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介紹TB藥品之副作用與相關之處理
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抗Tb藥品副作用處理
1.
抗肺結核藥品副作用之處理 加護病房查房日誌 1
2.
肺結核用藥相關副作用 2 • 肝炎 • 周邊神經炎
(糖尿病,酗酒,營養不良等可同時給pyridoxine) Isoniazid(INH) • 肝毒性(發生率低於INH)Rifampin(RMP) • 肝毒性 • 高尿酸血症 (長期使用,可考慮用降尿酸藥Benzbromarone類) Pyrazinamide(PZA) • 眼球後視神經炎Ethambutol(EMB) Ref: 結核病診治指引第五版
3.
此類副作用,密切觀察,不必停藥 1. 無症狀而AST/ALT未超過正常上限的五倍, 或有輕微症狀但AST/ALT未超過正常上限的 三倍。 2. 輕微的皮膚搔癢。 3.
一開始用藥後發生全身倦怠(Flu-like syndrome),但AST/ALT未超過正常上限的 三倍,可給予心理支持或改為睡前服藥。 4. 血清中尿酸濃度在13 mg/dL以下,沒有關節 炎的症狀時,請病人多喝水,並攝取低普林 飲食,暫不停藥也不使用降尿酸藥物。 3 Ref: 結核病診治指引第五版
4.
此類副作用,症狀治療,不必停藥 1. 病人發生腸胃不適症狀時,可將藥物改為 飯後服用,或併用Primperan等藥物來緩 解 2. 輕度皮膚搔癢,可開立抗組織胺劑來緩解 不適。 3.
輕度痛風、關節酸痛,先以短暫非類固醇 抗發炎藥物(NSAID)作症狀處理。 4. 輕微的末梢神經麻木,可以使用 pyridoxine改善。 4 Ref: 結核病診治指引第五版
5.
若發生此類副作用須立即停藥 1. 有肝炎症狀而AST/ALT超過正常上限的三倍;或無肝 炎症狀但AST/ALT超過正常上限的五倍。 2. 嚴重之貧血、血小板下降、紫斑、白血球低下、或甚 至泛血球寡少症。 3.
使用抗結核藥物後,creatinine上升超過0.5 mg/dL。 4. 嚴重無法緩解之痛風症狀、或血清尿酸值高於13 mg/dL無法改善、或高血清尿酸症併急性腎功能惡化。 5. 嚴重無法緩解之皮疹、搔癢、或併發Steven-Johnson syndrome。 6. 視力模糊。 7. 其他任何導致病人無法規則服藥的副作用、或不適反 應。 5 Ref: 結核病診治指引第五版
6.
針對此病人皮疹的處理 • 最輕微的urticaria到最嚴重Stevens- Johnson症候群 • 任何藥品皆可能發生 •
一般輕微約兩周內會自行減輕或消失 • 中度可給抗組織胺 • 嚴重者,應立即停用所有抗結核藥品,待 症狀完全解除後,依 INH→RMP→EMB→PZA順序,由小劑量 至足夠劑量進行藥物減敏試驗 6 Ref: 結核病診治指引第五版
7.
藥物減敏試驗 7 Ref: 結核病診治指引第五版
8.
感恩聆聽 8
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