College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, South Korea.
Graduate School of Clinical Pharmacy, CHA University, Pocheon, South Korea.
Support Care Cancer. 2018 Aug;26(8):2737-2742. doi: 10.1007/s00520-018-4106-4. Epub 2018 Feb 27.
Network analysis was conducted to systematically analyze the relationship between causative drugs and types of drug-related problems (DRPs) in hospitalized patients with hematologic malignancies.
A total of 1187 DRPs identified in hematology wards between 2013 and 2015 were analyzed. DRPs were classified into 11 sub-domains for problems and 35 sub-domains for causes according to Pharmaceutical Care Network Europe classification. Causative drugs were classified by Anatomical Therapeutic Chemical code. Network analytic tool was used to represent the relationship between drugs, causes, and problems. In-degree centrality (C) was calculated to identify major causes of DRPs.
The following drugs accounted for more than 5% of DRP, including antibacterials (J01, 26.5%), drugs for acid-related disorders (A02, 11.5%), antiemetics (A04, 9.7%), antifungals (J02, 8.8%), and antineoplastic agents (L01, 7.0%). Inappropriate combinations (C1.3, C of 161) of drugs for acid-related disorders, antifungals, and antineoplastic agents were major causes of DRPs and induced non-optimal effects of drug treatment (P1.2). Inappropriate dose adjustments (C3.6, C of 151) of antibacterials lowered effects (P1.2) and increased side effects (P2.1). Missing necessary synergistic or preventive drugs, especially antiemetics, (C1.8, C of 54) resulted in untreated indication (P1.4).
DRPs were mainly related to medications for supportive care. More attention should be paid to interactions of drugs used for acid-related disorders, dose adjustment of antibacterials, and omission of antiemetics in hospitalized patients with hematologic malignancy.
通过网络分析系统地分析血液病住院患者的致病药物与药物相关问题（DRP）类型之间的关系。
分析 2013 年至 2015 年血液科病房中确定的 1187 例 DRP。根据欧洲药学保健网络分类，将 DRP 分为 11 个问题亚域和 35 个原因亚域。致病药物按解剖治疗化学代码分类。网络分析工具用于表示药物、原因和问题之间的关系。计算出度中心度（C）以确定 DRP 的主要原因。
以下药物占 DRP 的 5%以上，包括抗菌药物（J01，26.5%）、酸相关疾病药物（A02，11.5%）、止吐药（A04，9.7%）、抗真菌药（J02，8.8%）和抗肿瘤药（L01，7.0%）。酸相关疾病药物、抗真菌药和抗肿瘤药的不当联合（C1.3，C 为 161）是 DRP 的主要原因，并导致药物治疗效果不理想（P1.2）。抗菌药物剂量调整不当（C3.6，C 为 151）降低了疗效（P1.2）并增加了副作用（P2.1）。缺少必要的协同或预防药物，尤其是止吐药（C1.8，C 为 54），导致未治疗的指征（P1.4）。
DRP 主要与支持性护理药物有关。应更加关注酸相关疾病药物的相互作用、抗菌药物的剂量调整以及血液病住院患者止吐药的遗漏。
