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題名 | 運用腎臟排除藥物監測系統進行病人用藥安全監測--Metformin=Monitoring Patient Medication Safety Using a Renal Excretion Drug Monitoring System for Diabetic Medications Containing Metformin |
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作者姓名(中文) | 蔡育菁; 林則先; 張展維; 戴慶玲; | 書刊名 | 醫務管理期刊 |
卷期 | 16:3 2015.09[民104.09] |
頁次 | 頁191-204 |
分類號 | 418.82 |
關鍵詞 | 伏糖錠; 腎功能不全; 腎臟排除藥物監測系統; 臨床藥事服務; Metformin; Renal impairment; Renal excretion drug monitoring system; Clinical pharmacy services; |
語文 | 中文(Chinese) |
中文摘要 | 目的:當metformin使用於腎功能不全病人,亦會增加發生乳酸中毒風險。運用「腎臟排除藥物監測(Renal excreted Drug Monitoring, RDM)系統」,由臨床藥師介入照護,以降低藥物不良反應發生。方法:自2012年5月至2013年8月在南部某區域醫院監測metformin、glimepiride/metformin、glyburide/metformin、sitagliptin/metformin,利用RDM 系統搜尋住院病人,當血中肌酸酐>1.5mg/dL且使用劑量不正確者,臨床藥師積極與醫師討論提供適當建議,並進行建議事項接受度統計資料分析。結果:本研究共評估605人次,用藥建議處方數186件,接受用藥建議結果,最主要為再次抽血追蹤腎功能且檢驗數值結果正常43.1%,其次為停用藥物35.4%及更改其他口服降血糖藥物或胰島素取代21.5%。在臨床藥事介入服務接受度為84.9%。結論:運用RDM系統可提供臨床藥師進行監測與即時劑量建議,確實降低病人因腎功能不全所造成之不良反應與藥物毒性。 |
英文摘要 | Objectives: If metformin is used in patients with renal impairment, it could increase the risk of lactic acidosis. With the assistance of pharmacists in the clinical care of patients, a renal excretion drug monitoring (RDM) system was developed which can improve the appropriateness of drug prescriptions and reduce the incidence of adverse drug reactions. Methods: In this study, four drugs (metformin, glimepiride/metformin, glyburide/ metformin, and sitagliptin/metformin) and laboratory data were collected from inpatients using the RDM system between May 2012 and August 2013 in a regional hospital in southern Taiwan. When the serum creatinine was > 1.5 mg/dL and the dosage of drug was inappropriate, clinical pharmacists provided a dosage recommendation to the physicians and conducted statistical analysis of acceptance rates. Results: A total 605 patients were screened by this system. Among the pharmacists' recommendations, it was suggested that 186 prescriptions be monitored for renal function (43.1%), discontinued (35.4%), and switched to other oral hypoglycemic agents or insulin (21.5%). The acceptance rate of pharmacist interventions was 84.9%. Conclusions: The RDM system may be helpful for clinical pharmacists and real-time renal dose adjustment suggestions, as well as to minimize adverse drug reactions and toxicities associated with renal dysfunction. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。