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調劑學- ADR & 交互作用 - Coggle Diagram

- - - - 噁心嘔吐: Al(OH)₃, MgO
        
        味覺障礙dysgeusia: metronidazole
        
        消化不良dyspepsia: NSAIDs；SOL- misoprostol(PGE1類似物)
        
        腹瀉: lincomycin, clindamycin，導致腸道內梭狀芽孢桿菌(clostridium difficile)大量生長
        
        膽囊相關疾病: ceftriaxone(三代cepha), octreotide(化療腹瀉三線)
    - - 角膜潰瘍ocular toxicity: practolol (beta-blocker)
        
        視網膜病變retinopathy: chloramphenicol(SOL-Vit B12), INH, streptomycin, ethambutol, chloroquine
        
        角膜增生cornea verticillata: amiodarone
        
        視力模糊blurred vision: 抗精神病藥(chlorpromazine, thioridazine)
        
        眼內壓升高elevated intraocular pressure: corticosteroid
        
        後囊性白內障posterior subcapsular cataract: triamcinolone acetonide
    - - 耳蝸毒性cochlear toxicity(聽覺喪失hearing loss)，ex. aminoglycoside + loop diuretics/ethacrynic acid/furosemide/bumetanide
        
        前庭毒性vestibular toxicity(暈眩dizziness)，ex. neomycin, gentamicin, streptomycin, netilmicin
  - - - 再生不良性貧血aplastic anemia，ex. chloramphenicol, (NSAIDs)indomethacin/phenylbutazone, 傳統化療
        
        顆粒性白血球減少症agranulocytosis，ex. sulfonamide, sulfonylurea, phenothiazine抗精神病藥
        
        紅斑性狼瘡Lupus-like syndrome，ex. procainamide, hydralazine, isoniazid, rifampicin, propylthiouracil
        
        血小板低下thrombocytopenia，ex. (骨髓抑制)傳統化療、抗癲癇、phenothiazine抗精神病, chloramphenicol & (免疫功能)quinine, quinidine, acetazolamide
        
        溶血性貧血hemolytic anemia，ex. (G6PD缺乏)nitrofurantoin, isosorbide dinitrate, quinine, quinidine & (後天免疫異常)mehyldopa, Pn&Cepha, aspirin, ibuprofen, mefenamic acid
  - - - acetaminophen，服藥後4hr的血濃>150µg/ml，如果用量太大導致glutathione用完，會引發代謝物與macromolecule結合，產生肝臟毒性；
        SOL- N-acetylcysteine，服藥後6-8hr給予防止傷害，服藥後24hr給予減輕傷害
    - - 腎毒性nephrotoxicity: amphotericin B, cyclosporine, lithium
        
        腎小管毒性: aminoglycoside, cisplatin
        
        間質性腎炎: NSAIDs, sulfonamide, penicillin, cephalosporin, rifampin, allopurinol
        
        急性腎衰竭ARF: aspirin, NSAIDs(ex. indomethacin)
    - - TEN毒性表皮壞死(20%致死率)，ex. sulfonamide, penicillin, phenylbutazone(NSAIDs), phenolphthalein(NSAIDs), allopurinol, chloramphenicol
        
        SJS(致死率5-20%)，ex. sulfonamide, penicillin, phenytoin, carbamazepine, phenobarbital, allopurinol, chlorpropamide
        
        hirsutism/hypertrichosis多毛症，ex. androgen, oral contraceptives, minoxidil, tamoxifen
        
        光敏感，ex. thiazdie利尿劑, oral hypoglycemic, tetracycline&fluoroquinolone(nalidixic acid), 灰黴素griseofulvin, sulfonamide, phenothiazine抗精神病藥
    - - 支氣管收縮/氣喘: aspirin, penicillin, beta-blocker, beta-agonist(isoproterenol, metaproterenol)
        
        肺纖維化: 傳統化療(busulfan, bleomycin, mitomycin-C,carmustine, cyclophosphamide, cytarabine, chlorambucil, methotrexate, melphalan), amiodarone, nitrofurantoin
- - - - 相反藥理作用: 利尿劑與降血糖藥物、利尿劑與降尿酸藥物
        
        相似藥理作用: 抗膽鹼(抗精神病/chlopromazine+抗PD/trihexyphenidyl+TCA/amitriptyline)、降血壓(prazosin + TCA)
        
