2014년 01월호vol .2

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2014년 12월호 VOL .06 Circadin ® PR tab. 2mg (서카딘 서방정) 수면 및 일주기성 리듬을 조절해 수면 의 질을 개선 약물관련 처리절차 Ⅰ. 고위험군/고주의성 약품의 안전 관리 Ⅱ. 항암제 안전사용 지침 육군자탕(六君子湯, 원내코드 : HH844) 기허(氣虛)상태에 사용하는 사군자탕에 담음(痰飮)을 없애 주는 반하, 진피가 가()해진 제제 •수가신설 안내: 집중영양 치료료 • 2014학년도 경희대 약대생 필수실무실습 종료 • 약품 처방 명칭 변경 공지 ㅣ발행인ㅣ 김정태 ㅣ편집위원ㅣ 정경주, 예경남, 천영주, 김정보, 배희경, 윤지은, 이순 134-090 서울시 강동구 동남로 892 [TEL] 02.440.6977 / 02.440.6992(한방) [FAX] 02.440.6984 ㅣ발행일ㅣ 15.01.27 ㅣ발행처ㅣ 강동경희대학교병원 약제부 / http://pharm.khnmc.or.kr 강동경희대학교병원 약품정보지

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  • 2014 12 VOL .06

    Circadin PR tab. 2mg ( )

    . /

    .

    (, : HH844) () () , ()

    : 2014

    , , , , , ,

    134-090 892 [TEL] 02.440.6977 / 02.440.6992() [FAX] 02.440.6984

    15.01.27 / http://pharm.khnmc.or.kr

  • Circadin PR tab. 2mg (Melatonin)

    1.

    2.

    Melatonin 2mg

    3.

    4.

    Melatonin (pineal gland)

    (pinealocytes)

    5.

    55

    6.

    1 1 1 1~2

    13

    7.

    Tmax : 2~4hr

    (Vd): 35L

    Tmax : 2~4()

    : (CYP1A)

    (6- Hydroxylation Sulfation Glucuronidase)

    : 3.5~4

    : AUC .

    .

    : (~85%)

    : 630~960 mL/min

    8.

    , , , ,

    1 2014 12

    9.

    CYP3A

    fluvoxamine :

    - CYP1A2, CYP2C19

    -

    nifedipine

    warfarin

    10.

    1) .

    2) (galactose intolerance), Lapp

    (Lapp lactase deficiency) -

    (glucose-galactose malabsorption)

    11.

    :

    :

    12.

    , (25)

    .

    .

    .

    .

    .

    Journal Review

    Prolonged release melatonin in the treatment of primary insomnia : evaluation of the age cut-off or short - and long-term response: Prolonged Release Melatonin (PRM) (Alan G. Wade et al., Current Medical Research & Opinion, 2011, 87-88)

    DSM-IV* 18-80, sleep latency( ) 20 3 6

    PRM . PRM 18-54, 55-80

    .

  • 2 2014 12

    , 1 sleep latency 55-80

    (-15.4 vs -5.5min, p=0.014)(Figure 2), 18-80

    (-14.6 vs -7.9min,

    p=0.129).(Table 3) 2 sleep diary parameters,

    PSQI** global scores, component scores, questione 2 & 4, CGI-S**. CGI-

    I**( ), WHO-5 well-being Index( ) 55-80

    (Table 4). 6

    ,

    rebound insomnia .

    * DSM-IV : Diagnostic and Statistical Manual for Mental Disorders -IV * PSQI : Pittsburgh Sleep Quality Index CGI-S: Clinical Global Impression -Severity of Illness Scale CGI-I: Clinical Global Impression of Improvement

    Lasting treatment effects in postmarketing surveillance study of Prolonged Release Melatonin (PRM): PRM (Gran Hajaka et al., International Clinical Psychopharmacology, 2014)

    PRM rebound insomnia, prospective,

    referenced, cohort . 3 PRM , 2 (early

    withdrawal) 2 (late withdrawal) site .

    Sleep quality, Morning alertness , 1~5 ,

    . PRM rebound insomnia 1 .

  • 3 2014 12

    , sleep quality, morning alertness (1~3) 42(7.1%) 462(77.4%), 87

    (14.6%) 472(79.1%) .(Fig.3) rebound insomnia , PRM

    (Fig.4), PRM , 10.2% .(Fig.5)

    , PRM , rebound insomnia,

    . PRM 55 1 , 2010

    3 13 .

    Nightly treatment of primary insomnia with Prolonged Release Melatonin (PRM) for 6months : a randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety: PRM (Wade et al., BMC Medicine, 2010, 8:51)

    ,

    . PRM

    (18-80) (65 /65 )

    (low/high) 3 6 PRM

    .

    1 sleep diary sleep latency ,

    PRM

    (-9.0 vs -9.0min, p=0.924), (65-80

    ) PRM .(-19.1 vs -1.7min, p=0.002)

  • 4 2014 12

    -. /

    Special Issue

    1 .

    -

    - : -

    - : , () ( )

    - : , , , , , ()

    - .

    KCl inj.

    3g/20ml(40mEq)

    (Pot.Chloride)

    -

    - KCL .

    - : 80mEq/L

    - : 200mEq/L

    - : 10mEq

    . 20-40mEq/hr

    .

