micromedex在藥物諮詢的運用neofax •drug database –covers more than 185 substances and...
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綱要
• Micromedex的特色
• Micromedex在藥物諮詢的案例分享
• Micromedex的手持裝置
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Micromedex的特色
• 正確的資訊：具實證等級
• 迅速的資訊：資料定期更新– Weekly update on Internet,
– REDBook & Urgent cases Daily
•貼心的設計：簡易的瀏覽頁面
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Micromedex在藥物諮詢的案例分享
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Medication errors and adverse drug
events(ADE) in pediatric patients
• Rate of ADE in pediatrics is 3 times higher
than adults.
• Rate of ADE in Neonatal Intensive Care Unit
(NICU) is 5 times higher than in neonatal
wards.
• 70% of pediatric medication errors are
calculation errors.
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Neonatal infants
• More than 430,000 premature babies are
admitted to NICU each year.
• Neonatal drug dosing and parenteral nutrition
ordering are among the most complex and
error prone.
• More than 90% of all drugs prescribed to
infants are off-label because commercially
available drugs are not tested on infants.
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NeoFax
• Micromedex Drugdex database is the world’s largest
repository of drug off-label uses.
• Help clinicians to accurately Prescribe, Calculate,
Formulate and Administer essential drugs and TPN
solutions for premature babies.
• Neonatal uses Weight-based and Age-adjusted dosing
based on
– Gestational age = time from conception to delivery
– Chronological age = postnatal age = time since birth
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NeoFax
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NeoFax
• Drug Database
– Covers more than 185 substances and dosing tables
– More than 90% of prescribed drugs are “off-label”
– Customizable to hospital formulary
– Print manual updated annually
• Infant Formula Database
– Provides detailed nutrient information of 42 infant formulas
– Compares 3 nutrients side-by-side
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NeoFax - Benefits
• Reduce medication errors
• Address hospital guidelines for neonatal care
especially infusion calculations
• Reduce time for ordering and compounding
• Prevent calcium and phosphorus precipitation
• Guide Total Parenteral Nutrition (TPN) order
entry and archive order history
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NeoFax-Drug Monographs
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NeoFax-Drug Monographs
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NeoFax-Drug Monographs
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NeoFax-Drug Monographs
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NeoFax-Enteral Formulas
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Micromedex-P&T Committee
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Micromedex-P&T Committee
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Micromedex-P&T Committee
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商品名 Saxagliptin Sitagliptin Linagliptin Vidagliptin
學名 Onglyza Januvia Trajenta Galvus
FDA及EMEA核准
狀態v v v
EMEA核准。由於肝毒性及皮膚毒性的緣故，未取得FDA核准
肝功能異常案例
無 無 無
有肝功能異常之案例，使用Galvus需持續監測肝功能。
FDA懷孕用藥分級
B級 B級 B級FDA未核准，但仿單記載不建議使用於懷孕期間
DPP4 inhibitors comparison
Dipeptidylpeptidase-4 inhibitors
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DPP4 inhibitors comparison
2013.3.25衛生署網站公告之Onglyza、Januvia、Trajenta、Galvus產品仿單
2013.3.25衛生署網站公告之健保價
Saxagliptin Sitagliptin Linagliptin Vidagliptin
Liver
impairment
(Child-Pugh)
A 5mg QD 100mg QD 5mg QD X
B 5mg QD 100mg QD 5mg QD X
C 5mg QD ? 5mg QD X
Renal
disease
Mild
[CrCl] >50
mL/min
5mg QD 100mg QD 5mg QD 50mg BID
Moderate
[CrCl] 30~50
mL/min
2.5mg QD 50mg QD 5mg QD 50mg QD
Severe
[CrCl] <30
mL/min
2.5mg QD 25mg QD 5mg QD 50mg QD
併用胰島素 O O X X
Daily cost
(BNHI price, NT$)28.7 30.3 30.3 30.2
Daily cost
(中度腎功能不良)14.3 15.1
30.3
(最貴)15.1
Daily cost
(重度腎功能不良)14.3
7.5
(1/4顆易碎)30.3
(最貴)15.1
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Micromedex-P&T Committee
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Micromedex-P&T Committee
SUMMARY:
The approval of linagliptin was based on eight double-blind,
placebo- controlled clinical trials involving approximately
3800 patients with type 2 diabetes. Results from these
studies showed that treatment with linagliptin produced
significant reductions in HbA1C compared with placebo
when used as monotherapy and in combination with
metformin, a sulfonylurea, pioglitazone, or metformin plus a
sulfonylurea. Linagliptin also produced significant reductions
in fasting plasma glucose (FPG) compared with placebo
when used as monotherapy and in combination with
metformin, a sulfonylurea, or pioglitazone. In addition,
linagliptin treatment resulted in significant reductions in 2-
hour postprandial glucose (PPG) levels compared with
placebo as monotherapy and when used in combination with
metformin. Clinical comparisons between linagliptin and
other DPP-4 inhibitors are not available.
