請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/38194
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 高純琇 | |
dc.contributor.author | Tzu-Ying Chen | en |
dc.contributor.author | 陳姿穎 | zh_TW |
dc.date.accessioned | 2021-06-13T16:27:46Z | - |
dc.date.available | 2008-08-02 | |
dc.date.copyright | 2005-08-02 | |
dc.date.issued | 2005 | |
dc.date.submitted | 2005-07-14 | |
dc.identifier.citation | 1. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. Drug Intelligence & Clinical Pharmacy. 1990;24(11):1093-1097.
2. Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Archives of Internal Medicine. 1995;155(18):1949-1956. 3. Mok H, Mulpeter K, O'Connor P, Feely J. Drug-drug interactions in hospital. Irish Medical Journal. 1991;84(1):26. 4. Kelly WN. Potential risks and prevention, Part 2: Drug-induced permanent disabilities. American Journal of Health-System Pharmacy. 2001;58(14):1325-1329. 5. Marcellino K, Kelly WN. Potential risks and prevention, Part 3: Drug-induced threats to life. American Journal of Health-System Pharmacy. 2001;58(15):1399-1405. 6. Grymonpre RE, Mitenko PA, Sitar DS, Aoki FY, Montgomery PR. Drug-associated hospital admissions in older medical patients. Journal of the American Geriatrics Society. 1988;36(12):1092-1098. 7. Jankel CA, Fitterman LK. Epidemiology of drug-drug interactions as a cause of hospital admissions. Drug Safety. 1993;9(1):51-59. 8. Stanton LA, Peterson GM, Rumble RH, Cooper GM, Polack AE. Drug-related admissions to an Australian hospital. Journal of Clinical Pharmacy & Therapeutics. 1994;19(6):341-347. 9. 中央健康保險局網站。http://www.nhi.gov.tw/ 10. 國家衛生研究院網站。http://www.nhri.org.tw/nhird/date_04.htm 11. Harris EC, Barraclough B. Excess mortality of mental disorder. British Journal of Psychiatry. 1998;173:11-53. 12. Warner JP, Barnes TR, Henry JA. Electrocardiographic changes in patients receiving neuroleptic medication. Acta Psychiatrica Scandinavica. 1996;93(4):311-313. 13. Reilly JG, Ayis SA, Ferrier IN, Jones SJ, Thomas SH. QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet. 2000;355(9209):1048-1052. 14. Thomas SH. Drugs, QT interval abnormalities and ventricular arrhythmias. Adverse Drug Reactions & Toxicological Reviews. 1994;13(2):77-102. 15. Zarate CA, Jr., Patel J. Sudden cardiac death and antipsychotic drugs: do we know enough? Archives of General Psychiatry. 2001;58(12):1168-1171. 16. Buckley NA, Sanders P. Cardiovascular adverse effects of antipsychotic drugs. Drug Safety. 2000;23(3):215-228. 17. Bigger JT, Jr., Weld FM. Drugs and sudden cardiac death. Annals of the New York Academy of Sciences. 1982;382:229-237. 18. Buckley NA, Whyte IM, Dawson AH. Cardiotoxicity more common in thioridazine overdose than with other neuroleptics. Journal of Toxicology - Clinical Toxicology. 1995;33(3):199-204. 19. Haverkamp W, Breithardt G, Camm AJ, et al. The potential for QT prolongation and pro-arrhythmia by non-anti-arrhythmic drugs: clinical and regulatory implications. Report on a Policy Conference of the European Society of Cardiology. Cardiovascular Research. 2000;47(2):219-233. 20. Glassman AH, Bigger JT, Jr. Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. American Journal of Psychiatry. 2001;158(11):1774-1782. 