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老人用藥Nitrofurantoin

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老人用藥Nitrofurantoin

  1. 1. 抗生素 NITROFURANTOIN 周孫鴻藥師
  2. 2. 劑量
  3. 3. •一天兩次,100mg/次 Nitrofurantoin monohydrate/macrocr ystals
  4. 4. •六小時一次,50-100mg/次 Nitrofurantoin macrocrystals
  5. 5. 作用
  6. 6. 殺菌(BACTERICIDAL) NITROFURANTOIN 會被細菌的蛋白轉化成活性成 分,此成分能抑制細菌的蛋白合成,產生殺菌效果 殺菌範圍為廣效,對革蘭氏陰性菌和革蘭氏陽性菌 皆有效
  7. 7. 藥物動力學 1.吸收: 隨餐服能提高40%的吸收 2.代謝: 身體組織會將60%的藥物轉化成非活性代謝 物 3.排除: 有40%的藥物會從尿液排除,所以用在泌尿道 感染
  8. 8. 用途
  9. 9. 尿路感染症 膀胱炎
  10. 10. 長輩要小心的 副作用
  11. 11. 長期使用容易發生以下~ 1.藥物引起的肝損傷: 肝炎、肝硬化 2.周邊神經炎 3.肺臟毒性: 咳嗽、呼吸困難、胸腔積液、肺部浸潤
  12. 12. 角色
  13. 13. • 泌尿道感染, NITROFURANTOIN和現在常用的 抗生素(PENICILLINS、CEPHALOSPORINS、 TMP/SMX、QUINOLONES)比起來,在膀胱外的 濃度會不夠,而且對長輩的副作用風險也比較高 • 所以NITROFURANTOIN目前在醫院比較少使 用了
  14. 14. 給長輩的建議
  15. 15. BEERS CRITERIA: 1.NITROFURANTOIN不建議用在65歲以上的長輩~ 因其肺臟、肝臟與神經副作用,尤其是長期使用更明 顯 2.肌酸酐清除率<30 ML/MINUTE ,不要使用 NITROFURANTOIN,因為體內濃度會升高很多 Nitrofurantoin is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older (independent of diagnosis or condition) due to its potential for pulmonary toxicity, hepatotoxicity and peripheral neuropathy, particularly when given long-term; safer alternatives exist. Avoid use in patients with a CrCl less than 30 mL/minute or for long-term suppressive therapy (Beers Criteria [AGS 2019]).
  16. 16. PHARMACY QUALITY ALLIANCE (PQA): 65歲以上的長輩,若連續使用NITROFURANTOIN 90天以上,算是高風險情形~產生毒性 Nitrofurantoin (when cumulative day supply is greater than 90 days) is identified as a high-risk medication in patients 65 years and older on the PQA's Use of High-Risk Medications in the Elderly (HRM) performance measure, a safety measure used by the Centers for Medicare and Medicaid Services (CMS) for Medicare plans (PQA 2017).

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