{"id":12048,"date":"2019-06-24T22:39:40","date_gmt":"2019-06-24T15:39:40","guid":{"rendered":"https:\/\/www.hmm88i.com\/drug\/?p=12048"},"modified":"2019-06-27T00:16:09","modified_gmt":"2019-06-26T17:16:09","slug":"van-de-dung-nhieu-thuoc-polypharmacy","status":"publish","type":"post","link":"https:\/\/hmm88i.com\/drug\/van-de-dung-nhieu-thuoc-polypharmacy\/","title":{"rendered":"V\u1ea5n \u0111\u1ec1 d\u00f9ng nhi\u1ec1u thu\u1ed1c (Polypharmacy)"},"content":{"rendered":"

GI\u1edaI THI\u1ec6U<\/h2>\n

Hi\u1ec7n nay, nhi\u1ec1u b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng \u0111\u1ed3ng th\u1eddi nhi\u1ec1u lo\u1ea1i thu\u1ed1c v\u00e0 ch\u1ebf ph\u1ea9m b\u1ed5 sung<\/strong>. Kh\u1ea3o s\u00e1t k\u00ea \u0111\u01a1n v\u00e0 c\u1ea5p ph\u00e1t kh\u00e1ng sinh tr\u00ean b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa t\u1ea1i B\u1ec7nh vi\u1ec7n Nguy\u1ec5n Tri Ph\u01b0\u01a1ng cho th\u1ea5y, s\u1ed1 thu\u1ed1c k\u00ea trung b\u00ecnh trong m\u1ed9t \u0111\u01a1n l\u00e0 7,1. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c cho th\u1ea5y, 25% ng\u01b0\u1eddi M\u1ef9 tr\u01b0\u1edfng th\u00e0nh d\u00f9ng 5 lo\u1ea1i thu\u1ed1c tr\u1edf l\u00ean. \u0110i\u1ec1u n\u00e0y g\u00e2y h\u1ea1i nhi\u1ec1u h\u01a1n l\u00e0 c\u00f3 l\u1ee3i.<\/p>\n

\"Polypharmacy\"<\/p>\n

D\u00f9ng nhi\u1ec1u thu\u1ed1c, cho d\u00f9 l\u00e0 thu\u1ed1c k\u00ea \u0111\u01a1n, thu\u1ed1c OTC, th\u1ea3o d\u01b0\u1ee3c ho\u1eb7c ch\u1ebf ph\u1ea9m b\u1ed5 sung \u2013 \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 polypharmacy \u2013 kh\u00f4ng ch\u1ec9 l\u00e0 g\u00e1nh n\u1eb7ng cho b\u1ec7nh nh\u00e2n m\u00e0 c\u00f2n r\u1ea5t nguy hi\u1ec3m. V\u00ed d\u1ee5 nh\u01b0 thu\u1ed1c \u0111\u01b0\u1ee3c k\u00ea khi kh\u00f4ng c\u1ea7n thi\u1ebft; thu\u1ed1c kh\u00f4ng \u0111\u01b0\u1ee3c k\u00ea khi c\u1ea7n thi\u1ebft; b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c kh\u00f4ng \u0111\u00fang c\u00e1ch; t\u01b0\u01a1ng t\u00e1c thu\u1ed1c hay s\u1ef1 gi\u1ea3m tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

D\u01b0\u1ee3c s\u0129 v\u00e0 c\u00e1c chuy\u00ean gia ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe kh\u00e1c c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c gi\u1ea3m v\u1ea5n \u0111\u1ec1 d\u00f9ng nhi\u1ec1u thu\u1ed1c. [1]\n

\u0110\u1ecaNH NGH\u0128A<\/h2>\n

Kh\u00f4ng c\u00f3 \u0111\u1ecbnh ngh\u0129a duy nh\u1ea5t c\u1ee7a polypharmacy, m\u1eb7c d\u00f9 n\u00f3 th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng n\u0103m lo\u1ea1i thu\u1ed1c tr\u1edf l\u00ean h\u00e0ng ng\u00e0y. Thu\u1ed1c \u1edf \u0111\u00e2y bao g\u1ed3m thu\u1ed1c k\u00ea \u0111\u01a1n, thu\u1ed1c OTC, ch\u1ebf ph\u1ea9m b\u1ed5 sung v\u00e0 th\u1ea3o d\u01b0\u1ee3c. [1]\n

