POLIFARMATSIYA VA DORI–DORI O‘ZARO TA’SIRLARI: KLINIK XAVFLAR, PROFILAKTIKA VA DORI KO‘RIB CHIQISH (MEDICATION REVIEW) ALGORITMLARI
Ключевые слова:
polifarmatsiya, dori–dori o‘zaro ta’siri, nojo‘ya dori reaksiyasi, dori xavfsizligi, medication reconciliationАннотация
Polifarmatsiya (odatda 5 va undan ortiq dori vositasini bir vaqtda qabul qilish) ko‘p kasallikli bemorlarda klinik natijalarni yaxshilashi mumkin, biroq u dori–dori o‘zaro ta’sirlari (DDI), nojo‘ya dori reaksiyalari, dori xatolari, adherens pasayishi hamda davolash xarajatlarining ortishi bilan bog‘liq xavflarni sezilarli oshiradi. Ayniqsa, keksa yosh, buyrak/jigar funksiyasi pasayishi, tor terapevtik oraliqli preparatlar (antikoagulyantlar, antiaritmiklar va boshqalar) qabul qilinishi hamda OTC/fitopreparatlar qo‘shilishi klinik ahamiyatli DDI ehtimolini kuchaytiradi. Ushbu tahliliy maqolada polifarmatsiyaning asosiy sabablari va “o‘rinli” hamda “muammoli” polifarmatsiya tushunchalari yoritiladi; farmakokinetik (CYP fermentlari, P-gp, absorbsiya va eliminatsiya o‘zgarishi) va farmakodinamik (qon ketish, giperkalemiya, sedatsiya/yiqilish, QT oralig‘i uzayishi) o‘zaro ta’sir mexanizmlari tizimlashtiriladi. Shuningdek, xavfni kamaytirish uchun dori yarashtirish (medication reconciliation), strukturali dori ko‘rib chiqish (medication review), skrining mezonlari (Beers, STOPP/START) hamda “Avoid–Adjust–Monitor” tamoyiliga asoslangan amaliy boshqaruv algoritmi taklif etiladi. Maqola yakunida individual depreskribing yondashuvi va monitoring orqali polifarmatsiya xavfsizligini oshirish bo‘yicha tavsiyalar beriladi
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