Taiwan Qiulity Indicator Project TQIP Taiwan Patient Reporting

數據分析 ¡ 台灣醫療品質指標計畫 (Taiwan Qiulity Indicator Project, TQIP) ¡ 台灣病人安全通報系統 (Taiwan Patient Reporting System, TPR) 9

藥物會增加跌倒風險 ¡服用任何會產生下列作用的藥物，都 會 ¡ Orthostatic hypotension ¡ 增加病人跌倒的機率 Confusion 混亂 ¡ ¡ Depression 憂鬱 Sedation 鎮靜 Arrhythmia 心律不整 Hypovolemia ¡ ¡ ¡ 姿勢性低血壓 Delayed reaction time 延緩反應時間 Diminished cognitive function 認知功能減損 Change in gait and balance 步伐不穩 25

院內品項利尿劑 (Diuretics) ¡ ¡ ¡ ¡ Acetazolamide (Azol®) Trichlormethiazide (Fluitran®) Glycerol, fructose, Na. Cl (Frucerol®) Mannitol (Maniton®) Indapamide (Nartrilix SR®) Furosemide (Rasitol®) Spironolactone (Spironolactone®) 27

院內品項緩瀉劑 (Laxotives) ¡ ¡ ¡ ¡ Castor oil (Castor oil®) Bisacodyl (Dulcolax®) Lactulose (Duphalac syrup®) Monosadium, disodium (Evac enema®) Magnesium, citric acid, potassium (Magvac oral solution®) Na. Cl, KCl, Na. HCO 3, Na 2 SO 4 (Niflec powder®) Sterculia, frangula (Normacol®) Sennoside A+B (Sennoside®) 28

院內品項鴉片類止痛劑 (Narcotics) ¡ ¡ ¡ ¡ Codeine (Codeine®) Propoxyphene HCl , Acetaminophen (Depain. X® ) Meperidine (Demerol®) Fentanyl (Fentanyl®) Morphine (Morphine®) Morphine (MST®) Tramadol (Tramtor®) 30

院內品項降壓劑 (Antihypertensives) ¡ Vasodilator l ¡ α 1 - blocker l l l ¡ Doxazosin (Doxaben®) Terazosin (Hytrin®) Prazosin (Pratsiol®) Centrally acting α- adrenergic agonist l ¡ Hydralazine (Apresoline®) Clonidine (Catapres®) α- nonselective β- blocker l Carvedilol (Dilatrend®) 32

院內品項降壓劑 (Antihypertensives) ¡ β-blockers l l l ¡ CCBs (Calcium channel blocker) l l ¡ Amoldipine (Norvasc®) Diltiazem (Herbesser®) ARBs (Angiotensin II receptor antagonist) l ¡ Acebutolol (Sectral®) Atenolol (Tenormin®) Propranolol (Inderal®) Candesartan (Blopress®) ACEIs (Angiotensin–converting enzyme inhibitor) l l Lisinopril (Zestril®) Captopril (Cabudan®) 33

院內品項BZDs (Benzodiazepines) ¡ 中效 l l l l ¡ ¡ Estazolam (Eurodin®) Flunitrazepam (Modipanol®) Lormetazepam (Loramet®) Lorazepam (Ativan®) Lorazepam (Anxicam®) Alprazolam (Xanax®) Bromazepam (Lexotan®) Oxazolam (Serenal®) 長效 l l Clonazepam (Rivotril®) Diazepam (Diazepam®) 非BZD類鎮靜安眠藥 l短效： Zolpidem (Stilnox®) 37

作用於BZD受體藥物之藥理特性 藥品 吸收 抗焦慮作用 催眠作用 Alprazolm (Xanax) 中 中 弱 Bromazepa (Lexotan) 中 中 弱 Estazolam (Eurodin) 快 弱 強 Flunitrazepam (Rohypnol) 快 弱 強 中效(Intermediate) 39

作用於BZD受體藥物之藥理特性 藥品 吸收 抗焦慮作用 催眠作用 Lorazepam (Ativan) 中 強 中 Lormetazepam (Loramet) 中 弱 強 Oxazolam (Serenal) 中 中 弱 中效 (Intermediate) 40

院內品項抗精神病藥物 (Antipsychotics) ¡ ¡ ¡ Haloperidol (Apo-Haloperidol®) Haloperidol (Binin-U®) Haloperidol decanoate (Binison ®) Haloperidol (Hadol liquid ®) Haloperidol (Halosten ®) ¡ ¡ Thioridazine (Thinin ®) Chlorpromazine (Winsumin ®) Clozapine (Zapine ®) Trifluoperazine (Flurazin ®) 43

