药物不良反应概论.ppt

“反应停”事件始末 PEM的优点 黄卡系统有益而必要的补充 迅速从所有处方监测药物的医生处获得报告； 非干预性, 对医生处方习惯、处方药物无任何影响； 对所发生的药物不良反应高度敏感； 可探测潜伏期较长的不良反应； 相对于前瞻性队列研究费用较少； What we see is “Tip of the unreported iceberg” 29 29 Thanks! * * * 药物过敏反应的特点及一般规律仅发生在用药人群中的少数人。 首次用药不发生或极少见，多是再次或多次用药后发病 多在再次接触到变应原（同样药物）后几分钟到24h内发病 停用致敏药物，一般可较快消退，预后良好，抗过敏药物治疗可加速恢复。 已致敏的患者对于该药的致敏性可持续很久，甚至终身不退。再次用药反应重现或更严重 结构相似的药物常可发生交叉或不完全交叉过敏反应。 某些药物的过敏反应可用皮肤试验来证实. 对于已致敏者可初始用小剂量药物，逐渐增量，以中和体内抗体，达到脱敏的目的 * * * * Hospital admissions resulting from preventable adverse drug reactions. McDonnell PJ, Jacobs MR. Source School of Pharmacy, Temple University, Philadelphia, PA 19140-5101, USA. pmcdonne@unix.temple.edu Abstract BACKGROUND: Adverse drug reactions (ADRs) are a significant cause of hospital admissions. These events can lead to significant morbidity and mortality and financial costs. ADRs that may be preventable might be considered a form of medication error. OBJECTIVE: To assess the potential preventability of ADRs directly related to a patients hospital admission. METHODS: A retrospective chart review of 437 ADRs occurring during an 11-month period was conducted at a university hospital. A subset of these events leading to hospital admissions was identified for further review. Those that resulted in admission were further examined to determine probability of causality, severity, and preventability. RESULTS: Over 11 months, 158 ADRs were directly related to hospital admission. The relationship of these admissions to drug exposure was determined to be probable or highly probable in 154 (97.4%) of these cases. From this group, 96 (62.3%) of these events were considered potentially preventable, with 23 (24%) considered severe to life-threatening. Characteristics associated with these ADRs included documentation of a toxic drug concentration or abnormal laboratory value (80%), inadequate monitoring of a patients drug therapy (67%), inappropriate dose (51%), patient noncompliance (33%), drug-drug interaction (26%), contraindication to t