应用群体药动学模型制订患儿抗癫痫给药方案的药学会诊实践

目的 为优化癫痫患儿卡马西平和丙戊酸给药方案提供参考。方法 药师参与1例脑外伤术后癫痫患儿的药学会诊,总结分析其使用卡马西平和丙戊酸血药浓度异常的原因,应用群体药动学模型为患儿调整给药剂量,并评价笔者团队所建模型的预测能力。结果 患儿病情得到了有效控制。结论 药师应用群体药动学模型优化抗癫痫药物治疗方案,为临床合理用药提供参考。     

临床药师参与妊娠期抗癫痫会诊1例分析

目的 为临床药师参与妊娠期抗癫痫会诊提供参考。方法 临床药师参与1例妊娠期抗癫痫的会诊,分析患者既往用药史和抗癫痫药在妊娠期的用药风险,将抗癫痫药由卡马西平调整为拉莫三嗪,并根据患者的血常规检查结果调整药物。结果 临床药师参与会诊,帮助临床医师解决了妊娠期患者用药难题,降低了用药风险。结论 临床药师通过参与会诊体现了临床药师的职业价值。     

526例癫痫患儿用药情况调查

目的 了解我院癫痫患儿抗癫痫药物的使用情况,为临床用药及个体化给药提供参考。方法 对我院门诊526例癫痫患儿的抗癫痫药物的药品品种、血药浓度、症状控制情况进行统计、归纳和讨论。结果 我院抗癫痫药物以丙戊酸钠和卡马西平使用最多,两药对血药浓度控制较好,86%患儿的症状得到控制。结论 我院抗癫痫药物的使用基本合理,在用药过程中还应该加强药学服务和个体化给药。     

1例化脓性脑膜炎伴肾功能不全小儿患者的治疗分析与药学监护

目的 探讨化脓性脑膜炎伴肾功能不全小儿患者的药物治疗及开展药学监护的方法。方法 临床药师利用治疗药物监测手段,与临床医师共同制订个体化给药方案。结果 临床药师通过实施药学监护,提供个体化药学服务,提高了临床治疗效果。结论 临床药师应当深入临床,积极参与临床实践,结合患者病情,发挥药学专业优势,协同临床医师优化给药方案。     

基于群体药动学原理对1例新生儿败血症合并脑膜炎的药学监护

目的 为临床制定万古霉素个体化给药方案提供参考。方法 临床药师运用万古霉素群体药动学模型对1例新生儿败血症合并脑膜炎病例开展个体化给药方案调整和实施药学监护。结果 在基于治疗药物的监测和万古霉素群体药动学模型制定的万古霉素静脉注射联合脑室内注射的给药方案下,患儿感染得到有效控制,无不良反应发生。结论 临床药师应用群体药动学模型优化万古霉素抗感染治疗方案,协助临床医师制定个体化给药方案。     

最大后验贝叶斯估算法制定华法林个体化给药案例探讨

摘 要 目的：探讨临床药师在华法林个体化给药方案制定及实施监护过程中发挥的作用。方法: 临床药师采用最大后验贝叶斯估算法制定华法林患者的给药方案,并对方案实施过程进行了监护,及时识别了药物相互作用导致的INR升高,避免了出血不良反应的发生,同时也及时发现了患者漏服药物导致的国际标准化比值（INR）降低,避免了患者再次发生血栓。结果:最大后验贝叶斯估算法可以较好地估算和指导临床用药,对于个体化给药方案具有极大的参考价值。结论:根据基因检测结果选择合适的算法为华法林患者制定了个体化给药方案后,临床药师还需要对整个给药方案实施过程提供全程化的监护,以便及时发现疾病、药物相互作用、依从性不佳等导致的INR异常波动,从而提供抗凝效果,减少出血和栓塞等不良反应。     

118例癫痫患者卡马西平血药浓度监测结果及影响因素分析

目的 探讨癫痫患者卡马西平（CBZ）血药浓度的影响因素,为临床合理使用提供依据。方法 选取118例规律服用卡马西平治疗的癫痫患者作为研究对象,采用高效液相色谱法（HPLC）进行血药浓度监测,分析影响卡马西平血药浓度的因素。结果 75.42%的患者服用卡马西平后血药浓度控制在4~12 μg·mL^-1之间;性别因素、年龄因素对卡马西平血药浓度的影响不明显（P＞0.05）;联合其他抗癫痫药时,无效浓度比例较高,具有统计学差异(P＜0.05)。结论 服用卡马西平后,患者卡马西平血药浓度的个体差异大,尤其是合并使用其他癫痫药者。因此应避免联合使用,并积极监测患者药物浓度,实施个体化给药,促进安全合理使用。     

