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3/1/2014

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Thng tin thuc
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PGS. TS. Nguyn Ngc Khi
BM. Dc lm sng, Khoa Dc
H Y Dc TP. H Ch Minh

Mc tiu
1. Trnh by c ngha ca vic cung cp thng tin thuc
2. Phn loi c cc cp thng tin
3. Trnh by c cc ngun thng tin cp 3 chnh
4. p dng c cch tm thng tin thuc
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Ni dung
1. ngha ca vic cung cp thng tin thuc
2. Phn loi thng tin thuc
3. Cc ngun thng tin thuc
4. Chin lc tm thng tin thuc
5. Cc k nng thng tin thuc
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ngha ca thng tin thuc
H tr cho cng tc lm sng
Tr li cc cu hi lin quan n:
Hng dn s dng thuc
Xy dng phc
Hot ng ca Hi ng thuc v iu tr
Chnh sch s dng thuc
La chn dng thuc s dng ph hp
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ngha ca thng tin thuc
Xut bn (tp ch, thng tin trn website)
Gio dc / ging dy
Hc vin cc ngnh y dc
Ngi tiu dng / bnh nhn
Tham gia vo kim sot cc hot ng iu tr
nh gi iu tr
Thng tin cho y, bc s

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Phn loi thng tin thuc
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Theo ni dung:
1. Danh php & xc nh
2. Cch s dng trong iu tr
3. Tc dng khng mong mun
4. Thng mi & Kinh t
5. Quy ch
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Danh php & xc nh
Tn ca mt loi thuc
Tn ng ngha v m ca mt loi thuc
Thnh phn ha hc v tnh cht vt l
Cc thuc c cu trc ha hc /tc ng tng t
Phn loi thng tin thuc
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Cch s dng trong iu tr
Cc khuyn co iu tr ca thuc
C ch tc ng
Liu lng khuyn co v ng s dng
Hp thu, phn phi, chuyn ha v thi tr (ADME)
Phn loi thng tin thuc
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Tc dng khng mong mun
Tc dng ph
Tng tc: Thuc / thuc
Thuc / Thc phm
Thuc / Dc liu
Kh nng gy c
Chng ch nh
Kh nng gy qui thai
Phn loi thng tin thuc
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Thng mi & Kinh t
Gi thuc
Doanh s thuc
Cc cng ty phn phi thuc
Cc nh sn xut
Cc hiu thuc
Cc loi thuc c ghi nhiu nht
Phn loi thng tin thuc
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Quy ch
Qu trnh ph duyt thuc
Cc nc chp thun s dng
Hn ch / cm vic s dng
Phn loi thng tin thuc
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C bn (background)
Vn ni cm
(foreground)
Phn loi thng tin thuc
Theo tnh cht:
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C bn (background)
Cu hi trong phm vi rng
Cu tr li l kin thc tng qut
C th c gii quyt tt vi cc ngun ti liu cp
ba
Vd: A l thuc c lu hnh M hay khng?
C ch tc ng ca thuc l g?
Chng ch nh ca thuc A?
Phn loi thng tin thuc
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Vn ni cm (foreground)
Cu hi trong phm vi hp
Cu tr li i hi kim tra mc chng c mi hoc
cc vn cn mu thun
C th c gii quyt tt vi cc ngun ti liu cp
mt v cp hai
Vd: Hiu qu ca thuc mi so vi cc thuc c?
Vic s dng off-label ca mt thuc?
Phn loi thng tin thuc
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Cc ngun thng tin thuc
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Tp ch Sch Internet
u im?
Nhc im?
tin cy?
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Ngun thng tin

Cp 1 (Primary Resource)
Cp 2 (Secondary Resource)
Cp 3 (Tertiary Resource)
Cc ngun thng tin thuc
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Ngun thng tin cp 1 (Primary Resource)
Cc tp ch khoa hc
Cung cp cc nghin cu c bn hoc bo co
V d: Th nghim lm sng, bo co hng lot ca/ 1 ca
Ph hp tr li v cc vn ni cm
Phm vi hp
Tt d liu mi hoc cng b mi
Cc ngun thng tin thuc
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Ngun thng tin cp 1 (Primary Resource)

