NSAIDS 알러지나 솤크시 어떤 약을 사용하나요 > 학술 Q&A

NSAIDS 알러지나 솤크시 어떤 약을 사용하나요

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질문 내용</TD>
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NSAIDS 알러지나 중독시 해독제?
 
 
 
안녕하세요!
약국에 NSAIDS에 알러지가 일어나서 오신 분은 
병원에 많이 보내는데 병원에서는 
어떤 주사제를 쓰는지 궁금합니다. 
NSAIDS마다 다른 것인지요? 특히 talniflumate 370mg을 치과에서 
치료 전에 항생제와 같이 투여하는데 
이때 알러지나 중독 증상이 있으면 
어떻게 해야 될지도 알고 싶습니다.</TD></TR>
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답변</TD></TR>
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1. 소염진통제든 어떤 약이든 간에 앨러지 증상은 
   앨러지 병태가 동일한 것이므로 치료 약도 동일합니다.
 
2. 항히스타민제 부신 피질 호르몬제를 일반적으로 사용합니다.
 
3. 심한 쇼크 상태인 경우(저혈압 등) 는 에피네프린 주사를 
   사용합니다.
 
4. talniflumate 를 포함한 소염진통제로 인한 앨러지 증상에는 
  응급이 아닌 피부에 나타난 일반 증상에 대해서는 
  부신피질 호르몬제와 항 히스타민제를 처방합니다 
 
 
5 이른바 숔크 같은 중증인 경우의 약물 요법은 아래 와 같습니다
   이하는 전성수 표준 처방집에 실려 있는 내용입니다
 

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단계별 조치</TD>
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약품 및 용량.용법</TD></TR>
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1) 초기 조치 : 전해질 점적주 </TD>
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(1) 반듯하게 눕히고 전해질 수액 점적주함 (2) 0.9% 식염수 IV 또는 sodium lactate 복합주     또는 Darow's & Glucose 액 IV </TD></TR>
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2) 호흡 있을 때</TD>
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산소 공급함 성인 : 4-6L/분 (face mask) 소아 : 4-6L/분 (funnel) </TD></TR>
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3) 호흡 없을 때</TD>
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(1) 기도를 확보한 후     (2) 인공 호흡을 시킴</TD></TR>
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4) 심박정지시</TD>
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1) CPR(심페 소생 술)실시함</TD></TR>
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5) 심기능 활성화 맥압상승 혈압상승 </TD>
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교감 흥분 제 </TD>
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(1) Epinephrine :</TD>
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\Epinephrine : 1 : 1000주사액 서서히 IV 실시</TD></TR>
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A</TD>
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폐 기능 마비 시 : 삽관 통해 주입</TD></TR>
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B</TD>
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의식 없을 때 : 1앰플을 0.9%식염수 10ml까지 희석 서서히 IV</TD></TR>
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C</TD>
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심박수가 140 이상이 아니면 성인 : 0.5ml를 단번에 피하주(필요시 5-10분 후 재 주사) 0-3세 : 0.1ml, 4-7세 : 0.2ml, 8-12세 : 0.3ml </TD></TR></TBODY></TABLE></TD></TR>
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6) 히스타민 억제 </TD>
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항히 스타 민제 </TD>
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(1) Diphenhydramine IV, IM or 경구 즉시 투약후 6시간마다 72시간 동안 재 투약 성인 : 25-50mg씩 소아 :1.25mg/kg; (최고 25mg 까지) </TD></TR>
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H2 - 차 단 제</TD>
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(2) Cimetidine: 항히스타민보다 효과적임 성인 : 300mg IV : 3-5분 주사 후 400mg b.i.d. P.O. 소아 : 5-10mg/kg/1회 </TD></TR>
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7) 증상지속화 방지 및 재발 방지 : 1) 2) 3) 4) 5) 6) 조치후 </TD>
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부 신 피 질 호 르 몬 제</TD>
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1) Hydrocortisone sod.succinate 주 (솔루코테푸주:업존)    성인 : 500-1,000mg 서서히 IV(10 앰플)    소아 1세 이하 : 100mg    1-3세 : 200mg              4-7 세 : 300mg    8-9세 : 400mg              10-12세 : 500mg ; 심하면 100-200mg 추가 or (2) Prednisone (1mg/kg/1회 ((60mg까지) or (3) Methyl Predmnisone (  1-2mg/kg IV </TD></TR>
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A</TD>
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1) + [ 2) or 3) or 4) ] + 5) + 6) + 7)</TD></TR>
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B</TD>
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응급 조치 후 72시간 부터 필요에 따라 경구 투약 1) 항히스타민제 경구 투여 or 2) 부필 홀몬 경구 투여 </TD></TR>
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C</TD>
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환자 관리: 심장 증상. 호흡기 증상 사라진 후 (1) 계속 관리 Point : 혈압. 심박. 리듬. 호흡 (2) 통상 약물 쇼크는 2시간까지 관찰(지속성 약물 쇼크는 24시간 관찰) </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>
 

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God bless you !
 
전성수
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