predavanje uporaba lijekova u trudnoi
TRANSCRIPT
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UPOTREBA LIJEKOVA UTRUDNOĆI
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TERATOGENI UČINCITERATOGENI UČINCI
SPECIFIČNOSTISPECIFIČNOSTIPRIMJENE LIJEKOVAPRIMJENE LIJEKOVA
U TRUDNICAU TRUDNICA
TERAPIJSKA PRIMJENATERAPIJSKA PRIMJENA
LIJEKOVA U PLODALIJEKOVA U PLODA
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• OPĆI PODACI:• Reproduk!"#$ do% u &e#$ '()* + ,,*-*.
• / )01 rud#o2$ #ep3$#!r$#o• Pre"$3e#4!5$ kro#!6#!7 %o3e8! kod &e#$ 9 ,) -*(
– 7% - astma
– 6% - hipete!"i#a
– $6 –&$% - epi'epsi#a
(* Ce#er or D!8e$8e Co#ro3 $#d Pre"e#!o# 'CDC.; <<*4d4*-o"=#478=re3e$8e=0>#e<8=<o?e#%!r7*7?*
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Porast primjene lijekova tijekom trudnoće(isključujući vitamine i minerale) 1 ----
od 1.7 1976.g. do 2.9 2000.g
!"0# u$me %ar 1 lijek tijekom trudnoće &0# u$me >4 lijeka
6 od prvi' 10 najčeće koriteni' su *+ lijekovi(aanalgeti,inalgeti,i antiantiemeti,iemeti,i laksativilaksativi))
(* De V!-$# C@ e $3* J Clin Epidemiol * )>'(0.:>@ (*
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UPOTRE(A LIJEKOVA U TRUDNO)I
• Trud#!4e kod ko5!7 5e pr!?5e#$3!5eko"$ opr$"d$#$:
– e#e ko5e u3$e u rud#o2u8 odree#!? dr$"8"e#!?
pro%3e?o? – e#e kod ko5!7 8e r$"!5e
#o"! dr$"8"e#! pro%3e?$ "r!5e?e rud#o2e
– Po-orH$#5e po8o5e2e-dr$"* pro%3e?$
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KOJE LIJEKOVE TRE(A I*(JE+AVATI ILIKORISTITI U* OPRE* ,
Sa./0!e!/ se ta1i mi2'#e!#e 3ama4e5ta i'i'i#e!i.a/ 0aa!#5 /0ee!ih 'i#e./at50!i4ama
Stah /0 TERATO+ENE*E 8
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TERATOLO+IJA 9teat/s - !a.a"a: m/!st5m;"!a!/st / !e!/ma'!/m a"/#5 p'/0a
• TERATO+ENIMA se !a"ia#5 si 5"/!i4i./!ata'!ih a!/ma'i#a
• TERATO+ENI < 3i"i.a i'i hemi#s.a ta:
mi.//=a!i"am
i2a. i'i ma!#a. !e./= e'eme!ta ./#i s5 ti#e./m em>i#s./= i'i 3et5s!/= 1i/ta 5
sta!#5 i"a"ati A(NORMALNOST O(LIKA i'i?UNK@IJE 5 /#e.a
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KON+ENITALNI POREME)AJI
eBe i'i ma!#e ma'3/ma4i#e 5 st5.t5i i'i35!.4i#i /=a!a: ./#e /0st5pa#5 /0!/ma'!/sti
Ka0a "apa1am/ a>!/ma'!/sti ,
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U*RO@I KON+ENITALNIC POREME)AJA
U!.!/!6% +e!eti4
F%
@hemi4a's:05=s
a0iati/!GhHpethemia&%
Mate!a'4/!0iti/!s
%
Mate!a'i!3e4ti/!s
%Me4ha!i4a'F%Schardein JL, 2000.
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VRSTE TERATO+ENA <
• D/.a"a!i teat/=e!i
• M/=5Bi teat/=e!i
• Ne0/.a"a!i teat/=e!i
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DOKA*ANI TERATO+ENI KOD LJUDI- LIJEKOVI<
• Ta'i0/mi0• Ka>ama"epi!
• Liti#• Va'p/i!a .ise'i!a
• Va3ai!
• I"/teti!/i!