Cc ngun thng tin thuc
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Ngun thng tin cp 1 (Primary Resource)
u im:
Hu ht l cc bng chng hin ti
Cung cp d liu v loi thuc mi
Tng c nhn c th nh gi tnh gi tr ca nghin cu
Cc ngun thng tin thuc
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Ngun thng tin cp 1 (Primary Resource)
Nhc im:
Phm vi gii hn
D liu t hay gy cn tranh lun
Nghin cu u c nhng hn ch
Qu phc tp cho bnh nhn
Cc ngun thng tin thuc
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Ngun thng tin cp 2 (Secondary Resource)
Cc ngun thng tin thuc
http://www.tripdatabase.com/
http://www.ncbi.nlm.nih.gov/pubmed/
http://www.cochrane.org/
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Cc ngun thng tin thuc
Tm kim vi t kha abiraterone
ngy 29-6-2011 cho 110 kt qu
ngy 05-3-2013 cho 310 kt qu
Ngun thng tin cp 2 (Secondary Resource)
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Ngun thng tin cp 2 (Secondary Resource)
Th mc c s d liu cung cp tm tt
hoc ton vn cc nghin cu
Ph hp tr li v cc vn ni cm
Cc ngun thng tin thuc
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Ngun thng tin cp 2 (Secondary Resource)
u im:
C th tm kim tm thng tin v mt vn c th c h
thng
Cc ngun thng tin thuc
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Ngun thng tin cp 2 (Secondary Resource)
Nhc im:
Thng i hi chuyn mn nhiu hn s dng ngun
ti liu ny
Chn lc ti liu tham kho
Theo di ngun ti liu trc khi tm kim cu tr li
Qu phc tp cho bnh nhn
Cc ngun thng tin thuc
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Ngun thng tin cp 3 (Tertiary Resource)
Cc ngun thng tin thuc
http://www.uptodate.com/index http://www.lexi.com/
http://www.micromedex.com/
Sch tham kho
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Ngun thng tin cp 3 (Tertiary Resource)
Sch chuyn kho, sch tham kho, cc chuyn lun
online


Tp hp kin thc trong lnh vc ny
Ph hp tr li v cc vn c bn
Phm vi rng
Cc ngun thng tin thuc
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Ngun thng tin cp 3 (Tertiary Resource)
u im:
Cung cp thng tin ton din
Thng tin phn nh quan im ca nhiu chuyn gia
trong lnh vc
Nhanh chng, d s dng cho bnh nhn
Cc ngun thng tin thuc
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Ngun thng tin cp 3 (Tertiary Resource)
Nhc im:
Thng thng thng tin chm t nht 2 nm do phi qua
khu bin tp v xut bn
Ph thuc nhiu vo cch gii thch ca tc gi **

** Dc s c th khc phc iu ny bng cch
tham kho t nht hai ngun thng tin cp 3
Cc ngun thng tin thuc
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Cc ngun thng tin thuc
Primary
Resources
JAPhA JAMA Pharmacotherapy
New England Journal of Medicine
Annals of Internal Medicine AJHP
Secondary
Resources
PubMed/Ovid MEDLINE
Cochrane Database of Systematic Reviews
DARE TRIP
National Guideline Clearinghouse
Tertiary
Resources
Access Pharmacy UpToDate
Drug Facts and Comparisons
Epocrates Lexi-Comp Micromedex
Clinical Pharmacology
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Chin lc tm thng tin thuc
Cch tip cn / tr li mt cu hi
Bc I. c im ca ngi yu cu
Bc II. Thng tin c bn (tn, tui)
Bc III. Xc nh v phn loi cu hi chnh
Bc IV. Pht trin chin lc v tin hnh tm kim
Bc V. Thc hin nh gi, phn tch v tng hp
Bc VI. Xy dng v cung cp cu tr li
Bc VII. Tin hnh theo di v lu ti liu
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Chin lc tm thng tin thuc
Chin lc tm kim
Chin lc tt nht l thng xuyn tham kho cc ngun ti liu
theo th t sau
Ngun thng tin cp 3 (Tertiary Resource)
Ngun thng tin cp 2 (Secondary Resource)
Ngun thng tin cp 1 (Primary Resource)
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Chin lc tm thng tin thuc
Chin lc tm kim
Ngun thng tin cp 3
Tr li cho mt cu hi l kin thc c bn
Vn c nghin cu rng ri v kt lun
Nhiu chuyn gia ng vi cu tr li
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Chin lc tm thng tin thuc
Danh php & xc nh
Ngun thng tin cp 3
Merck Index
Martindale: the complete drug reference
Dc th
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Chin lc tm thng tin thuc
Cch s dng trong iu tr
Ngun thng tin cp 3 (theo nhm)
AHFS Drug Information
Drug Facts and Comparisons
Martindale
Dc th
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Chin lc tm thng tin thuc
Cch s dng trong iu tr
Ngun thng tin cp 3 (theo bnh)
Harrisons Principles of Internal Medicine
Applied Therapeutics: The Clinical use of Drugs
(Mary Anne Koda-Kimble)
Goldman's Cecil Medicine

