\u00dclkemizde de gittik\u00e7e artan opioid re\u00e7etelendirmenin Amerika Birle\u015fik Devletleri\u2019nde yanl\u0131\u015f ve k\u00f6t\u00fcye kullan\u0131m\u0131n\u0131n mevcut sonu\u00e7lar\u0131n\u0131n epidemik \u00f6l\u00e7\u00fclere ula\u015ft\u0131\u011f\u0131; \u00f6yle ki 15 y\u0131ll\u0131k bir s\u00fcre\u00e7te ila\u00e7 depolar\u0131\/eczanelerden da\u011f\u0131t\u0131lan opioid miktar\u0131n\u0131n 3 kat artm\u0131\u015f durumda oldu\u011fundan bahsedilmekte.<\/p>\n
\u0130laca eri\u015fimin artmas\u0131yla ila\u00e7 k\u00f6t\u00fcye kullan\u0131m davran\u0131\u015f\u0131n\u0131n tetiklenebilece\u011fi \u00f6ne s\u00fcr\u00fclmektedir. Doz a\u015f\u0131m\u0131na ba\u011fl\u0131 morbidite ve mortalite s\u0131kl\u0131\u011f\u0131nda art\u0131\u015fla birlikte, sosyal ve sa\u011fl\u0131k hizmet harcamalar\u0131n\u0131n da art\u0131\u015f g\u00f6sterdi\u011fi a\u015fikard\u0131r. Eczanelerden re\u00e7ete kar\u015f\u0131l\u0131\u011f\u0131 verilen opioidlerin %85\u2019ini hidrokodon ve oksikodon olu\u015fturuyor ve \u00f6n g\u00f6r\u00fclebilir \u015fekilde bu maddeleri i\u00e7eren preparatlar\u0131n doz a\u015f\u0131m\u0131na ba\u011fl\u0131 \u00f6l\u00fcmlerde bu kategorideki en y\u00fcksek oranlar bu iki ilaca ait.<\/p>\n
\u0130la\u00e7 potensinin Acil Servis\u2019e ila\u00e7 k\u00f6t\u00fcye kullan\u0131mla ili\u015fkili ba\u015fvuru tahmininde ge\u00e7erli oldu\u011fu g\u00f6sterilmi\u015ftir. Ancak literat\u00fcrde, farkl\u0131 potensteki opiod analjeziklerin klinik morbidite ve mortalite oranlar\u0131n\u0131n kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131na dair olduk\u00e7a s\u0131n\u0131rl\u0131 veri\/\u00e7al\u0131\u015fma mevcut. \u00c7al\u0131\u015fman\u0131n yazarlar\u0131; s\u0131k re\u00e7etelendirilen opiodler ve maruziyetlerine ba\u011fl\u0131 sonu\u00e7lar\u0131n\u0131n Zehirlenme Merkezleri taraf\u0131ndan takip edildi\u011finde bu merkezlerin surveliyans verilerinin bu soruya cevap getirebilece\u011fi fikrinden yola \u00e7\u0131km\u0131\u015f ve ila\u00e7 potensinin ciddi advers etki g\u00f6r\u00fclmesinde bir etken oldu\u011fu hipotezini kurmu\u015flar.<\/p>\n
\u00c7al\u0131\u015fman\u0131n dizayn\u0131nda RADARS \u00a9<\/sup>(\u0130la\u00e7 K\u00f6t\u00fcye Kullan\u0131m\u0131 ve Ba\u011f\u0131ml\u0131l\u0131k ili\u015fkili Ara\u015ft\u0131rma ve G\u00f6zetim) ad\u0131nda kar amac\u0131 g\u00fctmeyen bir kurumunun Zehirlenme Merkezi Program\u0131 tarafa\u0131ndan toplanan 2010 ile 2016 y\u0131lllar\u0131 aras\u0131ndaki veriler incelenerek, yedi tane opioid analjezik preparat\u0131ndan (oksikodon, hidrokodon, morfin, hidromorfin, ksimorfin, tapentadol ve tramadol) birini i\u00e7eren tabletlerle maruziyet sonucu geli\u015fen ciddi advers etkiler de\u011ferlendirilmi\u015f.<\/p>\n Ciddi advers etkiler (CAE);\u00a0 \u00f6l\u00fcm, major t\u0131bbi etki veya hastaneye yat\u0131\u015f olarak tan\u0131mlan\u0131rken \u201cMajor t\u0131bbi\u00a0 etki\u201d\u00a0 hastada hayat\u0131 tehdit eden semptomlar veya \u00f6nemli kal\u0131c\u0131 sakatl\u0131kla sonu\u00e7lanan maruziyet olarak belirlenmi\u015f.<\/p>\n Primer sonlan\u0131m i\u00e7in de\u011fi\u015fkenler: Da\u011f\u0131t\u0131lan 100.000 gram, al\u0131nan 100.000 re\u00e7ete, da\u011f\u0131t\u0131lan 100.000 doz \u00fcnite ve re\u00e7eteyi alan 100.000 ki\u015fi olarak belirlenip, ayaktan tedavi g\u00f6ren hastalar\u0131n ald\u0131\u011f\u0131 re\u00e7eteler ulusal veri taban\u0131 \u00fczerinden (IMH) elde edilmi\u015f.