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Ketorolac 주사제와 Ketoprofen 주사제의 약물 사용 평가
배희경,김정미,손기호,최경업,이숙향 韓國病院藥師會 2004 병원약사회지 Vol.21 No.2
The nonsteroidal anti-inflammatory drugs(NSAIDs) provide relief from the acute pain associated with surgery or trauma. However, the use of NSAIDs needs to be carefully considered because they may produce severe adverse effects such as gastrointestinal(GI) bleeding or renal toxicity. The objectives of this study were to evaluate the appropriateness of using injectable Ketorolac(KRL) and injectable Ketoprofen(KPF) in Samsung Medical Center and to find out methods to improve their use. The charts of 101 patients who received KRL and 85 patients who received KPF for one month(Feb. 2003), were retrospectively reviewed. The criteria of DUE were based on the standard of the American Society of Health-System Pharmacists(ASHP) and modified appropriately according to our hospital settings. Only 34.7% of the patients in the KRL group and 67.1% in the KPF group were found to meet criteria for justification for use. Analysis of critical indicators revealed that the appropriateness in measuring of SCr within 48 hours before initial dose was 53.5% for the KRL group and 27.1% for the KPF group. The appropriateness of maximum daily dosage and duration of therapy accounted for 97.0% and 85.1% of the KRL patients according to the ASHP criteria(120 mg/day, 5 days) and for 94.1% and 66.3% of the KRL patients according to Korean National Insurance criteria(90mg/day, 2days). On the basis Martindale's usual dosage(200 mg/day, 3days), 82.4% of KPF use was appropriate in maximum daily dosage and 75.3% in duration of therapy. It was found that 10.9% of the KRL patients and 5.9% of the KPF patients had complications such as GI effects, CNS effects, etc. In outcome measures, the pain decreased in 98.0% of the KRL patients and 96.5% of the KPF patients. In conclusion, justification for use was inadequate and consideration for critical indicators was insufficient. Therefore, we suggest that there is necessity to elevate the level of physicians' understanding regarding the use of injectable NSAIDs and to provide continuous interventions of pharmacists.