1例骨关节结核合并结核性脑膜炎患儿的药学监护

摘 要 目的： 探讨临床药师对骨关节结核合并结核性脑膜炎患者实施药学监护的方法与思路。 方法: 临床药师参与1例骨结核合并结核性脑膜炎患者的会诊,从针对病情调整抗结核治疗方案、关注抗结核药不良反应、患者的用药教育等方面进行综合分析。结果:临床药师在疾病治疗过程中,提出的会诊意见和建议得到了临床认可,对协助医师合理用药发挥了一定作用,明显提高了药物治疗效果。结论: 临床药师为患者进行个体化的药学监护,能帮助临床医师优化药物治疗方案,提高患者用药安全性、有效性。     

药师参与1例颅内多重耐药鲍曼不动杆菌感染病例的治疗

摘 要 目的：临床药师通过参与1例鲍曼不动杆菌导致颅内感染患者的治疗过程,探索最佳的药物治疗方案。方法: 临床药师参加治疗团队,参与患者治疗方案的设计,从药物的选择、给药剂量、途径及不良反应(ADR)方面对患者进行个体化给药。结果: 选择敏感抗菌药物,成功的治疗颅内多重耐药鲍曼不动杆菌感染。鲍曼不动杆菌引起的颅内感染,头孢哌酮舒巴坦钠、米诺环素都可以作为有效治疗药物。结论:临床药师参与临床会诊,医师与药师互相协作,保证了患者用药的安全、有效、经济。     

1例华法林药源性肾损伤的用药分析和药学监护

摘 要 目的：通过临床药师参与华法林给药方案的设计,探讨华法林个体化给药的合理方式。方法: 临床药师参与1例华法林抗凝过度致肾损伤患者的用药方案的优化和药学监护。结果: 确定符合患者特点华法林个体化用药方案,患者病情得到缓解,用药依从性提高。结论:临床药师参与个体化给药过程,有利于增强临床药物治疗效果和发挥临床药师的作用。     

Teaching medication adherence in US colleges and schools of pharmacy

Objective. To determine and describe the nature and extent of medication adherence education in US colleges and schools of pharmacy.Methods. A mixed-methods research study was conducted that included a national survey of pharmacy faculty members, a national survey of pharmacy students, and phone interviews of 3 faculty members and 6 preceptors.Results. The majority of faculty members and students agreed that background concepts in medication adherence are well covered in pharmacy curricula. Approximately 40% to 65% of the students sampled were not familiar with several adherence interventions. The 6 preceptors who were interviewed felt they were not well-informed on adherence interventions, unclear on what students knew about adherence, and challenged to provide adherence-related activities for students during practice experiences because of practice time constraints.Conclusions. Intermediate and advanced concepts in medication adherence, such as conducting interventions, are not adequately covered in pharmacy curriculums; therefore stakeholders in pharmacy education must develop national standards and tools to ensure consistent and adequate medication adherence education.     

福州市社区居民安全用药现状及教育需求调查

目的：调查了解社区居民安全用药知识水平的现状与用药教育的需求,探讨其影响因素,为制定合适的药学服务模式提供参考。方法：便利选取福州市200例社区居民进行问卷调查,SPSS20.0分析调查结果,统计方法采用描述性分析、Anova方差分析、Spearman相关分析、Logistic回归等。结果：居民安全用药认知与行为得分率分别为76.6%、71.7%,各维度分析显示自我购药得分最低。受教育程度是居民安全用药认知、行为与用药教育需求的影响因素（P<0.05）,不同工作状况的居民参加用药教育的频率有统计学意义（P<0.05）。结论：福州社区居民安全用药认知与行为仍然存在不足,其用药教育意识待加强;药师有必要根据不同学历居民的接受情况,并结合工作状况与性质,给予多样化、有针对性的安全用药指导。     

药物咨询的实践与分析

目的开展药物咨询工作,指导临床合理用药。方法设立临床药物咨询台,为患者解答疑问。结果增强了患者用药的依从性,并促进药师知识积累和更新,提高了业务水平。结论药物咨询是全程化、个体化药学服务的重要内容,促进了门诊药房工作的拓展和完善。     

黄石地区居民用药行为风险知识-态度-行为调查研究

目的 提高公众的用药安全,促进合理用药.方法 调查2020年7月至9月黄石地区居民用药行为风险的知识-态度-行为(KAP),分析不同人群的用药风险水平和安全用药教育现状,以及用药风险的影响因素.调查问卷采用《中国居民用药安全行为风险KAP调查研究》问卷,结果按6级量表进行赋分,评估居民用药风险水平(用药知识、用药前行为...     

