Thong Tin Thuoc 3-2014

8/12/2019 Thong Tin Thuoc 3-2014

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Thng tin thuc

1

PGS. TS. Nguyn Ngc KhiBM. Dc lm sng, Khoa Dc

H Y Dc TP. H Ch Minh

Mc tiu

1. Trnh by c ngha ca vic cung cp thng tin thuc

2. Phn loi c cc cp thng tin

3. Trnh by c cc ngun thng tin cp 3 chnh

4. p dng c cch tm thng tin thuc

2


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Ni dung

1. ngha ca vic cung cp thng tin thuc

2. Phn loi thng tin thuc

3. Cc ngun thng tin thuc

4. Chin lc tm thng tin thuc

5. Cc k nng thng tin thuc

3

ngha ca thng tin thuc

H tr cho cng tc lm sng

Tr li cc cu hilin quan n:

Hng dn s dng thuc

Xy dng phc

Hot ng ca Hi ng thuc v iu tr

Chnh schs dng thuc

La chn dng thucs dng ph hp

4


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ngha ca thng tin thuc

Xut bn(tp ch, thng tin trn website)Gio dc / ging dy

Hc vin cc ngnh y dc

Ngi tiu dng / bnh nhn

Tham gia vo kim sot cc hot ng iu tr

nh gi iu tr

Thng tin cho y, bc s

5

Phn loi thng tin thuc

6

Theo ni dung:

1. Danh php & xc nh

2. Cch s dng trong iu tr

3. Tc dng khng mong mun

4. Thng mi & Kinh t

5. Quy ch


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Danh php & xc nh

Tnca mt loi thuc

Tn ng nghav mca mt loi thuc

Thnh phn ha hcv tnh cht vt l

Cc thuc c cu trc ha hc /tc ng tng t


8

Cch s dng trong iu tr

Cc khuyn co iu trca thuc

C chtc ng

Liulngkhuyn co v ng s dng

Hp thu, phn phi, chuyn ha v thi tr (ADME)



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Tc dng khng mong mun

Tc dng ph

Tng tc: Thuc / thuc

Thuc / Thc phm

Thuc / Dc liu

Kh nng gy c

Chng ch nh

Kh nng gy qui thai


10

Thng mi & Kinh t

Gi thuc

Doanh s thuc

Cc cng ty phn phi thuc

Cc nh sn xut

Cc hiu thuc

Cc loi thuc c ghi nhiu nht



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Quy ch

Qu trnh ph duyt thuc

Cc nc chp thun s dng

Hn ch / cm vic s dng


12

C bn (background)

Vn ni cm

(foreground)


Theo tnh cht:


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C bn (background)

Cu hi trong phm vi rng

Cu tr li l kin thc tng qut

C th c gii quyt ttvi cc ngun ti liu cp

ba

Vd: A l thuc c lu hnh M hay khng?

C ch tc ng ca thuc l g?

Chng ch nh ca thuc A?


14

Vn ni cm (foreground)

Cu hi trong phm vi hp

Cu tr li i hi kim tra mc chng c mihoc

cc vn cn mu thun

C th c gii quyt tt vi cc ngun ti liucpmt v cp hai

Vd: Hiu qu ca thuc mi so vi cc thuc c?

Vic s dng off-label ca mt thuc?



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Cc ngun thng tin thuc

15

Tp ch Sch Internet

u im?

Nhc im?

tin cy?

16

Ngun thng tin

Cp 1 (Primary Resource)

Cp 2 (Secondary Resource)

Cp 3 (Tertiary Resource)

http://www.atypon-link.com/PPI/toc/phco/29/9


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Ngun thng tin cp 1 (Primary Resource)

Cc tp ch khoa hc

Cung cp cc nghin cu c bnhoc bo co

V d: Th nghim lm sng, bo co hng lot ca/ 1 ca

Ph hp tr li v cc vn ni cm

Phm vi hp

Tt d liu mihoc cng b mi


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u im:

Hu ht l cc bng chng hin ti

Cung cp d liu v loi thuc mi

Tng c nhn c th nh gi tnh gi tr ca nghin cu


20


Nhc im:

Phm vi gii hn

D liu t hay gy cn tranh lun

Nghin cu u c nhng hn ch

Qu phc tp cho bnh nhn



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Ngun thng tin cp 2 (Secondary Resource)

Th mc c s d liucung cp tm tt

hocton vncc nghin cu

Ph hp tr li v cc vn ni cm


24


u im:

C th tm kim tm thng tin v mt vn c th c h

thng



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Nhc im:

Thng i hi chuyn mnnhiu hn s dng ngun

ti liu ny

Chn lcti liu tham kho

Theo dingun ti liu trc khi tm kim cu tr li

Qu phc tpcho bnh nhn


26

Ngun thng tin cp 3 (Tertiary Resource)


http://www.uptodate.com/index http://www.lexi.com/

http://www.micromedex.com/

Sch tham kho


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Sch chuyn kho, sch tham kho, cc chuyn lun

online

Tp hp kin thctrong lnh vc ny

Ph hp tr li v cc vn c bn

Phm vi rng


28


u im:

Cung cp thng tin ton din

Thng tin phn nh quan im ca nhiu chuyn gia

trong lnh vc

Nhanh chng, d s dngcho bnh nhn



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Nhc im:

Thng thng thng tin chm t nht 2 nm do phi qua

khu bin tp v xut bn

Ph thuc nhiu vo cch gii thch ca tc gi **

** Dc s c th khc phc iu ny bng cch

tham kho t nht hai ngun thng tin cp 3


30


Primary

Resources

JAPhA JAMA Pharmacotherapy

New England Journal of Medicine

Annals of Internal Medicine AJHP

Secondary

Resources

PubMed/Ovid MEDLINE

Cochrane Database of Systematic Reviews

DARE TRIPNational Guideline Clearinghouse

Tertiary

Resources

Access Pharmacy UpToDate

Drug Facts and Comparisons

Epocrates Lexi-Comp Micromedex

Clinical Pharmacology


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Chin lc tm thng tin thuc

Cch tip cn / tr li mt cu hi

Bc I.c imca ngi yu cu

Bc II. Thng tin c bn (tn, tui)

Bc III. Xc nh v phn loi cu hi chnh

Bc IV. Pht trin chin lc v tin hnh tm kim

Bc V. Thc hin nh gi, phn tch v tng hp

Bc VI. Xy dng v cung cp cu tr li

Bc VII. Tin hnh theo di v lu ti liu

32

Chin lc tm thng tin thucChin lc tm kim

Chin lc tt nht l thng xuyntham kho cc ngun ti liu

theo th tsau





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Chin lc tm kim

Ngun thng tin cp 3

Tr li cho mt cu hi l kin thc c bn

Vn c nghin cu rng ri v kt lun

Nhiu chuyn gia ng vi cu tr li

34

Chin lc tm thng tin thucDanh php & xc nh

Ngun thng tin cp 3

Merck Index

Martindale: the complete drug reference

Dc th


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Ngun thng tin cp 3(theo nhm)

AHFS Drug Information


Martindale

Dc th

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Chin lc tm thng tin thucCch s dng trong iu tr

Ngun thng tin cp 3(theo bnh)

Harrisons Principles of Internal Medicine

Applied Therapeutics: The Clinical use of Drugs

(Mary Anne Koda-Kimble)

Goldman's Cecil Medicine


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Ngun thng tin cp 3(dc l)

Goodman & Gilman's the

Pharmacological Basis of Therapeutics

38

Chin lc tm thng tin thucTc dng khng mong mun

Ngun thng tin cp 3(tc dng ph)

Meyler's Side Effects of Drugs

AHFS Drug Information


Dc th


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Tc dng khng mong mun

Ngun thng tin cp 3(tng tc)

Drug Interactions: Analysis and

Management (Philip D. Hansten & John R. Horn)


Stockleys Drug Interactions

Tng tc thuc v ch khi ch nh

40


Ngun thng tin cp 3(gy qui thai)

Drugs in Pregnancy and Lactation.

(Gerald Briggs)

Prescribing in pregnancy


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S dng thuc cho tr em

Pediatric & Neonatal Dosage Handbook

944 chuyn lun v thuc

> 130 cng thc pha ch dng ngay

Tn gi, cc thuc c th nhm ln (tn, hnh dng)

iu tr: c ch, dc lc hc, dc ng hc, liu cho tr,

liu ti a, hiu chnh (suy thn), theo di trong tr liu

Cc dng ch phm, liu ca mt n v (M)

42

Chin lc tm thng tin thucS dng thuc cho tr em

The Harriet Lane Handbook

(The Johns Hopkins University)

Chm sc tr trong cp cu

Xp theo tng nhm bnh:tim mch, gim au, da liu, huyt

hc, nhim trng, thn-tit niu, thn kinh, dinh dng, ung th,

chm sc gim nh

Trong mi phn, cc bc cn nh gi, iu tr c thc km

phc iu tr


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Dc ng hc

Applied Clinical Pharmacokinetics

Phn 1: Khi nim c bn, cch tnh ton,

liu s dng i tng c bit(suy thn,

suy gan, thm phn, suy tim, bo ph) v cc tng tc thuc

Cc phn sau:sp xp theo tng nhm thuc nh khng sinh, tim

mch, thuc chng ng kinh, c ch min dch

Trong mi phn nu r v liu iu tr/ gy c, cc thng s dc

ngc th ca thuc, vic xc nh liu (liu u, duy tr)

trong iu tr, mt s v d bi tp

44

Chin lc tm thng tin thucDc ng hc

Basic Clinical Pharmacokinetics

Phn 1: Khi nim c bn, nguyn tc v

dc ng hc, sinh kh dng, th tch phn b,

tc thi tr, T1/2.

