我院住院麻醉药品处方点评与分析

目的:总结山西省儿童医院住院麻醉药品处方质量和合理用药情况,保证麻醉药品安全、合理使用。方法:根据《麻醉药品临床应用指导原则》《医院处方点评管理规范(试行)》《处方管理办法》以及《麻醉药品和精神药品管理条例》,汇总山西省儿童医院2015年3月—2016年3月住院麻醉药品处方8 562张进行点评。结果:不合理处方169张,不合格率1.97%,其中主要是处方不规范,包括处方内容缺项51张、处方用量书写不规范110张、用法用量不适宜1张、其他7张。结论:山西省儿童医院住院麻醉药品总体用药情况基本合理,处方书写质量较高,但仍需进一步提高麻醉药品用药合理性及处方书写水平,确保麻醉药品的质量和使用安全有效。     

某综合医院门诊第二类精神药品处方点评及不合理处方分析

目的:分析我院门诊第二类精神药品处方,促进第二类精神药品的临床合理使用。方法:根据《麻醉药品和精神药品管理条例》、《处方管理办法》、《医院处方点评管理规范(试行)》以及《精神药品临床应用指导原则》,对我院2017年10月-12月的门诊第二类精神药品处方进行处方点评。结果:共收集门诊精二类处方7754张,其中不合理处方783张,占第二类精神药品处方总数的10.10%。主要不合理处方类型为未写临床诊断(19.41%)、适应症不适宜(2.94%)、用法及用量不适宜(42.66%)及联合用药不适宜(34.86%)等。结论:我院门诊第二类精神药品处方合理性有待提高,应确保精神药品临床安全、合理使用。     

4800张新型抗肿瘤药物处方专项点评与分析

目的：总结该院新型抗肿瘤药物处方专项点评情况,以促进临床合理用药。方法：回顾性分析2018—2021年该院新型抗肿瘤药物处方专项点评情况,对点评结果进行分析和汇总。结果：2018—2021年该院新型抗肿瘤药物处方点评共48次,共抽取处方4 800张,其中合理处方4 578张,处方合格率为95.38%。222张不合理处方中,不规范处方197张(占88.74%),不合理类型均为“开具处方未写临床诊断或临床诊断书写不全”;用药不适宜处方25张(占11.26%)。超说明书用药共涉及276张处方,均为超说明书适应证用药;涉及的药品中,阿帕替尼的超说明书用药处方数最多,为166张(占60.14%),其次为安罗替尼(49张,占17.75%)。结论：根据现行法规制度、临床指南等证据不断完善新型抗肿瘤药物点评规则和流程将使得处方更加规范,临床用药更加合理。     

某院门诊麻醉药品处方点评与分析

目的:对某院门诊麻醉药品处方进行点评,分析不合理处方,以促进麻醉药品的合理使用。方法:收集某院2017年8月至2018年7月门诊麻醉药品处方进行点评,并分析不合理处方。结果:共收集1398张麻醉药品处方,不合理处方45张(3.2%),主要不合理处方类型为前、后记不规范,用法、用量不适宜等。结论:该院应持续提升对麻醉药品处方的监管力度,改进和规范处方不合理之处,保障麻醉药品用药的安全性和有效性。     

2011年我院门诊处方点评及不合理处方分析

目的通过门诊处方点评,了解我院门诊用药情况,促进临床合理用药。方法对我院随机抽取的2011年1～12月门诊处方共11653张进行点评,并对不合理处方进行分析。结果抗菌药物处方3058张,使用率为26.24%。不合理处方3747张,不合理率为32.15%,主要表现在超规定剂量开具处方、未使用药品规范名称开具处方和处方内容缺项等。结论通过处方点评,可提高处方质量,促进临床合理用药。     

门诊处方审核与点评分析对提高合理用药水平的影响

目的 探讨门诊处方审核与点评分析对提高合理用药水平的影响.方法 回顾性分析我院2015年6月至2016年6月1876张门诊处方,于调配处方时审核其用药的合理性,事后在进行点评分析,评价处方审核与点评分析对临床合理用药的影响.结果 不合理处方共计299张(占15.94%),其中药师在实时审核中发现不合理处方112张,不合理用药126例次,主要为临床诊断与用药不符45例次(占2.40%)及抗菌药物使用不合理28例次(占1.49%),事后点评中发现不合理处方187张,不合理用药226例次.结论 调配处方时进行用药审核可有效的拦截部分不合理处方,但在事后处方点评中仍然存在处方不合理现象,因此应不断提高药师的专业技能及审核水平,严格执行处方管理办法,加强处方的审核与点评,有助于提高临床合理用药水平.     