• Test/ste/!
• A!titi/i0!i 'i#e./i
• Met/te.sat• A@E i!hi>it/i
• Teta4i.'i!i
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Tha'i0/mi0e
Is/teti!/i!
a3ai!
Va'p/i4 A4i0
@a>ame"epi!e
@/5mai!
Phe!Ht/i!
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TALIDOMIDSKA KATASTRO?A
• INDIKACIJE:• &< p/5"0a!
ta!.i'i"at/ i hip!/ti.888888• Da!as<
'i#ee!#e i p/3i'a.sa
'epe: m5'tip'i mi#e'/m
• & si!teti"ia!• & !a e5/ps./m t1i2t5 .a/ p/5"0a!ta!.i'i"at/ i hip!/ti.
• &-&6(0 000 !///e!e0#e4e s te2.ims.e'et!im
0e3/ma4i#ama• ?DA 5 SAD !i#e
/0/>i/ e=ista4i#5 90?a!4es Ke'seH;
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KATE+ORI*A@IJA LIJEKOVA PREMA
STUPNJU RI*IKA PRIMJENE U TRUDNO)I //ontrolontroliraneirane studistudi j jee u ljudi negativneu ljudi negativne
tudije na ivotinjama nisu poka$ale ri$iktudije na ivotinjama nisu poka$ale ri$ik
3skustva primjene na ljudima negativna3skustva primjene na ljudima negativna
++ tudije na ivotinjama po$itivne ili nisu učinjenetudije na ivotinjama po$itivne ili nisu učinjene4edostatak podataka u '4edostatak podataka u 'umanumanoj primjenioj primjeni
55 umanumanii poda,i poka$ujupoda,i poka$uju riri$i$ikk (omjer ri$ik-korist)(omjer ri$ik-korist)
nimalnimalnini iliili 'uman'umanii poda,ipoda,i popo$$itivitivnini88
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KATE+ORIJE LIJEKA *A PRIMJENU UTRUDNO)I PREMA ?DA
A - K/!t/'ia!e st50i#e !is5 p/.a"a'e
p/st/#a!#e i"i.a p/ 3et5s 5 p/m
timest5 t50!/Be: !ema 0/.a"a "a p/st/#a!#e i"i.a 5
/sta'a 0a timesta
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KATE+ORIJE LIJEKA *A PRIMJENU UTRUDNO)I PREMA ?DA
( - St50i#e !a 1i/ti!#ama !is5 p/.a"a'e
p/st/#a!#e i"i.a: a !ema
./!t/'ia!e st50i#e !a t50!im1e!ama:
i'i st50i#e !a 1i/ti!#ama s5 p/.a"a'e
2tet!a 0#e'/a!#a: ./#a 5 st50i#ama!a t50!im 1e!ama !is5 0/.a"a!a
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KATE+ORIJE LIJEKA *A PRIMJENU UTRUDNO)I PREMA ?DA
@ - st50i#e !a 1i/ti!#ama s5 p/.a"a'e
2tet!/ 0#e'/a!#e !a 3et5s
9teat/=e!/: em>i/4i0a'!/; i'i !is55i!#e!e:
!ema ./!t/'ia!ih st50i#a !a '#50ima
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KATE+ORIJE LIJEKA *A PRIMJENU UTRUDNO)I PREMA ?DA
D - Ima p/"iti!ih 0/.a"a "a i"i. p/ 3et5sa'i se
">/= 0/>/>iti pim#e!e "a t50!51e!5 ./iste
5sp./s m/=5Bem i"i.5
9!p 'i#e. 5 1i/t!/ /pas!/# sit5a4i#ii'i /">i'#!/# >/'esti "a ./#5 !ema si=5!i#e='i#e.a;
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KATE+ORIJE LIJEKA *A PRIMJENU UTRUDNO)I PREMA ?DA
- St50i#e !a 1i/ti!#ama i '#50ima s5
0/.a"a'e 0a 'i#e. i"a"ia
a>!/ma'!/sti- p/st/#i 0/.a" "a m/=5Bi i"i. p/
3et5s 5teme'#e! !a is.5st5
- 'i#e. #e ./!tai!0i4ia! "a pim#e!5 5t50!/Bi
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i!i/4i teat/=e!/= 0#e'/a!#a9pema i's/!5;
(* MATERNOFETUSNI GENOTIP >* KOLIČINA TERATOGENA
STUPANJ RA*VOJA PLODA U TRENUTKU
DJELOVANJATERATO+ENA <a; 0/& 0a!a !a./! /p'/0!#e "ameta. #e e'ati!/ e"iste!ta!