21. Binggeli C, Candinas R, Brunckhorst C. Psychopharmaceuticals and arrhythmias. Therapeutische Umschau. 2004;61(4):279-283. 22. Kelly HG, Fay JE, Laverty SG. Thioridazine Hydrochloride (Mellaril): Its Effect on the Electrocardiogram and a Report of Two Fatalities with Electrocardiographic Abnormalities. Canadian Medical Association Journal. Sep 14 1963;89:546-554. 23. Schoonmaker FW, Osteen RT, Greenfield JC, Jr. Thioridazine (mellaril)-induced ventricular tachycardia controlled with an artificial pacemaker. Annals of Internal Medicine. Nov 1966;65(5):1076-1078. 24. Wendkos MH. Cardiac changes related to phenothiazine therapy, with special reference to thioridazine. Journal of the American Geriatrics Society. 1967;15(1):20-28. 25. Giles TD, Modlin RK. Death associated with ventricular arrhythmia and thioridazine hydrochloride. The Journal of the American Medical Association. Jul 8 1968;205(2):108-110. 26. Burda CD. Electrocardiographic abnormalities induced by thioridazine (Mellaril). American Heart Journal. Aug 1968;76(2):153-156. 27. Fletcher GF, Kazamias TM. Cardiotoxic effects of Mellaril: conduction disturbances and supraventricular arrhythmias. American Heart Journal. Jul 1969;78(1):135-138. 28. Levine DF, Marshall AJ. Letter: Cardiac arrhythmia induced by phenothiazine. Lancet. Nov 15 1975;2(7942):990. 29. Thornton WE, Pray BJ. Ventricular arrhythmia and thioridazine: a case report. American Journal of Nursing. 1976;76(2):245-246. 30. Fowler NO, McCall D, Chou TC, Holmes JC, Hanenson IB. Electrocardiographic changes and cardiac arrhythmias in patients receiving psychotropic drugs. American Journal of Cardiology. Feb 1976;37(2):223-230. 31. Chouinard G, Ghadirian AM, Jones BD. Death attributed to ventricular arrhythmia induced by thioridazine in combination with a single Contac C capsule. Canadian Medical Association Journal. 1978;119(7):729-730. 32. Khan MM, Logan KR, McComb JM, Adgey AA. Management of recurrent ventricular tachyarrhythmias associated with Q-T prolongation. American Journal of Cardiology. Jun 1981;47(6):1301-1308. 33. Kemper AJ, Dunlap R, Pietro DA. Thioridazine-induced torsade de pointes. Successful therapy with isoproterenol. The Journal of the American Medical Association. Jun 3 1983;249(21):2931-2934. 34. Liberatore MA, Robinson DS. Torsade de pointes: a mechanism for sudden death associated with neuroleptic drug therapy? Journal of Clinical Psychopharmacology. 1984;4(3):143-146. 35. Flugelman MY, Tal A, Pollack S, et al. Psychotropic drugs and long QT syndromes: case reports. Journal of Clinical Psychiatry. 1985;46(7):290-291. 36. Kiriike N, Maeda Y, Nishiwaki S, et al. Iatrogenic torsade de pointes induced by thioridazine. Biological Psychiatry. 1987;22(1):99-103. 37. Paoloni P, Ciliberti D, Blasi N, Capone P. Iatrogenic torsade de pointes induced by thioridazine. Minerva Cardioangiol. Jun 1992;40(6):245-249. 38. Tatro DS. Drug Interaction Facts. St. Louis, Missouri: Facts and Comparisons; 2005. 39. 吳啟誠、張懷嘉等人,加護病房內藥物交互作用之考量,中華民國重症醫學雜誌,民國89年,頁300-311。 40. 謝業洪,藥物交互作用,第一版,民國88年,實優資訊有限公司。 41. 陳佳君,簡介藥物交互作用--以Digoxin為例。臨床藥學雜誌第十五期,民國88年,頁130-136。 42. 張豫立、周美惠,藥物交互作用,臨床醫學第三十八期,民國85年,頁403-410。 