<\/p>\n CAE\u2019yi tahmin etmek i\u00e7in ba\u011f\u0131ms\u0131z de\u011fi\u015fken olarak R\u00f6latif opioid potensi <\/strong>belirlenmi\u015f olup; CDC\u2019nin d\u00f6n\u00fc\u015ft\u00fcrme tablosu kullan\u0131larak Morfin Miligram E\u015fde\u011feri (MME) \u00fczerinden hesaplama yap\u0131lm\u0131\u015f.<\/p>\n \u0130ndeks ila\u00e7lara bakt\u0131\u011f\u0131m\u0131zda, tramadol <\/em>kar\u015f\u0131la\u015ft\u0131rmada ila\u00e7 potenslerinin aral\u0131\u011f\u0131n\u0131 geni\u015f tutmak i\u00e7in dahil edilirken, fentanil<\/em>\u2019in primer olarak parenteral yoldan uyguland\u0131\u011f\u0131 i\u00e7in dahil edilmemi\u015f oldu\u011funu g\u00f6r\u00fcyoruz. Yine RADARS taraf\u0131ndan \u00e7al\u0131\u015fma s\u00fcresinin tamam\u0131nca takip edilmedi\u011fi i\u00e7in kodein<\/em> de \u00e7al\u0131\u015fmaya dahil edilmemi\u015f.<\/p>\n Yedi y\u0131ll\u0131k \u00e7al\u0131\u015fma s\u00fcresince belirtilen opiodlerden biri ile ili\u015fkili zehirlenme merkezlerine bildirilen 64.538 olgu g\u00f6r\u00fclm\u00fc\u015f. Bir veya daha fazla indeks opioidlerle maruziyetin oldu\u011fu t\u00fcm olgular\u0131n %30.1\u2019i (19.480) CAE kriterlerini kar\u015f\u0131lam\u0131\u015f. CAE g\u00f6r\u00fclen olgular\u0131n %52.5\u2019i erkek cinsiyet olup,\u00a0 %78.1\u2019i 20-59 ya\u015flar\u0131nda bulunmu\u015f.<\/p>\n Ciddi advers etki da\u011f\u0131l\u0131m\u0131na bakt\u0131\u011f\u0131m\u0131zdaysa; 148 \u00f6l\u00fcm, 22955 major t\u0131bbi etki, 18.713 hastaneye yat\u0131\u015fla sonu\u00e7lanm\u0131\u015f olarak kar\u015f\u0131m\u0131za \u00e7\u0131kmakta.<\/p>\n Daha \u00f6nceki \u00e7al\u0131\u015fmalarda acil servisten taburcu olurken re\u00e7ete edilen opioidler aras\u0131nda ilk s\u0131rada yer ald\u0131\u011f\u0131 g\u00f6sterilen hidrokodon ve oksikodonun, CAE olgular\u0131n\u0131n %77\u2019sinde e\u015flik etti\u011fi g\u00f6sterilmi\u015f.<\/p>\n Hidrokodon ciddi advers olay, hastaneye yat\u0131\u015fla sonlan\u0131mda etken olarak en ba\u015fta gelirken t\u00fcm opioid ili\u015fkili \u00f6l\u00fcmlerin %49\u2019unda yer alm\u0131\u015f. Yine en s\u0131k re\u00e7etelendirilen, doz \u00fcnite kullan\u0131m\u0131, re\u00e7ete alan ki\u015fi say\u0131s\u0131na g\u00f6re ilk s\u0131rada bulunurken, en y\u00fcksek miktarda da\u011f\u0131t\u0131lan ila\u00e7 olarak oksikodon saptanm\u0131\u015f.<\/p>\n R\u00f6latif potense g\u00f6re sonlan\u0131m (\u00f6l\u00fcm, maj\u00f6r t\u0131bbi etki veya hastaneye yat\u0131\u015f) oran\u0131 kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda aralar\u0131nda 30 kat kadar fark\u0131n bulundu\u011fu hidromorfin ( 8.02 CAE\/100 kg) ve tapentadol (0.27 CAE\/100 kg) s\u0131rayla en y\u00fcksek ve en d\u00fc\u015f\u00fck orana sahip opioid preparatlar\u0131 olarak raporlanm\u0131\u015f.<\/p>\n Uygulanan ilac\u0131n CAE\/100 kg ve ila\u00e7 potenslerinin lineer regresyon analizinde MME\u2019nin g\u00f6zlenen varyasyonun %96\u2019s\u0131n\u0131 olu\u015fturdu\u011fu g\u00f6r\u00fclm\u00fc\u015f. CAE oran\u0131 ve potens aras\u0131nda lineer bir ili\u015fki saptan\u0131p MME\u2019de her 1 \u00fcnite de\u011fi\u015fikli\u011fe kar\u015f\u0131l\u0131k, kullan\u0131lan ila\u00e7 dozunun 100 kg ba\u015f\u0131na 2.04 vaka (\u00f6l\u00fcm, maj\u00f6r t\u0131bbi etki veya hastaneye yat\u0131\u015f) art\u0131\u015f oldu\u011fu g\u00f6r\u00fclm\u00fc\u015f (p=0.004).