埃克替尼与华法林药物相互作用1例

<正>埃克替尼是一种高效特异性的表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI),可强有力地选择性抑制EGFR及其3个突变体,用于晚期非小细胞肺癌二线治疗。华法林是香豆素类抗凝剂的一种,在体内有对抗维生素K的作用,可以抑制维生素K参与的凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ在肝脏的合成,主要用于防治血栓栓塞性疾病。华法林可与很多药物发生相互作用,但与埃克替尼的相互作用笔者未见病例报道。本院收治的一名     

抗癫痫药物与华法林相互作用的研究进展

口服抗凝药华法林的抗凝作用受很多因素的影响,如患者的年龄、体重、合并症等。与其他药物的相互作用也是影响华法林抗凝作用的重要因素之一,其中一些抗癫痫药物对华法林的影响较大且机制复杂,作用持续时间也较长,对于联用华法林的癫痫患者,抗癫痫药物的选择与监测更为重要。本文通过整合国内外相关研究,探讨和总结华法林与抗癫痫药物间的相互作用机制和应对策略,比较不同抗癫痫药物的药代动力学特性及与华法林相互作用的差异,从而为抗癫痫药物的选择和相应剂量的调整提供参考,以降低用药风险。     

华法林与药物之间相互作用的研究进展

检索目前国内外华法林与药物相互作用的文献,其中涉及与华法林存在相互作用的药物报道共254种,按照《2015版中华人民共和国药典临床用药须知》并依据药物的作用对254种药物进行分类,探讨华法林与药物之间相互作用的机制,明确华法林与药物同时或前后序贯使用时,在体内引起华法林抗凝作用的增强或减弱作用。本文按药物作用分类,分析华法林与其他药物之间的相互作用,使之更加直观、系统、更易查询,为临床医师、药师及长期服用华法林的患者提供参考。     

华法林的药物相互作用案例分析

目的了解华法林与其他药物的相互作用。方法通过总结分析1例应用华法林的房颤患者的诊治经过、用药情况。结果华法林与较多药物如头孢哌酮舒巴坦钠、氟康唑等存在较严重的相互作用。结论临床上使用华法林时应格外重视,并加强监测。     

华法林与其他药物的相互作用及其安全性分析

华法林为是一种合成的香豆素类口服抗凝药物,主要用于预防凝血和治疗血栓性疾病,其结构与维生素K相似,作用机理是在体内竞争性抑制维生素K依赖性凝血因子的合成而发挥抗凝血的作用.临床应用广泛,在体内可受到很多药物的影响,出现相互作用,本文旨在探讨华法林与其他药物的相互作用,为临床安全用药提供参考依据.     

华法林与中草药的相互作用

目的综述国内外报道华法林与常用中草药相互作用的相关文献,为临床安全应用华法林提供参考。方法查阅近年来国内外学者对于华法林与常用中草药相互作用的研究情况及可能的发生机制,进行归纳分析。结果部分中草药会影响华法林的抗凝作用,如当归、鹿衔草、大蒜等。结论多种中草药与华法林存在相互作用,提示在临床应用华法林的同时,重视中草药对抗凝作用的影响,提高临床用药的有效性和安全性。     

药物相互作用致华法林药效增强的病例分析

目的分析华法林治疗的药物相互作用,促进临床合理应用。方法对4例华法林治疗过程中发生出血病例的治疗方案进行讨论,分析参与华法林药物相互作用的药物,并分析可能的作用机制。结果胺碘酮、喹诺酮类和质子泵抑制剂等药物的联用可能是引起华法林代谢抑制,导致其抗凝作用增强并引起出血的主要原因。结论临床药师参与临床药物治疗有助于医师对药物相互作用引起的药物不良反应的识别,提高用药安全性。     

药物相互作用致华法林抗凝作用增强引起出血的病例分析

1例82岁女性房颤患者,服用华法林治疗2年余,INR控制在1.5～2.5,因肺部感染,合用氟康唑及头孢哌酮/舒巴坦钠等药物,用药后第4天,INR升至12.28,咯血.分析出血原因,建议立即停用华法林、输注冰冻血浆并给予维生素K1注射液等,2d后INR降至1.3,出血停止.     