某妇产儿童医院2015~2016年门急诊处方点评与分析

目的:了解医院门急诊处方开具情况,分析不合理原因,为合理用药提供依据.方法:汇总2015年7月~2016年6月点评处方共20365张,对不合理的处方情况进行回顾性分析.结果:在点评的20365张处方中,不合理处方399张,占点评总处方数的1.96%.结论:通过处方点评,可发现临床用药存在的问题,从而规范门急诊处方,提高医师用药水平,保障用药安全有效.     

某院普外科33张门诊处方点评及其不合理处方用药分析

目的:分析医院普外科门诊处方点评内容及其合理用药,为临床合理用药提供参考。方法:抽取医院2016年4月份3 d的普外科门诊用药处方,共计33张,点评其处方用药。结果:33张普外科门诊处方中仅12张处方合格,其处方合格率为36.36%,不合格率为63.64%,不合理处方项目主要为临床诊断不全、用药次数不当、用法不对、用药与临床诊断不符等。结论:通过处方点评,改善普外科不合理用药现象,保障患者用药安全。     

山西省某三甲医院处方点评分析

目的 通过对该院门诊处方进行规范性点评,分析不合理处方原因,并提出改进建议,为提高处方质量,促进合理用药,保障患者用药安全提供依据。方法 采用回顾性分析方法,随机抽取太原市中心医院2021年1-12月门诊处方,以《医院处方点评管理规范(试行)》、《处方管理办法》、药品说明书等为依据,进行处方规范性点评,分析不合理处方的类型并结合帕累托图进行讨论。结果 分析随机抽取的47 557张处方,其中合理处方46 689张,处方合理率为98.17%,不合理处方868张,处方不合理率为1.83%。在868张不合理处方中,不规范处方681张,用药不适宜处方55张,超常处方132张。开具抗菌药物的处方3 353张,抗菌药物使用率7.05%。结论 该院处方合理率未达三甲医院评审的要求,其中处方超量、书写不规范等是当前影响处方不合理的主要原因,其次超说明书用药备案流程未完善是超常处方主要原因。建议加强医师培训,优化管理流程,不断完善处方点评制度,以提高处方质量,保证患者用药安全。     

我院2014年麻醉药品和第一类精神药品使用分析

目的:为麻醉药品和第一类精神药品的合理使用提供参考。方法:对郑州人民医院临床科室2014年1-12月麻醉药品和第一类精神药品使用的品种、科室分布、用药目的、用药频度(DDDs)、日均费用(DDC)、药物利用指数(DUI)等进行调查,并进行统计分析。结果:2014年我院麻醉药品和第一类精神药品医嘱总共28 981张,共使用16种麻醉药品和1种第一类精神药品,其中麻醉药品主要是枸橼酸舒芬太尼注射液(7 816张)和枸橼酸芬太尼注射液(5 104张),第一类精神药品是盐酸氯胺酮注射液(190张)。麻醉药品和第一类精神药品主要在麻醉科、疼痛科和肿瘤内科使用。主要用药目的为术中麻醉、癌痛和术后镇痛。DDDs列前3位的药品为枸橼酸舒芬太尼注射液、枸橼酸芬太尼注射液(0.1 mg)和注射用盐酸瑞芬太尼。结论:该院麻醉药品和第一类精神药品的使用合理,临床医师能够掌握相应药品的适应证,符合该类药品的用药原则,并能根据患者病情个体化合理用药。     

Interaction of estrone and estradiol with DNA and protein of liver and kidney in rat and hamster in vivo and in vitro

