30例奥沙利铂致严重过敏反应的临床资料分析

探讨奥沙利铂过敏反应的临床特点及防治策略。方法：分析2010年1月至2017年12月北京市朝阳区三环肿瘤医院30例奥沙利铂致严重过敏患者的病例资料,归纳临床特征。结果：30例患者均在多周期使用奥沙利铂后发生过敏反应,给药后即刻或10 min内出现,临床表现主要包括：胸闷、呼吸困难、口唇紫绀、结膜充血水肿、荨麻疹、乏力、恶心、呕吐、腹痛、休克等。1例严重血小板下降、出血。抢救措施：首先停用奥沙利铂,同时给予抗组胺药物、糖皮质激素、肾上腺素等治疗,约15~30 min症状缓解。结论：奥沙利铂致过敏反应通常发生在多次用药后、化疗10 min内,医护人员若准确判断、迅速停药、及时治疗多不会造成严重后果。     

奥沙利铂所致过敏反应9例分析

摘 要 目的：分析我院使用奥沙利铂治疗胃肠道肿瘤患者发生过敏反应的情况。方法：回顾性收集9例奥沙利铂致过敏反应的临床资料,分析其过敏反应的特点。结果：9例过敏反应患者均使用国产奥沙利铂,其中Ⅱ级过敏反应3例,Ⅲ级过敏反应2例,Ⅳ级过敏反应4例,中位周期为第10周期,8例在给药后30 min内出现症状;经及时处理,症状可以缓解。结论：多周期应用奥沙利铂后过敏反应风险增高,用药过程中应密切监护,一旦发生过敏反应要及时停药,并予对症处理。     

多囊卵巢综合征患者口服炔雌醇环丙孕酮片致过敏反应

摘 要 目的：探讨临床药师在多囊卵巢综合征患者口服炔雌醇环丙孕酮片抗雄激素治疗中出现过敏反应的处理方法及药学监护。方法: 临床药师通过综合分析患者过敏史及用药史,结合患者用药时间和不良反应的发生时间,判断所用药物与过敏反应的相关性,并对其后续治疗替代药物提出用药建议。结果: 最终判定炔雌醇环丙孕酮片与此次不良反应的关联性评价为很可能,其中两种成分炔雌醇和醋酸环丙孕酮都不能排除为此次过敏反应的发生原因,建议选用屈螺酮炔雌醇片或含天然雌激素成分的口服避孕药进行后续替代治疗。结论:临床药师针对药物致过敏反应展开的病例分析及药学监护,有助于促进多囊卵巢综合征患者的个体化治疗,在保证用药安全,提高患者依从性方面发挥重要作用。     

多西他赛化疗所致过敏反应和体液潴留相关因素和预处理方案分析

目的 探讨多西他赛化疗所致过敏反应和体液潴留与地塞米松给药剂量和给药方案之间的关系,以期为临床提供一定参考。方法 对重庆医科大学附属第三医院2016年5月—2019年2月因多西他赛化疗所致的过敏反应和体液潴留进行回顾性分析,总结过敏反应和体液潴留临床特点、相关因素、治疗措施及转归。结果 共搜集247例使用多西他赛化疗患者,发生过敏反应和体液潴留患者分别为11例（4.45%）和10例（4.05%）,其中过敏反应与患者是否存在过敏史具有统计意义（P<0.05）,过敏反应发生率随地塞米松剂量增大而降低,但无统计意义;体液潴留的发生与地塞米松给药剂量和给药方案相关（P<0.05）,低剂量地塞米松预处理时发生率最低。结论 针对多西他赛化疗所致过敏反应和体液潴留,应给予有效预处理,降低发生率,提高患者耐受性。     

临床药师参与1例胰岛素制剂过敏糖尿病患者的降糖方案制定

摘 要 目的： 分析1例胰岛素制剂致过敏的具体病例,探讨临床药师在参与治疗胰岛素制剂过敏的糖尿病患者中的作用。方法: 1例糖尿病患者使用胰岛素治疗过程中出现过敏,多次换用不同种类胰岛素但过敏症状未明显好转,临床药师建议停用含鱼精蛋白的胰岛素,改用甘精胰岛素联合既往口服降糖药物治疗。结果: 调整为临床药师建议的降糖治疗方案后,患者住院期间过敏症状较前明显好转,之后未再次出现过敏症状,最终达到满意的降糖治疗效果。结论:临床药师参与患者对胰岛素制剂过敏的治疗,可运用药学知识,准确的判断过敏原,制定个体化的降糖治疗方案,对提高临床诊疗水平及保障患者用药安全性具有帮助和促进作用。     