!a teat/=e!e i!"5'te Vi#e0i pai'/ se i'i !i2ta - 5i!a. #e'eta'a! i'i #e >e" p/s'#e0i4a
>; & – 6$ 0a!a !a./! /p'/0!#e !a#/s#et'#ii#i - Q.iti!i pei/0 "a a"/# /=a!a i s5staa 9st5.t5!i i 35!.4i/!a'!i 0e3e.ti 8; 4; .as!i#e: 5 sta0i#5 asta i sa"i#ea!#a p'/0a: /2teBe!#e a"/#a 9@NS: sp/'!i /=a!i: im5!/'/2.i i ./2ta!i s5sta;
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PRVI TRIMESTAR TRUDNO)E
Pei/0 #e OR+ANO+ENE*E9s i"5"et./m @NS ./#i se a"i#a ti#e./m
4i#e'et50!/Be;: .a0a te>a
I*(JE+AVATI DAVANJE LIJEKOVA
TRUDNI@AMA /0!/s!/ sesti ih !a !a#ma!#5 m/=5B5
m#e5
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UTVRIVANJE TERATO+ENOSTI
• La>/at/i#s.a ispitia!#a !a 1i/ti!#ama9.5!iB 05=a sta;
• Epi0emi/'/2.a ista1ia!#a a0i p/tp5!i#ep/4#e!e teat/=e!/sti
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PRIJENOS LIJEKA S MAJKE NAPLOD
PLACENTA !3! POSTELJICA #e0i!ste!i
mem>a!s.i s5sta +'a!e 35!.4i#e<
• espia4i#s.e i !5titi!e• 3i'ta4i#s.e i e'imi!a4i#s.e
0#e'5#e 5 ./ist p'/0a p/ma15Bi !#e=/ ast i/=a!iaa#5Bi 2tet!/ 0#e'/a!#e /./'i!e
.a/ se'e.ti!a >ai#ea !e a0i i0ea'!/
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MECANI*MI PRIJENOSA LIJEKOVA KRO*PLA@ENTU
• PASIVNA DIFUIJA: !ei/!i"ia!i 'i#e./i: ma'e MM:'ip/s/'5>i'!i: !ee"a!i "a p/tei!e p'a"me 9!p hepai! !e p/'a"i;
• OLAKANA DI?U*IJA: /0i#a se !i" ./!4 =a0i#e!t: !ema 5t/2.ae!e=i#e a'i #e p/te>a! pi#e!/s!i. (carrier substance)
• AKTIVNI TRANSPORT: 5" 5t/2a. e!e=i#e i p/ti./!4 =a0i#e!ta: !51a! pi#e!/s!i. 9ami!/.ise'i!e:mi/e'a.sa!si;
• PINO@ITO*A I ?A+O@ITO*A: sp/i meha!i"mi!e"!at!/= "!aa#a "a 'i#e./e
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PRIJENOS LIJEKOVA KRO* PLA@ENTU
• P'a4e!ta ima 9te/ets.5; sp/s/>!/st meta>/'i"ma'i#e./a 9sa01aa e!"ime< 4it/./m P-$ ipepti0a"e;
• Li#e./i p/sti15 $ - &$$% ./!4e!ta4i#e 5 3et5s5 5/0!/s5 !a /!5 5 ma#.e – /m#e ?GM9a./ !is5 s'i!i pi/0!im taima .a/ ami!/.ise'i!e;
• VeBi!a se 'i#e./a 5.'a!#a i" p'/0a p/ste'#i4/mNe.i se 5.'a!#a#5 pe./ >5>e=a: 2t/ m/1e p/051iti 0#e'/a!#e'i#e.a !a 3et5s
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P+3:3;4*3 *<P3=/P+3:3;4*3 *<P3=/P<3>=4 ?3=/@ A *<A543+P<3>=4 ?3=/@ A *<A543+
Bolest?