43. Hull JH, Murray WJ, Brown HS, Williams BO, Chi SL, Koch GG. Potential anticoagulant drug interactions in ambulatory patients. Clinical Pharmacology & Therapeutics. Dec 1978;24(6):644-649. 44. Hansten PD. Drug interactions. 3 ed. Philadelphia: Lea & Febiger; 1975. 45. Jinks MJ, Hansten PD, Hirschman JL. Drug interaction exposures in an ambulatory Medicaid population. American Journal of Hospital Pharmacy. Jul 1979;36(7):923-927. 46. Miyasaka LS, Atallah AN. Risk of drug interaction: combination of antidepressants and other drugs. Revista de Saude Publica. 2003;37(2):212-215. 47. Carter BL, Lund BC, Hayase N, Chrischilles E. The extent of potential antihypertensive drug interactions in a Medicaid population. American Journal of Hypertension. Nov 2002;15(11):953-957. 48. 田俊雄,急診處方藥物交互作用之研究,醫院藥學,民國88年,頁30-43。 49. 李秀月,含Digoxin處方其藥物交互作用之研究,中山大學醫學研究所碩士論文,民國90年。 50. 王博彥,各層級醫療院所門診藥物交互作用分析-以全民健康保險學術研究資料庫為例,臺北醫學大學醫學資訊研究所碩士論文,民國92年。 51. Food and Drug Administration, US Department of Health and Human Services. Important drug warning [Mellaril]. [Retyped text of a letter from Novartis Pharmaceuticals Corporation, East Hanover, NJ, 2000 July 7.] www.fda.gov/medwatch/safety/2000/mellar.htm 52. Important drug warning: Mellaril. Dorval (QC): Novartis Pharmaceuticals Canada Inc., 2000 July 31. http://www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/mellaril_e.pdf 53. CSM. Current Problem in Pharmacovigilance. Feb 2001;27. 54. MHRA press releases.11 December 2000. http://www.mca.gov.uk/whatsnew/pressreleases/thioridazinepressrelease.htm 55. CSM. Thioridazine:restricted indications and new warnings on cardiotoxicity.December 2000. 56. News & Updates,25 January 2005. www.druginfozone.nhs.uk 57. MARC Minutes of the 105th meeting. http://www.medsafe.govt.nz/Profs/adverse/Minutes105.htm 14/03 2001 58. Medsafe. Prescriber Update. June 2001;21:4-7. 59. MARC Minutes of the 120th meeting. http://www.medsafe.govt.nz/profs/adverse/Minutes120.htm 60. http://www.health.gov.mt/mru/pub/ma_thioridazine.pdf 61. IMB.Drug Safety Newsletter.April 2001.NO.12. http://www.imb.ie/uploads/publications/745612_Issue%2012.pdf 62. WHO Pharmaceuticals Newsletter. 2000.No.4. http://www.who.int/medicines/library/pnewslet/npn0400.html 63. HSA. Product Safety Alerts. 31 March 2005. http://www.hsa.gov.sg/docs/safetyalert_thioridazine_31Mar05.pdf 3/. 64. MICROMEDEX(R) Healthcare Series [computer program]. Version; 2005. 65. WHO Collaborating Centre for Drug Statistics Methodology,ATC classification index with DDDs2005. Oslo; 2004. 66. McEvoy GK,editor. American Hospital Formulary Service. Bethesda: American Society of Health-System Pharmacists; 2005. 67. Waraich PS, Adams CE, Roque M, Hamill KM, Marti J. Haloperidol dose for the acute phase of schizophrenia. Cochrane Database of Systematic Reviews. 2002(3):CD001951. 68. Quraishi S, David A. Depot haloperidol decanoate for schizophrenia. Cochrane Database of Systematic Reviews. 2000(2):CD001361. 69. 陳姿婷、張文和,精神分裂症之多重用藥,生物精神醫學暨神經精神藥理學通訊,第一卷第二期,民國92年。 70. Stahl SM. Antipsychotic polypharmacy, Part 1: Therapeutic option or dirty little secret? Journal of Clinical Psychiatry. 1999;60(7):425-426. 71. 行政院衛生署網站,西醫、醫療器材、化妝品許可證查詢。 http://203.65.100.151/DO8180.asp 72. Wilt JL, Minnema AM, Johnson RF, Rosenblum AM. Torsade de pointes associated with the use of intravenous haloperidol. Annals of Internal Medicine. 