临床药师干预对脑梗死患者用药依从性的影响

目的 探讨脑梗死患者用药依从性差的相关因素,研究药师用药教育对患者依从性的影响。方法 选取鼓楼医院2016年1-6月住院的128名因脑梗死复发住院的患者,对患者入院前用药类别和用药方法进行调查。在对患者进行用药教育后第3天和出院后1个月,对患者依从性进行随访。结果 入院前仅有36.7%的患者坚持每日服药,并对用药方法掌握明显不足。较低的依从性与患者上次住院期间未接受用药教育有关。药师对患者进行用药教育后,患者的依从性显著提升。结论 药师作为临床诊治的重要一环,进行用药教育对提高患者依从性、减少脑梗死的复发具有重要意义。     

Retrospective Analysis of Opioid Medication Incidents Requiring Administration of Naloxone

Background:

Opioid analgesics are high-alert medications known to cause adverse drug events.

Objectives:

The purpose of this study was to determine the cause of opioid incidents requiring administration of naloxone, an opioid reversal agent. The specific objectives were to determine the number of opioid incidents and the proportion of incidents documented through occurrence reporting and to characterize the incidents by phase in the medication-use process, by type of incident, and by drug responsible for toxic effects.

Methods:

A retrospective chart analysis was conducted using records from 2 acute care centres in the Regina Qu’Appelle Health Region. The study included inpatients who received naloxone for reversal of opioid toxicity resulting from licit, in-hospital opioid use. Cases were classified as preventable or nonpreventable. Preventable cases were analyzed to determine the phase of the medication-use process during which the incident occurred. These cases were also grouped thematically by the type of incident. The drug most likely responsible for opioid toxicity was determined for each case. The proportion of cases documented by occurrence reporting was also noted.

Results:

Thirty-six cases involving administration of naloxone were identified, of which 29 (81%) were deemed preventable. Of these 29 preventable cases, the primary medication incident occurred most frequently in the prescribing phase (23 [79%]), but multiple phases were often involved. The cases were grouped into 6 themes according to the type of incident. Morphine was the drug that most frequently resulted in toxic effects (18 cases [50%]). Only two of the cases (5.6%) were documented by occurrence reports.

Conclusion:

Preventable opioid incidents occurred in the acute care centres under study. A combination of medication safety initiatives involving multiple disciplines may be required to decrease the incidence of these events and to better document their occurrence.     

Factors Associated With Medication Errors at a Teaching Hospital in Malaysia

Background: Medication errors (MEs) continue to pose a significant problem to health care systems across the world, not only causing harm and death in patients but also consuming approximately $42 billion annually in health care expenditure. The emergency department (ED) is considered a high-risk area of having MEs to occur. Little is known about the associated factors of ME in the ED of hospitals in Malaysia. Objective: The objective of this study was to determine the factors associated with ME in an ED of a teaching hospital. Methods: A cross-sectional study was conducted on patients who visited the ED of Hospital Universiti Sains Malaysia over 9 weeks during normal working hours (ie, 8:00 am-5:00 pm). A total of 547 patients who satisfied the inclusion criteria were enrolled for the study. Patient demographic information, clinical characteristics, and medication orders and procedures were observed and recorded. The required number of patient data (n = 311) were selected randomly for analysis. Multiple logistic regression method was employed to determine factors associated with ME. Results: Of the 311 patient data, 95 (30.5%) patients had at least 1 ME. The factors found to be associated with ME were number of medications (adjusted odds ratio [OR], 1.91; 95% confidence interval [CI], 1.51-2.41), triage (adjusted OR, 0.11; 95% CI, 0.04-0.27), gender (adjusted OR, 0.50; 95% CI, 0.26-0.93), and time of patient visit (adjusted OR, 0.34; 95% CI, 0.52-0.75). Conclusion: Medication error was not uncommon in our ED setting. Patients with a higher number of medications prescribed during visit to the ED were found to be particularly at risk. Identification of such factors may guide intervention measures to prevent MEs in this setting.     

236例药品不良反应报告分析

目的 了解本院药品不良反应(ADR)发生情况,促进临床合理用药.方法 采用回顾性方法,对本院2009～2011年成功上报省中心的236例ADR报告分别从药品种类、给药途径、引发ADR前10位的药品、ADR累及的器官或系统及临床表现等方面进行统计、分析.结果 ADR涉及药品104种,抗菌药物和中药制剂的ADR报告例数居第...     

住院输液医嘱前置审核实践

目的:提高药师对输液医嘱干预能力,发挥药师自身价值,促进临床合理用药。方法:对2015年—2017年的5500271组住院输液医嘱的前置审核记录进行统计分析,观察医嘱前置审核工作对住院输液医嘱质量的影响。结果:2015年—2017年,经处方审核管理系统(pivas mate系统)和药师双重审核的住院输液医嘱总的不合理医嘱拦截率为2.1%,2015年—2017年,不合理医嘱拦截率分别为1.68%、1.95%、2.79%。不合理医嘱类型主要为书写不规范或录入错误、溶媒限制、无适应症给药等。结论:实施医嘱前置审核,可有效提高住院输液医嘱安全合理性,同时提高药师处方审核干预能力。