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Micromedex-P&T Committee
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Martindale
• 學名，包含英美及國際核准名稱(Generic drug names, including U.S., British, and international approved names)
• 俗名/化學名 (Synonyms/chemical names)
• 分子式/分子量，CAS登錄號• (Molecular formula/molecular weight,
CAS registry numbers)
• 藥典 (Pharmacopeias)
• 物理特性 (Physical characteristics)
• 副作用及其處置方法• (Adverse effects and their treatment)
• 注意事項，包括禁忌• (Precautions, including contraindications)
• 藥物交互作用 (Interactions)
• 藥物動力學 (Pharmacokinetics)
• 用途與服用，包括藥理與給藥• (Uses and administration, including
pharmacology and dosage)
• 製劑與商品名• (Preparations and brand names)
• 收錄 17國超過 70,000種專賣藥品的製劑摘錄，提供了商品名、製造藥廠、出產國家、有效成份及註冊用途。文中並儘可能將每一成分作交互參照 (Cross-reference)，連結至適當的藥物專題。
•包含世界各國臨床使用和選擇性研究的藥物以及動物用藥、草藥、製藥賦形劑、維他命和營養劑、疫苗、放射性藥物、對比劑和診斷藥劑、藥用氣體、濫用藥物和休閒藥物、有毒物質、消毒劑以及殺蟲劑等。
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Martindale
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Micromedex-P&T Committee
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Index Nominum
• 出自瑞士藥學會 (from the Swiss Pharmaceutical Society) ，為世界公認的國際藥物目錄。
• 收錄 45個以上國家超過 5,300種有地區特色的人體及動物用藥資訊。
• 國際藥物目錄內容包含：– 藥物商品名 (Drug tradenames)
– 正式與非正式俗名 (Official and unofficial synonyms)
– 物質與衍生物 (Substances ans derivatives)
– 製造藥廠名稱與地址 (Manufacture names and addresses)
– 治療分類 (Therapeutic classes)
– CAS 登錄號 (CAS numbers)
– ATC 代碼 (ATC codes)
– 化學結構式 (Chemical structure)
– 分子量 (Molecular weights)
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Index Nominum
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Comparative efficacy
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產品查找
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產品查找
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產品查找
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產品查找
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產品查找
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產品查找
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POISINDEX® System
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Red Book
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Patient education
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Patient education
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AltMedDex® System
• 草藥與飲食資訊 (Herbal and Dietary Information)
• 互補與另類醫療系列[Complementary and Alternative Medicine (CAM) Series] 之一。
• 提供草藥、維他命、礦物質及其他飲食補充品等的實證臨床資料。這些客觀的資訊都是經由來自另類醫療及傳統西方醫療團體的專家小組審核。
• 內容包含二部分：– 另類藥物評估 (Alternative Medicine
Evaluations)• 其特定主題如下：• 給藥資訊 (Dosing Information)
• 俗名 (Synonyms)
• 藥物動力學 (Pharmacokinetics)
• 警語 (包括禁忌、不良反應、藥物交互作用) [Cautions (contraindications, adverse reactions, drug interactions)]
• 治療上的定位 (Place in therapy)
• 作用機轉 (Mechanism of Action)
• 治療用途 (Therapeutic Uses)
• 比較療效 (Comparative Efficacy)
– 另類藥物諮詢 (Alternative Medicine Consults)
• 主題包括美國食品藥物管理局（FDA）提供的警語、孕婦用藥危險等級以及給藥指引、安全性與藥效等
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AltMedDex® System
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AltMedDex® System
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AltMedDex® System
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Micromedex-Interaction
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Micromedex-Interaction
Concurrent use of CLOPIDOGREL and
ESOMEPRAZOLE may result in reduction in
clinical efficacy of clopidogrel and increased risk for
thrombosis.
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Micromedex-Interaction
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Micromedex
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Micromedex
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Micromedex
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Micromedex
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Micromedex
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Micromedex
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Micromedex
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Updates & What's New
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Mobile MICROMEDEXTM
System
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Mobile MICROMEDEXTM System
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Mobile MICROMEDEXTM System
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Mobile MICROMEDEXTM System
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敬請指教