1993;119(5):391-394. 73. Di Salvo TG, O'Gara PT. Torsade de pointes caused by high-dose intravenous haloperidol in cardiac patients. Clinical Cardiology. 1995;18(5):285-290. 74. Jackson T, Ditmanson L, Phibbs B. Torsade de pointes and low-dose oral haloperidol. Archives of Internal Medicine. 1997;157(17):2013-2015. 75. O'Brien JM, Rockwood RP, Suh KI. Haloperidol-induced torsade de pointes. Annals of Pharmacotherapy. 1999;33(10):1046-1050. 76. Hassaballa HA, Balk RA. Torsade de pointes associated with the administration of intravenous haloperidol:a review of the literature and practical guidelines for use. Expert Opinion on Drug Safety. 2003;2(6):543-547. 77. Hassaballa HA, Balk RA. Torsade de pointes associated with the administration of intravenous haloperidol. American Journal of Therapeutics. 2003;10(1):58-60. 78. Ochiai H, Kashiwagi M, Usui T, Oyama Y, Tokita Y, Ishikawa T. Torsade de Pointes with T wave alternans in a patient receiving moderate dose of chlorpromazine: report of a case. Kokyu to Junkan - Respiration & Circulation. Aug 1990;38(8):819-822. 79. Hoehns JD, Stanford RH, Geraets DR, Skelly KS, Lee HC, Gaul BL. Torsades de pointes associated with chlorpromazine: case report and review of associated ventricular arrhythmias. Pharmacotherapy. Jul 2001;21(7):871-883. 80. Shivkumar K. Images in cardiovascular medicine. Labile repolarization from 'cell to bedside'. Circulation. Aug 15 2000;102(7):817-818. 81. Verdun F, Mansourati J, Jobic Y, et al. Torsades de pointe with spiramycine and metiquazine therapy. Apropos of a case. Archives des Maladies du Coeur et des Vaisseaux. Jan 1997;90(1):103-106. 82. Roe CM, Odell KW, Henderson RR. Concomitant use of antipsychotics and drugs that may prolong the QT interval. Journal of Clinical Psychopharmacology. 2003;23(2):197-200. 83. Rubin RH CR, Tolkoff-Rubin NE. Brenner and Rector's The Kidney. 5 ed. Philadelphia: W.B. Saunders Company; 1996. 84. Hamilton-Miller JM. Issues in urinary tract infections in the elderly. World Journal of Urology. 1999;17(6):396-401. 85. Herve J, Santin A, Hinglais E, Lejonc JL, Roupie E. Urinary tract infections in the elderly. Presse Medicale. 2000;29(39):2137-2141. 86. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Disease-A-Month. 2003;49(2):53-70. 87. Strain JJ, Caliendo G, Alexis JD, Lowe RS, 3rd, Karim A, Loigman M. Cardiac drug and psychotropic drug interactions: significance and recommendations. General Hospital Psychiatry. 1999;21(6):408-429. 88. Strain JJ, Caliendo G, Alexis JD, Karim A, Loigman M, Lowe IR. Cardiac drug and psychotropic drug interactions: significance and recommendations. Heart Disease. 2001;3(4):248-262. 89. Alderman CP. Patient-oriented strategies for the prevention of drug interactions. Drug Safety. 2000;22(2):103-109. 90. Hennessy S, Bilker WB, Knauss JS, et al. Cardiac arrest and ventricular arrhythmia in patients taking antipsychotic drugs: cohort study using administrative data. British Medical Journal. 2002;325(7372):1070. 91. Glassman AH. Clinical management of cardiovascular risks during treatment with psychotropic drugs. Journal of Clinical Psychiatry. 2002;63(Suppl 9):12-17. 92. 「醫療機構設置標準」法規:民國76年9月16日行政院衛生署發布,92年5月14日修正。 | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/38194 | - |