Warfarin and acetaminophen interaction

A 74-year-old man who was receiving warfarin for atrial fibrillation experienced an abrupt increase in his international normalized ratio (INR) after taking acetaminophen. To investigate this effect, the patient's anticoagulation therapy was stabilized, and he was given acetaminophen 1 g 4 times/day for 3 days. His INR rose from 2.3 before receiving acetaminophen to 6.4 on the day after acetaminophen was discontinued. Warfarin was stopped for 2 days, and the patient's INR returned to 2.0. Warfarin was restarted at the same dosage, and his INR remained within 2.0-3.0 for 6 months. Factor VII activity decreased from 29.4% before acetaminophen therapy to 15.5% when his INR was 6.4, and factor X activity fell from 27.0% to 20.2%. His warfarin plasma concentration was 1.54 microg/ml before acetaminophen compared with 1.34 microg/ml when his INR was 6.4. No significant changes in drug intake, clinical status, diet, or lifestyle were noted. Changes in INR of this magnitude with the addition of another drug during stable anticoagulation therapy suggest a drug interaction. The lack of an increase in warfarin plasma concentration associated with the increased INR suggests a possible pharmacodynamic mechanism for this interaction. Acetaminophen or a metabolite may enhance the effect of oral coumarin anticoagulants by augmenting vitamin K antagonism. Thus, the anticoagulant effect of warfarin may be significantly elevated after only a few days of acetaminophen therapy. Patients receiving warfarin should be counseled to have their INR monitored more frequently when starting acetaminophen at dosages exceeding 2 g/day.     

1例华法林抗凝患者INR异常升高病例分析

目的:探讨导致华法林抗凝患者国际标准化比值(INR)异常升高的影响因素,以及临床药师对这类病例的药学监护和处理。方法:临床药师参与1例服用华法林抗凝患者INR异常升高的处理,通过相关基因检测及查阅文献,探讨可能的原因及解决方案,为临床提供合理用药建议。结果:患者的基因型、合用的药物均可能导致INR异常升高,根据患者具体情况设计了个体化给药方案,最终使INR维持在目标范围。结论:临床药师在治疗团队中可发挥专业特长,从多角度全面分析影响华法林抗凝作用的因素,对医生及患者分别开展有针对性的药学服务,保证抗凝治疗的有效性、安全性。     

Warfarin and royal jelly interaction

An 87-year-old African-American man came to the internal medicine clinic for a routine anticoagulation management visit. He had no complaints. His medical history was significant for stage IV-A follicular non-Hodgkin's lymphoma, atrial fibrillation, and hypertension. His long-term drug therapy consisted of warfarin, felodopine, lisinopril-hydrochlorothiazide, controlled-release diltiazem, potassium chloride, and oxycodone. He reported adherence with his prescribed drugs and denied taking any over-the-counter or herbal products. Overall, the patient's drug therapy had been consistent during the preceding 3 months, no significant changes had occurred in his clinical status, and no significant changes had been noted in his diet; his international normalized ratio (INR) had ranged from 1.9-2.4 (therapeutic range 2-3). He denied tobacco use, alcohol consumption, and recent travel. Four weeks later, the patient came to the emergency department with hematuria. He denied dysuria, taking more than the prescribed amount of warfarin, any changes in his diet, taking any over-the-counter or herbal products, and any other bleeding. On admission to the hospital, his INR was 6.88, which increased to 7.29 during his hospital stay. On further investigation, the patient admitted that he had started taking an herbal supplement, royal jelly, 1 week earlier. When asked specifically about the ingredients in the supplement, he stated that royal jelly was the only component. Relative to the patient's denial of any other changes in his condition or drug regimen, the most probable explanation for his elevated INR and subsequent bleeding is a possible interaction between royal jelly and warfarin. To our knowledge, no case reports concerning royal jelly and warfarin taken concomitantly have been reported. Clinicians should be proactive and repeatedly provide education regarding the potential dangers of dietary supplements taken with conventional drugs.     