莲必治注射液的过敏性研究

摘 要 目的: 研究两种不同纯度的莲必治注射液在被动皮肤过敏试脸(passive cutaneous anaphylaxis,PCA)和全身主动过敏试验(active systemic anaphylaxis,ASA)中是否有过敏反应。方法: 按照《中药、天然药物免疫毒性(过敏性、光变态反应)研究的技术指导原则》的试验方法对两种不同纯度的莲必治注射液进行被动皮肤过敏试验和全身主动过敏试验研究。结果:被动皮肤过敏试验中两种莲必治液均有过敏反应。在全身主动过敏试验中,莲必治A 高剂量组有2只动物出现弱阳性,而莲必治B 高剂量组1只出现弱阳性,5只出现阳性反应,2只出现过敏反应的极强阳性反应,其他未见过敏反应。结论:莲必治注射液所引发的过敏反应可能与其所含的杂质有关。     

精蛋白胰岛素注射液无菌检查方法的建立

目的 建立精蛋白胰岛素注射液的无菌检查方法。方法 根据中国药典2015年版四部通则1101无菌检查法进行方法适用性试验,对药典收载的精蛋白胰岛素注射液无菌检查方法进行优化,使用无微生物毒性的肝素钠溶液中和胰岛素注射液中的精蛋白,使精蛋白胰岛素注射液由白色混悬液变为澄清透明液体,便于薄膜过滤法处理。结果 使用薄膜过滤法,无菌检查方法适用性试验中6株阳性对照菌均可正常生长。结论 建立了可行的精蛋白胰岛素注射液的无菌检查方法,为下一版中国药典修订已收载的精蛋白胰岛素注射液无菌检查方法提供了实验依据。     

门冬胰岛素联合地特胰岛素对新诊断2型糖尿病患者血糖和胰岛β细胞功能的影响

目的 探讨门冬胰岛素联合地特胰岛素对新诊断2型糖尿病（T2DM）患者血糖和胰岛β细胞功能的影响。方法 选取西电集团医院2017年1月-2018年12月收治的100例新诊断T2DM患者为研究对象,按就诊顺序分为两组,每组50例。对照组采取地特胰岛素皮下注射,观察组采取门冬胰岛素联合地特胰岛素皮下注射。对比两组用药对新诊断T2DM患者血糖和胰岛β细胞功能的影响。结果 两组治疗前空腹血糖（FPG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）对比无统计学差异;经治疗,观察组各项血糖指标均明显下降（P<0.05）,下降幅度明显优于对照组（P<0.05）。两组治疗前空腹血清C肽（FC-P）、餐后2 h血清C肽（2 h C-P）对比无统计学差异;经治疗,观察组的FC-P、2 h C-P明显提高（P<0.05）,且高于对照组,具有统计学差异（P<0.05）;观察组血糖达标时间明显短于对照组（P<0.05）。两组治疗前胰岛β细胞功能指数（HBCI）对比无统计学差异,治疗后,观察组HBCI明显高于对照组,具有统计学差异（P<0.05）。结论 对于新诊断T2DM患者,采取门冬胰岛素联合地特胰岛素治疗可有效控制血糖,促使胰岛β细胞功能恢复,治疗效果显著,值得临床上进一步推广应用。     

血清素与胰岛素抵抗相关疾病的关系研究进展

目的 探究血清素与胰岛素抵抗相关疾病的关系。方法 利用PubMed、中国知网检索相关文献和相关专著研读总结归纳。结果 血清素与肝脏、脂肪组织及骨骼肌的胰岛素抵抗密切相关。结论 血清素上下游的相关合成酶和受体极有可能成为胰岛素抵抗相关疾病的治疗靶点。     

