{"id":20153,"date":"2015-02-27T09:07:05","date_gmt":"2015-02-27T08:07:05","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=20153"},"modified":"2015-02-27T09:07:19","modified_gmt":"2015-02-27T08:07:19","slug":"lze-za-stejne-penize-lecit-hemofiliky-lepe-ano-resenim-je-farmakokinetika","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=20153","title":{"rendered":"Lze za stejn\u00e9 pen\u00edze l\u00e9\u010dit hemofiliky l\u00e9pe? Ano! \u0158e\u0161en\u00edm je farmakokinetika"},"content":{"rendered":"

Farmakokinetika je pro mnoh\u00e9 laiky nezn\u00e1m\u00fdm pojmem, av\u0161ak jej\u00edm prost\u0159ednictv\u00edm dok\u00e1\u017e\u00ed l\u00e9ka\u0159i l\u00e9pe nastavit l\u00e9\u010dbu hemofilie a p\u0159esn\u011b stanovit l\u00e9\u010debn\u00e9 d\u00e1vky sr\u00e1\u017eec\u00edho faktoru na m\u00edru jednotliv\u00fdm pacient\u016fm.<\/strong><\/p>\n

Tato metoda l\u00e9\u010dby je tedy p\u0159\u00ednosem jak pro pacienty samotn\u00e9, tak pro zdravotn\u00ed poji\u0161\u0165ovny, kter\u00e9 d\u00edky n\u00ed mohou maxim\u00e1ln\u011b zefektivnit hospoda\u0159en\u00ed s prost\u0159edky na l\u00e9\u010dbu hemofilie v \u010cR.<\/p>\n

Prevence<\/p>\n

Dne\u0161n\u00ed p\u0159\u00edstup k l\u00e9\u010den\u00ed hemofilie spo\u010d\u00edv\u00e1 p\u0159edev\u0161\u00edm v jej\u00ed prevenci. L\u00e9ka\u0159i zabra\u0148uj\u00ed v\u00e1\u017en\u00fdm komplikac\u00edm tohoto onemocn\u011bn\u00ed profylaktickou l\u00e9\u010dbou sv\u00fdch pacient\u016f, p\u0159i kter\u00e9 jsou hemofilikovi pod\u00e1v\u00e1ny chyb\u011bj\u00edc\u00ed koagula\u010dn\u00ed faktory. Tato terapie je pro nemocn\u00e9ho velmi p\u0159\u00ednosn\u00e1 a dovoluje mu v\u00e9st plnohodnotn\u00fd \u017eivot, av\u0161ak jedn\u00e1 se o l\u00e9\u010dbu pom\u011brn\u011b n\u00e1kladnou.<\/p>\n

„Zjednodu\u0161en\u011b se d\u00e1 \u0159\u00edci, \u017ee c\u00edlem profylaktick\u00e9 l\u00e9\u010dby je z t\u011b\u017ek\u00e9ho hemofilika ud\u011blat hemofilika st\u0159edn\u00edho, tedy takov\u00e9ho, kter\u00fd nem\u00e1 spont\u00e1nn\u00ed krv\u00e1cen\u00ed nebo je m\u00e1 jen minim\u00e1ln\u011b. T\u00edm eliminujeme v\u011bt\u0161inu komplikac\u00ed, kter\u00e9 nen\u00e1vratn\u011b po\u0161kozuj\u00ed klouby, vedou k trval\u00e9mu bolestiv\u00e9mu posti\u017een\u00ed a zkracuj\u00ed \u017eivot,“ uv\u00e1d\u00ed k t\u00e9matu d\u016fle\u017eitosti profylaktick\u00e9 l\u00e9\u010dby MUDr. Jan Blatn\u00fd, Ph. D., prim\u00e1\u0159 Odd\u011blen\u00ed d\u011btsk\u00e9 hematologie FN Brno.<\/p>\n