TerapTerapijskeijske oo p pcijecije??
PRIMIJENITI DOKA*ANO NEKODLJIV LIJEK SAMO AKOJE NUNO POTRE(AN8VODITI RAUNA O PROMJENI ?I*IOLOKIC IM(ENIKA8
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SPE@I?INOSTI TERAPIJSKEPRIMJENE LIJEKOVA U TRUDNI@A
• P/m#e!e 5 3ama./.i!eti4i 'i#e./a<
• APSORP@IJA – sma!#e! m/ti'itet +I ta.ta• DISTRI(U@IJA – p/ast 5.5p!e t te.5Bi!e i tmas!/Be
• META(OLI*AM – p/ast a.ti!/sti e!"ima
• ELIMINA@IJA – p/t/. .i ./" >5>e=e se50/st55#e 9pim#e 0/"ia!#a am/.si4i'i!a 5 'i#ee!#5 s5sta!ih!as5p/t 'i#ee!#5 5i!a!ih i!3e.4i#a;
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A!tii!3e.tii 5 t50!/Bi
• Pe!i4i'i!i
• @e3a'/sp/i!i
• Ka>ape!emi• ?'5//.i!/'/!i
• Ma./'i0i
• Ami!/='i./"i0i
• S5'3/!ami0i
• A!ti35!=i4i
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Pe!i4i'i!i
• Kate=/i#a ( 5 t50!/Bi – P/'a"e ./" p'a4e!t5 'a./ i >"/ – K/!4e!ta4i#a #e0!a.a .a/ 5 ma#.e
• La.ta4i#a – Pe'a"e 5 ma!#/# ./!4e!ta4i#i – K/mpati>i'!i s 0/#e!#em
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@e3a'/sp/i!i
• Kate=/i#a ( 5 t50!/Bi
P/'a"e ./" p'a4e!t5 –
I"#e2Ba / p/eBa!#5 a!/ma'i#a ./0pim#e!e spe4i3i!ih 4e3a'/sp/i!a94e3a4'/: 4e3a'e.si!: 4e3a0i!;
• La.ta4i#a – Pe'a"e 5 ma!#/# ./!4e!ta4i#i – 5"eti 5 />"i ./0 0/#e!#a
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Ka>ape!emi9etape!em: imipe!em: me/pe!em;
• Kate=/i#a (G@G( 5 t50!/Bi – P/'a"e ./" p'a4e!t5
– '/ ma'/ p/0ata.a 9h5ma!i i"/i;
• La.ta4i#a
– Pe'a"e 5 ma!#/# ./!4e!ta4i#i – !ep/"!at 5i!a. a'i #e/#at!/ ma'e .'
"!aa#!/sti
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?'5//.i!/'/!i
• Kate=/i#a @ 5 t50!/Bi – Ne pep/5a se 5 t50!/Bi
– I"#e2Ba / /2teBe!#ima 5 1i/ti!#a
– Si=5!i#a a'te!atia />i!/ p/st/#i
• La.ta4i#a
– Pe'a"e 5 m m'i#e./ – O=a!ie!i p/0a4i 9h5ma!i;
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Ma./'i0i9a"it/mi4i!: .'ait/mi4i!: eit/mi4i!;
• Kate=/i#e (G@G( 5 t50!/Bi – P/'a"e ./" p'a4e!t5 5 ma!#im ./'ii!ama
– O=a!ie!i p/0a4i / a"it/mi4i!5 i.'ait/mi4i!5
• La.ta4i#a – Eit/mi4i! ./mpati>i'a!