        改變電解質濃度: digoxin/sirolimus + 利尿劑(降低K+)/緩瀉劑(降低K+, Mg2+)/醣質皮質固醇(降低K+)，前後兩者至少間隔2小時
        
        作用相同受體位置: MAOI + SSRI，高血壓危及；SOL- 間隔1-2周，像是fluoxetine要5周
    - - A: 食物(DFI)、PH值、螯合作用、腸胃道蠕動
        
        D: 蛋白運輸、蛋白結合
        
        M: CYP450(phase1)、共軛(phase2)
        
        E: 腎臟、膽汁、汗腺
        
        PH值: bisacodyl(腸溶衣錠)/ketoconazole，如果胃PH值過高，前者提早溶出失效，後者無法吸收無效
        
        螯合作用: tetracycline(除了doxycycline, minocycline), fluoroquinolone + 多價陽離子，無法吸收
        吸附作用: cholestyramine, colestipol, SPS(sodium polystyrene sulfonate)
        
        腸胃道蠕動: (增加)cisapride(活化5-HT4)/metoclopramide(拮抗D2)等瀉藥；(減少)麻醉性止痛藥/抗膽鹼藥/高熱量飲食/止瀉藥
        
        腸道微生物菌叢:
        warfarin + 抗感染藥物(VitK減少，容易出血)
        digoxin + 抗感染藥(腸道代謝減少，容易中毒)，像是erythromycin、tetracycline、clarithromycin
        口服避孕藥 + 抗感染藥物(減少腸肝循環，導致避孕成效下降，像是ampicillin, cepha, erythromycin, tetracycline, sulfonamide, TMP-SMX, INH)
        
        蛋白結合: warfarin+phenylbutazone(前者free form增加)；MTX+salicylate(前者free form增加)；phenytoin+VPA(前者free form增加)
        
        Pgp(排出): clarithromycin(Pgp抑制劑) + digoxin；OATP(吸進): 葡萄柚汁/ritonavir/saquinavir(OATP抑制劑)
        
        CYP450代謝:
        高血壓危及專區- MAOI + tyramine/TCA/meperidine(腎排泄)/MDMA；SSRI(肝排泄) + L-tyr/MAOI/trazodone/selegiline/dextromethorphan；TCA + trazodone/venlafaxine(腎排泄)
        DHP-CCB/lovastatin, simvastatin/免疫抑制劑/CBZ + 葡萄柚汁(72hr)/clarithromycin
        theophylline + fluovoxamine/ciprofloxacin(CYP1A2抑制劑)
        
        其他代謝:
        disulfiram effect，ex. cefamandole, cefmetazole, cefoperazone, cefotetan(含有methylthiotetrazole)
        骨髓抑制，ex. mercaptopurine/azathioprine + allopurinol(XO抑制劑)
        
        腎臟排泄: NSAIDs/ACEI/ARB/rthiazied抑制lithium；theophylline/caffeine促進lithium；NSAIDs/probenecid抑制MTX；catopril/spironolactone抑制digoxin(備註: 抑制Pgp- cyclosporine/quinidine/verapamil抑制digoxin)
  - - - erythromycin stearate, didanosine
    - - erythromycin estolate
    - - 含金屬離子之食物 + tetracycline = 降低藥物吸收，至少間隔1hr
        
        含金屬離子之食物 + fluoroquinolone = 降低藥物吸收，至少間隔2hr
        
        含Vit K之食物 + warfarin = 抗凝血藥效下降
        
        含鉀之食物 + ACEI/spironolactone = 高血鉀導致的心律不整
        
        咖啡因 + fluoroquinolone/aminophylline/BZD類抗焦慮藥物 = 心悸/加強藥效/降低藥效
        
        含tyramine之食物 + MAOI(moclobemide) = 高血壓危及
        
        高蛋白/高脂肪食物 + rilpivirine(NNRTI) = 降低吸收40%
        
        紅麴(monacolin-K) + atorvastatin/simvastatin = 肌病肌痛
        
        酒精 + ketoconazole/metronidazole/cefamandole, cefmetazole, cefoperazone, cefotetan/chloramphenicol/nitrofurantoin = disulfiram-like syndrome
        
        酒精 + NSAIDs/beta-agonist/nitroglycerin/BZD類抗焦慮藥物/一代抗組織胺 = 肝損傷/噁心腹痛/低血壓/加強藥效*2
    - - eryhromycin ethylsuccinate