Ka\u017ed\u00e9 t\u011blo je jin\u00e9<\/p>\n

D\u00e1vkov\u00e1n\u00ed profylaktick\u00e9 l\u00e9\u010dby bylo po dlouh\u00e1 l\u00e9ta ur\u010dov\u00e1no pouze na z\u00e1klad\u011b t\u011blesn\u00e9 hmotnosti a klinick\u00e9ho obrazu hemofilika. Ka\u017ed\u00e9 lidsk\u00e9 t\u011blo ale pracuje trochu jinak a p\u0159i stejn\u00e9m d\u00e1vkov\u00e1n\u00ed se doba, za kterou klesne koncentrace l\u00e9ku pod kritickou hodnotu, m\u016f\u017ee u jednotliv\u00fdch hemofilik\u016f li\u0161it o dva a\u017e dva a p\u016fl dne!<\/p>\n

Proto m\u016f\u017ee doch\u00e1zet k tomu, \u017ee n\u011bkte\u0159\u00ed pacienti dost\u00e1vaj\u00ed vy\u0161\u0161\u00ed d\u00e1vku, ne\u017e jejich organismus opravdu pot\u0159ebuje, a jsou tedy l\u00e9\u010deni nadm\u011brn\u011b, naopak jin\u00ed pacienti jsou z opa\u010dn\u00e9ho d\u016fvodu l\u00e9\u010deni nedostate\u010dn\u011b. V obou p\u0159\u00edpadech pak doch\u00e1z\u00ed k neefektivn\u00edmu vyu\u017eit\u00ed l\u00e9k\u016f i n\u00e1klad\u016f na n\u011b.<\/p>\n

L\u00e9\u010dba \u0161it\u00e1 na m\u00edru<\/p>\n

T\u011bmto individu\u00e1ln\u00edm nesrovnalostem v d\u00e1vk\u00e1ch m\u016f\u017ee zabr\u00e1nit farmakokineticky \u0159\u00edzen\u00e1 l\u00e9\u010dba, d\u00edky kter\u00e9 se hemofilikovi dost\u00e1v\u00e1 p\u0159esn\u011b takov\u00e1 d\u00e1vka l\u00e9ku koagula\u010dn\u00edho faktoru, kterou pot\u0159ebuje. Tato l\u00e9\u010dba, „\u0161it\u00e1 na m\u00edru“ ka\u017ed\u00e9mu konkr\u00e9tn\u00edmu hemofilikovi, se st\u00e1v\u00e1 nov\u00fdm trendem vedouc\u00edm k optimalizaci l\u00e9\u010dby, kter\u00fd uplat\u0148uje st\u00e1le v\u00edce l\u00e9ka\u0159\u016f z hemofilick\u00fdch center v \u010cesk\u00e9 republice.<\/p>\n

Pacient d\u00edky t\u00e9to metod\u011b z\u00edsk\u00e1v\u00e1 lep\u0161\u00ed kontrolu nad svoj\u00ed l\u00e9\u010dbou, m\u016f\u017ee si nap\u0159\u00edklad pl\u00e1novat sv\u00e9 sportovn\u00ed i jin\u00e9 aktivity podle toho, kdy je optim\u00e1ln\u011b chr\u00e1n\u011bn, nebo tomu p\u0159izp\u016fsobit aplikaci d\u00e1vky. „Pacient m\u016f\u017ee se sv\u00fdmi v\u00fdsledky pracovat ka\u017ed\u00fd den. Najednou m\u00e1 srozumitelnou informaci o tom, za jak dlouho poklesne koncentrace faktoru na n\u011bjak\u00e9 kritick\u00e9 hodnoty, kdy u\u017e by nem\u011bl d\u011blat rizikov\u00e9 \u010dinnosti, p\u0159\u00edpadn\u011b kdy by u\u017e v\u016fbec nebyl chr\u00e1n\u011bn\u00fd“, up\u0159es\u0148uje benefity pro pacienty MUDr. Jan Blatn\u00fd, Ph. D. Pro stanoven\u00ed spr\u00e1vn\u00e9 d\u00e1vky l\u00e9ku je zapot\u0159eb\u00ed sestavit farmakokinetick\u00fd profil pacienta. Cel\u00e9 vy\u0161et\u0159en\u00ed spo\u010d\u00edv\u00e1 v s\u00e9rii odb\u011br\u016f krve, na jejich\u017e z\u00e1klad\u011b je sledov\u00e1na farmakokinetick\u00e1 k\u0159ivka. Podle doporu\u010den\u00fdch postup\u016f se prov\u00e1d\u00ed jeden\u00e1ct a\u017e dvan\u00e1ct odb\u011br\u016f krve v rozmez\u00ed 48 a\u017e 72 hodin u dosp\u011bl\u00e9ho, u d\u011bt\u00ed se obvykle jedn\u00e1 o p\u011bt nebo \u0161est odb\u011br\u016f a vy\u0161et\u0159en\u00ed je vhodn\u00e9 opakovat p\u0159ibli\u017en\u011b ka\u017ed\u00e9 dva roky.<\/p>\n

