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Optimizacija zdravljenja z metildigoksinom v Univerzitetnem kliničnem centru Maribor : enoviti magistrski študijski program Farmacija
ID Reisman, Katja (Author), ID Mrhar, Aleš (Mentor) More about this mentor... This link opens in a new window, ID Drofenik, Polonca (Co-mentor)

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Abstract
Metildigoksin je zdravilna učinkovina, ki se že dalj časa uporablja za zdravljenje srčnega popuščanja in atrijske fibrilacije, vendar njegova zastopanost med zdravniki zaradi možnosti predpisovanja sodobnejših varnejših učinkovin v zadnjem času upada. Spada med učinkovine z ozkim terapevtskim območjem, v okviru katerih se režim odmerjanja načeloma nenehno prilagaja na osnovi koncentracije učinkovine v serumu. Zato je pomembno, da je za vsakega posameznega bolnika, pri katerem je potrebna terapija z metildigoksinom, optimalno terapevtsko območje dobro definirano in da se spremljanje serumskih koncentracij (metil)digoksina izvaja pravilno, saj je le tako moč zagotoviti ustrezno učinkovitost in varnost terapije z metildigoksinom. Pri optimiranju režima odmerjanja učinkovin z ozkim terapevtskim območjem naj bi zdravnikom in farmacevtom UKC Maribor bil v veliko pomoč, in v primeru gentamicina in vankomicina tudi je, farmakokinetični računalniški program Kinetidex®. Namen retrospektivne raziskave je bil ovrednotiti uporabnost Kinetidex®-a pri napovedovanju koncentracij (metil)digoksina v serumu. S prospektivno raziskavo pa smo v vsakdanjo klinično prakso želeli uvesti na osnovi pregleda aktualne literature pripravljena navodila za odmerjanje metildigoksina in spremljanje serumskih koncentracij (metil)digoksina. Nadalje je bil namen prospektivne raziskave v primeru za izbranega bolnika neustreznih nivojev (metil)digoksina v serumu določiti optimalni režim odmerjanja na osnovi izvedbe simulacije v Kinetidex®-u. V retrospektivno raziskavo smo izmed 206 bolnikov, ki so se med 1. januarjem in 31. marcem 2013 na Oddelku za kardiologijo in angiologijo UKC Maribor zdravili pod diagnozo atrijska fibrilacija in undulacija in/ali zastojna srčna odpoved, s pregledom popisa vsakega posameznega pacienta vključili 65 tistih, ki so se pred in med zdravljenjem v bolnišnici zdravili z metildigoksinom. V prospektivno raziskavo pa smo vključili 18 bolnikov, ki so se med 1. junijem in 31. julijem na Oddelku za kardiologijo in angiologijo UKC Maribor pred in med zdravljenjem v bolnišnici zdravili z metildigoksinom. Ugotovili smo, da je Kinetidex® pri napovedovanju koncentracij (metil)digoksina v serumu uporaben do te mere, da je na osnovi izvedene simulacije moč določiti za izbranega bolnika optimalni režim odmerjanja. Prav tako je simulacija zdravniku in farmacevtu lahko v pomoč pri odločitvi za odvzem serumskega vzorca, saj je iz grafa zelo jasno razvidno, kdaj se pri izbranem bolniku vzpostavi stacionarno stanje.

Language:Slovenian
Keywords:metildigoksin digoksin farmakokinetika metildigoksina farmakodinamika metildigoksina neželeni učinki
Work type:Master's thesis/paper
Typology:2.09 - Master's Thesis
Organization:FFA - Faculty of Pharmacy
Place of publishing:Ljubljana
Publisher:[K. Reisman]
Year:2014
Number of pages:III, 65 f.
PID:20.500.12556/RUL-121092 This link opens in a new window
UDC:615.011.015(043.3)
COBISS.SI-ID:3704177 This link opens in a new window
Publication date in RUL:30.09.2020
Views:756
Downloads:83
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Secondary language

Language:English
Title:Optimisation of methyldigoxin therapy in University Medical Centre Maribor
Abstract:
Methyldigoxin is an active ingredient that has been used for a long time to treat heart failure and atrial fibrillation, but its prescription rate among physicians has dropped recently due to the possibility of prescribing modern and safer active ingredients. It belongs to the active ingredients with a narrow therapeutic window, requiring, in principle, a continual adjustment of their dosage regimen to the concentration of the active ingredient in the serum. It is therefore important that in patients requiring methyldigoxin therapy the therapeutic range is well defined and that the (methyl)digoxin concentration monitoring is correct to ensure adequate efficiency and safety of the therapy. Kinetidex®, a pharmacokinetic computer program, could be very helpful to the doctors and pharmacists at the University Medical Centre Maribor, as it is in gentamicin and vancomycin therapy, to optimise the dosage regimen of the active ingredients with a narrow therapeutic window. The purpose of retrospective study was to assess the applicability of Kinetidex® in forecasting (methyl)digoxin serum concentration levels. The purpose of prospective study on the other hand was to introduce the methyldigoxin dosage and serum (methyl)digoxin concentration monitoring instructions into everyday clinical practice following a review of the current literature. Furthermore, was the aim of prospective study to determine an optimal dosage regimen through a Kinetidex® simulation in patients with inadequate serum (methyl)digoxin levels. The retrospective study included 65 out of 206 patients treated for atrial fibrillation and undulation and/or congestive heart failure between 1 January and 31 March 2013 at the Department of Cardiology and Angiology of the University Medical Centre Maribor by reviewing a list of the patients receiving methyldigoxin therapy prior to and during the hospital treatment. And the prospective study included 18 patients receiving methyldigoxin therapy prior to and during the hospital treatment between 1 June and 31 July at the Department of Cardiology and Angiology of the University Medical Centre Maribor. The results of this study suggest that in forecasting serum (methyl)digoxin concentrations Kinetidex® is applicable to the extent that it is possible to define an optimal dosage regimen for a selected patient by carrying out a simulation. Likewise, a simulation may be helpful to doctors and a pharmacists in deciding to take a serum sample, since the graph clearly shows when the stationary state of a selected patient is reached.


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