抗心律失常药物的不良反应

<正>心律失常是心内科常见病种,抗心律失常药物分类不同,作用机制有差异,不良反应也较多,这为临床医生合理使用抗心律失常药物增加了难度。了解抗心律失常药物的不良反应有助于临床合理、安全用药,现将国内常用抗心律失常药物的不良反应做一总结。 1 抗心律失常药物的致心律失常作用抗心律失常药物的致心律失常作用,是指服用治疗量或亚治疗量抗心律失常药物引起用药前没     

25例药源性心律失常病例分析

目的：了解药源性心律失常的发生情况，为临床用药提供参考。方法：对江苏省2004～2006年上报省药品不良反应监测中心的符合药源性心律失常的ADR报告表进行了综合分析。结果：报告引起药源性心律失常的药物主要为循环系统用药和抗微生物药，大部分病例发生在用药期间，剂型以注射剂和片剂为主。25例心律失常病例经合理治疗后均治愈或好转。结论：注意可能导致药源性心律失常药物的合理使用，加强观察，积极治疗。     

老年药源性心律失常50例临床分析

目的探讨老年药源性心律失常的临床特征。方法对50例发生药源性心律失常的老年住院患者的年龄、发病原因、用药情况、临床表现进行分析。结果 >80岁老年患者易发生药源性心律失常,注射给药及联合用药易引发,最易引起药源性心律失常的药物是抗心律失常药、抗感染药物。结论老年患者用药时应综合考虑临床用药指征,合理用药是预防药源性心律失常的主要方法。     

抗心律失常药物致心律失常作用16例临床分析

抗心律失常药物可以促使心律失常发生的现象久已认识，促心律失常是指用药后诱发既往未曾发生过的心律失常，或者使原有心律失常恶化，现将16例抗心律失常药物致心律失常情况报道如下。     

药物诱发的致命性心律失常

本文报告１４例患者应用药物引发的致命性心律失常的临床资料。此较明确是由药物的致心律失常作用所致者２例,明显的不合理用药所致者１例,大多数病人考虑为联合用药造成的心脏副作用相加,某些患者致命性心律失常的发生原因及机理尚难明了。提示临床医师在选择治疗药物时应注意：①全面了解病人情况;②对某些药物的致心律失常作用应提高警惕;③合并应用两种或两种以上药物时应注意药物间的相互作用。     

我院住院患者抗心律失常类药物使用情况分析

目的调查分析本院住院患者抗心律失常类药物临床使用情况,为促进临床合理用药提供有效信息。方法利用本院医院信息化（HIS）系统与药事管理系统,调取2013年本院住院患者抗心律失常药物使用数据,进行回顾分析。结果本院常用的抗心律失常类药物有盐酸利多卡因注射液、酒石酸美托洛尔片、盐酸胺碘酮片、盐酸胺碘酮注射液、盐酸普罗帕酮注射液等,使用范围主要为心内科,主要用于治疗心脏节律紊乱。结论本院抗心律失常类药物临床使用基本合理。由于心律失常的发生机理比较复杂,各种抗心律失常药物的作用及副作用也多不相同,因此在选择药物时必需作全面考虑,并应讲究用药的剂量及方法,才能取得预期的效果。     

药物诱发的致命性心律失常

本文报告１４例患者应用药物引发的致命性心律失常的临床资料,此较明确是由药物的致心律失常作用所致者２例,明显的不合理用药所致者１例,大多数病人考虑为联合用药造成的心脏副作用相加,某些患者致命性心律失常的发生原因及机理尚难明了,提示临床医师在选择治疗药物时应注意：１）全面了解病人情况;（２）对某些药物的致心律失常作用应提高警惕;（３）合并应用两种或两种以上药物时应注意药物间的相互作用。     

药物治疗错误：患者的角色

目的 探讨抗精神病药物所致不良反应(ADR)的发生情况,为临床合理用药提供参考。方法 对我院2007年1月至2010年3月住院患者中,搜集上报的160例抗精神病药物所致不良反应/事件(ADR/ADE)的临床资料,如患者性别、年龄、用法用量、合并用药、不良反应/事件史以及不良反应/事件表现等情况进行统计分析。 结果 本院上报的抗精神病药物发生的不良反应/事件各年龄段皆有发生,主要发生在30～60岁;不良反应/事件共累及7个系统-器官,主要为中枢神经系统损害和肝功能损害;引起不良反应/事件的药物中,非典型抗精神病药物的上报例数多于典型抗精神病药物。结论 医疗机构应重视抗精神病药引起的不良反应,加强抗精神病药的合理应用。     