\"Polypharmacy\"<\/p>\n

NGUY\u00caN NH\u00c2N<\/h2>\n

Polypharmacy c\u00f3 th\u1ec3 x\u1ea3y ra khi c\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n m\u1edbi d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a c\u00e1c lo\u1ea1i thu\u1ed1c c\u0169. \u0110\u00e2y g\u1ecdi l\u00e0 \u201ck\u00ea toa d\u00e2y chuy\u1ec1n\u201d. Khi \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh m\u00e3n t\u00ednh, nh\u01b0 cao huy\u1ebft \u00e1p v\u00e0 suy tim, vi\u1ec7c s\u1eed d\u1ee5ng nhi\u1ec1u lo\u1ea1i thu\u1ed1c th\u01b0\u1eddng l\u00e0 c\u1ea7n thi\u1ebft v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng. Polypharmacy tr\u1edf n\u00ean c\u00f3 v\u1ea5n \u0111\u1ec1 khi l\u00fd do d\u00f9ng thu\u1ed1c kh\u00f4ng r\u00f5 r\u00e0ng, khi d\u00f9ng thu\u1ed1c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a c\u00e1c thu\u1ed1c kh\u00e1c, khi li\u1ec1u l\u01b0\u1ee3ng v\u00e0 th\u1eddi gian d\u00f9ng thu\u1ed1c ph\u1ee9c t\u1ea1p, v\u00e0 khi thu\u1ed1c t\u01b0\u01a1ng t\u00e1c v\u1edbi nhau. [3]\n

Polypharmacy th\u01b0\u1eddng x\u1ea3y ra \u1edf ng\u01b0\u1eddi m\u1eafc nhi\u1ec1u b\u1ec7nh m\u00e3n t\u00ednh, ch\u1eb3ng h\u1ea1n nh\u01b0 ti\u1ec3u \u0111\u01b0\u1eddng, cao huy\u1ebft \u00e1p, suy tim, lo\u00e3ng x\u01b0\u01a1ng v\u00e0\/ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111au, m\u1ea5t ng\u1ee7, c\u1ea7n \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i b\u1eb1ng thu\u1ed1c. B\u1ec7nh m\u00e3n t\u00ednh v\u00e0 tri\u1ec7u ch\u1ee9ng t\u00edch l\u0169y theo tu\u1ed5i t\u00e1c. V\u00ec l\u00fd do n\u00e0y, ng\u01b0\u1eddi l\u1edbn tu\u1ed5i c\u00f3 nguy c\u01a1 d\u00f9ng nhi\u1ec1u thu\u1ed1c cao h\u01a1n. [3]\n

H\u1eacU QU\u1ea2<\/h2>\n

Polypharmacy l\u00e0m t\u0103ng nguy c\u01a1 ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i v\u1edbi thu\u1ed1c. C\u00e0ng nhi\u1ec1u thu\u1ed1c, nguy c\u01a1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u00e0ng cao. Nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng 5-9 lo\u1ea1i thu\u1ed1c c\u00f3 50% kh\u1ea3 n\u0103ng t\u01b0\u01a1ng t\u00e1c thu\u1ed1c b\u1ea5t l\u1ee3i, t\u0103ng l\u00ean 100% khi h\u1ecd d\u00f9ng 20 lo\u1ea1i thu\u1ed1c tr\u1edf l\u00ean. M\u1ed9t nghi\u00ean c\u1ee9u y t\u1ebf b\u00e1o c\u00e1o r\u1eb1ng polypharmacy chi\u1ebfm g\u1ea7n 30% t\u1ed5ng s\u1ed1 b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y t\u1eed vong \u0111\u1ee9ng th\u1ee9 5 \u1edf Hoa K\u1ef3. [2]\n

Polypharmacy c\u00f3 li\u00ean quan \u0111\u1ebfn c\u00e1c r\u1ee7i ro bao g\u1ed3m gi\u1ea3m nh\u1eadn th\u1ee9c, l\u00fa l\u1eabn, t\u00e9 ng\u00e3, ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c, t\u0103ng th\u1eddi gian n\u1eb1m vi\u1ec7n, t\u00e1i nh\u1eadp vi\u1ec7n ngay sau khi xu\u1ea5t vi\u1ec7n v\u00e0 th\u1eadm ch\u00ed l\u00e0 t\u1eed vong. [4]\n

B\u1ec7nh nh\u00e2n c\u00e0ng d\u00f9ng nhi\u1ec1u thu\u1ed1c, c\u00e0ng kh\u00f3 c\u00f3 \u0111\u01b0\u1ee3c ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c ch\u00ednh x\u00e1c, \u0111i\u1ec1u n\u00e0y c\u1ea3n tr\u1edf vi\u1ec7c xem x\u00e9t v\u00e0 k\u00ea \u0111\u01a1n thu\u1ed1c. T\u1ef7 l\u1ec7 ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c t\u0103ng theo s\u1ed1 l\u01b0\u1ee3ng thu\u1ed1c s\u1eed d\u1ee5ng. [4]\n

Vi\u1ec7c s\u1eed d\u1ee5ng nhi\u1ec1u lo\u1ea1i thu\u1ed1c kh\u00e1c nhau c\u00f9ng m\u1ed9t l\u00fac c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ef1 nh\u1ea7m l\u1eabn trong vi\u1ec7c l\u01b0u tr\u1eef thu\u1ed1c ho\u1eb7c d\u00f9ng thu\u1ed1c kh\u00f4ng ch\u00ednh x\u00e1c. B\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 kh\u00f4ng bi\u1ebft nh\u1eefng lo\u1ea1i thu\u1ed1c m\u00e0 b\u1ec7nh nh\u00e2n c\u1ee7a h\u1ecd \u0111ang d\u00f9ng, d\u1eabn \u0111\u1ebfn sai s\u00f3t trong vi\u1ec7c k\u00ea \u0111\u01a1n. V\u00ed d\u1ee5, c\u00f9ng m\u1ed9t lo\u1ea1i thu\u1ed1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n 2 l\u1ea7n. [3]\n