Warfarin toxicity and individual variability-clinical case

Warfarin is a widely used anticoagulant in the treatment and prevention of thrombosis, in the treatment for chronic atrial fibrillation, mechanical valves, pulmonary embolism, and dilated cardiomyopathy. It is tasteless and colorless, was used as a poison, and is still marketed as a pesticide against rats and mice. Several long-acting warfarin derivatives-superwarfarin anticoagulants-such as brodifacoum, diphenadione, chlorophacinone, bromadiolone, are used as pesticides and can produce profound and prolonged anticoagulation. Several factors increase the risk of warfarin toxicity. However, polymorphisms in cytochrome P450 genes and drug interactions account for most of the risk for toxicity complications. Each person is unique in their degree of susceptibility to toxic agents. The toxicity interpretation and the health risk of most toxic substances are a subject of uncertainty. Genetically determined low metabolic capacity in an individual can dramatically alter the toxin and metabolite levels from those normally expected, which is crucial for drugs with a narrow therapeutic index, like warfarin. Personalized approaches in interpretation have the potential to remove some of the scientific uncertainties in toxicity cases.     

临床药师参与1例华法林抵抗患者的抗凝治疗实践

目的:探讨临床药师在心脏瓣膜置换患者华法林个体化抗凝治疗及抗凝管理中的作用。方法:临床药师参与胸心外科1例华法林抵抗患者抗凝治疗用药方案的制订及对患者进行抗凝指导和出院后抗凝随访。结果:临床药师依据基因检测对患者实施个体化抗凝治疗,建议医师将华法林剂量调整为5.625 mg/d,使国际标准化比值达到目标抗凝范围。患者在抗凝期间未发生严重的出血或血栓栓塞等不良事件。患者出院后,临床药师对其进行6个月抗凝随访,调整华法林抗凝方案,并使华法林剂量维持至8.125mg/d。结论:临床药师把握工作切入点,并且通过对患者住院及出院后实施全程化抗凝管理,充分体现临床药师的职业价值,也彰显临床药师在药物治疗团队的作用和地位。     

1例长期服用华法林患者围手术期的抗凝策略

目的：探索长期接受抗凝治疗患者围手术期的抗凝治疗策略,体现临床药师参与药物治疗的作用。方法：回顾临床药师参与1例长期接受华法林抗凝治疗患者围手术期抗凝方案,结合相关的文献资料,从药物的选择、使用时机、剂量、疗程等方面进行分析。结果：临床药师结合药动学知识,制定抗凝方案,最大程度上降低了患者出血和栓塞的风险。结论：围手术期应该至少提前5d停用华法林,并监测国际标准化比值（INR）;术后无继续出血可在12h内开始使用低分子肝素,同时服用华法林,并监测INR,待达标后停用低分子肝素。如果患者要连续进行多次手术,则在整个手术期间建议使用低分子肝素进行抗凝。     

抗菌药物不合理应用案例分析

目的:调查上海市松江区中心医院抗菌药物的应用情况,为规范抗菌药物的使用,控制药占比提供依据.方法:对本院住院病案进行回顾性统计,记录病人的基本情况、疾病诊断、用药前后实验室检查结果、手术和用药情况等,对抗菌药物的使用合理性进行分析和评价.结果:共调查住院病案1 176份,其中857份使用了抗菌药物,517份存在不合理用药情况,抗菌药物使用率为72.87%,抗菌药物不合理使用比例为60.33%.结论:本院住院病人抗菌药物使用率高,存在各种情况的不合理用药,需要制定有力的措施来纠正抗菌药物滥用和不合理应用的现象.     

一例他克莫司引起血糖升高的用药分析

在临床工作中药师发现患者因膜性肾病使用他克莫司,引起继发性糖尿病1例,通过查阅文献对于患者此次出现血糖升高的机制和治疗策略展开讨论,指导患者正确使用降糖药物,患者目前血糖控制良好。临床工作中应重视他克莫司诱发的继发性糖尿病,正确认识并合理使用降糖药物。     

Potential drug interactions with antibacterials in long-term care facilities analyzed by two interaction checkers

International Journal of Clinical Pharmacy - Background Residents in long-term care facilities take many medications concomitantly, including antibacterials, which increases the risk of...