抗心律失常药物引起的心律失常

抗心律失常药物引起的心律失常,临床上已逐渐引起人们很大关注和重视。着重指出,在抗心律失常的治程中,如又发现另一种新的心律失常,则首先考虑为药物所致。及时停药观察或积极给予治疗,可避免发生严重后果。     

160例抗精神病药物不良反应/事件分析

目的探讨抗精神病药物所致不良反应/事件(ADR/ADE)的发生情况,为临床合理用药提供参考。方法对我院2007年1月至2010年3月住院患者中,搜集上报的160例抗精神病药物所致不良反应/事件,对患者性别、年龄、用法用量、合并用药、不良反应/事件史以及表现等情况进行统计分析。结果本院上报的抗精神病药物发生的不良反应/事件主要发生在30～60岁;不良反应/事件共累及7个系统-器官,主要为中枢神经系统损害和肝功能损害;引起不良反应/事件的药物中,非典型抗精神病药物的上报例数多于典型抗精神病药物。结论医疗机构应重视抗精神病药引起的不良反应,加强抗精神病药的合理应用。     

新药研发中的me-too, me-better, me-new

文中根据作者对我国新药研发的认识和理解,提出了新药研发过程中me-too,me-better和me-new类新药的概念,并对新药研发过程中的这3类创新活动之间的关系、新药研发的创新程度与经济效益的关系,以及目前我国新药研发的途径选择做了简要的论述。     

药物分子设计的策略：双靶标药物设计

新药研究可分两种模式：以生理学和表型为基础的研究和以生物靶标为核心的药物研究,这两种模式相互补充和印证。当今以靶标为切入点的模式占主导地位,研发出不少新药。许多疾病如肿瘤、代谢性和中枢神经系统疾病的药物治疗非单一靶标可治愈,同时干预与疾病相关的双（多）靶标药物可提高药物的效力,因而成为创制新药的活跃领域。双靶标药物可以是两个受体的调节剂、两个酶的抑制剂或同时作用于酶和受体或作用于受体和通道或转运蛋白的双功能性分子等。从药物分子设计的视角,构建双靶标药物分子可将两个活性分子或其药效团用连接基连接在一起,构成连接型分子;两个活性分子的部分结构或药效团特征相同,可将共同部分融合或并合,形成融合型或并合型分子,可以控制分子的大小和相对分子质量,使得分子结构的药效空间与药代动力学空间有较大的重叠,提高成药的几率。     

映射法分析药物联合治疗的相互作用(英文)

目的:在联合药物治疗中,建立一种分析药物相互作用的新方法。方法:基于联合用药的量效关系曲线和等效性检验的原理,建立一种新的数学模型:Q=(E_o-E_t》/L(-1相似文献   

谈原研药与仿制药的不同

本文主要从新药法规、药价、质量和疗效等方面介绍原研药与仿制药的区别,并使公众对两者有更深入的了解。     

Clinical perspectives in drug safety and adverse drug reactions

Adverse drug reactions (ADRs) remain a common clinical problem since they can mimic many diseases and cause significant morbidity and mortality. Judicious prescribing is important to minimize their occurrence. Apart from the recent identification of a few pharmacogenomic biomarkers for serious reactions, many remain unpredictable. Spontaneous reporting continues to play an important role in pharmacovigilance and the value of astute clinical observation and well-documented reports of suspicions of a causal link cannot be underestimated. Many national reporting schemes have developed considerable experience and expertise over many years and have large ADR databases, which are national assets. Despite advances in pharmacovigilance, numerous deficiencies have been identified; postmarketing surveillance remains the weakest link in the regulatory process. Regulatory authorities have tended to act later rather than sooner in response to safety signals, and this, when combined with under-reporting, may have led to exposure of a large number of patients to drug-related harm before restriction or withdrawal. In an attempt to improve vigilance, international surveillance may benefit by moving from its current passive/reactive mode toward active surveillance systems with a prospective, comprehensive and systematic approach to monitoring, collecting, analyzing and reporting data on ADRs. This will include increased pressure on pharmaceutical companies to conduct postmarketing studies. Such an active/proactive approach, while maintaining focus on ADR detection, could also aim to extend knowledge of safety, such that emerging changes in risk–benefit during a drug’s marketed life are effectively communicated to clinicians and patients. Drug safety monitoring and its regulation are now undergoing an overhaul and it is hoped that vigilance, public safety and trust will improve as a result.     

