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如何在臨床工作中找到實證解答?
臺大醫院藥師 陳建豪
2015.07.23
2015 Micromedex
使用者分享大會
自我介紹-Who Am I?
1
 台大臨床藥學研究所
 Ohio State University
海外交換計畫
 台大醫院藥劑部藥師
 住院藥局
 門診藥局
 急診藥局
 每日一冷
 Mr. Thursday Jr.
2
病人
同事
醫療
團隊
電話
諮詢
醫師
學生自己
病人
家屬
Outline
 Find an evidence-based answer
 FDA & Non-FDA Uses
 Pharmacodynamics & Pharmacokinetics
 Comparative Efficacy
...
What we’ve known….
4
 Case-oriented
user experiences
 Clinical pharmacists
 General pharmacists
 Drug information
 藥師...
Case 1
5
 65歲男性,懷疑因MRSA造成腦膜炎而住院,病
人過去住院有vancomycin過敏紀錄(skin rash)。
 醫師詢問:對vancomycin過敏的病人是否可以改
用teicoplanin進行治療?
 Adver...
Case 2
13
 65歲男性,有心衰竭病史,本次因懷疑因MRSA
造成骨髓炎而住院。
 醫師詢問使用vancomycin或teicoplanin治療
MRSA造成的骨髓炎是否有實證上的差異?
 Comparative Efficacy...
14
Teicoplanin vs. Vancomycin
15
 Comparative efficacy
 Less nephrotoxicity
 Less CNS penetration
 Once-daily dosing (for...
Other instances
 Ticagrelor (Brilinta®)
 Comparative efficacy: acute coronary syndrome
 Doripenem (Finibax®)
 Place in...
Drug Interactions
 User friendly
 Index by drug name / brand name
 Various contents
 – Food, – Tobacco, – Ethanol,
– L...
1) Warfarin – Benzbromarone
2) Warfarin – Cefmetazole
3) Warfarin – Cyclosporine
4) Warfarin – Valproic acid
5) Levothyrox...
19
 Correct answer (B)- 3) 4) 5)
20
 Correct answer: (D)- 4) 6)
Drug Interactions
 Variable results within Micromedex® database
 Warfarin – Benzbromarone
 Warfarin – Cefmetazole
 Var...
Discrepancies between database
32
 Evidence-based interactions
 More applicable in clinical setting
 With stronger evid...
33

clinical observation
pharmacological knowledge
mobile Micromedex
 Free Micromedex® Drug Reference
for Internet Subscribers
 Micromedex ® Drug Interactions
 Micromedex...
溫故知新….
35
Other Clinical Questions
 Drug dosing in extremes of body weight
 Drug Dosing in Extremes of Body Weight (UKCPA)
 Medic...
2015 Micromedex使用者大會 如何在臨床工作中找到實證解答
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2015 Micromedex使用者大會 如何在臨床工作中找到實證解答

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2015/07/23 Micromedex使用者大會中分享的內容,包括四部分:由案例進行搜尋示範(著重於不同搜尋策略)、由藥品交互作用看資料庫的限制(強調臨床觀察及應用藥理學知識的重要性)、如何在手機上使用Micromedex(強調限制)、未來展望(建議可增加的部分)。
所有黃色標記都是超連結,若投影片出現黃色標記時請按黃色標記。

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2015 Micromedex使用者大會 如何在臨床工作中找到實證解答

