偏头痛的药物治疗

偏头痛是一种临床上常见的慢性神经血管性疾患,患病率约为5%～10%,一般儿童期或青春期起病,中青年期达到发病高峰,女性较男性多见,具有遗传倾向.     

偏头痛的药物治疗

一、偏头痛的病理生理学偏头痛是一种不明原因的综合征,包括阵发性头痛及全身症状(特别是胃肠道症状),有时有局限性神经障碍。现代有关偏头痛发病理论主要有两种学说,即血管发病理论和神经发病理论。 1.血管理论 17和18世纪,Willis T等人认为颅内外血管异常对偏头痛发病非常重要。支持这一理论的较新的证据包括血管活性麦角生物碱可消除偏头痛急性发作,血管扩张剂如亚硝酸异戊酯可消除偏头痛先兆发作,而偏头痛先兆发作时局部脑血流是减少的。     

偏头痛的药物治疗进展

偏头痛是临床常见病,多发病.呈一侧或两侧疼痛,发作时常伴有恶心,呕吐.发病机理目前尚不清楚[1].先后有人提出血管源性和神经性两种学说.但目前更倾向于三叉神经血管学说[2],该学说认为,过多的内、外刺激可引起血管扩张,当血管扩张时,伤害性刺激促使三叉神经末梢释出血管活性肽类物质,如P物质、钙基因相关肽及神经激肽,引起神经性炎症[3].在我国对偏头痛的流行病的调查,虽然未引起死亡,但其频繁的发作会严重影响患者身心健康、日常生活和工作,随着对偏头痛病的病因学以及与该病相关的受体亚型的研究,其药物治疗有了较大的突破,本文就偏头痛的药物治疗及进展作一概述.     

偏头痛的药物治疗进展

偏头痛是一种常见的慢性疾病，呈反复发作性。在西方国家，大约11％的成人患有偏头痛，我国也有大量的偏头痛患者。药物治疗的目的包括减少头痛发作的频度、强度及持续时间；以及最大程度地减少头痛带来的不适，提高生活质量；避免头痛加剧及药物的滥用。现简要介绍近年来偏头痛的药物治疗进展。     

治疗偏头痛药物的临床研究进展

根据国际头痛协会(IHS)的定义,偏头痛是一种以间歇性头痛发作伴有自发性功能紊乱为特征的疾病[1].在西方国家大约10%的人患有这种疾病[2].大约有30%的妇女被与月经有关的偏头痛所折磨,且难以医治[3].偏头痛通常从清晨开始发作,持续4～72 h.     

偏头痛的药物治疗

偏头痛是临床常见病、多发病,本文对近年来预防及治疗偏头痛药物进行综述,为临床用药提供借鉴.     

偏头痛常用治疗药物分析

偏头痛也称血管性头痛,是一种颅内外血管收缩与舒张功能异常性疾病,是较常见的神经系统疾病。多见于女性。颅内动脉收缩,出现偏头痛症状,继而由于颅内缺血、缺氧产生大量活性物质,引起颅外动脉扩张,出现搏动性头痛,其疼痛范围通常局限于头部一侧,但也有两侧同时发生的。引起偏头痛病因较复杂,遗传（46％-55％的患者有家族遗传史）、血小板和生化改变、内分泌、饮食、情绪紧张及气候变化等因素通过影响脑血管,引起血管舒缩功能障碍而导致本病发生。     

偏头痛治疗药物的临床研究进展

可用于治疗偏头痛的药物较多,主要有麦角碱制剂、选择性5-HT1受体激动剂、雌激素、钙通道阻滞剂、抗抑郁药、非甾体类抗炎药等,应针对不同患者选择安全、高效、价廉的药物.     

Drug safety in acute migraine treatment

Introduction: A number of drugs are available for acute migraine treatment, but they are not all effective for all patients and all attacks. The safety profiles of migraine drugs limit their use in patients with certain comorbid conditions, and adverse effects may also reduce the level of patient compliance.

Areas covered: The different types of acute migraine drugs are discussed, with particular regard to safety issues and potential adverse effects. The frequent use of analgesics, ergot alkaloids and triptans may result in the development of medication overuse headache (MOH).

Expert opinion: The initiation of a migraine attack is not fully understood, and therefore treatment aimed at causative factors is currently not available. The tolerability and adverse effects of the drugs available at present often limit their use. NSAIDs are frequently associated with gastrointestinal, and possibly also cardiovascular side effects. Ergot alkaloids may induce arterial vasoconstriction, while the administration of triptans is contraindicated in cardiovascular, cerebrovascular and peripheral vascular diseases. The frequent use of these drugs poses the risk of the development of MOH. There is a need for pathomechanism-based drugs, and for the future achievement of personalized medicine.     