Phn 2:ng dng dc ng hc trong lm sng bao gm cc

chuyn lun sp xp theo tng nhm v thuc c th.


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Dc ng hc

Applied Biopharmaceutics & Pharmacokinetics

Dc ng hc mt ngn, nhiu ngn;

dng timtruyn, tim bolus, dng ung.

S hp thu, phn ha, chuyn ha, thi trca thuc; dc l di

truyn; cc dng bo ch mi (phng thch ti ch, cc dng

phng thch c kim sot).

Tng ng sinh hc v sinh kh dng ca thuc.

Cc ng dng ca dc ng hc trn lm sng v hiu chnh liu

cho ngi suy gan, thn

46

Chin lc tm thng tin thucDc l

Goodman & Gilman's the Pharmacological Basis

of Therapeutics

Chng m u: thng tin chung s pht trin thuc, dc ng

hc, dc lc hc, c tnh v ng c thuc, dc l di truyn.

Cc chng k tip trnh by tng nhm thuc theo tc dng

dc ltrn thn kinh, tim mch, qu trnh vim, iu ha min

dch, huyt hc, hormon, tiu ha, nhim trng v ung th.

Sch kinh in: nguyn tc v dc l hc + ng dng lm sng


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Dc l

Basic and Clinical Pharmacology

Chng m u: thng tin chung v receptor,

dc ng hc v dc lc hc, pht trin v qun l thuc.

Cc chng k tip trnh by tng nhm thuc theo tc dng

dc ltrn thn kinht ng, tim mchthn, c trn, thn

kinh trung ng, mu, qua 1trnh vim, ni tit v ung th

Nguyn tc v dc l hc + ng dng lm sng: la chn thuc,

theo di tc dng, cc ca lm sng minh ha.

48

Chin lc tm thng tin thucDc l

Rang & Dale's Pharmacology

Phn 1: cc khi nim, c ch tc ng ca thuc, cc

tnh cht v hp thu, phn b, chuyn ha, thi tr ca thuc v

dc l di truyn.

Phn 2: Cc cht trung gian ha hc

Cc phn cn li ln lt m t chi tit cc tc ng (xp theo h c

quan, thn linh trung ng hay nhim trng, ung th).

C bn, khng qu phc tp


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S dng thuc khi c thai / cho con b

Drugs in Pregnancy and Lactation

Trong tng chuyn lun, mi thuc s c ghi nhn

v khuyn co cho cc i tng c bit ny,

cc bng chng nguy hi cng c cp, gip cho cc nh

lm sng c th tra cu thuc trc khi quyt nh

S dng tra cu thuc

50

Chin lc tm thng tin thucS dng thuc khi c thai / cho con b

Drugs During Pregnancy and Lactation

Thng tin chung bao gm: s pht trin bo thai,

dc ng hc khi c thai, ng hc ca thuc qua bo thai,

phn loi thuc trong thai k.

Cc chng tip theo cp tng nhm thuc trong iu tr nh

nhm gim au, khng vim, chng d ng, thuc iu tr hen

suyn v tr ho, thuc chng nn, thuc tc ng trn tiu ha

v lipid huyt, nhim trng, tim mch

Chn la thuc khi iu tr


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nh gi iu tr / la chn thuc

Applied Therapeutics: The Clinical Use of Drugs

Chm sc c bn: nh gi tr liu, xt nghim,

sc phn v, d ng thuc, iu tr ng c, nn, au, khi phu

thut, ri lon dch v cht in gii, chng nga, thiu mu.

Cc chng tip theo cp vic iu tr tng nhm iu tr:tim

mch, h hp, tiu ha, thn, ghp tng, dinh dng, da liu,

S dng cc ca lm sng c th tip cn tng vn

52

Chin lc tm thng tin thucnh gi iu tr / la chn thuc

Goldman's Cecil Medicine

Vn chung: au, s thay i trong c th

(thn nhit, thn kinh, nhn khoa, h hp, sinh dc), di truyn,

dinh dng

i vi tng nhm bnh, vic thm khm, xt nghim cho tng h

c quan pht hin cc bt thng, trong mi bnh cc phn

sinh l bnh, chn on phn bit v iu tr.


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The Merck Manual

Ngun ti liu ny cung cp tm tt bnh hc,

triu chng, chn on v iu tr.

Cho php truy cp min ph trc tuyn ti a ch:

http://www.merckmanuals.com/home/index.html

54

Chin lc tm thng tin thucnh gi iu tr / la chn thuc

Pharmacotherapy: A Pathophysiologic Approach

Tp trung vo iu tr bnh.