[6,7-³H] Estrone (E) and [6,7-³H]estradiol-17 (E₂) have been synthesized by reduction of 6-dehydroestrone and 6-dehydroestradiol with tritium gas. Tritiated E and E₂ were administered by oral gavage to female rats and to male and female hamsters on a dose level of about 300 g/kg (54 mCi/kg). After 8 h, the liver was excised from the rats; liver and kidneys were taken from the hamsters. DNA was purified either directly from an organ homogenate or via chromatin. The radioactivity in the DNA was expressed in the units of the Covalent Binding Index, CBI = (mol chemical bound per mol DNA-P)/(mmol chemical administered per kg b.w.). Rat liver DNA isolated via chromatin exhibited the very low values of 0.08 and 0.09 for E and E₂, respectively. The respective figures in hamster liver were 0.08 and 0.11 in females and 0.21 and 0.18 in the males. DNA isolated from the kidney revealed a detectable radioactivity only in the female, with values of 0.03 and 0.05 for E and E₂, respectively. The values for male hamster kidney were < 0.01 for both hormones. The minute radioactivity detectable in the DNA samples does not represent covalent binding to DNA, however, as indicated by two sets of control experiments. (A) Analysis by HPLC of the nucleosides prepared by enzyme digest of liver DNA isolated directly or via chromatin did not reveal any consistent peak which could have been attributed to a nucleoside-steroid adduct. (B) All DNA radioactivity could be due to protein contaminations, because the specific activity of chromatin protein was determined to be more than 3,000 times higher than of DNA. The high affinity of the hormone to protein was also demonstrated by in vitro incubations, where it could be shown that the specific activity of DNA and protein was essentially proportional to the concentration of radiolabelled hormone in the organ homogenate, regardless of whether the animal was treated or whether the hormone was added in vitro to the homogenate.Carcinogens acting by covalent DNA binding can be classified according to potency on the basis of the Covalent Binding Index. Values of 10³–10⁴ have been found for potent, 10² for moderate, and 1–10 for weak carcinogens. Since estrone is moderately carcinogenic for the kidney of the male hamster, a CBI of about 100 would be expected. The actually measured limit of detection of 0.01 places covalent DNA binding among the highly unlikely mechanisms of action. Similar considerations can be made for the liver where any true covalent DNA binding must be below a level of 0.01. It is concluded that an observable tumor induction by estrone or estradiol is unlikely to be due to DNA binding.Paper presented at the Satellite Symposium of the European Society of Toxicology, Rome, March 29, 1983     

Penetration and action of edoxudine in vitro and in vivo

The penetration of 5-ethyl-2'-deoxyuridine (edoxudine, Aedurid) from gel base with and without the addition of urea and other adjuvant has been studied in an in vitro model using guinea pig skin. The formulation of 3% edoxudine gel with 5% urea showed the best results. In vivo experiments on hairless mice infected intracutaneously with herpes simplex virus type 1 also showed this formulation's good efficacy as compared to other formulations.     

Extraction and determination of prednisolone in drugs and excipients in ointments and creams and the uniformity of distribution in prednisolone ointment

For the purpose of measuring the contents of prednisolone in low concentrated ointments and creams an instruction was elaborated that includes several steps of extraction, in the resulting solution of which the assay of the steroid by Blue Tetrazolium reaction will be done. The procedure permits the determination of prednisolone in presence of most of usual ingredients of ointment bases except wool alcohols. Also no influence is given by some remedies combined with prednisolone for topical application except coal tar solution. The results confirm a correct reflection of the steroid contents declared respectively the recovery of the steroid added to various ointment bases. Introducing discussion to content uniformity concerning low concentrated ointments is made, and some deviations are shown.     

Mechanisms of antiplatelet and antithrombotic activity of midazolam in in vitro and in vivo studies

Dopamine regulates various physiological functions in the central nervous system and the periphery. Dysfunction of the dopamine system is implicated in a wide variety of disorders and behaviors including schizophrenia, addiction, and attention-deficit hyperactivity disorder. Medications that modulate dopamine signaling have therapeutic efficacy on the treatment of these disorders. However, the causes of these disorders and the role of dopamine are still unclear. Studying the dopamine system in a model organism, such as Caenorhabditis elegans, allows the genetic analysis in a simple and well-described nervous system, which may provide new insight into the molecular mechanisms of dopamine signaling. In this review, we summarize recent findings on pharmacological and biochemical properties of the C. elegans dopamine receptors and their physiological role in the control of behavior.     

Comparative in vivo and in vitro studies of phenytoin protein binding and in vitro lipolysis in plasma of pregnant and nonpregnant rats