– Osta'i #e/#at!/
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Ami!/='i./"i0i9ami.a4i!: =e!tami4i!: t/>ami4i!;
• Kate=/i#a @ 9D; 5 t50!/Bi – ("/ p/'a"e p'a4e!t5
– U'a"e 5 am!i/!s.5 te.5Bi!5
• La.ta4i#a
– K/mpati>'!i s 0/#e!#em – Ne aps/>ia#5 se i" +I ta.ta
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S5'3/!ami0i
• Kate=/i#a @ 5 t50!/Bi – ("/ p/'a"e p'a4e!t5
– Ne ./istiti – p/st/#i a'te!atia
• La.ta4i#a
– I"'55#e se 5 m m'i#e./ 5 ma!#/# ./'ii!i – Up/a>5 i">#e=aati
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Teta4i.'i!i 90/.si4i.'i!: mi!/4i.'i!;
• Kate=/i#a D 5 t50!/Bi – M/1e 5"/./ati 0e3e.te s ./stima i
"5>ima
• La.ta4i#a – K/mpati>i'!i s 0/#e!#em
– Se5m ./!4 5 0#e4e !is5 m#e'#ie
A"/'!i a!ti35!=i4i
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A"/'!i a!ti35!=i4i93'5./!a"/': ita./!a"/': .et/./!a"/':
p/sa./!a"/': /i./!a"/';• Kate=/i#e @G@G@GD 5 t50!/Bi
– P/'a"e ./" p'a4e!t5
– ?'5./!a"/' W $$m=G0a! p/e"5#e se s.a!i/-3a4i#a'!im a>!/ma'!/stima
– Nema p/0ata.a 9h5ma!i i"/i; "a
/i./!a"/': p/eBa! i"i. 5 1i/ti!#a
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A!ti35!=i4i
• Amph/tei4i! ( – Kate=/i#a ( 5 t50!/Bi
– La.ta4i#a – !ema p/0ata.a
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DIA*EPAM.ate=/i#a D 5 t50!/Bi
Re"5'tati et/spe.ti!ih st50i#a s5=eia#5<P/eBa! i"i.a !asta!.a ./!=e!ita'!ih
ma'3/ma4i#a ./0 pim#e!e 5 p/m
timest5 t50!/Be
./0 pim#e!e 0/"a eBih /0 $ m= !ep/se0!/ pe0p//a# < hip/a.ti!/st: hip/t/!i#a: hip/temi#a: ap!ea:
p/>'emi ha!#e!#a: !a52e!i meta>/'i.i /0=// !ah'a0!i stes: hipe>i'i5>i!emi#a i .e!i.te5s >e!"/0ia"epi!i se i"'55#5 m'i#e./m – 0/#e!#e:
se0a4i#a88
A@ETILSALI@ILNA
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A@ETILSALI@ILNAKISELINA
.ate=/i#a @GD 5 t50!/Bi Ne.e st50i#e p/.a"5#5 0a
5"ima!#e aspii!a 5 t#e0!imape0 p//0 p/eBaai!4i0e!4i#5 i!ta.a!i#a'!ehem/a=i#e
Vis/.e 0/"e /0 &F-& =0!e!/ 5"/.5#5 hem/a=i#s.e./mp'i.a4i#e i ./0 ma#.e i ./03et5sa
U do! od 0 ()0 ?-d#e"#o 9p/3i'a.sape.'ampsi#e;: #!8u !$"$3e7e?or$-!58ke ko?p3!k$4!5ekod eu8$*
Pre-#$#4 R!8k F$4or 'Le!Co?pONLINE.
C/D (full-dose aspirin in 3rd trimester -
expert analysis) Pregnancy Considerations
ali,Blates 'ave %een noted to ,ross t'e pla,enta andenter Cetal ,ir,ulation. dverse eCCe,ts reported in t'eCetus in,lude mortalitB intrauterine groDt' retardationsali,Blate intoEi,ation %leeding a%normalities andneonatal a,idosis. Ase oC aspirin ,lose to deliverB maB
