疗养院中最重要相互作用的治疗药物监测的可能性。
The Possibility of Therapeutic Drug Monitoring of the Most Important Interactions in Nursing Homes.
作者信息
Schjøtt Pernille, Šutovská Martina, Schjøtt Jan
机构信息
Jessenius Faculty of Medicine, Martin, Comenius University, Bratislava, Slovakia.
Bergen Clinics Foundation, Bergen, Norway.
出版信息
Curr Clin Pharmacol. 2019;14(2):152-156. doi: 10.2174/1574884714666181224144722.
BACKGROUND
Therapeutic drug monitoring is a relevant tool in drug treatment of elderly patients. The aim of this study was to assess the possibility of therapeutic drug monitoring of the most important potential interactions in nursing homes.
METHODS
A material of prescribed drugs to 446 patients in three nursing homes in Bergen, Norway from a single day in March 2016 was analysed. Clinically relevant drug interactions (pharmacodynamic or pharmacokinetic) were identified and classified with Stockleys Interaction Alerts. The most important interaction among several in each patient were ranked by recommended action > severity > evidence according to Stockleys. The possibility of therapeutic drug monitoring of drug combinations involved in the most important interactions was retrieved from a database of all laboratories performing clinical pharmacology in Norway (the Pharmacology Portal).
RESULTS
Two or more drugs were used by 443 (99.3%) of 446 patients. Three-hundred and eightyfour patients (86.1%) had > 1 interaction. About 95% of the most important interactions were pharmacodynamic. In 280 (72.9%) of these interactions, Stockley`s recommended adjust dose or monitoring. Among the 384 most important interactions, 93% involved one drug and 41% involved two drugs available for therapeutic drug monitoring.
CONCLUSION
In this pilot study, therapeutic drug monitoring was possible in the majority of the most important interactions in Norwegian nursing homes. This option is of importance since adjust dose or monitoring were frequently recommended actions associated with these interactions.
背景
治疗药物监测是老年患者药物治疗中的一项重要工具。本研究的目的是评估在养老院中对最重要的潜在相互作用进行治疗药物监测的可能性。
方法
对2016年3月某一天挪威卑尔根市三家养老院中446名患者的处方药资料进行分析。使用《斯托克利药物相互作用警示》识别并分类临床相关的药物相互作用（药效学或药代动力学）。根据《斯托克利药物相互作用警示》，按照推荐措施>严重程度>证据的顺序，对每位患者多种相互作用中最重要的相互作用进行排序。从挪威所有开展临床药理学研究的实验室数据库（药理学门户网站）中获取对最重要相互作用中涉及的药物组合进行治疗药物监测的可能性。
结果
446名患者中有443名（99.3%）使用了两种或更多药物。384名患者（86.1%）存在>1种相互作用。约95%的最重要相互作用为药效学相互作用。在这些相互作用中，280例（72.9%），《斯托克利药物相互作用警示》推荐调整剂量或进行监测。在384项最重要的相互作用中，93%涉及一种药物，41%涉及两种可进行治疗药物监测的药物。
结论
在这项初步研究中，挪威养老院中大多数最重要的相互作用都可以进行治疗药物监测。由于调整剂量或监测是与这些相互作用相关的常见推荐措施，因此这一选择具有重要意义。
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