Pay attention to the dosing regimen and monitoring of drugs!
发布日期:
2024-11-13
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NEWS


Recently, a piece of news has attracted widespread attention, drawing attention to the safe use of medication. According to Fujian Health News reported on October 18, 40-year-old Ms. Zhang (a pseudonym) in Fuzhou, Fujian, with a history of hypertension for more than a year, bit off the antihypertensive drug with her teeth and ate most of the tablet. Eventually, due to low blood pressure unconsciousness was sent to the local hospital for treatment. It turned out that Ms. Zhang was taking nifedipine controlled-release tablets, a drug 1 tablet equivalent to the dose of 3 ordinary nifedipine tablets. Once chewed, broken, and ground to take, large doses of antihypertensive drugs will be instantly released into the body resulting in a sudden and significant drop in blood pressure.

In addition, Hangzhou First People's Hospital reported that it had recently diagnosed a case of brain atrophy in a 23-year-old nurse named Xiao Tu. The patient, a 23-year-old nurse, had a history of epilepsy for more than six years, and had been taking “loose drugs” provided by a primary healthcare organization without controlling the dosage, which led to a serious overdose of phenytoin sodium in her body. Phenytoin sodium is an antiepileptic drug that has long been widely used in clinical practice, and its therapeutic window is quite narrow. When the blood concentration exceeds the therapeutic window, it is easy to produce toxic reactions. Currently, there is no antidote for phenytoin sodium poisoning, which means that Xiaotu's cerebellar atrophy is irreversible.

Similar such painful cases have been staged, so for the majority of the need for long-term use of drugs, especially the toxic effect of the most effective means of prevention of the population is to standardize the use of drugs, do not arbitrarily change the doctor's orders, on time and in accordance with the amount of medication, and with the monitoring of the blood drug concentration, to ensure that the efficacy of the same time to minimize the side effects.



Which medications require therapeutic drug monitoring?


1.Drugs with a close relationship between blood concentration and efficacy.




2.Drugs with a low therapeutic index and a strong toxic response (digoxin, theophylline, antiarrhythmics, aminoglycoside antibiotics, antiepileptics, methotrexate, lithium, etc.).




3.Drugs for which the effective therapeutic concentration range has been determined.




4. Drugs with non-linear kinetic properties. These drugs in a certain dose, the body of drug metabolism enzyme or transfer carrier saturation, the emergence of a mixed process of first-order and zero-level kinetics, when the dose is slightly increased, the blood concentration will rise sharply, t1/2 significantly prolonged, and produce symptoms of toxicity, such as phenytoin, ponadolol, and so on.




5. When it is difficult to distinguish the toxic reaction of drugs from the symptoms of diseases, it is because of insufficient dosage of drugs or because of overdose poisoning, such as digoxin.




6.Drugs used to prevent and treat some chronic diseases (e.g. theophylline, antiepileptic drugs, anti-arrhythmic drugs), it is not easy to judge the efficacy quickly, and the dosage can be adjusted appropriately through the measurement of steady state blood concentration.




7.Treatment can have serious consequences if it fails.




8.Suffering from heart, liver, kidney and gastrointestinal tract and other organs, can significantly affect the absorption, distribution, metabolism and excretion of drugs in vivo process, blood concentration changes, need to be monitored.




9.To determine in individual cases whether the patient is taking the drug as prescribed.




10.The need to provide a medico-legal basis for treatment.





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Pay attention to the dosing regimen and monitoring of drugs!

Pay attention to the dosing regimen and monitoring of drugs!






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