M\u1ed9t lo\u1ea1i thu\u1ed1c c\u00f3 th\u1ec3 kh\u00f4ng ph\u00e1t huy t\u00e1c d\u1ee5ng ho\u1eb7c c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 khi s\u1eed d\u1ee5ng chung v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c. \u0110\u00e2y g\u1ecdi l\u00e0 m\u1ed9t t\u01b0\u01a1ng t\u00e1c thu\u1ed1c-thu\u1ed1c. B\u1ec7nh nh\u00e2n c\u00e0ng d\u00f9ng nhi\u1ec1u thu\u1ed1c v\u00e0 ch\u1ebf ph\u1ea9m b\u1ed5 sung th\u00ec nguy c\u01a1 m\u1eafc c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u00e0ng cao. [3]\n

M\u1ed9t lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb m\u1ed9t b\u1ec7nh ho\u1eb7c tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 c\u00f3 t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c \u0111\u1ebfn m\u1ed9t b\u1ec7nh ho\u1eb7c tri\u1ec7u ch\u1ee9ng kh\u00e1c. \u0110\u00e2y g\u1ecdi l\u00e0 m\u1ed9t t\u01b0\u01a1ng t\u00e1c thu\u1ed1c-b\u1ec7nh. V\u00ed d\u1ee5, thu\u1ed1c ch\u1ed1ng vi\u00eam, th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng l\u00e0m thu\u1ed1c gi\u1ea3m \u0111au, c\u00f3 th\u1ec3 l\u00e0m t\u0103ng huy\u1ebft \u00e1p v\u00e0 l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, do \u0111\u00f3 c\u1ea7n c\u00e2n nh\u1eafc khi k\u00ea \u0111\u01a1n thu\u1ed1c cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u00e1p cao ho\u1eb7c c\u00f3 c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 th\u1eadn. [3]\n

C\u00c1CH \u0110\u1ed0I PH\u00d3<\/h2>\n

Polypharmacy l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 c\u1ea7n s\u1ef1 \u0111\u1ed3ng t\u00e2m hi\u1ec7p l\u1ef1c c\u1ee7a c\u1ea3 \u0111\u1ed9i ng\u0169 nh\u00e2n vi\u00ean y t\u1ebf, b\u1ec7nh nh\u00e2n v\u00e0 gia \u0111\u00ecnh. C\u1ea7n c\u00f3 nh\u1eefng ho\u1ea1t \u0111\u1ed9ng th\u00f4ng tin thu\u1ed1c, ch\u01b0\u01a1ng tr\u00ecnh khuy\u1ebfn kh\u00edch gi\u1ea3m thu\u1ed1c, t\u1ed5 ch\u1ee9c kh\u00e1m chuy\u00ean v\u1ec1 polypharmacy \u0111\u1ec3 g\u00f3p ph\u1ea7n ng\u0103n ng\u1eeba t\u00e1c h\u1ea1i.<\/p>\n

Nh\u1eefng c\u00f4ng c\u1ee5 h\u1eefu \u00edch c\u00f3 th\u1ec3 tham kh\u1ea3o: [5]\nBeers Criteria: h\u01b0\u1edbng d\u1eabn cho c\u00e1c chuy\u00ean gia ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe \u0111\u1ec3 c\u1ea3i thi\u1ec7n s\u1ef1 an to\u00e0n c\u1ee7a vi\u1ec7c k\u00ea \u0111\u01a1n thu\u1ed1c cho ng\u01b0\u1eddi cao tu\u1ed5i, gi\u00fap gi\u1ea3m c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 polypharmacy, t\u01b0\u01a1ng t\u00e1c thu\u1ed1c v\u00e0 ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c, t\u1eeb \u0111\u00f3 c\u1ea3i thi\u1ec7n ch\u1ebf \u0111\u1ed9 d\u00f9ng thu\u1ed1c \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 nguy c\u01a1. www.americangeriatrics.org
\nSTOPP Criteria: Screening Tool of Older Persons\u2019 Potentially (C\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc c\u00e1c \u0111\u01a1n thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng kh\u00f4ng ph\u00f9 h\u1ee3p c\u1ee7a ng\u01b0\u1eddi l\u1edbn tu\u1ed5i).
\nSTART Criteria: Screening Tool to Alert Doctors to Right Treatments (C\u00f4ng c\u1ee5 s\u00e0ng l\u1ecdc \u0111\u1ec3 c\u1ea3nh b\u00e1o c\u00e1c b\u00e1c s\u0129 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb \u0111\u00fang)
\n7 b\u01b0\u1edbc \u0111\u1ec3 ng\u0103n ng\u1eeba polypharmacy: [6]\n