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Chin lc tm thng tin thuc
Cch s dng trong iu tr
Ngun thng tin cp 3 (dc l)
Goodman & Gilman's the
Pharmacological Basis of Therapeutics


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Chin lc tm thng tin thuc
Tc dng khng mong mun
Ngun thng tin cp 3 (tc dng ph)
Meyler's Side Effects of Drugs
AHFS Drug Information
Drug Facts and Comparisons
Dc th
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Chin lc tm thng tin thuc
Tc dng khng mong mun
Ngun thng tin cp 3 (tng tc)
Drug Interactions: Analysis and
Management (Philip D. Hansten & John R. Horn)
Drug Facts and Comparisons
Stockleys Drug Interactions
Tng tc thuc v ch khi ch nh
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Chin lc tm thng tin thuc
Tc dng khng mong mun
Ngun thng tin cp 3 (gy qui thai)
Drugs in Pregnancy and Lactation.
(Gerald Briggs)
Prescribing in pregnancy
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Chin lc tm thng tin thuc
S dng thuc cho tr em
Pediatric & Neonatal Dosage Handbook
944 chuyn lun v thuc
> 130 cng thc pha ch dng ngay
Tn gi, cc thuc c th nhm ln (tn, hnh dng)
iu tr: c ch, dc lc hc, dc ng hc, liu cho tr,
liu ti a, hiu chnh (suy thn), theo di trong tr liu
Cc dng ch phm, liu ca mt n v (M)
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Chin lc tm thng tin thuc
S dng thuc cho tr em
The Harriet Lane Handbook
(The Johns Hopkins University)
Chm sc tr trong cp cu
Xp theo tng nhm bnh: tim mch, gim au, da liu, huyt
hc, nhim trng, thn-tit niu, thn kinh, dinh dng, ung th,
chm sc gim nh
Trong mi phn, cc bc cn nh gi, iu tr c th c km
phc iu tr
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Chin lc tm thng tin thuc
Dc ng hc
Applied Clinical Pharmacokinetics
Phn 1: Khi nim c bn, cch tnh ton,
liu s dng i tng c bit (suy thn,
suy gan, thm phn, suy tim, bo ph) v cc tng tc thuc
Cc phn sau: sp xp theo tng nhm thuc nh khng sinh, tim
mch, thuc chng ng kinh, c ch min dch
Trong mi phn nu r v liu iu tr/ gy c, cc thng s dc
ng c th ca thuc, vic xc nh liu (liu u, duy tr)
trong iu tr, mt s v d bi tp
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Chin lc tm thng tin thuc
Dc ng hc
Basic Clinical Pharmacokinetics
Phn 1: Khi nim c bn, nguyn tc v
dc ng hc, sinh kh dng, th tch phn b,
tc thi tr, T
1/2
.
Phn 2: ng dng dc ng hc trong lm sng bao gm cc
chuyn lun sp xp theo tng nhm v thuc c th.
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Chin lc tm thng tin thuc
Dc ng hc
Applied Biopharmaceutics & Pharmacokinetics
Dc ng hc mt ngn, nhiu ngn;
dng tim truyn, tim bolus, dng ung.
S hp thu, phn ha, chuyn ha, thi tr ca thuc; dc l di
truyn; cc dng bo ch mi (phng thch ti ch, cc dng
phng thch c kim sot).
Tng ng sinh hc v sinh kh dng ca thuc.
Cc ng dng ca dc ng hc trn lm sng v hiu chnh liu
cho ngi suy gan, thn
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Chin lc tm thng tin thuc
Dc l
Goodman & Gilman's the Pharmacological Basis
of Therapeutics
Chng m u: thng tin chung s pht trin thuc, dc ng
hc, dc lc hc, c tnh v ng c thuc, dc l di truyn.
Cc chng k tip trnh by tng nhm thuc theo tc dng
dc l trn thn kinh, tim mch, qu trnh vim, iu ha min
dch, huyt hc, hormon, tiu ha, nhim trng v ung th.
Sch kinh in: nguyn tc v dc l hc + ng dng lm sng
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Chin lc tm thng tin thuc
Dc l
Basic and Clinical Pharmacology
Chng m u: thng tin chung v receptor,
dc ng hc v dc lc hc, pht trin v qun l thuc.
Cc chng k tip trnh by tng nhm thuc theo tc dng
dc l trn thn kinh t ng, tim mch thn, c trn, thn
kinh trung ng, mu, qua 1trnh vim, ni tit v ung th
Nguyn tc v dc l hc + ng dng lm sng: la chn thuc,
theo di tc dng, cc ca lm sng minh ha.
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Chin lc tm thng tin thuc
Dc l
Rang & Dale's Pharmacology
Phn 1: cc khi nim, c ch tc ng ca thuc, cc
tnh cht v hp thu, phn b, chuyn ha, thi tr ca thuc v
dc l di truyn.
Phn 2: Cc cht trung gian ha hc
Cc phn cn li ln lt m t chi tit cc tc ng (xp theo h c
quan, thn linh trung ng hay nhim trng, ung th).
C bn, khng qu phc tp
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Chin lc tm thng tin thuc
S dng thuc khi c thai / cho con b
Drugs in Pregnancy and Lactation
Trong tng chuyn lun, mi thuc s c ghi nhn
v khuyn co cho cc i tng c bit ny,
cc bng chng nguy hi cng c cp, gip cho cc nh
lm sng c th tra cu thuc trc khi quyt nh
S dng tra cu thuc
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Chin lc tm thng tin thuc
S dng thuc khi c thai / cho con b
Drugs During Pregnancy and Lactation
Thng tin chung bao gm: s pht trin bo thai,
dc ng hc khi c thai, ng hc ca thuc qua bo thai,
phn loi thuc trong thai k.
Cc chng tip theo cp tng nhm thuc trong iu tr nh
nhm gim au, khng vim, chng d ng, thuc iu tr hen
suyn v tr ho, thuc chng nn, thuc tc ng trn tiu ha
v lipid huyt, nhim trng, tim mch
Chn la thuc khi iu tr
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Chin lc tm thng tin thuc
nh gi iu tr / la chn thuc
Applied Therapeutics: The Clinical Use of Drugs
Chm sc c bn: nh gi tr liu, xt nghim,
sc phn v, d ng thuc, iu tr ng c, nn, au, khi phu
thut, ri lon dch v cht in gii, chng nga, thiu mu.
Cc chng tip theo cp vic iu tr tng nhm iu tr: tim
mch, h hp, tiu ha, thn, ghp tng, dinh dng, da liu,
S dng cc ca lm sng c th tip cn tng vn
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Chin lc tm thng tin thuc
nh gi iu tr / la chn thuc
Goldman's Cecil Medicine
Vn chung: au, s thay i trong c th
(thn nhit, thn kinh, nhn khoa, h hp, sinh dc), di truyn,
dinh dng
i vi tng nhm bnh, vic thm khm, xt nghim cho tng h
c quan pht hin cc bt thng, trong mi bnh cc phn
sinh l bnh, chn on phn bit v iu tr.
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Chin lc tm thng tin thuc
nh gi iu tr / la chn thuc
The Merck Manual
Ngun ti liu ny cung cp tm tt bnh hc,
triu chng, chn on v iu tr.