,ause premature ,losure oC t'e du,tus arteriosus.dverse eCCe,ts reported in t'e mot'er in,lude anemia'emorr'age prolonged gestation and prolonged la%or.?oD-dose aspirin is used to treat ,ompli,ations resultingCrom antip'osp'olipid sBndrome in pregnan,B (eit'erprimarB or se,ondarB to ?). In general, lo doses during pregnancy needed for
t!e treatment of certain medical conditions !a"e not
#een s!on to cause fetal !arm$
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TERAPIJSKA PRIMJENA LIJEKOVA U PLODAPERINATALNA ?ARMAKOLO+IJA• U .'i!i./# pa.si i"!im!/ i#et.a<
• kor!ko8ero!d! – stim5'a4i#a sa"i#ea!#a 3eta'!ih p'5Ba ./0 aa!#a
pemat55sa
• 3e!/>a>it/! – kor!He# pr!5e 3/t/teapi#e: 5esta'/st p/#ae!e/!ata'!e 15ti4e !i1a
• a!tiaitmi4i – "a 'i#ee!#e aitmi#a p'/0a
PRIMJENA LIJEKOVA U ENA KOJE
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PRIMJENA LIJEKOVA U ENA KOJEDOJE
• *NAAJ DOJENJA• MAJINO MLIJEKO< i2e masti: !i1i pC
• Li#e./i
• !a#e2Be 5 !is.im ./!4e!ta4i#ama 95.5p!a DD 5 0/#e!etaX &% ma#i!e 0/"e;
• 'ip/s/'5>i'!i: i2e= pC 'a.2e se i"'55#5 5 m m'i#e./• m/=5 p/i"esti 3ama./'/2.i 5i!a.: 9./'ii!a: t/.si!/st:
a.ti!/st meta>/'i.ih
• e!"ima 0#eteta;• m/=5 i"a"ati ea.4i#e pe/s#et'#i/sti
• I">#e=aati 5p/a>5 'i#e./a8
• K/istiti si=5!e 'i#e./e: $ -6$Y !a./! 0/#e!#a
Li# . i > . #ih # t >
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Li#e./i ">/= ./#ih #e p/te>a!PREKID DOJENJA
• Z->'/.at/i
• sa'i4i'ati
• 'iti#
• 4it/stati4i• teta4i.'i!i: 3'5//.i!/'/!i: .'/am3e!i./'
• a0i/a.ti!i #/0
• se0sta /is!/sti 9!a./ti4i: ./.ai!: am3etami!i;
• Li#e./i ./#i 5"/.5#5 s5pesi#5 i"'5ia!#a m'i#e.a<
• >/m/.ipti!• /a'!i ./!ta4eptii 5 is/.im 0/"ama
• Li#e./i ./#i 0//0e 0/ se0a4i#e 0/#e!eta<
• 0ia"epam 9a.5m5'a4i#a 'i#e.a ">/= 05=/=
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KATE+ORI*A@IJA LIJEKOVA PREMA STUPNJURI*IKA PRIMJENE U TRUDNO)I 9?DA;
• A K/!t/'ia!e st50i#e 5 '#50i: !e=ati!e• ( St50i#e !a 1i/ti!#ama !is5 p/.a"a'e i"i.
• Is.5sta pim#e!e !a '#50ima: !e=ati!a
• @ St50i#e !a 1i/ti!#ama p/"iti!e i'i !is5 5i!#e!e
• Ne0/stata. p/0ata.a 5 h5ma!/# pim#e!i• D C5ma!i p/0a4i p/.a"5#5 i"i.: 9/m#e i"i.-./ist;
• A!ima'!i i'i h5ma!i p/0a4i p/"iti!i[
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• Pe!i4i'i!i• Kate=/i#a i"i.a 5 t50!/Bi< B
• P/'a"e ./" p'a4e!t5 'a=a!/ i >"/
• K/!4e!ta4i#a 5 3et5s5 #e0!a.a .a/ 5 ma#.e
• La.ta4i#a
• Pe'a"e 5 m m'i#e./ 5 ma'/# ./!4e!ta4i#i
• K/mpati>i'!i s 0/#e!#em
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Am/\i4i''i!
