門診疑義處方討論

1、門 診疑義 處 方 討 論,Use of Methylphenidate in Traumatic Brain Injury (TBI)報告日期：99.3.30黃信裕 藥師,,,,Content,Methylphenidate 之藥理作用Methylphenidate核準之適應癥Methylphenidate in TBI之合理性Methylphenidate in TBI之建議劑量Methylphenidate in

2、 TBI之證據(jù)等級ConclusionReferences,Methylphenidate 之藥理作用,Mechanism of Action,CNS stimulantReuptake of Dopamine inhibitor,Challman TD, Lipsky JJ. Methylphenidate: Its Pharmacology and Uses Mayo Clin Proc. 2000 Jul;75(7):71

3、1-21. Review,Methylphenidate核準之適應癥,,衛(wèi)生署核準適應癥,,FDA核準適應癥,Methylphenidate in TBI之合理性,What are the most common problems after a TBI?,Thinking Changes (1),Attention Reduced concentrationReduced visual attentionInability to

4、 divide attention between competing tasks Processing speed Slow thinkingSlow readingSlow verbal and written responses,Thinking Changes (2),CommunicationDifficulty finding the right words, naming objectsDisorganized

5、 in communicationLearning and Memory Information before TBI intactReduced ability to remember new informationProblems with learning new skills,Methylphenidate in TBI之證據(jù)等級,FDA Approval: Adult, no;

6、 Pediatric, noEfficacy: Adult, Evidence favors efficacy; Pediatric, Evidence favors efficacyRecommendation: Adult, Class IIb; Pediatric, Class IIbStrength of Ev

7、idence: Adult, Category B; Pediatric, Category B,MICROMEDEX(r) Healthcare Series 醫(yī)療照護系列資料庫 (Database) Thomson MICROMEDEX,Evidence (I),Evidence (II),Sivan M et al. Clin Rehabil. 201

8、0 Feb;24(2):110-21,Methylphenidate in TBI之建議劑量,1. Enhance attentional function Dose: 0.25–0.30 mg/kg bid2. Enhance the speed of cognitive processing Dose: 0.25–0.30 mg/kg bid3. Enhance learning and memory

9、Dose: 0.30 mg/kg bid4. Improve speed in mental processing Dose: 0.30 mg/kg bid,Recommended Dose,Neurobehavioral Guidelines Working Group, Warden DL, Gordon B, McAllister TW, Silver JM, Barth JT, Bruns J, Drake A, G

10、entry T, Jagoda A, Katz DI, Kraus J, Labbate LA, Ryan LM, Sparling MB, Walters B, Whyte J, Zapata A, Zitnay G. Guidelines for the pharmacologic treatment of neurobehavioral sequelae of traumatic brain injury.J Neurotr

11、auma. 2006 Oct;23(10):1468-501,醫(yī)師開立處方：Methylphenidate 10mg/tab, 1tab, QD ?,結(jié)果：可能造成改善癥狀之劑量不足,結(jié)論,Methylphenidate用於TBI(創(chuàng)傷性腦損害)乃屬於合理之治療，因為TBI會造成腦部神經(jīng)性病變，如：認知不足、注意力缺乏、記憶力減退…等。 但是衛(wèi)生署核準之適應癥為過動兒癥候群及發(fā)作型嗜睡癥，若醫(yī)師將Methylphenida

12、te用於器質(zhì)性腦徵候群或腦震盪後徵候群，需考慮以自費方式給予。,參考資料,Siddall OM. Use of methylphenidate in traumatic brain injury. Ann Pharmacother. 2005 Jul-Aug;39(7-8):1309-13. Epub 2005 May 24. Review. 2. Sivan M, Neumann V, Kent R, Stroud

13、A, Bhakta BB Pharmacotherapy for treatment of attention deficits after non-progressive acquired brain injury. A systematic review. Clin Rehabil. 2010 Feb;24(2):110-21.3. Challman TD, Lipsky JJ. Methylphenidate:

14、 its pharmacology and uses. Mayo Clin Proc. 2000 Jul;75(7):711-21. Review. 4. Neurobehavioral Guidelines Working Group, Warden DL, Gordon B, McAllister TW, Silver JM, Barth JT, Bruns J, Drake A, Gentry T, Jag

15、oda A, Katz DI, Kraus J, Labbate LA, Ryan LM, Sparling MB, Walters B, Whyte J, Zapata A, Zitnay G. Guidelines for the pharmacologic treatment of neurobehavioral sequelae of traumatic brain injury. J Neur

16、otrauma. 2006 Oct;23(10):1468-501. 5. MICROMEDEX(r) Healthcare Series 醫(yī)療照護系列資料庫(Database) Thomson MICROMEDEX,Thank you for your attention,Background,Deficits in attention are commonly seen in non-progressive acquire

17、d brain injury.The prevalence of attention deficits even after mild traumatic brain injury has been reported to range from 40-60% at 1-3 months post injury,Pierce SR. et al. Arch Phys Med Rehabil 2002,Attention,Focused