dc.description.abstract | 藥物交互作用(Drug-Drug Interaction,DDI)可能導致藥物不良反應的發生,甚至死亡。文獻指出有些抗精神病藥物會延長QT 間隔,可能造成torsade de pointes,甚至猝死;其中又以thioridazine之危險性較高,而藥物交互作用在很多因藥物引發QT間隔延長而致死的病例中扮演著重要角色。2000年7月起,世界各國衛生單位先後發佈thioridazine藥物安全警訊,將會抑制CYP 2D6活性或可能延長QT 間隔的藥物列為併用禁忌,以提醒重視thioridazine可能的心臟毒性。
本研究使用全民健康保險研究資料庫中「精神疾病住院病患歸人檔(Psychiatric Inpatient Medical Claim Dataset,簡稱PIMC)」,目的在分析台灣精神分裂症病患使用thioridazine之相關潛在嚴重藥物交互作用發生情形,並探討病患特質與處方型態,以及各醫療機構潛在嚴重藥物交互作用處方分布情形。 利用MICROMEDEX®與Drug Interaction Facts建立與thioridazine有潛在嚴重藥物交互作用的藥物檔,依此藥物檔來比對住院診斷為精神分裂症(ICD-9:295),且曾於住院或門診處方thioridazine的病患,其1997年至2001年的處方。將住院期間有開立thioridazine和與其具潛在嚴重藥物交互作用的藥品之住院記錄,列為住院病患有DDI之案例。門診處方則係利用比對藥品之用藥期間,有任何一日重疊者視為併用,依此篩選出同一處方和不同處方間有thioridazine相關DDI之處方。 研究結果發現,住院和門診使用thioridazine之精神分裂症病患,暴露在與thioridazine相關之潛在嚴重藥物交互作用發生情形,無論是依處方數或人數分析,在1997年至2001年各年度DDI組合發生率較高的藥品是haloperidol(>15.9%)、propranolol(>15.9%)、chlorpromazine(>3.5%)、lithium(>8.6%)、risperidone(除1997年外,>4.6%)和trifluoperazine(>2.9%)。 1997年至2001年門診使用thioridazine的病患,有55.4%∼59.7%的人曾暴露在同一處方DDI;65.2%∼68.9%的人曾暴露在不同處方間DDI;整體而言有75.0%∼77.4%的人曾暴露在thioridazine相關的DDI。同一期間,門診thioridazine的處方中,49.2%∼55.2%的處方有同一處方DDI;51.8%∼55.3%的處方有不同處方間DDI;59.2%∼65.0%的處方有thioridazine相關DDI。 病患之性別與是否發生DDI並無相關性;曾暴露在DDI的病患之平均每年門診就醫次數(25.3∼29.9次)比未曾暴露在DDI的病患(17.2∼20.3次)多(p<0.0001),顯示出就醫次數愈多的病患,愈容易暴露於thioridazine相關潛在藥物交互作用的風險中。有DDI之thioridazine處方的平均藥品品項數(5.3∼5.5項)比無DDI之處方的品項數(3.8∼4.1項)多(p<0.0001),且發現隨著開方藥品品項數愈多,DDI發生率愈高。有DDI之處方的thioridazine平均每日劑量(124.8∼143.2毫克)較無DDI之處方(150.3∼183.6毫克)低(p<0.0001)。且在有DDI的處方中,有併用其他與thioridazine有DDI之抗精神病藥物組之thioridazine平均每日劑量(120.5∼134.3毫克),較沒有併用組(143.7∼178.1毫克)顯著地低(p<0.0001)。推測在抗精神病藥物的多重用藥情況下,醫師會有降低個別抗精神病藥物劑量的傾向,或可能thioridazine是作為輔助性藥物而非主要治療藥物,以致有併用抗精神病藥物組之thioridazine平均每日劑量較低的結果。 各特約類別醫事機構於1998年至2001年皆以「醫學中心」及「基層院所」之DDI發生率較高;權屬別分析發現「私立」醫事機構的DDI發生率大於「公立」,且其中「私立診所」的DDI發生率逐年上升;型態別分析卻發現只有「一般診所醫務室」的DDI發生率大幅上升,其他型態別包括「專科診所」的DDI發生率則是有下降之趨勢。顯然「私立診所」之DDI發生率逐年上升的現象,其實是反應「一般診所醫務室」之DDI發生率的增加。另一方面,除了1999年外之各年度,皆顯示型態別是否為「精神科醫院」與是否同一處方有thioridazine相關DDI有高度相關性。推測可能與第二代抗精神病藥物問市後,減少第一代抗精神病藥物的使用有關。分析各地區DDI發生率則以「中區」和「南區」較高。 研究也發現,精神分裂症病患之thioridazine處方主要仍由精神科所開方(92.6%∼93.9%)。Type B-DDI處方對之處方來源分析顯示,其他精神科相關用藥的處方與thioridazine處方有併用的情形,主要來自相同醫事機構之開方,且有極高比例處方對之兩藥品處方皆來自精神科。 由本研究結果顯示,1997年至2001年thioridazine處方之相關潛在嚴重交互作用發生率很高,其中以與精神科相關用藥的併用較普遍。雖然thioridazine的處方量及使用人數已逐年降低,但相較於國際上各國衛生單位自2000年7月起紛紛發佈thioridazine藥物安全警訊,我國中央衛生主管機關對藥物安全的管理仍應有努力空間。 | zh_TW |
dc.description.abstract | Background: Drug-drug interactions (DDIs) may contribute to the occurance of adverse drug reactions, and unfortunately may cause death. It is one of the major concerns in clinical practice. It has been well-documented that some antipsychotics may cause QT interval prolongation or torsade de pointes leading to sudden death. The potential cardiotoxicity of thioridazine, in which drug interactions may play an important role, has caught lots of attention than other antipsychotics. The bulletins of the health regulatory agencies in many countries have continuously provided warnings with thioridazine to alert the potential cardiotoxicity of thioridazine since July, 2000. Drugs that may inhibit CYP 2D6 or prolong QT interval are considered as contraindications to combined use with thioridazine.
