Improve the rational use of drug level monitoring

ncycgdxhl · Wysłany: Pią 8:38, 18 Mar 2011

Improve the rational use of drug level monitoring is a prerequisite

Glucuronidation is also a small amount of material; In addition, they do not sound the excretion function, so the dosage is not easy to master. Children have a sound for a variety of functions can be administered according to the weight, but sometimes the drug's clearance rate of its inverse adult fast, drug half-life shorter than the adult. Old age, liver function and kidney function will decline, affect drug metabolism and excretion of drugs will cause changes in body weight change in volume of distribution, these factors can affect plasma concentration, the use of dosage is difficult to grasp. ② Gender: In general, women than men,[link widoczny dla zalogowanych], the drug sensitive to drug clearance rate slower than men, if the conventional dose, women can lead to poisoning. ① 2.2 pathological factors with impaired renal function: patients with impaired renal function, decreased urine output, if the drugs used primarily by renal excretion,[link widoczny dla zalogowanych], normal doses of the drug easy to accumulate in the body, causing poisoning. Even though some in the liver metabolism of drugs as the major clearance pathway, when the renal dysfunction, its incidence of adverse reactions is much higher than normal renal function, one of the reasons is that some are pharmacologically active metabolites, renal excretion and accumulation can not increase drug toxicity. ② liver injury: liver is bad, will cause changes in drug clearance rates, thus affecting the blood concentration and efficacy. In addition, because of hepatitis, patients sometimes reduce the concentration of serum protein, drug and protein binding rate decreased, resulting in free drug concentration in blood, so that conventional doses can lead to poisoning. ③ heart disease: myocardial infarction and congestive heart failure patients, the hemodynamic changes occur, so that other parts or organs within the blood flow, and affect the clearance of certain drugs. ④ gastrointestinal disorders: the pathological changes of gastrointestinal function, such as an increase or slow down gastric emptying rate, pH value changes in the gastrointestinal tract, the absorption area of the reduction in the increase in intestinal permeability, change of enzyme etc., can significantly alter the speed of drug absorption and bioavailability, thus affecting the blood concentration. ⑤ plasma protein binding of drugs and disease: drug into the blood circulation, the existence of two forms, one free model, the second is bound to plasma proteins. Only free drug can be freely distributed in the body to reach the target site, play a pharmacological effect, effect a cure. The combination of drug and plasma protein there is a limit, when the dose increased to a certain extent, and plasma protein binding reached saturation, the concentration of plasma free drug to dramatically increase, the possible toxicity. Certain diseases will change the drug and plasma protein binding of these diseases, including kidney disease, hyperbilirubinemia, hyperlipidemia and so on. ⑥ genetic factors: genetic factors on drug metabolism has drawn attention, individual differences in the cause of many factors, genetic plays an important role. ⑦ Environmental factors: Many drugs or chemicals known to have to change the drug metabolizing enzymes in liver microsomal enzyme activity directly affect the clearance rate of drug in the body, thus affecting the blood concentration. ⑧ drug interactions: more than two drugs combined with, their efficacy than single may increase or decrease may reduce or increase side effects may occur, should not have side effects. This phenomenon is called drug interaction. It can be divided into pharmacokinetic interactions and pharmacodynamic interactions. Pharmacokinetic interactions often lead to changes in blood concentration,[link widoczny dla zalogowanych], thus affecting drug efficacy and adverse reactions. Discussion of 3 serum concentrations of factors,[link widoczny dla zalogowanych], most doctors can not predict individual differences between patients in particular, can not be expected for each patient to the same dose of drug treatment are able to get the ideal effect. Therefore, the proposed individualized dosing, based on individual patient plasma concentration monitoring to achieve therapeutic purposes. Clinical Pharmacology in our hospital to monitor blood total of 1 million copies of the statistical analysis of monitoring results, about 48% of patients with serum concentrations outside the scope of the effective concentration,[link widoczny dla zalogowanych], coincident with the clinical situation. According to the results of blood concentration to develop individualized dosing regimen, the patient's condition can be well controlled the vast majority; poisoning patients receive timely if a result of treatment, patients will be more opportunities for rescue; reached the treatment of concentration is still ineffective, suggesting that patients may be patients with other diseases, it is recommended for further medical diagnosis to identify the cause, leaving a result of the treatment of patients cured, it can be seen that blood concentration monitoring carried out the necessity and importance. Therapeutic drug monitoring is a scientific, rational use of the necessary measures to improve drug efficacy and reducing drug toxicity helpful. But not all drugs are necessary for blood concentration monitoring, and only some of the low therapeutic index (ie the effective concentration of drug and the toxic concentration is close), safe range of small or non-linear dynamics, poisoning symptoms and disease onset difficult to distinguish between the symptoms of the drug, only to be monitored. 21Xl3-05-16 closed lotus