This investigation was designed to determine the cause of the changes in drug protein binding that occur in rat plasma, particularly in plasma from pregnant animals, during in vitro drug-protein binding measurements. In vivo estimates of phenytoin binding in plasma were obtained from steady-state CSF-plasma concentration ratios in pregnant and nonpregnant rats. Immediate ultrafiltration of heparin- or EDTA-anticoagulated plasma yielded phenytoin free fraction values that were in good agreement with in vivo estimates for nonpregnant rats but that were about one-third higher than in vivo estimates for pregnant animals. In vitro free fraction values tended to increase during incubation of plasma and/or during equilibrium dialysis. The concentrations of the four major endogenous free fatty acids were similar in plasma of pregnant and nonpregnant rats if determined immediately after blood collection. Six hours of incubation at 37 degrees C caused fatty acid concentrations to increase about fivefold and twofold in heparin-anticoagulated plasma from pregnant and nonpregnant animals, respectively. The corresponding increases in EDTA-anticoagulated plasma were only about twofold and 1.14-fold, respectively. These changes were associated with decreased plasma protein binding of phenytoin. The in vivo differences between pregnant and nonpregnant rats with respect to phenytoin binding in plasma are not due to differences in fatty acid concentrations, but the in vitro differences are due primarily to corresponding differences in free fatty acid concentrations if extensive in vitro lipolysis occurs.     

Comparison of in vitro and in vivo developmental toxicity and pharmacokinetics of phenytoin in the rat

The rat whole embryo culture was compared to an in vivo experiment with regard to embryotoxicity as well as exposure characteristics, using phenytoin as a model compound. Intra-embryonic concentrations and their embryotoxic effects were determined on gestation day 11 after in vitro administration of 50-150 microg/ml or in vivo gavage of 500-1500 mg/kg body-weight on gestation day 10. In addition, exposure kinetics were studied in vivo after a single oral dose on gestation day 10, and developmental defects on gestation day 21 were scored. The embryotoxic effects observed on gestation day 11 were more pronounced after in vitro exposure in comparison to in vivo exposure at similar intra-embryonic concentrations. Exposure of phenytoin on gestation day 10 in vitro via the culture medium resulted in general embryotoxicity on gestation day 11, whereas in vivo effects as determined on gestation day 11 were minimal. Plasma concentrations of phenytoin increased and plateaued around 35 microg/ml during the 48 hr monitoring period. Plasma concentration curves and pharmacokinetic parameters did not show remarkable differences between the dose groups, indicating that absorption is the limiting factor at the dose range used. Although the developmental effects were minimal as observed in vivo on gestation day 11, specific malformations (defects encompassing the urogenital. craniofacial and skeletal systems) were observed on gestation day 21. These findings show that with similar intra-embryonic concentrations of phenytoin the embryotoxicity in rat whole embryo culture was not comparable with the in vivo embryotoxicity as determined on gestation day 11. This discrepancy may at least partly be explained by differences in exposure characteristics.     

Mathematical modelling of in situ and in vitro efflux of ciprofloxacin and grepafloxacin

The efflux process due to p-glycoprotein-like mechanisms of ciprofloxacin (CIP) and grepafloxacin (GRX) has been studied "in situ" in rats and "in vitro" in Caco-2 cells. The results were modelled by a curve fitting procedure which allowed the characterization of the passive (Pd) and carrier mediated parameters (Vm and Km) from the raw data without initial velocities estimation. CIP absorption in rat was characterized as a passive diffusion at the assayed concentrations. Although the involvement of an efflux transporter cannot be ruled out, its relevance in the transport of the fluoroquinolone is negligible. In GRX absorption, an efflux process is implicated and it is detected in both absorption models. GRX permeability depends on the intestinal segment, reflecting the previously reported different expression level of the efflux transporters along the gut in rat. A first attempt to correlate the "in vitro" and the "in situ" data has been done. The mathematical model has been constructed using very simplistic assumptions and it will require further refinement but, nevertheless, the results are promising and demonstrate that a good modelling approach helps to identify the system critical parameters and how the system behaviour change when the parameters are modified as it happens when we move from the "in vitro" to the "in situ" level. Predicted versus experimental permeability values show a good correlation, demonstrating that the relevance of the secretion process "in situ" in rat can be predicted from the "in vitro" cell results.     

Comparison of pulmonary and hepatic glucuronidation and sulphation of ethanol in rat and rabbit in vitro

1. Pulmonary and hepatic UDP-glucuronyltransferase and sulphotransferase activities in subcellular fractions from rats and rabbits were determined, comparing ethanol with known substrates for these enzymes.

2. No ethyl glucuronide formation was detected with either hepatic or pulmonary microsomal incubations.

3. Chromatographic, autoradiographic and scintillation counting analysis indicated that ethanol is sulphated by rat and rabbit pulmonary cytosol, although this activity was approx. 2–6% of that in liver.

4. Rat hepatic and pulmonary sulphotransferase activities with β-naphthol were approx. 13 and 60 times higher than with ethanol, respectively.

5. Rabbit hepatic and pulmonary sulphotransferase activities with both substrates were higher than those in rat.