某醫學中心癌症病患使用口服抗癌藥品之藥物交互作用處方評估

The Evaluation of Drug Interaction of Oral Anti-Cancer Prescriptions in Cancer Patients

林凱逸(Kai-Yi Lin)

指導教授 ： 吳信昇

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2007年)

摘要

目的：
探討使用潛在口服抗癌藥品之癌症病患，其門診處方發生潛在藥物
交互作用的比例、嚴重度、類型、影響與處置，和目前藥物交互作用電腦警示之成效。
方法：
本研究為回溯性研究，研究材料來自南部某醫學中心醫事處健保行
政申報資料。研究對象為2007 年1-12 月於門診處方使用口服抗癌藥品的癌症病患。藥品交互作用資料依據Drug Interaction Facts,version 4.0。病患資料和用藥數據以Microsoft Access 和Excel 進行篩選，再以病歷回顧方式，確認病患的基本資料、用藥記錄、潛在藥品交互作用的類型、潛在藥品交互作用的影響與處置等。
結果：
本研究分析使用口服抗癌藥品處方的門診癌症病患共2,482 人，發生潛在藥物交互作用的比例為7.9%。潛在藥物交互作用處方的嚴重度最常見為中度(60.8%)和重度(39.2%)。潛在藥物交互作用最常見的口服抗癌藥品為methotrexate (78.5%) ，而非抗癌藥品為warfarin、抗高血壓藥品和phenytoin。潛在藥物交互作用處方的影響，口服抗癌藥品方面最常造成抗癌藥品的療效或毒性增加，而非抗癌藥品最常見的是增加warfarin 的抗凝血活性和增加phenytoin 的血中濃度。電腦警示之成效，電腦警示之偵測率為68.1%，受電腦警示的處方，大部份醫師均會更改醫囑，只有2筆處方沒有更改，所以醫囑修改率為99.7%。
結論：
依本研究結果顯示使用口服抗癌藥品的門診癌症病患的處方，不少
比例有嚴重、跨處方不易避免的藥物交互作用，且藥物交互作用電腦警示系統未將之列入警示項目或沒有偵測到，而未被監測和注意。所以建議定期確效電腦警示系統和增加藥物交互作用的品項，尤其是對較常發生和臨床影響較嚴重的藥物交互作用與建議健保卡能增加呈現病患用藥紀錄之功能，列入藥物交互作用中電腦偵測的範圍。
關鍵字：口服抗癌藥品處方、藥物交互作用評估

關鍵字

口服抗癌藥品處方 ； 藥物交互作用評估

並列摘要

PURPOSE:
We attempted to evaluate incidence, severe-degree, classification, influence and management and detection rate of computer alarm system for potential drug interactions among ambulatory patients who using oral
anticancer agents.
METHODS:
A retrospective study design was implemented using administrative claims data from a medical center in the southern part of Taiwan (index data of ambulatory patients who using oral anticancer agents between January 2007 and December 2007). Data of potential drug interactions are defined according to Drug Interaction Facts, version 4.0. Basic data of patients and medication records were identified with Microsoft Access and Excel. Chart
review was performed to confirm the patient basic data, medication record, classification, influence and management of potential drug interactions.
RESULTS:
The survey was analyzed from 2,482 patients using oral anticancer agents. We observed that incidence of potential drug interactions is 7.9%. Among prescriptions with severe-degree of potential drug interaction, 39.2% are classified as major and 60.8% as moderate. Oral anticancer agent that has the most potential drug interactions with other drugs is methotrexate, and warfarin, antihypertensives and phenytoin are non-anticancer agents that have the most potential drug interactions with oral anticancer agents. The most influences of potential drug interactions from oral anticancer agents are increased effect and toxicity of anticancer agent. The most influences from non-anticancer agents are increased anticoagulant activity of warfarin and increased concentration of phenytoin. The detection rate of computer is 68.1%.
The prescriptions detected by alarm system, almost were corrected by the most physicians, and only two prescriptions were uncorrected. Corrected rate of prescription of potential drug interaction order is 99.7%.
CONCLUSIONS:
We found that there were some severe and even unpreventable potential drug interactions among cancer patients receiving oral anticancer agents in outpatient settings. And the influences of potential drug interactions didn’t be monitored or taken care, because the drug interaction items weren’t included or recognized by the computer alarm system. So we suggest that computer
alarm system should be validated routinely, and especially the drug interaction items with most common and severe potential drug interaction shall be added into computer alarm system and advise to add the function of medication history shown in Health Insurance Card which will led the
computer alarm system of the hospital to detect the potential drug interactions
Keyword: oral anti-cancer prescriptions, evaluation of drug interaction

並列關鍵字

oral anti-cancer prescriptions ； evaluation of drug interaction

參考文獻

參考文獻

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