  1. 1. 如何在臨床工作中找到實證解答? 臺大醫院藥師 陳建豪 2015.07.23 2015 Micromedex 使用者分享大會
  2. 2. 自我介紹-Who Am I? 1  台大臨床藥學研究所  Ohio State University 海外交換計畫  台大醫院藥劑部藥師  住院藥局  門診藥局  急診藥局  每日一冷  Mr. Thursday Jr.
  3. 3. 2 病人 同事 醫療 團隊 電話 諮詢 醫師 學生自己 病人 家屬
  4. 4. Outline  Find an evidence-based answer  FDA & Non-FDA Uses  Pharmacodynamics & Pharmacokinetics  Comparative Efficacy  Place In Therapy  Interpret drug Interactions  mobile Micromedex®  Discussion 3
  5. 5. What we’ve known…. 4  Case-oriented user experiences  Clinical pharmacists  General pharmacists  Drug information  藥師周刊記者  Integrate Micromedex® into clinical decision supporting system (CDSS)  Formulary  Drug interaction detecting system  IV Compatibility information
  6. 6. Case 1 5  65歲男性,懷疑因MRSA造成腦膜炎而住院,病 人過去住院有vancomycin過敏紀錄(skin rash)。  醫師詢問:對vancomycin過敏的病人是否可以改 用teicoplanin進行治療?  Adverse Effects  Teicoplanin是否可用來治療MRSA造成的腦膜炎?  FDA uses/Non-FDA uses  Pharmacokinetics/Pharmacodynamics  Search in Full Document * MRSA: methicillin-resistant Staphylococcus aeruginosa
  7. 7. Case 2 13  65歲男性,有心衰竭病史,本次因懷疑因MRSA 造成骨髓炎而住院。  醫師詢問使用vancomycin或teicoplanin治療 MRSA造成的骨髓炎是否有實證上的差異?  Comparative Efficacy  Place In Therapy
  8. 8. 14
  9. 9. Teicoplanin vs. Vancomycin 15  Comparative efficacy  Less nephrotoxicity  Less CNS penetration  Once-daily dosing (for outpatient)  IV/IM administration (for water-restriction)  TDM not warranted in NTUH  Higher cost  Teicoplanin 200 mg/vial : NTD 728/vial;  10 mg/kg daily for a 60 kg patient : NTD 2184/day  Vancomycin 500 mg/vial : NTD 101/vial  15 mg/kg Q12H for a 60 kg patient : NTD 404/day
  10. 10. Other instances  Ticagrelor (Brilinta®)  Comparative efficacy: acute coronary syndrome  Doripenem (Finibax®)  Place in therapy: nosocomial pneumonia  Tranexamic acid (Transamin®)  Non-FDA uses: postoperative bleeding  Sulcrafate (Sucrate®)  Non-FDA uses: Hyperphosphatemia 16
  11. 11. Drug Interactions  User friendly  Index by drug name / brand name  Various contents  – Food, – Tobacco, – Ethanol, – Lab, – Allergy, – Pregnancy, – Lactation  Evidence-based drug interaction  Illustrated by icons 17
  12. 12. 1) Warfarin – Benzbromarone 2) Warfarin – Cefmetazole 3) Warfarin – Cyclosporine 4) Warfarin – Valproic acid 5) Levothyroxine – Digoxin 6) Levothyroxine – Theophylline     Which drug combinations have interactions? (A)- 2) 3) 4) 5) (B)- 3) 4) 5) (C)- 1) 2) 4) 6) (D)- 4) 6)
  13. 13. 19  Correct answer (B)- 3) 4) 5)
  14. 14. 20  Correct answer: (D)- 4) 6)
  15. 15. Drug Interactions  Variable results within Micromedex® database  Warfarin – Benzbromarone  Warfarin – Cefmetazole  Variable results between different databases  Thyroxin – Digoxin  Thyroxin – Theophylline  Cyclosporine – Warfarin  Variable degrees between different databases  Warfarin – Valproic acid : different significance level 21
  16. 16. Discrepancies between database 32  Evidence-based interactions  More applicable in clinical setting  With stronger evidence level & more clinical significance  Pharmacokinetics- & pharmacodynamics- proposed interactions  Class effects warrant close monitoring  Especially not yet American-approved medications  Exploring under-reporting interactions
  17. 17. 33  clinical observation pharmacological knowledge
  18. 18. mobile Micromedex  Free Micromedex® Drug Reference for Internet Subscribers  Micromedex ® Drug Interactions  Micromedex ® IV Compatibility 34
  19. 19. 溫故知新…. 35
  20. 20. Other Clinical Questions  Drug dosing in extremes of body weight  Drug Dosing in Extremes of Body Weight (UKCPA)  Medication Dosing Guidelines in Obese Adults (RQHR)  Quick index of drug-disease interaction  Myasthenia gravis (MG)  Glucose-6-phosphate dehydrogenase defect (G-6PD)  Discrepancy of American references with other nations’  Infusion rate of fluconazole (Diflucan®)  Infusion rate of albumin 20% “國血製劑益康” 36

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