Pe=!a!4H Ris. ?a4t/ (Pe=!a!4H @/!si0eati/!sA0ese ee!ts hae !/t >ee! />see0 i!a!ima' st50ies] thee3/e: am/\i4i''i! is 4'assi3ie0 as pe=!a!4H 4ate=/H (It is the 05= /3 4h/i4e 3/ the teatme!t /3 4h'amH0ia' i!3e4ti/!s i!pe=!a!4H a!0 3/ a!tha\ p/phH'a\is he! pe!i4i''i! s5s4epti>i'itH is0/45me!te0
D5e t/ pe=!a!4H-i!054e0 phHsi/'/=i4 4ha!=es: am/\i4i''i! 4'eaa!4e isi!4ease0 05i!= pe=!a!4H es5'ti!= i! '/e 4/!4e!tati/!s a!0 sma''e AU@s Oa' ampi4i''i!-4'ass a!ti>i/ti4s ae p//'H-a>s/>e0 05i!= 'a>/La4tati/!< E!tes >east mi'.G4/mpati>'e(east-?ee0i!= @/!si0eati/!s VeH sma'' am/5!ts /3 am/\i4i''i! aee\4ete0 i! >east mi'. The AAP 4/!si0es am/\i4i''i! t/ >e Q5s5a''H
4/mpati>'e ith >east3ee0i!= N/!0/se-e'ate0 e33e4ts 4/5'0 i!4'50em/0i3i4ati/! /3 >/e' 3'/a a!0 a''e=i4 se!siti"ati/! /3 the i!3a!t
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• @e3a'/sp/i!i
• Kate=/i#a i"i.a 5 t50!/Bi< B
•
P/'a"e ./" p'a4e!t5• La.ta4i#a
• Pe'a"e 5 m m'i#e./ 5 ma'/#
./!4e!ta4i#i• K/mpati>i'!i 95='a!/m; s 0/#e!#em
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Ka>ape!emi
• Kate=/i#a i"i.a 5 t50!/Bi< (G@G(• P/'a"e ./" p'a4e!t5
• V'/ ma'/ h5ma!ih p/0ata.a
• La.ta4i#a
• I"'55#e se 5 m m'i#e./ 5 ma'im ./'ii!ma
•
U='a!/m !ep/"!ati 5i!4i: #e/#at!/ma'e
• .'i!i.e "!aa#!/sti
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?'5//.i!/'/!i
• Kate=/i#a i"i.a 5 t50!/Bi< C• Ne pep/5a se 5p/a>a 5 t50!/Bi
•
K/istiti si=5!i#e a'te!atie• La.ta4i#a
• I"'55#5 se 5 m m'i#e./:
•
!e pep/5a se 0/#iti "a i#emeteapi#e
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Ma./'i0i
• a"it/mi4i!: .'ait/mi4i!: te'it/mi4i!: eit/mi4i!• Kate=/i#a i"i.a 5 t50!/Bi< (G@G@G(
• P/'a"e ./" p'a4e!t5 5 ma'im ./'ii!ama
• La.ta4i#a
•
Eit/mi4i!< 9Case report i kohortna studija) moguća povezanost • sa ste!/"/m pi'/5sa 5 !///e!a0i i"'/1e!/# eit/mi4i!5 p5tem
• ma#i!/= m'i#e.a
• Osta'i< ./mpati>i'!i
A i 'i. i0i
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Ami!/='i./"i0i
9ami.a4i!: =e!tami4i!: t/>ami4i!;• Kate=/i#a i"i.a 5 t50!/Bi< D
• ("/ p/'a"e ./" p'a4e!t5
• U'a"e 5 am!i/!s.5 te.5Bi!5 p5tem 3eta'!e
• 4i.5'a4i#e• La.ta4i#a
• K/mpati>i'!i s 0/#e!#em
• Ne a>s/>ia#5 se p5tem +I ta.ta
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S5'3/!ami0i
• Kate=/i#a i"i.a 5 t50!/Bi< C• P/'a"e ./" p'a4e!t5
• S5p'eme!ta4i#a s 3/'!/m .is m/1e 5>'a1iiti"i.
• Pe0 p//0 ./!tai!0i4ia!i 9.e!i.te5s;
• La.ta4i#a<
• I"'55#5 se 5 m m'i#e./
• I">#e=aati 5 0/#e!#5
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Teta4i.'i!i
• Kate=/i#a i"i.a 5 t50!/Bi< D• M/=5 5"/./ati 0e3e.te 9./sti: "5>i:;
•
Cae >ee! 'i!.e0 t/ mate!a' 'iet/\i4itH
• La.ta4i#a
• I"'55#e se 5 m m'i#e./• Pep/5a se pe.i0 0/#e!#a
A ' i ti3 i i
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A"/'!i a!ti35!=i4i
• 93'5./!a"/': ita./!a"/': .et/./!a"/': p/sa./!a"/':
• /i./!a"/';
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• NEMA NEKODLJIVO+ LIJEKA 8
• OPRE* PRI DAVANJU LIJEKOVA SVIMENAMA U +ENERATIVNOJ DO(I8