Objective : The objective of this study is to evaluate potential significant DDIs with thioridazine in patients with schizophrenia from 1997 to 2001 in Taiwan using National Health Insurance Research Database – Psychiatric Inpatient Medical Claim Dataset (PIMC). Method:Criteria for DDIs regarding thioridazine was established based on the information from the MICROMEDEX® software program and Drug Interaction Facts. Patients with schizophrenia, who were prescribed thioridazine in the ambulatory settings from 1997 to 2001 based on the PIMC, were enrolled in this study. Concomitant administration is defined when the dates of prescriptions of drug interaction pairs were overlapped. Results: Our results showed that interactive drugs that most frequently combined with thioridazine (incidence >3.5%) were haloperidol, propranolol, chlorpromazine, lithium, risperidone and trifluoperazine., Of patients who were prescribed thioridazine from 1997 to 2001, 55.4% to 59.7% were exposed to potential risk of thioridazine related DDIs in the same prescription sheet, 65.2% to 68.9% were exposed to potential risk of thioridazine related DDIs from different prescription sheets. Overall, 75.0% to 77.4% were exposed to potential DDIs with thioridazine. According to thioridazine prescriptions, the rates of potential thioridazine-related DDIs in the same prescription sheet were 49.2% to 55.2%; and were 51.8% to 55.3% from different prescription sheets. Overall, the rates of potential DDIs with thioridazine were 59.3% to 65.0% per prescription. We found that polypharmacy is one of the factors that contribute to the high incidence of thioridazine related DDIs. The average daily dose of thioridazine (124.8∼143.2 mg) of the prescriptions with thioridazine related DDIs were lower than that of those without thioridazine related DDIs (150.3∼183.6 mg) (p<0.0001). Moreover, the average daily dose of thioridazine in combination with potential interactive antipsychotics (120.5∼134.3 mg) were lower than that of thioridazine without such combination (143.7∼178.1 mg) (p<0.0001). The dosage difference is most likely because physicians may prescribe thioridazine with low dose under antipsychotics polypharmacy or the thioridazine was used to as an adjunct treatment to other antipsychotics. | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T16:27:46Z (GMT). No. of bitstreams: 1 ntu-94-R92451012-1.pdf: 894409 bytes, checksum: e1a7c3c7e07e05061aab6d77c1651f51 (MD5) Previous issue date: 2005 | en |
dc.description.tableofcontents | 中文摘要 i