Drug safety and tolerability in prophylactic migraine treatment

Introduction: Migraine is a frequent, disabling primary headache disorder, whose pathomechanism is not yet fully understood. Prophylactic treatment is advisable for migraineurs with severe or highly frequent attacks, which impair the quality of life.

Areas covered: The different types of prophylactic migraine drugs are discussed, with particular regard to potential adverse effects and safety issues. β-Adrenergic blockers, antiepileptic drugs and calcium-channel blockers are drugs widely used for migraine prevention, whereas complementary medicine and onabotulinumtoxin A can be used in selected cases.

Expert opinion: The background of the recurrence and chronification of migraine attacks has not been fully clarified, and causative preventive therapy is therefore not currently available. The tolerability and adverse effects of the currently used medications often limit their use. β-Adrenergic receptor blockers may induce adverse cardiovascular events, whereas flunarizine is frequently associated with a weight gain and depression. As most migraine sufferers are young women of child-bearing age, the use of valproate is limited. Topiramate is associated with central nervous system-related side effects. There is a need for future development of pathomechanism-based preventive drugs, and personalized therapy tailored to the patient.     

血清镁水平对偏头痛的影响

目的 :探讨偏头痛发病机制和镁与偏头痛的关系 ,观察镁对偏头痛的治疗效果。方法 :选择偏头痛病例、非偏头痛性疼痛病例、健康人各 5 6例 ,分别作血清镁测定 ,偏头痛组病例于头痛发作时给予2 .5 g硫酸镁注射液稀释后缓慢静脉滴注 ,观察其治疗效果。结果 :偏头痛组血清镁 (0 .74±s 0 .0 7)mmol·L- 1明显低于非偏头痛性疼痛组 (0 .83±0 .0 7)mmol·L- 1和健康组 (0 .84± 0 .0 5 )mmol·L- 1,经统计学比较差异有非常显著意义 (P <0 .0 1)。偏头痛组病例静脉滴注硫酸镁治疗后 ,4 9例头痛症状在 2 4h内消失或明显缓解 ,总有效率88%。结论 :镁在偏头痛发病机制中起着重要作用 ,偏头痛发作与镁缺乏有关。硫酸镁静脉滴注对偏头痛有较好的冶疗效果。     

Inhaled drug therapy development for the treatment of migraine

Introduction: The inhalation of substances, both medicinally and recreationally, is a commonly used method of drug administration but has been underutilized in the treatment of neurologic disorders such as migraine. Three drugs have been studied as potential inhalable treatments for acute migraine: dihydroergotamine (MAP0004), prochlorperazine (Staccato prochlorperazine), and loxapine (Staccato loxapine).

Areas covered: This review discusses the available literature describing the pharmacokinetics, tolerability and efficacy of MAP0004, Staccato prochlorperazine and Staccato loxapine, including data from Phase II and Phase III clinical trials.

Expert opinion: Inhaled DHE offers rapid absorption with a pharmacokinetic profile similar to IV administration. Improved side effect profile results from more selective binding at antimigraine serotonergic receptors 5-HT_1B and 5-HT_1D. Inhaled prochlorperazine is rapidly absorbed and resulted in statistically significant migraine pain relief at 2 hours compared to placebo but is not currently being pursued by the manufacturer as a potential migraine abortive. Inhaled loxapine is also rapidly absorbed into systemic circulation but Phase IIb trials did not show statistically improved pain relief or pain freedom compared to placebo. MAP0004 will likely provide a good alternative to patients seeking rapid relief without the need for injection or other invasive routes.     

自身对照左乙拉西坦添加治疗耐药性癫痫部分性发作的疗效及安全性

目的:评价左乙拉西坦作为添加剂治疗成人耐药性癫痫部分性发作的疗效和安全性。方法:本试验为单盲、前瞻性研究,27例耐药性癫痫病人在原用药基础上加用安慰剂16 wk,停用安慰剂,再加用左乙拉西坦治疗16 wk,X~2检验比较左乙拉西坦添加期疗效与安慰剂期疗效的差别,并观察其不良反应。结果:左乙拉西坦治疗有效而安慰剂无效的病例13例(48%),安慰剂治疗有效而左乙拉西坦无效的病例5例(19%),左乙拉西坦治疗有效的病例数明显高于安慰剂治疗有效的病例数(P＜0．05)。左乙拉西坦添加治疗期21例(78%)出现不良反应,安慰剂添加期20例(74%)出现不良反应。左乙拉西坦添加治疗期的不良反应主要有情绪异常、头晕、胃肠不适,部分病人有短暂性轻度血白细胞减少,没有病例因严重不良反应退出。结论:左乙拉西坦治疗成人耐药性癫痫部分性发作有效,且不良反应轻,对耐药性癫痫病人是一种有益的选择。     

