98 年度台北縣藥師公會社區藥局用藥照護諮詢站

98年度台北縣藥師公會社區藥局用藥照護諮詢站98年度台北縣藥師公會社區藥局用藥照護諮詢站居家藥事服務個案研討前回春藥局陳雅德藥師

居家個案研討 前回春藥局陳雅德藥師

居家個案研討 第一次訪視前回春藥局陳雅德藥師

居家個案研討 HMG-CoA Reductase Inhibitors Amiodarone Atorvastatin (Lipitor) Amiodarone* (eg,Cordarone) Lovastatin (eg,Mevacor) Simvastatin* (eg,Zocor) Significance1 Onset ☆ Rapid★ Delayed Severity★ Major☆ Moderate☆ Minor Documentation★ Major☆ Moderate☆ Minor ☆ Established ☆ Probable★ Suspected☆ Possible☆ Unlikely 前回春藥局陳雅德藥師

居家個案研討 Effects: Plasma concentrations of certain HMG-CoA REDUCTASE INHIBITORS may be elevated, increasing the risk of toxicity (eg, myositis, rhabdomyolysis). Mechanism: Inhibition of HMG-CoA REDUCTASE INHIBITOR metabolism (CYP3A4) is suspected. Management: If coadministration of these agents cannot be avoided, use the lowest possible HMG-CoA REDUCTASE INHIBITOR dose and advise patients to immediately report any unexplained muscle pain, tenderness, or weakness. Fluvastatin (Lescol), pravastatin (eg,Pravachol), and rosuvastatin (Crestor) are not metabolized by CYP3A4 and may be safer alternatives. 前回春藥局陳雅德藥師

居家個案研討 Discussion: Several cases of rhabdomyolysis, azotemia, and increased liver function tests have been reported when high-dose simvastatin 40 to 80 mg/day was given with amiodarone.1-3 Severe myopathy developed in a 63-year-old man receiving simvastatin 400 mg/day 21 days after amiodarone 1,000 mg/day for 10 days followed by 200 mg/day was added to his treatment regimen.1 The patient developed diffuse muscle pain with generalized weakness, and his creatine kinase level was elevated, peaking at 40,392 units/L. Simvastatin and amiodarone were stopped. The creatine kinase normalized over the next 8 days, and the patient made an uneventful recovery. The pharmacokinetics of simvastatin or pravastatin were studied in 12 healthy volunteers following 3 days of amiodarone 400 mg/day.4 Amiodarone increased simvastatin lactone and simvastatin acid AUCs 73% and 78%, respectively. Pravastatin levels were not affected. 前回春藥局陳雅德藥師

居家個案研討 第二次訪視前回春藥局陳雅德藥師

居家個案研討 SulfonylureasLoop Diuretics Chlorpropamide (eg,Diabinese) Bumetanide (eg,Bumex) Glimepiride (eg,Amaryl) Ethacrynic Acid (eg,Edecrin) Glipizide (eg,Glucotrol) Furosemide (eg,Lasix) Glyburide (eg,DiaBeta) TolazamideTolbutamide (eg,Orinase) Significance 5 Onset ☆ Rapid★ Delayed Severity ☆ Major☆ Moderate★ Minor Documentation ☆ Established☆ Probable☆ Suspected★ Possible ☆ Unlikely 前回春藥局陳雅德藥師

居家個案研討 Effects: LOOP DIURETICS may decrease glucose tolerance, resulting in hyperglycemia in patients previously well controlled on SULFONYLUREAS. Discussion: Although some data suggest that loop diuretics are capable of causing hyperglycemia or altered carbohydrate metabolism, other studies report no significant alteration in blood sugar or carbohydrate metabolism.1-9No studies have been published that specifically examine the effect of the addition of a loop diuretic to the regimen of a non-insulin-dependent diabetic patient controlled on a sulfonylurea. Such controlled trials are necessary to clarify the importance of this interaction. 研究報告發現當loop diuretics類與sulfonylureas類併用時，loop diuretics可能會降低葡萄糖耐受性，以致先前用sulfonylureas控制很好的病人出現高血糖，其作用機轉不明。報告發現，loop diuretics可能會改變碳水化合物之代謝，甚至導致血糖增高。這類對照組的試驗仍需澄清此交互作用的意義，依據現有資料，當病人併用兩藥時，治療上並不需建議任何改變。前回春藥局陳雅德藥師

感謝聆聽 前回春藥局陳雅德藥師

98 年度台北縣藥師公會 社區藥局用藥照護諮詢站