英文摘要 v 縮寫或簡稱對照表 vii 中英文名詞對照表 viii 目錄 ix 表目錄 xvi 圖目錄 xxiii 附錄目錄 xxiv 第一章 前言 1 第一節 研究動機 1 第二節 背景分析 3 第二章 文獻探討 5 第一節 藥物交互作用 5 一、 藥物交互作用的定義 5 二、 藥物交互作用之分類 6 三、 藥物交互作用的臨床處理 8 第二節 藥物交互作用研究方法之探討 9 一、 國外之藥物交互作用研究 9 二、 國內之藥物交互作用研究 11 第三節 Thioridazine國際上的使用及限制 13 一、 美國 13 二、 加拿大 14 三、 英國 14 四、 紐西蘭 15 五、 歐盟 18 六、 愛爾蘭 18 七、 日本 19 八、 新加坡 19 第三章 研究目的 20 第四章 研究方法 21 第一節 研究資料 21 第二節 研究對象 23 第三節 研究變項與定義 24 一、 病患特質 24 二、 處方型態 24 三、 醫事機構類別 25 四、 就醫科別 25 第四節 建立與thioridazine有潛在嚴重藥物交互作用的藥物檔 26 第五節 藥品主檔轉碼說明 35 第六節 研究步驟 36 一、 建立與thioridazine有潛在嚴重藥物交互作用的藥物檔 36 二、 分析使用thioridazine之住院病患thioridazine相關潛在嚴重藥物交互作用發生情形 36 三、 分析使用thioridazine之門診病患thioridazine相關潛在嚴重藥物交互作用發生情形 37 四、 結果的描述與分析 40 第七節 各資料檔擷取欄位與自訂欄位 42 第五章 研究結果 45 第一節 資料概述 45 第二節 住院病患各thioridazine相關潛在嚴重藥物交互作用組合之發生情形 47 一、 依處方數分析 47 二、 依病人數分析 48 第三節 門診病患各thioridazine相關潛在嚴重藥物交互作用組合之發生情形 56 一、 Thioridazine相關之Type A-DDI 分析 56 二、 Thioridazine相關之Type B-DDI分析 59 三、 Thioridazine相關之潛在嚴重藥物交互作用分析 61 第四節 門診使用thioridazine之病患特質分析 82 一、 性別 82 二、 年齡 84 三、 每年門診就醫次數 88 第五節 門診thioridazine處方之處方型態分析 90 一、 門診thioridazine處方之藥品品項數分析 90 二、 門診thioridazine處方之平均每日劑量分析 98 三、 門診thioridazine處方之藥物交互作用藥品組合數之分析 101 四、 門診thioridazine平均用藥天數分析 105 五、 有潛在嚴重藥物交互作用之藥品的併用天數分析 105 第六節 依醫事機構類別分析門診thioridazine處方 108 一、 依特約類別分類thioridazine處方之開方醫事機構,分析其thioridazine相關潛在嚴重藥物交互作用的發生率 108 二、 依權屬別分類thioridazine處方之開方醫事機構,分析其thioridazine相關潛在嚴重藥物交互作用的發生率 114 三、 依型態別分類thioridazine處方之開方醫事機構,分析其thioridazine相關潛在嚴重藥物交互作用的發生率 119 四、 依醫事機構所屬健保分局別分析各地區之thioridazine相關潛在嚴重藥物交互作用的發生率 123 第七節 以就醫科別分析門診thioridazine處方 127 第六章 討論 131 第一節 研究限制 131 第二節 門診病患之各thioridazine相關潛在嚴重藥物交互作用組合發生情形與併用合理性 134 一、 發生率較高之與thioridazine具潛在嚴重藥物交互作用的藥品………………………………………………………………….135 二、 Thioridazine與抗憂鬱劑的併用情形 143 三、 Thioridazine與Class I、Class Ia及Class III 抗心律不整藥物的併用情形 146 四、 Thioridazine與仿單上列為併用禁忌之藥物的併用情形 147 第三節 門診使用thioridazine之病患特質與處方型態 148 一、 性別 148 二、 年齡 151 三、 每年門診就醫次數 156 四、 門診thioridazine處方之藥品品項數分析 158 五、 門診thioridazine處方之平均每日劑量分析 159 六、 門診thioridazine處方之藥物交互作用藥品組合數分析 162 七、 門診thioridazine平均用藥天數分析 163 八、 有潛在嚴重藥物交互作用之藥品的併用天數分析 164 第四節 依醫事機構類別分析門診thioridazine處方 166 一、 依特約類別分類thioridazine開方之醫事機構,分析其與潛在嚴重藥物交互作用的關係 166 二、 依權屬別分類thioridazine開方之醫事機構,分析其與潛在嚴重藥物交互作用的關係 169 三、 依型態別分類thioridazine開方之醫事機構,分析其與潛在嚴重藥物交互作用的關係 172 四、 各地區之thioridazine相關潛在嚴重藥物交互作用發生率分析………………………………………………………………….177 五、 Type B-DDI處方對之處方來源分析 179 第五節 以就醫科別分析門診thioridazine處方 192 第六節 預防藥物交互作用發生之策略 194 第七章 結論及建議 197 第一節 結論 197 第二節 建議及未來研究方向 200 一、 對中央衛生主管機關的建議 200 二、 未來研究方向 201 參考文獻 202 | |
dc.language.iso | zh-TW | |
dc.title | 臺灣精神分裂症病患使用thioridazine之潛在嚴重藥物交互作用研究:
全民健康保險研究資料庫分析 | zh_TW |
dc.title | Potential Drug Interactions with Thioridazine in Patients with Schizophrenia in Taiwan:
An analysis of National Health Insurance Research Database | en |
dc.type | Thesis | |
dc.date.schoolyear | 93-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 張景瑞,高淑芬,林慧玲 | |
dc.subject.keyword | 藥物交互作用,精神分裂症,健保資料庫, | zh_TW |
dc.subject.keyword | thioridazine,drug interaction,schizophrenia,torsade de pointes, | en |
dc.relation.page | 218 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2005-07-14 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床藥學研究所 | zh_TW |
顯示於系所單位: | 臨床藥學研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-94-1.pdf 目前未授權公開取用 | 873.45 kB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。