RISK-FACTORS FOR ADVERSE DRUG-REACTIONS - EPIDEMIOLOGIC APPROACHES
RISK-FACTORS FOR ADVERSE DRUG-REACTIONS - EPIDEMIOLOGIC APPROACHES
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DOI：
10.1007/bf00315403
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发表时间：
1990-01-01
影响因子：
2.9
通讯作者：
WEBER, E
中科院分区：
文献类型：
--
作者：
HOIGNE, R;LAWSON, DH;WEBER, E
年龄本身不是ADR的重要风险因素。与胃肠道出血相关的变化是许多个体因素的结果，例如与多种药物治疗相关的发病率、老年人肾或肝功能下降、低白蛋白血症、体重减轻等。胃肠道出血与非甾体抗炎药之间的关系可以在大型队列研究中通过计算机数据进行全球评估，但完全准确性需要获得原始患者记录。非甾体类抗炎药和阿司匹林使用者胃肠道出血风险增加50%，高于非使用者。住院患者中约四分之一的ADR似乎不是由纯粹的药理学机制引起的。它们主要是由于过敏、类过敏反应或特异质反应以及不耐受。在这些非药理学反应中，暴露时间、反应时间甚至剂量可能是鉴别致病药物的重要因素。通过考虑效力、作用时间和停药后遇到的不同症状，可以优化苯二氮卓类药物的使用。除了器质性戒断症状外，人们越来越认识到长期使用抗精神病药物后的复发和反弹问题。这些药物不良反应的发生率在不同的药物之间有很大的差异，即使在考虑了剂量和合并用药后，潜在致癌药物的流行病学筛查也只能在预先记录了完整信息集的大型患者队列中进行，这些信息集可以在HMO（健康维护组织）中找到。几项此类研究的结果已发表在癌症专业期刊上。然而，观察到的大多数相关性应仅被视为进一步调查的假设，在一项经典的非那西丁滥用者队列的20年随访研究中，有过多的患者肾功能不全和死亡与肾脏和泌尿生殖系统的原因。
Age by itself is not an important risk factor for ADRs. Age-related changes are the consequence of a number of individual factors, for example morbidity associated with polypharmacy, decline in renal or liver function in the elderly, hypoalbuminaemia, reduced body weight, etc.The relationship between gastrointestinal bleeding and non-steroidal anti-inflammatory drugs can be assessed globally in large cohort studies with access to computerized data, but complete accuracy requires access to the original patient records. The increase in the risk of GI bleeding in users of NSAIDs and aspirin was 50% above that in non-users.About a quarter of ADRs in hospitalized patients seem not to arise from purely pharmacological mechanisms. They are mainly due to allergic, anaphylactoid, or idiosyncratic reactions and to intolerance. In such non-pharmacological reactions, the time of exposure, reaction time, and even dosage may be important factors in identification of the causal drug.The use of benzodiazepines can be optimized by taking into account potency, time of action and the different syndromes encountered after withdrawal. Following long-term use problems of relapse and rebound are being increasingly recognized, in addition to organic withdrawal symptoms.In psychiatric patients extrapyramidal disorders due to neuroleptics are common. The rates of these ADRs differ markedly between various drugs, even after dosages and co-medications are taken into account.Epidemiological screening for potentially carcinogenic drugs can only be done in large cohorts of patients with pre-recorded full information sets as may be found in an HMO (Health Maintenance Organization). The findings of several such studies have been published in specialist cancer journals. However, most of the associations observed should only be viewed as hypotheses for further investigation.In a classical twenty-year follow-up study of a cohort of phenacetin abusers, there was an excess of patients with renal insufficiency and death related to renal and urogenital causes.