Cho php truy cp min ph trc tuyn ti a ch:
http://www.merckmanuals.com/home/index.html
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Chin lc tm thng tin thuc
nh gi iu tr / la chn thuc
Pharmacotherapy: A Pathophysiologic Approach
Tp trung vo iu tr bnh.
Thng tin c cung cp v cc ri lon bao gm dch t hc,
nguyn nhn, sinh l bnh, iu tr v nh gi kt qu iu tr.
Cc bng so snh cc thuc v liu, c ch tc ng, tc dng
ph, chng ch nh, mc chng c
S tm tt phc iu tr
Tm tt cc khi nim quan trng (key concepts)
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Chin lc tm thng tin thuc
nh gi iu tr / la chn thuc
Pharmacotherapy Principles and Practice
Tng t nh quyn Pharmacotherapy:
A Pathophysiologic Approach.
Phn chung: ngi gi, tr em, chm sc gim nh.
Bnh: cc phn dch t hc, nguyn nhn, sinh l bnh, iu tr v
nh gi kt qu iu tr c trnh by tm tt.
Km thm Pharmacotherapy Principles and Practice Study Guide
tng ca lm sng km cc cu hi v tr li
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Chin lc tm thng tin thuc
c cht hc
Casarett & Doull's Toxicology
Nu cc vn chung ca c cht hc.
Phn i cng
c tnh hng c quan (mu, min dich, gan, thn)
c tnh khng hng c quan (kh nng sinh ung th, di truyn,
trn s pht trin)
Cc ngun c cht (thuc tr su, kim loi, dung mi, cht phng
x, thc vt).
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Chin lc tm thng tin thuc
c cht hc
Clinical Toxicology
Phn chung ca c cht hc.
X tr ng c trong tng trng hp c th t vic trnh by
c ch dc l, sinh l bnh ca tng trng hp ng c,
biu hin lm sng, chn on phn bit, iu tr
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Chin lc tm thng tin thuc
Tc dng khng mong mun
Ngun thng tin cp 3 (gy qui thai)
Phn loi
trong thai
k nh ngha
A Nghin cu c i chng cho thy khng c nguy
c.
B Khng c bng chng v nguy c ngi.
C Khng th loi tr nguy c.
D C bng chng v cc nguy c trn bo thai.
X Chng ch nh trong thai k.
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Chin lc tm thng tin thuc
tr li mt cu hi
Ngun thng tin cp 2 v cp 1
Vn mi
Khng c s ng thun gia cc chuyn gia
C bng chng mu thun nhau
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Chin lc tm thng tin thuc
V d 1: BN nam 44 tui, cao huyt p c ghi toa
thuc c ch ACE Ho khan
Cu hi: Ho l mt tc dng ph ca cc thuc c ch
ACE?
Loi cu hi:
Ngun ti liu:
Cc khi nim tm kim:
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Chin lc tm thng tin thuc
C ch tc ng
Ho
T bo c trn
Mch mu
Gin mch
Thn
Gin mch
Gim gi
Na v H
2
O
Bt hot
Mch mu
Stan Bardal et al, Applied Pharmacology, Saunders, 2010
Thuc c ch men chuyn angiotensin
Angiotensin-Converting Enzyme Inhibitors (ACEIs)
62
Chin lc tm thng tin thuc
V d 2: BN nam 64 tui, ri lon lipid huyt ang
s dng vin Ti Khuyn co?
Cu hi: Tc dng ca Ti trong vic lm h lipid huyt
Loi cu hi:
Ngun ti liu:
Cc khi nim tm kim:
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Chin lc tm thng tin thuc
T kha (keywords):
Thut ton Boolean:



