1、1Unit 4 Adverse Drug Reactions21.DefinitionAdverse drug reactions are unwanted effects caused by normal therapeutic doses .Drugs are great mimics of diseases, and adverse drug reactions present with diverse clinical signs and symptoms.药物不良反应是正常的治疗剂量造成不必要的影响是伟大的模仿疾病和 药物不良反应，出现不同的临床症状和体征的药物。 3atopy n.
2、特应性benoxaprofen 苯恶洛芬benzodiazepines 苯二氮卓类；苯二氮杂卓类；dexfenfluramine 右芬氟拉明digoxin n.异羟洋地黄毒苷，地高辛（一种强心剂）felbamate 非尔氨酯fenfluramine n.（抑制食欲以治疗肥胖的）芬氟拉明4herbicide n.除草剂idiosyncratic adj.特质的，独特的 特殊的 特异体质的 特异反应的intracranial adj.头颅内的，颅骨内的lethargy n.昏睡 没精打采 懒洋洋 嗜眠症mitoxantrone 米托蒽醌neonatal adj.新生的，初生的neuroleptic
3、 adj.安定（精神）的5nephropathy n.肾病polymorphism n.多型现象，多态性 多机组合形式 多形性practolol n.普拉洛尔，心得宁temafloxacin 替马沙星thiazide n.噻嗪化物，噻嗪类（利尿药，尤用于降低血压）tranquillizers n.镇定剂，精神安定剂 ( tranquillizer的名词复数 )troglitazone 医 曲格列酮62.ClassificationThe classification proposed by Rawlins and Thompson divides reactions into type A a
4、nd type B. 2.1 Type A reactions ,which constitute the great majority of adverse drug reactions, are usually a consequence of the drugs main pharmacological effect (bleeding from warfarin) or a low therapeutic index (nausea from digoxin), and they are therefore predictable, They are doserelated and u
5、sually mild, although they may be serious or even fatal (intracranial bleeding from warfarin). Such reactions are usually due to incorrect dosage (too much or too long), for the individual patient or to disordered pharmacokinetics, usually impaired drug elimination. The term “side-effects” is often
6、applied to minor type-A reactions.罗林斯和汤普森提出的分类划分为 A型和 B型反应2.1类型 反应，构成绝大多数药物不良反应，药物的主要药理效应（华法林出血）或一个低的治疗指数（恶心地高辛）的后果，以及他们因此可预见的，他们是剂量相关的，通常是温和的，虽然他们可能是严重的，甚至是致命的（颅内出血华法林）。这样的反应通常是由于不正确的剂量（过多或过长），个别病人或无序的药代动力学，通常药物消除受损。术语 “副作用 ”小 A型反应往往是应用。72.2 Type-BType-B (idiosyncratic) reactions are not predictabl
7、e from the drugs main pharmacological action, are not dose-related and are severe, with a considerable mortality. The underlying pathophysiology of type B reactions is poorly if at all understood, and often has a genetic or immunological basis. Type B reactions occur infrequently(1:1000-1:1000 treat
8、ed subjects being typical) B型（特 质 ）的反 应 是不可 预测 的 药 物的主要 药 理作用， 剂 量无关，是 严 重的，死亡率相当。基本的病理生理 B型反 应 差，如果在所有的理解，往往有 遗传 或免疫学基 础。 B型反 应 很少出 现 的（ 1:1000-1:1000治 疗对 象是典型） 8n Adverse drug reactions due to specific drug-drug interactions are studied. Three further minor categories of adverse drug reactions hav
9、e been proposed.1 Type C-continuous reactions due to long-term drug use (neuroleptic-related tardive dyskinesia or analgesic nephropathy)2 Type D-delayed reactions (alkylating agents leading to carcinogenesis, or retinoid-associated teratogenesis )3 Type E-end-of-use reactions such as adrenocortical
10、 insufficiency following withdrawal of corticosteroids, or withdrawal syndromes following discontinuation of treatment with clonidine, benzodiazepines, tricyclic antidepressants or beta-adrenoreceptor antagonists. 由于特定的药物相互作用的药物不良反应进行了研究。另外三个小类别药品不良反应已被提出。1 C型连续反应，由于长期使用药物（抗精神病药物有关的迟发性运动障碍或镇痛剂肾病）2型
11、D-延迟反应（烷化剂导致癌变，或维甲酸相关致畸）使用 E-3型反应，如皮质类固醇激素停药后，肾上腺皮质功能不全或可乐定，苯二氮卓类，三环类抗抑郁药或-肾上腺素受体拮抗剂治疗停药后的戒断症状。9There are between 30000 and 40000 medicinal products available directly or on prescription in the UK, A recent survey suggested that approximately 80% of adults take some kind of medication during any 2-w
12、eek period, Exposure to drugs in the population is thus substantial ,and the incidence of adverse reactions must be viewed in this context有 30000和 40000之间的医药产品可直接或在英国，最近的一项调查表明，约 80的成年人在任何 2个星期的期间内，采取某种药物的处方，因此药物在人口暴露可观，不良反应的发生率，在这种情况下，必须被视为 10n Type A reactions are beliveved to be responsible for u
13、p to 3%of acute hospital admissions and 2%3%of consultations in general practice. In hospital, clinically significant adverse reactions are estimated to complicate10%20% of all admissions ,prolonging hospital stay and causing suffering and an appreciable number of fatalities, as well as wasting reso
14、urces, They are the most frequent and severe in neonates, the elderly, women, patients with hepatic or renal disease, and individuals with a history of previous adverse drug reactions, Adverse drug reactions often occur early in therapy(during the first 110day). A型反 应 beliveved的 负责 急性入院的 3和 2 3的普遍做法协 商。在医院， 临 床 显 着的不良反 应 ，估 计 所有招生 complicate10 20，延长 住院 时间 和造成的痛苦和死亡，以及浪 费资 源了 为 数可 观 的，他 们 是最常 见和最 严 重的新生儿，老人， 妇 女，肝或肾脏 疾病的患者，以及个人的 历 史以前的 药 物不良反 应 ， 药 物不良反 应 常 发 生在治 疗 早期（在第 1 10天）。
