中医院开展中药临床药学工作的建议和方法

对于中医药传统理论,临床医师较临床药师更熟悉,尽管其中争议的部分较多,不易于临床干预,但传统理论是临床药师与临床医师沟通交流的基础,临床药师必须尽可能多地掌握。中药现代研究临床医师较生疏,由于其结论较明确,易于为临床所接受,是开展中药临床药学的主要切入点,临床药师必须及时掌握。中药临床药师只有深入临床,并全面熟悉中医药相关知识,中药临床药学才能有效开展起来。     

临床治疗团队中临床药师应有的基本要素界定

目的:界定临床治疗团队中临床药师应有的基本要素。方法:考察在临床中设定临床药师制度的目的、临床治疗团队中临床药师与临床医师的不同工作范畴以及不同专业要求等,从而界定出临床治疗团队中临床药师应有的基本要素。结果与结论:我国实行临床药师制度是医院临床制度建设的重大进步,而临床治疗团队中的临床药师必须具备其应有的临床责任、临床作用、临床能力和临床效果这四大临床应有的基本要素。只有这样,临床药师才能在临床治疗团队中成为不可替代的重要组成部分。     

临床药师参与23例糖尿病患者治疗体会

随着临床药学服务在医院的不断发展和深入,临床药学专业知识也越来越广泛地渗透和联系到临床各学科,与之相互影响关系越来越密切。临床药师越来越多地参与到患者的诊断治疗中来,在临床各科请临床药师会诊、参与治疗意见、调整治疗方案等提供临床药学服务。很多研究表明,临床药师参与临床诊断治疗,提供临床药学服务明显提高疾病的治疗效果。临床药师参与临床诊断治疗,临床药师职能转换后的一项重要工作内容。临床药师应为患者建立临床药例,为更加有效地参与临床的诊断治疗做足准备,以便提供行之有效的临床药学服务。研究分析我院2011年1～2月间临床药师参与23例糖尿病患者诊断治疗记录,探讨临床药学服务在临床治疗中的重要作用。     

探讨临床药师参与临床工作的临床药学思维

目的:探讨临床药师建立临床药学思维的重要性。方法:结合临床药师在临床工作的特点,通过临床药师参与临床实践工作,对临床药学思维进行分析总结。结果:临床药师通过临床药学思维,能在临床上发现、识别并预防潜在的用药问题,可以与医师有效合作,使病人得到更加有效的治疗。结论:临床药师的临床药学思维能力的提高,对于临床药师能更好地开展药学服务,保障药物在临床使用过程中的安全及有效性具有重要意义。     

国冢级继续医学教育项目“临床思维和临床决策”学习班报名通知（项目编号：2009-15-01-002）

临床思维和临床决策是临床工作者（医师、药师、护师、营养师、心理师、康复师和检验师）的逻辑思维能力和临床处置能力。临床思维是临床决策的前提,而临床决策则是临床思维的结果;临床思维和临床决策都以临床信息和医药知识作为基础。临床思维和临床决策是否得当,决定了临床信息的收集是否全面,分析是否得当,疾病诊断是否正确,病情判断是否适当,治疗方案是否合理,治疗监护是否充分。一句话,正确的临床思维和临床决策让病人承受必要的痛苦、承担必须的风险、     

临床药师与临床互动开展QCC活动提高吸入制剂的正确使用率

目的帮助临床开展QCC活动。方法分派人员到临床,与临床科室互动,按照QCC活动程序进行QCC。结果成功地与临床科室一起开展了QCC,完成了一项主题。结论临床药师通过与临床互动,帮助临床开展QCC活动,通过头脑风暴解决临床常见的问题,不仅提高了临床药师的沟通能力,更有助于临床解决一些实质性问题。     

临床药师在临床治疗团队中的专业优势

目的：探讨临床药师在临床治疗团队中的作用及专业优势。方法结合本院临床药师临床工作实践,临床药师在为医护人员、患者提供药学专业技术服务中,体现临床药师发挥的临床作用。结果临床药师作为医生的参谋,为患者的临床用药进行把关,判断用药的科学性、合理性,规避用药风险,确保临床用药安全,提高药物疗效,减少药物的不良反应等发挥着重要作用。结论随着国家临床药师制度的不断完善,临床药师队伍的不断壮大,临床药师素质的不断提高,临床药师在临床治疗团队中发挥的临床作用将更加明显。     

我院开展临床药学工作的实践与体会

目的:介绍我院临床药学工作的开展情况。方法:从建立临床药师制,负责药物遴选、处方审核,参与查房、会诊,开展药品不良反应监测,协助临床做好抗感染药物监测等方面阐述我院临床药师开展临床药学工作的内容。结果与结论:我院临床药师目标明确,深入临床,对临床合理用药起到了一定的作用。临床药师应加强学习,提高自身业务素质,积极深入临床,与医师、护士密切配合,促进临床合理用药。     

临床药师在住院内科的药学实践与体会

目的 探讨临床药师工作模式.方法 临床药师深入临床,每天和临床内科医师一起查房、学习.结果 药师的工作能够得到临床的认可.结论 只有深入临床,才能发挥临床药师的作用,体现临床药师的价值,促进合理用药.     

我院临床药师参与临床合理用药的体会

目的 介绍我院临床药学的开展情况,为药师提供参考.方法 介绍我院临床药师深入临床查房,结合具体实例,总结临床药师参与临床用药的体会.结果 临床药师能够有效协助临床医师合理用药.结论 临床药师能在临床合理用药方面发挥重要作用.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Hyperkalaemia in patients in hospital

A survey of all laboratory blood specimens with a plasma potassium concentration greater than or equal to 5.5 mmol/L was conducted over a three month period. Of 331 specimens with hyperkalaemia, 71 were excluded because the specimens was haemolysed, old or contaminated. The laboratory served a population of 348,561 and during this time measured the plasma potassium on 25,016 occasions. Sixty-six outpatients and 20 neonates were not evaluated. The survey was undertaken on 86 of 102 inpatients (46 males), 48 of whom were over 66 years of age. Fifty-seven patients were admitted under a medical service and 29 under a surgical service. Fifty-nine had a single episode of hyperkalaemia. Thirty-two underwent a surgical procedure. The commonest contributing factor was impaired renal function which was present in 71 (83%) patients. Although a definitive causative role for drugs could be identified in only five patients, in 52 (60%) patients drugs were a contributing factor (potassium supplements 24, ACE inhibitors 16, nonsteroidal antiinflammatory drugs 12). Thirty-five of the 86 (41%) patients died during their hospital admission. Nineteen of the 35 deaths occurred within three days of the hyperkalaemia being recorded. A normal plasma potassium was eventually documented in 50 of the 86 patients. Of the remaining 36 patients, 25 (69%) subsequently died. In general the treatment of patients with hyperkalaemia focused on identifying and treating the underlying cause. Hyperkalaemia must always be considered seriously and regard given to the overall clinical status of the patient, with particular attention to drug therapy, renal and cardiac function, acid base status and the possibility of sepsis.