重症肌无力患者的药学监护

目的探讨重症肌无力患者的药学监护方法。方法临床药师参与整个治疗过程,从治疗方案的确定、不良反应处理、患者用药教育等方面展开工作。结果通过药物疗效和不良反应监护,调整治疗方案,患者症状好转,药物不良反应减轻,顺利出院。结论临床药师参与临床治疗团队,充分发挥药学专业技能,有利于提高医疗质量。     

1例重症肌无力患者的药学监护

目的：探讨临床药师在重症肌无力患者治疗过程中如何开展药学监护工作。方法临床药师选择1例重症肌无力并发肝炎、肝功能异常的典型病例,为临床药物治疗提供药学服务。结果临床药师紧密结合患者的实际病情,以糖皮质激素治疗方案的选择、药品不良反应的监测等为切入点,在与临床医师的合作下,制定个体化给药方案及监护计划,并对患者行激素相关用药指导和健康教育,提高了患者的用药依从性,促进了临床合理用药。结论临床药师参与临床药物治疗,能结合药学专业特色,优化临床给药方案,有利于临床治疗水平的提高。     

临床药师参与重症肌无力合并支气管哮喘病例的药学实践

1例重症肌无力合并支气管哮喘的中年男性患者,既往肾肿瘤切除病史,临床药师参与患者的药物治疗并对其进行药学监护。因患者哮喘控制欠佳,为重症肌无力一线治疗方案即溴吡斯的明的用药禁忌,且糖皮质激素用药初期可能引发重症肌无力危象,治疗方案需要多重考虑后制定。临床药师通过文献调研,利用药学相关专业知识,协助医师制定治疗方案,筛查用药合理性,对患者进行药学监护及用药依从性宣教。临床药师为医师及患者提供个体化药学服务,促进临床合理用药。     

1例支原体肺炎并发人丙种球蛋白非敏感型川崎病患儿的药学监护

目的:探讨临床药师参与支原体肺炎并发川崎病(KD)患儿治疗的药学监护切入点。方法:以1例支原体肺炎并发KD患儿的治疗为例,根据抗菌药物、人丙种球蛋白(IVIG)、非甾体类抗炎药、糖皮质激素具体用药情况,结合患儿临床表现与病情变化,以药物相互作用、药品不良反应、用药注意事项、出院宣教等作为切入点开展全程化药学监护。结果:临床药师针对可能发生的不良反应采取联合用药措施早预防、采取监护措施早发现早干预,能及时发现问题,避免不良反应的发生,提高患儿依从性。结果:临床药师在治疗团队中深入开展药学监护并找准切入点,有利于提高临床治疗水平,从而更好地保障患儿用药安全。     

分级诊疗模式下医联体药师参与高血压患者长期药学监护工作实践

目的：通过医联体药师参与高血压患者长期药学监护工作的探索实践,为分级诊疗模式下实现医联体连续性药学服务提供经验参考。方法：选取2019年5月16日至6月30日在北京市垂杨柳医院就诊且符合入选标准的135例住院患者为研究对象,由我院临床药师带动指导社区药师共同参与,综合借鉴国内外先进管理经验和工作规范,对患者进行住院期间、出院后转诊至社区诊疗及居家康复期间的长期连续性药学监护,进行药物整合、用药风险评估、用药合理性评估、用药教育与长期随访等,并实施用药风险分级管理,制定高血压患者长期药学监护技术手册,建立长期药学监护管理数据库。结果：该工作模式运行6个月,与干预前对照,高风险组和低风险组患者安全用药认知能力评分、用药依从性评分、 患者血压达标率均有显著提高,药师对不合理处方的有效辨识率和干预率显著提高,以上差异均具有统计学意义(P＜0.05)。结论：医联体药师参与高血压患者长期药学监护工作对于提升患者用药认知能力及用药依从性、提高患者血压达标率具有重要作用,同时也有助于提升药师对临床不合理用药的辨识和干预能力。     

某院激素补充治疗用药监护药学门诊工作实践与效果

目的：介绍某院激素补充治疗（MHT）用药监护药学门诊工作实践与效果。方法：简述MHT用药监护药学门诊工作内容，收集2016年7月1日到2018年6月30日就诊的80例患者，分别于初诊时、MHT治疗1个月、3个月、12个月后对患者绝经相关症状、用药依从性进行评分，并统计年新增MHT用药率、MHT坚持用药率及不良反应发生情况。结果：完成随访患者73人，初诊时，MHT治疗1个月、3个月、12个月随访时的Kupperman评分随MHT用药时间的延长逐渐下降，用药依从性评分逐渐提高，差异均有统计学意义（与前次随访时比较，P<0.05）；年新增MHT用药率20.00%，MHT 1年及以上坚持用药率41.10%；不良反应发生率15.07%，72.73%发生于MHT 3个月内，随访期间无乳腺癌等严重不良反应发生。结论：通过开设MHT用药监护药学门诊，临床药师在患者MHT治疗中发挥了积极的作用，证明了药学门诊服务的价值，为其他药学专科门诊的开展提供了参考。     

1例老年重症感染患者诊疗中的药学监护报告

目的提高老年重症感染患者抗菌治疗效果。方法临床药师全程参与并配合医师对1例重症感染的老年患者实施药学监护。在分析疾病和用药特点、评估并提供可选治疗方案、监护不良反应和相互作用,以及药物的剂量调整等方面为临床提供药学服务。结果药师与医师紧密配合,患者治愈出院。结论临床药师应积极参与临床治疗工作。     

1 例慢性阻塞性肺疾病急性加重期合并多种老年病患者的药学监 护简

目的探讨,临床药师在治疗慢性阻塞性肺疾病急性加重期（AECOPD）合并多种老年病患者的药学监护。方法参与1例AECOPD合并糖尿病、心功能不全、肾功能损害患者个体化治疗方案的制订,发挥自身药学特长,为患者进行药物选择、调整用法用量、监测药品不良反应及出院用药教育。结果通过对该患者的药学监护,避免了潜在的治疗风险,为临床合理用药提供了意见。结论药师直接深入临床为医生、患者提供药学服务,可有效提高药物治疗水平,避免药品不良反应,提高患者用药的依从性。     

1例肺癌患者化疗期间引起幻觉的药学监护

目的：探讨临床药师在恶性肿瘤患者化疗期间发生罕见不良反应时药学监护的作用与意义。方法：临床药师介入1例化疗期间出现幻觉的肺癌患者,充分利用药师专业背景,参与临床用药,实施药学监护。结果：经过积极、合理、有效的治疗后,患者痊愈出院。对患者进行追踪随访,未再发生该不良反应。结论：临床药师积极参与药学监护,提供药学服务,促进医院安全合理用药具有重要的意义。     

1例婴儿药物超敏反应综合征的药学监护

目的：探讨临床药师对婴儿药物超敏反应综合征的药学监护要点,以提高对治疗药物的管理水平。方法：临床药师参与1例婴儿药物超敏反应综合征的治疗,对可能出现的药物相互作用及不良反应进行分析和药学监护,促进患儿病情转归。结果：经过包括临床药师在内的诊疗团队共同评估,调整治疗方案,提出用药建议,为患儿及家属提供药学监护和用药宣教,患儿好转出院,随访期间病情没有复发。结论：临床药师在药物超敏反应综合征治疗中可发挥药学专业优势进行药物精细化监护管理,提高疗效,以保障婴幼儿用药安全。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.