Thng tin c cung cp v cc ri lon bao gm dch t hc,

nguyn nhn, sinh l bnh, iu tr v nh gi kt qu iu tr.

Cc bng so snh cc thuc v liu, c ch tc ng, tc dng

ph, chng ch nh, mc chng c

S tm tt phc iu tr

Tm tt cc khi nim quan trng(key concepts)
http://www.merckmanuals.com/home/index.htmlhttp://www.merckmanuals.com/home/index.html


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Pharmacotherapy Principles and Practice

Tng t nh quyn Pharmacotherapy:

A Pathophysiologic Approach.

Phn chung: ngi gi, tr em, chm sc gim nh.

Bnh: cc phn dch t hc, nguyn nhn, sinh l bnh, iu tr v

nh gi kt qu iu tr c trnh by tm tt.

Km thm Pharmacotherapy Principles and Practice Study Guide

tng ca lm sng km cc cu hi v tr li

56

Chin lc tm thng tin thucc cht hc

Casarett & Doull's Toxicology

Nu cc vn chung ca c cht hc.

Phn i cng

c tnh hng c quan (mu, min dich, gan, thn)

c tnh khng hng c quan (kh nng sinh ung th, di truyn,

trn s pht trin)

Cc ngun c cht (thuc tr su, kim loi, dung mi, cht phng

x, thc vt).


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c cht hc

Clinical Toxicology

Phn chung ca c cht hc.

X tr ng c trong tng trng hp c th t vic trnh by

c ch dc l, sinh l bnh ca tng trng hp ng c,

biu hin lm sng, chn on phn bit, iu tr

58


Ngun thng tin cp 3(gy qui thai)

Phn loitrong thai

k nh ngha

A Nghin cu c i chngcho thy khng c nguyc.

B Khng c bng chng v nguy c ngi.

C Khng th loi tr nguy c.

D C bng chng vcc nguy ctrn bo thai.

X Chng ch nh trong thai k.


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trlimtcu hi

Ngunthng tin cp2 v cp1

Vnmi

Khng c sngthungiacc chuyn gia

C bngchngmu thunnhau

60

Chin lc tm thng tin thucV d1: BN nam 44 tui, cao huytp cghi toa

thuccchACE Ho khan

Cu hi: Ho l mttc dngphcacc thuccch

ACE?

Loicu hi:

Ngunti liu:

Cc khi nimtm kim:


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C ch tc ng

Ho

T bo c trn

Mch muGin mch

Thn

Gin mch

Gim giNa v H2O

Bt hot

Mch mu

Stan Bardal et al, Applied Pharmacology, Saunders, 2010

Thuc c ch men chuyn angiotensinAngiotensin-Convert ing Enzym e Inhib itors (ACEIs)

62

Chin lc tm thng tin thucV d2: BN nam 64 tui, rilonlipid huytang

sdngvin Ti Khuynco?

Cu hi: Tc dngcaTitrong viclm hlipid huyt

Loicu hi:

Ngunti liu:

Cc khi nimtm kim:


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Tkha (keywords):

Thutton Boolean:

Cc cng ctrn PubMed: MeSH

64


tinc

ytng

dn


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Nghin cu bnh chng (case-control study)

Hin ti

Bnh (+)

Chng Bnh thng

Dn s

Phi nhim(+)

Phi nhim(-)

Phi nhim(+)

Phi nhim(-) Thi gian (nm)

Vd: acetaldehydv K phi

66

Chin lc tm thng tin thucNghin cu on h (Cohort Studies)

Hin ti

Phi nhim(+)

Phi nhim(-)

Hu qu(-)

Hu qu(+)

Hu qu

(-)

Hu qu(+)

Dn s

Mu

B. thng

Thi gian (nm)

Vd: The Nurses Health Study (NHS):

1200 n y t KS sd aspirin v bnh tim mch


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Nghin cu ngu nhin c i chng (RCT)

Ngu nhin:Tt c cc i tng nghin cuc c hi nh

nhau'phn cng' vo mt trong hai nhm can thip hoc i

chng

So snh KQ

Theo diCan thip

i chng

Chia

ngu nhin

68

Chin lc tm thng tin thucNghin cu ngu nhin c i chng (RCT)

Th nghim

Khng m

i tng S phn cng nhm

Bit Khng bit

M n

M i

M ba

v X

hay X

v X

v Xv


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Cc k nng thng tin thuc

69

nh gi cc thng tin/ thu thp d liu cn thitXy dng cu hi / bc tip cnthch hp

Tip cn c h thng tm thng tin cn thit

nh gi thng tinquan trng (gi tr / ng dng)

Xy dng, sp xp v tm tt tr li cho vn

Giao tipr rng (ni /vit)

D onnhu cu thng tin khc

Documents

Thong Tin Thuoc 3-2014