    -

    .

    - : []

    (T

    , QRS , ST , P

    ) . ,

    .

    - : .

    .

    NaCl inj.

    2.34g/20ml

    (40mEq)

    (Sod.chloride)

    - :

    iv infusion .

    -

    - : , , ,

    .

    - : .

    .

    Sodium Chloride

    3% 500ml Bag

    - iv infusion .

    Masi inj. 50%

    20ml (Magnesium

    sulfate)

    - : 20% .

    40g/24hrs .

    - 2g/hr,

    4g/hr.

    - : 4 knees up , ,

    urine output

    .

    - : ,

    , , , ,

    .

    - : .

    .

    () . .

    -

    - : -

    - : , () ( )

    - . 4 ,

    , , .

    Heparin inj.

    25000IU/5ml,

    Heparin inj.

    20000IU/20ml

    - EMR (HOAP, Heparin

    order & administration program) .

    - , aPTT, ACT

    -

    -

    .

    - : (Protamine sulfate inj.

    50mg/5mL) 1000unit 1-1.5 mL

    (10~15mg) .

  • 5 2014 12

    2 .

    (vial) Humalog inj.1000IU/10mL

    HumulinN 1000IU/10ml

    HumulinR 1000IU/10mL

    Lantus inj. Vial 1000U/10ml

    Novorapid inj. 1000IU/10ml

    Apidra inj. 1000U/10ml/V

    - ( )

    -

    ()

    Actilyse inj. 50mg, 20mg

    Urokinase inj. 500,000IU , 100,000IU

    Urotine inj.50,000IU

    -

    (look-alike), (sound-

    alike),

    -

    - [!] , EMR

    , , ,

    > Zoloft tab. 50mg[!](Sertraline)

    -

    , ,

    > IsopTIN SR tab. 180mg[X] (Verapamil)

    - ,

    , , ,

    >Adalat oros tab. 30mg, Adalat oros tab. 60mg

    - : 2-8,

    - : -20 ,

    - :

    ,

    ,

    > IsopTIN SR tab. 180mg[X] (Verapamil)

    - , powder ,

    -.

    1 .

    , .

    2 .

    1) ,

    .

    2)

    .

    3) , , , .

    4) Bolus/IV .

    5) .

    3 .

    1) Regimen protocol .

    2) 2 .

    3) .

    4) , 1 .

    5) .

    6) . ,

    , , , , .

  • 6 2014 12

    4 .

    1)

    .

    .

    2)

    . (

    .)

    3)

    .

    5 .

    1) spill kit (Nitrile glove) .

    2) spill kit .( .)

    3) .

    4) 2 .

    5) , .

    6) .

    Reference 1. 2. 3.

    : , (), ()

  • 7 2014 12

    (, : HH844)

    1. : 1(3g) (JP) 2050mg, (JP) 2.0g,

    (JP) 2.0g, (JP) 2.0g, (JP) 2.0g, (JP) 1.0g,

    (JP) 1.0g, (JP) 0.5g, (JP) 0.25g

    2. : 3g/

    3.

    (: ,,,) ,

    () (;

    ) () ,

    (), , (: ), , (: ), ,

    (), (: ) .

    (: ) , ()

    . ()

    () . ()

    () , () .

    () , ,

    , ()

    , ()

    , . ()

    ()

    . ()

    (: ) (:

    ), .

    .

    4.

    1) ()

    2)

    3) ()

    1)

    2)

    1) ()

    2)

    1)

    2)

    3)

    4)

    5)

    1)

    2)

    3)

    4)

    Reference

    1. DC,

    2. , ,( 2003)

    3. , , ()(2012)

    4. , , , (2013)

    : ()

    5. : (), (), ()

    6. : , , ,

    : , ,

    , , (), ,

    7. : 1 6.0g 2~3

    8.

    9.

    1) , , ,

    (, ) (

    )

    .

    2)

    .

    10.

    () , Lapp

    () -

    .

    11. : 36, , (1~30)

    : wafarin,

    aspirin, clopidogrel, enoxaparin

    : glimepiride, glyburide,

    insulin, metformin

    : azathioprine,

    cyclosporine, sirolimus

    Digoxin, furosemide,

    hydrochlorothiazide, thiazide

    : metoprolol, verapamil,

    diltiazem

    : glimepiride, lyburide,

    insulin, metformin, pioglitazone,

    rosiglitazone

    : nifedipine,

    verapamil, diltiazem, felodipine

  • 8 2014 12

    :

    (2014-123, 2014.7.29) 2014 8 1 .

    (Nutrition Support Team, NST) , .

    .

    : NST NST

    : NST NST

    : (PN) NST (02)440-6978)

    (EN) NST (02)440-7568)

    8-1

    (Therapy by Nutrition Support Team)

    (Therapy by Nutrition Support Team) , , , , . . : . : 1 (1) 3.0g/dl (2) (3) (4) (5) (6) 5percentile ( ) . : 1 ( 4 )

    2014

    2014 2 12 19 . 8 11

    15 .

    .

    []Codenal syr. 1ML []Codenal Solution. 1ML , 2014.12.1 .

    Isepacin inj. 200mg/2mL (Isepamicin)

    Isepamicin inj. 200mg/2mL (Isepamicin)

    , . EDI .