Center for Education and Research on Therapeutics

描述：(由申请人提供)：在乔治敦CERT(GUCERT)的最初三年中，该计划研究了不良药物相互作用(ADI)，特别是那些导致药物引起的心律失常，女性风险增加的药物。这些原创性研究确定了新的潜在致命相互作用，并在广泛的药物类别中培养了对ADI的认识。医疗保健提供者在实践中一直无法预防ADI，我们发现医学院和实习医生的课程包含的信息很少，无法让他们准备好以避免ADI伤害的方式开出处方。GUCERT已经制定了课程和助手，以指导提供者潜在的ADI范围，目前正在实施和评估这些教育计划。随着转移到亚利桑那州健康科学中心，新的AzCERT继续研究导致心律失常的药物-药物相互作用。网上登记处www.QTdrags.org继续作为启动这些研究的机制。一项具有挽救生命潜力的重大发现是观察到美沙酮可以引起致命性室性心律失常。AzCERT调查人员进行的机制研究现在使测试预防措施成为可能。在这一应用中新提出的项目将包括对美沙酮引起的QT延长的预测因素的临床研究。GUCERT过渡到AzCERT创造了机会，扩大了我们研究的定义和范围，并将这一知识传达给西南地区多元文化背景下的医疗保健提供者和消费者。我们对ADI的潜在促成因素的了解正在急剧扩大，这对所有医疗保健提供者构成了巨大的挑战。我们最初三年的经验表明，必须从多个方面处理药物相互作用问题。我们现在充分认识到，由于消费者和多个提供者独立管理治疗的系统性故障，可能会发生药物相互作用。替代处方药，增加非处方药、草药或中性药物治疗，以及患者修改给药方案，都是常见的。当提供者和消费者在治疗管理中不公开沟通和分享时，不良结果的风险就会增加。AzCERT将采用我们对药物相互作用的更广泛的系统定义进行实验室、临床和卫生服务研究。将检查整个医疗保健提供系统的弱点和潜在的改进，以防止药物-药物和药物-草药ADI。同样重要的是，AzCERT将解决提供者与消费者的对话，并开发健康沟通模型，以将这些更广泛定义的ADI的风险降至最低。

DESCRIPTION: (PROVIDED BY APPLICANT):During the initial three years of the Georgetown CERT (GUCERT) the program studied adverse drug interactions (ADIs), particularly those that result in drug-induced cardiac arrhythmias for which women are at increased risk. These original studies have identified new potentially lethal interactions and fostered awareness of ADIs across a wide array of drug classes. Healthcare providers have been unable to prevent ADIs in practice and we have found that curricula of medical schools and medicine residencies contain little information to prepare them to prescribe in ways that avoids harm from ADIs. GUCERT has developed curricula and aides to instruct providers on the range of potential ADIs, and is currently implementing and evaluating these educational programs. With the move to the Arizona Health Sciences Center, the new AzCERT continues the study of drug-drug interactions that result in arrhythmias. The web-based registry, www.QTdrugs.org, continues as the mechanism for initiating these studies. A major finding with life-saving potential is the observation that methadone can induce lethal ventricular arrhythmias. Mechanistic studies performed by AzCERT investigators now make it possible to test preventive measures. Newly proposed projects in this application will include a clinical study of the predictors of methadone-induced QT prolongation. The transition of the GUCERT to the AzCERT creates opportunities to expand the definition and scope of our research and convey this knowledge to healthcare providers and consumers in the multicultural context of the southwest. Our knowledge of the potential contributing factors for ADIs is expanding dramatically and this poses a substantial challenge for all healthcare providers. Our experience during the initial three years has shown that drug interactions must be approached on multiple fronts. We now fully recognize that drug interactions can occur due to systemic failures in which consumers and multiple providers are independently managing therapeutics. Substitution of prescribed drugs, addition of non-prescription, herbal or neutraceutical therapies, and modification of dosing regimens by patients are common. The risk of adverse outcomes grows when providers and consumers do not openly communicate and share in the management of therapies. AzCERT will employ laboratory, clinical and health services research using our broader systemic definition of drug interactions. The entire healthcare delivery system will be examined for weaknesses and potential improvements that are designed to prevent drug-drug and drug-herbal ADIs. Of equal importance, AzCERT will address the provider-consumer dialogue and develop health communication models to minimize risks from these more broadly defined ADIs.