Profil lze sestavit i na z\u00e1klad\u011b men\u0161\u00edho po\u010dtu odb\u011br\u016f, nicm\u00e9n\u011b plat\u00ed, \u017ee \u010d\u00edm v\u00edce odb\u011br\u016f krve bude z\u00edsk\u00e1no, t\u00edm p\u0159esn\u011bj\u0161\u00ed budou farmakokinetick\u00e9 \u00fadaje. V sou\u010dasn\u00e9 dob\u011b se nap\u0159\u00edklad pracuje na v\u00fdvoji metody ur\u010den\u00ed optim\u00e1ln\u00edch l\u00e9\u010debn\u00fdch d\u00e1vek zalo\u017een\u00e9 na popula\u010dn\u00ed statistice \u2013 na z\u00e1klad\u011b sofistikovan\u00e9ho statistick\u00e9ho vyhodnocen\u00ed velk\u00e9ho souboru pacient\u016f lze ke stanoven\u00ed farmakokinetick\u00e9 k\u0159ivky uskute\u010dnit pouze dva a\u017e t\u0159i odb\u011bry krve (kdykoliv v pr\u016fb\u011bhu \u010dasu) a zbytek se matematicky dopo\u010d\u00edt\u00e1. Jedn\u00e1 se sice o odhad, je ale velmi p\u0159esn\u00fd.<\/p>\n

Co se t\u00fd\u010de finan\u010dn\u00ed n\u00e1ro\u010dnosti l\u00e9\u010dby, sestaven\u00ed farmakokinetick\u00e9ho profilu nezat\u011b\u017euje z\u00e1sadn\u00edm zp\u016fsobem syst\u00e9m financov\u00e1n\u00ed l\u00e9\u010dby hemofilie zdravotn\u00edmi poji\u0161\u0165ovnami. Nestoj\u00ed toti\u017e ani tolik, jako jedna d\u00e1vka l\u00e9ku. U n\u011bkter\u00fdch pacient\u016f se l\u00e9\u010debn\u00e9 d\u00e1vky profylaktick\u00e9 l\u00e9\u010dby sn\u00ed\u017e\u00ed, u jin\u00fdch zv\u00fd\u0161\u00ed. Prim\u00e1rn\u011b tedy farmakokinetika nen\u00ed cestou k \u00faspo\u0159e finan\u010dn\u00edch prost\u0159edk\u016f, ale k jejich lep\u0161\u00edmu vyu\u017eit\u00ed a dosa\u017een\u00ed maxim\u00e1ln\u00ed efektivity se st\u00e1le stejn\u00fdmi n\u00e1klady na l\u00e9\u010dbu.<\/p>\n