美国药品安全信息发布及其对我国的借鉴

美国FDA药品安全信息发布形式多样,保证了信息的及时传达,具有指导临床合理用药的意义;而我国的药品安全信息发布途径有限,形式单一,信息传达的及时性受到限制。应当借鉴FDA的成熟经验,完善我国的药品安全信息发布体系。     

56家大中型医疗机构药品质量安全风险评价

目的:排查和防控武汉市大中型医疗机构药品质量安全管理体系中存在的风险,规范医疗机构药品全流程的管理。方法:依据《医疗机构药事管理规定》、《湖北省药品使用质量管理规定》等要求,药学专家和药品监管人员以全市56家大中型医疗机构为评估对象,对组织机构与人员管理、文件管理、药库管理、药房管理、医院制剂配制管理、特药抗菌药及ADR监测管理进行药品质量安全风险评估,排查药品安全管理中存在的风险点,提出合理化建议。结果:本次评估56家医疗机构的平均得分率为88.2%,评级优秀的占76.8%;药库管理是6个大项中风险最高的项目,82.1%医疗机构此项目存在风险;按子项目风险级别排序,排名前5的分别是冷链管理、临床药师配备、药库药品存放、药品养护和特药管理。三级医院药品质量安全风险管理情况优于二级医院、综合医院风险管理情况优于专科医院。结论:该市大中型医疗机构药品质量安全管理还存在一定的风险,各级医疗机构应加强药品管理,降低药品质量安全风险,保障患者用药安全。     

护士专科药物学知识的继续教育与用药安全

目的加强护士专科药物学知识的继续教育，保障用药安全。方法有目标、有计划、系统地、适时地进行专科药物学知识的继续教育，保障给药安全，加强用药监护，及时发现药品不良反应。结果护士从被动盲从医嘱变为主动正确执行医嘱，安全给药的同时积极主动进行用药监护，最大限度地保障了用药安全。结论护士通过专科药物学知识的继续教育，避免药品不良事件的发生，及时发现药品不良反应，承担起用药安全的护理职责，展示护理专业的价值。     

关于若干药物安全术语的定义及译法的讨论

药物安全术语的准确定义及规范译法对于正确理解其涵义具有非常重要的作用。本文介绍了药物不良反应、志愿报告系统、现实世界研究等术语的译法,阐述了药物不良反应监测、药物警戒、公共卫生监测的定义,并对medication error的中文译法做了详细解释。     

Clinical perspectives in drug safety and adverse drug reactions

Adverse drug reactions (ADRs) remain a common clinical problem since they can mimic many diseases and cause significant morbidity and mortality. Judicious prescribing is important to minimize their occurrence. Apart from the recent identification of a few pharmacogenomic biomarkers for serious reactions, many remain unpredictable. Spontaneous reporting continues to play an important role in pharmacovigilance and the value of astute clinical observation and well-documented reports of suspicions of a causal link cannot be underestimated. Many national reporting schemes have developed considerable experience and expertise over many years and have large ADR databases, which are national assets. Despite advances in pharmacovigilance, numerous deficiencies have been identified; postmarketing surveillance remains the weakest link in the regulatory process. Regulatory authorities have tended to act later rather than sooner in response to safety signals, and this, when combined with under-reporting, may have led to exposure of a large number of patients to drug-related harm before restriction or withdrawal. In an attempt to improve vigilance, international surveillance may benefit by moving from its current passive/reactive mode toward active surveillance systems with a prospective, comprehensive and systematic approach to monitoring, collecting, analyzing and reporting data on ADRs. This will include increased pressure on pharmaceutical companies to conduct postmarketing studies. Such an active/proactive approach, while maintaining focus on ADR detection, could also aim to extend knowledge of safety, such that emerging changes in risk–benefit during a drug’s marketed life are effectively communicated to clinicians and patients. Drug safety monitoring and its regulation are now undergoing an overhaul and it is hoped that vigilance, public safety and trust will improve as a result.