Cc cng c trn PubMed: MeSH

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Chin lc tm thng tin thuc


t
i
n

c

y

t

n
g

d

n

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Chin lc tm thng tin thuc
Nghin cu bnh chng (case-control study)
Hin ti
Bnh (+)
Chng Bnh thng
Dn s
Phi nhim
(+)
Phi nhim
(-)
Phi nhim
(+)
Phi nhim
(-)
Thi gian (nm)
Vd: acetaldehyd v K phi
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Chin lc tm thng tin thuc
Nghin cu on h (Cohort Studies)
Hin ti
Phi nhim
(+)
Phi nhim
(-)
Hu qu
(-)
Hu qu
(+)
Hu qu
(-)
Hu qu
(+)
Dn s
Mu
B. thng
Thi gian (nm)
Vd: The Nurses Health Study (NHS):
1200 n y t KS sd aspirin v bnh tim mch
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Chin lc tm thng tin thuc
Nghin cu ngu nhin c i chng (RCT)
Ngu nhin: Tt c cc i tng nghin cu c c hi nh
nhau 'phn cng' vo mt trong hai nhm can thip hoc i
chng
So snh KQ
Theo di Can thip
i chng
Chia
ngu nhin
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Chin lc tm thng tin thuc
Nghin cu ngu nhin c i chng (RCT)
Th nghim


Khng m
i tng


S phn cng nhm

Bit


Khng bit



M n
M i
M ba
v
X
hay
X
v X
v
X
v
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Cc k nng thng tin thuc
69
nh gi cc thng tin / thu thp d liu cn thit
Xy dng cu hi / bc tip cn thch hp
Tip cn c h thng tm thng tin cn thit
nh gi thng tin quan trng (gi tr / ng dng)
Xy dng, sp xp v tm tt tr li cho vn
Giao tip r rng (ni /vit)
D on nhu cu thng tin khc

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