Attention deficit hyperactivity disorder; ADHD; |
語文 | 中文(Chinese) |
中文摘要 | 美國藥物食品管理局於 2006年2月公告聲明,治療注意力不足過動症( Attention Deficit Hyperactivity Disorder, ADHD)的中樞性興奮劑必須在仿單附加黑框警語說明使用上造成心臟功能的危險性。 ADHD是一種在兒童時期很常見的神經行為障礙,常見臨床表現症狀為注意力缺損不集中和過動及衝動情形,若未治療下將可能會持續表現至青少年與成人時期,進而影響學業、家庭、工作關係等。目前臨床處理 ADHD的方法包括藥物的治療、行為治療及精神療法的介入,而其中以接受藥物的治療方式達最顯著的效果。中樞性興奮劑心血管的副作用包括心跳速率增加、心縮心舒壓上升等現象,在臨床上對一般心臟功能正常的孩童影響不大;但心血管的副作用對先天性心臟結構異常,心律不整及馬凡氏症的病童卻有猝死的危險性。雖然 ADHD治療藥物與導致猝死或心血管不良反應發生的機率不是很高,但為了安全上的考量;建議在投與藥物之前應先評估病人的心血管功能,包括測量心跳速率、血壓及第一次使用者應監控 ECG或心臟超音波。 |
英文摘要 | On February 9, 2006, the drug safety and risk management advisory committee of the Food and Drug Administration (FDA) voted by a narrow margin to recommend a “black-box”warning describing the cardiovascular risks of stimulant drugs used to treat attention deficit-hyperactivity disorder (ADHD). ADHD, the most common neurobehavioral disorder of child-hood, is characterized by developmentally inappropriate levels of hyperactivity, inattention, and impulsivity. Additional defining features include impairment in executive function and behavioral self-regulation. For most children with ADHD, it has been recommended that stimulant drugs should be used as an important component of the treatment plan. The drugs under review were primarily amphetamines and methylphenidates. These agents are closely related members of the class of sympathomimetic amines. These compounds exert potent stimulant effects on the cardiovascular and central nervous system. The drug-related events reviewed by committee included 25 cases of sudden death, some with evidence on autopsy of undiagnosed congenital heart disease. It is reasonable to obtain ECGs or echocardiography as part of the evaluation of children being considered for stimulant drug therapy. |
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