<\/p>\n Buna kar\u015f\u0131l\u0131k potensin di\u011fer \u00e7al\u0131\u015fma de\u011fi\u015fkenleri olan kullan\u0131lan re\u00e7eteler, uygulanan doz \u00fcniteleri ve re\u00e7eteyi alan ki\u015fi say\u0131s\u0131 de\u011fi\u015fkenleri ise s\u0131ras\u0131yla %42, %38 ve %33\u2019\u00fcn\u00fc a\u00e7\u0131klayabilmi\u015f ve bu de\u011fi\u015fkenlerle sonlan\u0131m oran\u0131 ve potens aras\u0131nda zay\u0131f korelasyon bulunmu\u015f. \u0130lac\u0131n potensi ve hastaneye yat\u0131\u015f oran\u0131 aras\u0131nda (R2<\/sup>= 0.96) major t\u0131bbi etki ve \u00f6l\u00fcme oranla daha y\u00fcksek bir ili\u015fki saptanm\u0131\u015f.<\/p>\n \u00a0 Sonu\u00e7larda g\u00f6ze \u00e7arpan bir ayr\u0131nt\u0131 olarak; tramadolun \u00e7al\u0131\u015fmaya al\u0131nan opiodler aras\u0131nda en az potent olmas\u0131na ra\u011fmen en s\u0131k CAE g\u00f6r\u00fclen olarak raporlanmas\u0131d\u0131r. Olas\u0131 neden tramadolun seratonin ve norepinefrin reuptake aktivitesini inhibe ederek adrenerjik hiperaktivite, n\u00f6bet ve seratonin eksikli\u011fi sendromu gibi di\u011ferlerinden farkl\u0131 toksik etkilerine yol a\u00e7mas\u0131 olabilir.<\/p>\n Sonu\u00e7 olarak relatif opioid analjezik potensi ile ezcane\/ila\u00e7 depolar\u0131ndan da\u011f\u0131t\u0131lan ila\u00e7 miktar\u0131n\u0131n toplam\u0131 ba\u015f\u0131na CAE oran\u0131 aras\u0131nda g\u00fc\u00e7l\u00fc bir ili\u015fki saptanm\u0131\u015f. Opioid analjezik re\u00e7etelendirmenin, kullan\u0131lan ilac\u0131n zehirlenme merkezine bildirilen Ciddi Advers Etkilerle sonu\u00e7lanana maruziyetle \u00f6nemli ve olduk\u00e7a y\u00fcksek pozitif lineer ili\u015fkili oldu\u011fu saptanm\u0131\u015f.<\/p>\n Daha fazla opiod re\u00e7eteleri verildi\u011finde ve dolay\u0131s\u0131yla t\u0131p d\u0131\u015f\u0131 kullan\u0131m i\u00e7in daha eri\u015filebilir oldu\u011funda, y\u00fcksek doz daha fazla olup daha b\u00fcy\u00fck tehlike olu\u015fturmas\u0131 olas\u0131d\u0131r. Bu riskin azalt\u0131lmas\u0131 i\u00e7in hekimler m\u00fcmk\u00fcn oldu\u011funca en d\u00fc\u015f\u00fck potensdeki opioidi, en k\u0131sa s\u00fcreli tedavi i\u00e7in re\u00e7etelendirmeli ve a\u011fr\u0131 y\u00f6netimini yeterince sa\u011flayacak ve opioid ihtiyac\u0131n\u0131 en aza indirecek \u015fekilde opioid olmayan alternatifler \u00fczerinde durmal\u0131d\u0131r.<\/p>\n Drug Safety dergisinde 2018 \u00a0y\u0131l\u0131 i\u00e7inde yay\u0131nlanan \u201cS\u0131k Re\u00e7etelendirilen Opioid Analjeziklerin Ciddi Advers Etkileri ve Mortalite Oranlar\u0131n\u0131n Kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131\u201d isimli \u00e7al\u0131\u015fmadan s\u00f6z etmek…<\/p>\n","protected":false},"author":1502,"featured_media":1961,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10014,10019],"tags":[53,313,315],"class_list":["post-1026","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","category-tft","tag-analjezik","tag-opioid","tag-opioid-yan-etkileri"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/1026","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/1502"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=1026"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/1026\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/1961"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=1026"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=1026"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=1026"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Ciddi Advers Etkiler\u00a0<\/strong><\/h2>\n
![\"\"](\"https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/123-1.png\")
<\/p>\n![\"\"](\"https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/221-3.png\")
<\/p>\n![\"\"](\"https:\/\/tatd.org.tr\/tatdtoks\/wp-content\/uploads\/sites\/36\/2021\/10\/317-1.png\")
<\/p>\nAnahtar Noktalar<\/strong><\/h2>\n
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