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| 題 名 | 藥物引起的耳毒性=Drug-induced Ototoxicity |
|---|---|
| 作 者 | 吳承誌; 戴慶玲; 王郁青; 李炳鈺; | 書刊名 | 藥學雜誌 |
| 卷 期 | 34:2=135 2018.06[民107.06] |
| 頁 次 | 頁93-98 |
| 分類號 | 418.11 |
| 關鍵詞 | 耳毒性; 含鉑化療藥物; Aminoglycosides; Ototoxicity; Platinum-based anticancer drugs; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 耳毒性可分為兩大面向:耳蝸毒性 (cochlear toxicity) 會出現耳鳴或聽覺喪失等症 狀,有可能永久性失能;前庭毒性 (vestibular toxicity) 則會出現暈眩或失衡症狀,副作 用大多於停藥後消失。含鉑化療藥物與 aminoglycosides 是最常見造成耳毒性的藥物。 兩種藥物的致病機轉存在些許差異,含鉑化療藥物主要與活性氧化物質的生成有關; aminoglycosides 透過抑制粒線體蛋白質合成與自由基大量生成造成耳毒性。 含鉑化療藥物和 aminoglycosides 的各類藥物風險不一。含鉑化療藥物和 aminoglycosides 的耳毒性風險因子相似,包括給藥途徑、劑量、合併使用藥物、腎功 能狀態、基因型。由於耳毒性不易被醫療人員或病人察覺,主動評估與鼓勵病人敘述 評估耳毒性症狀十分重要。超高頻聽力測驗 (extended high-frequency (EHF) audiometry) 和變頻耳聲傳射都是能夠協助偵測初期耳毒性的客觀檢查。預防策略以反轉致病機轉 的抗氧化劑或自由基清除者為主,但未有任何藥物被證實其療效。各類抗氧化藥物中 以 aspirin 和 acetylcysteine 的證據最為完整。藥師需先了解具有耳毒性的藥物種類,熟 悉常見症狀與風險因子,適時提供醫療團隊用藥建議,以利提升照護能力。 |
| 英文摘要 | Ototoxicity is composed of two facets: cochlear toxicity and vestibular toxicity. Tinnitus and hearing loss are symptoms of cochlear toxicity, which might lead to permanent dysfunction. Manifestations of vestibular toxicity are made of vertigo and loss of balance, which will subside after discontinuing culprit drugs. Platinum-based anticancer drugs and aminoglycosides are common drugs related to ototoxicity. Mechanisms between platinum-based anticancer drugs and aminoglycosides have been existed mild discrepancy. Reactive oxygen species formation is related to platinum-based anticancer drugs, while aminoglycosides is associated with inhibition on mitochondrial protein synthesis and free radical formation. There is risk difference among those drugs belong to platinum-based anticancer drugs and aminoglycosides. Similar risk factors were shared among those two categories of drugs, including administration route, dosage, combined medication, renal function, and genotypes. It is of great importance to implement active evaluation and encourage patients that delineate the hearing condition, because ototoxicity is rarely recognized by health professionals and patients. Extended high-frequency (EHF) audiometry and distortion product otoacoustic emissions (DPOAEs) should be regarded as objective examination to detect incipient ototoxicity. Anti-oxidants and free radical scavengers which can reverse the mechanism can be candidates as preventive strategies, however, without proven efficacy on separated drug. Aspirin and acetylcysteine possess the most intact evidence among those anti-oxidants. Only when pharmacists are familiar with categories of ototoxic drugs, symptoms, and risk factors related to toxicity can we offer optimal recommendation toward medical team with wellprepared ability on pharmaceutical care. |
本系統中英文摘要資訊取自各篇刊載內容。