院內品項抗憂鬱劑 (Antidepressants) ¡ SSRIs (Serotonin reuptake inhibitors) l l ¡ TCAs (Tricyclic antidepressants) l l l ¡ Fluvoxamine (Anwu®) Venlafaxine (Valosine®) Doxepin (Sinequan®) Imipramine (Tofranil®) (Clozaril ®) MAOIs (Monoamine oxidase inhibitors) l Selegiline (Parkryl ®) 45

Psychotropics抗精神病藥物 (Antipsychotics)和抗憂鬱劑 (Antidepressants) ¡ 實證顯示所有種類的Psychotropics都會 增加老年人跌倒的機率 ¡ 應盡可能減少Psychotropics的使用 46

院內品項降血糖劑 (Hypoglycemics) ¡ 胰島素 l l l l (Insulin) NPH human insulin (Humulin N®) Regular human insulin (Humulin R®) Insulin glargine (Lantus®) 30% Soluble human insulin / 70% isophane human insulin (Mixtard®) 30% Insulin aspart + 70% Insulin aspart w/ protamine (Novo. Mix Penfill®) Insulin aspart (Novo. Rapid Penfill®) Isophane insulin (Protaphane®) 48

院內品項降血糖劑 (Hypoglycemics) ¡ 口服降血糖藥 l Sulfonylurea ¡ ¡ l Glibenclamide (Gliben ®) Glipizide (Glidiab ®) Gliclazide (Diamicron®) Glimepiride (Amaryl®) Thiazolidinedione ¡ ¡ l Meglitinide ¡ l α-Glucosidase inhibitor ¡ l Repaglinide (Novonorm®) Acarbose (Glucobay ®) Biguanide ¡ Metformin (Uformin ®) Pioglitazone (Actos ®) Rosiglitazone (Avandia ®) 49

院內品項抗癲癇藥 (Anticonvulsants) ¡ ¡ ¡ ¡ Phenytoin (Aleviatin®) Carbamazepine (Carbatol®) Valproic acid (Convulex-500®) Valproate (Depakine®) Phenytoin (Dilantin®) Phenytoin, Phenobarbital (LA®) Lamotrigine (Lamictal®) ¡ Gabapentin (Neurotin®) Phenobarbital (Phenobarbital®) Clonazepam (Rivotril®) Vigabatrin (Sabril®) Carbamazepine (Tegretol®) Topiramate (Topamax®) ¡ Oxcarbazepine (Trileptal®) ¡ ¡ ¡ 51

院內品項抗膽鹼藥物 (Anticholinergics) ¡ ¡ ¡ Atropine (Atropine®) Dycyclomine (Bentyl®) Hyosine-N-butylbromide (Buscopan®) Alverine (Spasmonal ®) Flopropione (Cospanon ®) Mepenzolate (Trancolon ®) 53

院內品項麻醉藥品 (Anesthetics ) ¡ ¡ ¡ Midazolam (Dormicum®) Etomidate (Etomidata-Lipuro®) Halothane (Fluothane®) Propofol (Fresofol®) Ketamine (Ketalar®) ¡ ¡ ¡ Bupivacaine (Marcaine®) Ropivacaine (Naropin®) Cisatracurium (Nimbex®) Thiopental (Pentothal®) Alfentanil (Rapifen®) Lidocaine (Xylocaine®) 56

院內品項抗組織胺劑 (Antihistamines) ¡ Diphenhydramine (Diphenhydramine ®) ¡ Buclizine (Longifene ®) ¡ Dexchlorpheniramine (Polaramine ®) ¡ Hydroxyzine (Vistaril ®) 58

其他藥物 ¡ NSAIDs ¡ Antiarrhythmics ¡ Antiparkisonians ¡ OTC products for sleep, pain, colds, and allergy 61

Reference ¡ ¡ ¡ 醫策會 International Quality Indicator Project. Center for Performance Sciences, 2001 Paul C. Walker, Ahemad Alrawi, john F. Mitcjell, Randolph E. Regal, and Ujjaini Khanderia. Medication use as a risk factor falls among hospitalized elderly patients. Am J Health-Syst Pharm. 2005; 62: 2495 -9 Carol A. Miller, RNC, MSN. The connection between drugs and falls in elders. Geriatric Nursing 2002; 23 (2): 109 -110 66

Thank you very much!! 67