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Clinically significant drug interactions at end of life

机译：生命终结时具有临床意义的药物相互作用

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摘要

Potential drug interactions encountered at the end of life may be cumbersome to predict and have significant impact on the palliation of symptoms. Recent advances in identifying metabolic pathways and metabolites of frequently used medications allow clinicians to consider the fate and pharmacodynamic effects of drugs prescribed. Numerous medications used in the palliative care population undergo hepatic and extrahepatic metabolism to active and inactive metabolites. Hepatic reactions rendering medications prepared for excretion or removal from the system are complex, but may be summarised for medications frequently used in end-of-life care as Phase 1 oxidation, hydroxylation, and reduction reactions, and Phase 2 glucuronidation reactions. Both general types of drug metabolism pathways may be altered by medications, disease states, and normal ageing processes. Specific to end-of-life care, Phase 1 reactions may become less robust, while Phase 2 reactions are typically preserved. Benzodiazepines, opioids, non-opioid analgesics, and hypnotics may all exhibit additive or reduced efficacy when given concurrently with medications which inhibit or induce these pathways. Unexpected dose-related toxicity or adverse effects may also manifest. In summary, understanding and anticipating potential drug interactions in end of life and palliative care is paramount for the health professional.
机译：生命终结时可能遇到的潜在药物相互作用可能难以预测，并且对减轻症状具有重大影响。在鉴定常用药物的代谢途径和代谢物方面的最新进展使临床医生可以考虑处方药的命运和药效学作用。姑息治疗人群中使用的许多药物都会通过肝和肝外代谢而代谢为活性和非活性代谢物。肝反应使准备排泄或从系统中清除的药物变得很复杂，但可以总结为生命周期后期护理中经常使用的药物，如1期氧化，羟基化和还原反应以及2期葡萄糖醛酸化反应。药物代谢途径的两种一般类型都可能因药物，疾病状态和正常衰老过程而改变。对于临终护理而言，第1阶段反应可能变得不那么稳健，而第2阶段反应通常得以保留。当与抑制或诱导这些途径的药物同时使用时，苯二氮卓类，阿片类药物，非阿片类镇痛药和催眠药都可能显示出加性或降低的功效。可能还会出现意料之外的剂量相关毒性或不良反应。总之，对于健康专业人员而言，了解和预测生命终结和姑息治疗中潜在的药物相互作用至关重要。

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  • 来源
    《Progress in Palliative Care》 |2010年第3期|147-156|共10页
  • 作者

    Herndon Christopher M.;

  • 作者单位

    Department of Pharmacy Practice, Southern Illinois University, Edwardsville, Illinois, USA Department of Community and Family Medicine, St Louis University School of Medicine, USA;

  • 收录信息 美国《科学引文索引》(SCI);美国《工程索引》(EI);美国《生物学医学文摘》(MEDLINE);
  • 原文格式 PDF
  • 正文语种 eng
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