Stanoven\u00ed farmakokinetick\u00e9ho profilu je v sou\u010dasnosti zpravidla prov\u00e1d\u011bno v\u0161em d\u011btem s t\u011b\u017ekou formou hemofilie A\/B, d\u00e1le n\u011bkter\u00fdm d\u011btem s jinou ne\u017e t\u011b\u017ekou formou hemofilie p\u0159i za\u017e\u00e1d\u00e1n\u00ed o jeho vypracov\u00e1n\u00ed, tak\u00e9 p\u0159i p\u0159echodu na jin\u00fd typ l\u00e9\u010diva (z jak\u00e9hokoliv d\u016fvodu), nebo p\u0159i zhor\u0161en\u00ed efektu st\u00e1vaj\u00edc\u00ed l\u00e9\u010dby hemofilika. „Vsou\u010dasnosti je \u00fazus, \u017ee by koncentrace faktoru nem\u011bla klesnout pod jedno procento, p\u0159\u00edpadn\u011b pod dv\u011b procenta. \u010c\u00edm d\u00e9le se \u010dlov\u011bk nach\u00e1z\u00ed pod touto hladinou, t\u00edm hor\u0161\u00ed v\u00fdsledek l\u00e9\u010dby je, i kdy\u017e tato korelace nen\u00ed \u00fapln\u011b line\u00e1rn\u00ed,“ uv\u00e1d\u00ed k t\u00e9matu d\u00e1vkov\u00e1n\u00ed profylaktick\u00e9 l\u00e9\u010dby MUDr. Jan Blatn\u00fd, Ph. D., prim\u00e1\u0159 Odd\u011blen\u00ed d\u011btsk\u00e9 hematologie FN Brno.<\/p>\n

V\u00fdhody pro v\u0161echny<\/p>\n

Z\u00e1v\u011brem lze tedy shrnout, \u017ee z farmakokinetiky v l\u00e9\u010db\u011b hemofilie profituj\u00ed v\u0161echny strany. Zdravotn\u00edk\u016fm poskytuje informace nezbytn\u00e9 pro klinickou i ekonomickou optimalizaci n\u00e1kladn\u00e9 l\u00e9\u010dby hemofilie a pacient se m\u016f\u017ee c\u00edtit bezpe\u010dn\u011bji, nebo\u0165 je schopen vyu\u017e\u00edt beze zbytku ochrany, kterou mu l\u00e9\u010dba poskytuje. Je nav\u00edc schopen, ve spolupr\u00e1ci se zdravotn\u00edky, p\u0159izp\u016fsobit co nejl\u00e9pe l\u00e9\u010dbu sv\u00fdm pot\u0159eb\u00e1m a nebo sv\u00e9 pot\u0159eby poskytovan\u00e9 l\u00e9\u010db\u011b.
\nFarmakokinetika tak jednozna\u010dn\u011b p\u0159isp\u00edv\u00e1 k omezen\u00ed po\u010dtu krv\u00e1cen\u00ed, m\u00e1 potenci\u00e1l zlep\u0161it kvalitu \u017eivota osob s hemofili\u00ed a rovn\u011b\u017e m\u016f\u017ee b\u00fdt pou\u017eita jako n\u00e1stroj ke zv\u00fd\u0161en\u00ed n\u00e1kladov\u00e9 efektivity l\u00e9\u010dby hemofilie. V\u00edce informac\u00ed k problematice najdete na www.hemofilie.cz<\/a>.<\/p>\n

Libereck\u00fd den\u00edk
\nwww.liberecky.denik.cz<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Farmakokinetika je pro mnoh\u00e9 laiky nezn\u00e1m\u00fdm pojmem, av\u0161ak jej\u00edm prost\u0159ednictv\u00edm dok\u00e1\u017e\u00ed l\u00e9ka\u0159i l\u00e9pe nastavit l\u00e9\u010dbu hemofilie a p\u0159esn\u011b stanovit l\u00e9\u010debn\u00e9 d\u00e1vky sr\u00e1\u017eec\u00edho faktoru na m\u00edru […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":14127,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-20153","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/20153","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=20153"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/20153\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/14127"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=20153"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=20153"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=20153"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}