护士专科药物学知识的继续教育与用药安全

目的加强护士专科药物学知识的继续教育，保障用药安全。方法有目标、有计划、系统地、适时地进行专科药物学知识的继续教育，保障给药安全，加强用药监护，及时发现药品不良反应。结果护士从被动盲从医嘱变为主动正确执行医嘱，安全给药的同时积极主动进行用药监护，最大限度地保障了用药安全。结论护士通过专科药物学知识的继续教育，避免药品不良事件的发生，及时发现药品不良反应，承担起用药安全的护理职责，展示护理专业的价值。     

Comparison of different approaches to predict metabolic drug–drug interactions

Three approaches were compared to predict the actual magnitude of drug interaction (the mean fold-change in the area under the curve (AUC)) of reversible or irreversible (mechanism-based) cytochrome P450 (CYP) inhibitors. These were: (1) the pragmatic use of the ‘[I]/K_i’ approach; (2) the ‘Mechanistic-Static Model’ (MSM), which is a more complex extension of the ‘[I]/K_i’ approach that incorporates f_m,CYP, intestinal availability for CYP3A substrates, and mechanism-based inhibition (MBI); and (3) the ‘Mechanistic-Dynamic Model’ (MDM) which considers the time-variant change in the concentration of the inhibitor by using physiologically-based pharmacokinetic (PBPK) models (as implemented within the Simcyp® Population-Based ADME Simulator). The three approaches ([I]/K_i, MSM, and MDM) predicted a ‘correct’ drug–drug interaction (DDI) result (interaction: Greater than or equal to twofold; no interaction: Less than twofold) in 74, 87, and 80% of the 100 trials evaluated, respectively. Importantly, for trials with a greater than or equal to twofold change in AUC in the presence of the inhibitor (59 trials), the [I]/K_i, MSM, and MDM approaches predicted the mean AUC change within twofold of actual in 17, 53, and 64% of the trials, respectively. Overall, the MDM approach showed an improvement in the prediction of DDI magnitude compared to the other methods evaluated and was useful in its ability to predict variability in DDI magnitude and pharmacokinetic parameters. Moreover, the MDM model allowed the automated prediction of the inhibition of parallel metabolic pathways and simulations of different dosing regimens.     

Adverse drug reactions in liver cirrhosis

Summary Impaired liver function may increase susceptibility to drug toxicity. In a prospective drug surveillance study of 1280 patients the frequency of adverse drug reactions (ADR) was higher in 333 patients with clinical and/or histopathological evidence of liver cirrhosis than in 188 with other liver diseases (p<0.01) and than in 759 without liver disease (p<0.0001). The 128 cirrhotics had 339 events considered definitely or probably related to drug therapy by consensus of the monitoring team and the attending physicians. ADR were 93.8% dose-related, 11.2% were severe but only one was fatal. ADR were most commonly associated with diuretics (32.6% of patients administered the drugs), potassium salts (6.5%), antimicrobials (3.9%) and sedatives (3.5%). Most common manifestations were metabolic (62.6%), gastrointestinal (13.2%) and neurologic (11.9%). The frequency of ADR was higher in females (p<0.05), patients receiving more drugs (p<0.001), those with longer hospital stay (p<0.001) and those with ascites (p<0.0001), portal hypertension (p<0.0001), prior hepatic encephalopathy (p<0.02) or prolonged prothrombin time (p<0.0001). Adverse reactions were more common for drugs biotransformed greater than 50% by the liver (p<0.005). These findings show that ADR are more frequent in severe hepatic dysfunction.     

Dapsone-associated fixed drug eruption

Introduction: Dapsone is a sulfone drug used to treat infectious conditions and also numerous dermatologic diseases. Fixed drug eruption is a distinctive adverse cutaneous reaction associated with the initial administration and subsequent delivery of a specific agent.

Areas covered: The authors preformed a literature search using the following keywords: dapsone, fixed drug eruption, and adverse cutaneous drug reaction. Bibliographies were also reviewed for pertinent articles. The results were combed for relevant papers and reviewed. Articles pertaining to dapsone-associated fixed drug eruption were included.

Expert commentary: The majority of cases of dapsone-associated fixed drug eruption in the literature come from Africa or India where there is a high prevalence of patients treated for leprosy. Characteristics of these cases are similar to fixed drug eruption described in the western literature, with differences in frequency of multiple versus solitary lesions. Dapsone-associated fixed drug eruption should be considered when reviewing the drug history of a patient with fixed drug eruption. In the case of darker pigmented individuals, multiple fixed drug eruption lesions may be more common. Multiple lesions may mimic Kaposi’s sarcoma in human immunodeficiency virus positive patients. Dapsone-associated fixed drug eruption should be considered in the differential diagnosis of multiple hyperpigmented lesions.     

治疗药物监测临床应用现状

回顾治疗药物监测(TDM)的临床应用等,本文重点综述抗癫痫药物与免疫抑制药物的TDM临床应用评价,分析开展TDM过程中存在的问题。