DUE模式在评价胰岛素临床应用中的研究与实证

摘 要 目的：建立精蛋白生物合成人胰岛素注射液(预混30R)的药物利用评价（DUE)标准,为合理使用该药提供参考。方法: 参照国内外文献及糖尿病治疗的权威指南,结合德尔菲专家咨询法建立药物利用评价标准,经评价、干预、再评价的过程得出精蛋白生物合成人胰岛素注射液（预混30R）的最终DUE标准。结果: 精蛋白生物合成人胰岛素注射液(预混30R)DUE 标准包括用药指征、用药过程、用药结果三个部分,具有临床可行性。结论:DUE模式对规范临床药物的合理使用具有一定的促进作用,可为相关医疗机构开展DUE工作提供参考。     

舒肝宁注射液致过敏反应的文献分析

目的分析舒肝宁注射液致过敏反应的病例及相关文献,为临床医护人员使用舒肝宁注射液提供对策建议。方法检索中文科技期刊全文数据库(维普)、中国学术期刊(网络版)、万方数字化期刊全文库和大医医学搜索数据库以及NGC、NICE、Cochrane、Pubmed,对2000—2019年因舒肝宁注射液致过敏反应的文献报道和重庆市涪陵中心医院1例舒肝宁注射液致过敏性休克病例进行分析。结果舒肝宁注射液过敏反应病例中男性多于女性,年龄主要集中于≥61岁。有3例过敏史患者和3例哮喘史患者。10 min内发生的不良反应有9例,构成比为40.9%。20 mL用药剂量的构成比最大,为54.5%;溶媒主要为5%葡萄糖注射液和10%葡萄糖注射液。有1例联合配伍使用。过敏反应累及的器官/系统主要包括皮肤、循环系统、呼吸系统等,具体临床表现主要为皮疹、瘙痒和心率异常等。结论临床应高度重视舒肝宁注射液致过敏反应的风险,熟悉舒肝宁注射液致过敏反应的特征和影响因素,用药前详细询问哮喘史,开始输入的30 min严密巡视,用药中加强观察,避免发生严重后果。     

2013～2016年国家药品不良反应监测年度报告统计分析

摘 要 目的：了解我国近年来药品不良反应/事件监测情况,分析其原因,提出建议,为加强药品不良反应/事件监测、降低药品质量风险、保障公众安全用药提供参考。方法：收集2013～2016年《国家药品不良反应监测年度报告》,对我国药品不良反应/事件报告的总体情况、基本药物监测情况、抗感染药物监测情况以及中药注射剂监测情况进行统计分析。结果：药品不良反应监测网络覆盖率逐年增加;收集的不良反应/事件报告数量也逐年增多;医疗机构是药品不良反应/事件报告的主要来源;抗感染药物不良反应报告数量仍居首位。结论：药品不良反应/事件监测事业的稳定运行是公众安全用药的有力保障,应当形成全员参与的意识,药品生产经营企业提高对上市药品的不良反应/事件监测力度;重视抗感染药物和中药注射剂的药品不良反应;关注老年人和儿童用药不良反应。     

The potential of sunitinib as a therapy in ovarian cancer

Introduction: Ocular allergies comprise a spectrum of conditions that are underreported and underdiagnosed, and are frequently associated with rhinoconjunctivitis. Although allergic conjunctivitis is often not a sight-threatening condition, it could have a significant impact on a person’s quality of life, morbidity and productivity. A variety of agents are available for the treatment of allergic conjunctivitis, including antihistamines, mast-cell stabilizers, dual action agents, glucocorticoids, calcineurin inhibitors and immunotherapy.

Areas covered: The goal of this review is to investigate new therapeutic strategies for the treatment of ocular allergy. Within, the authors analyze the pharmacological management of allergic conjunctivitis and highlight Phase II clinical trial studies.

Expert opinion: Recent findings about the pathophysiology of allergic conjunctivitis have enabled us to gain a better understanding of the molecular and cellular mechanisms of ocular disease. This, in turn, has led to the identification of novel targets, which, in turn, has led to the development of new therapeutic agents that are currently under evaluation in the first phases of clinical development. The most interesting agents, under development, are the new topical glucocorticoids, leukotriene receptor antagonists, resolvins, interleukin-1 receptor antagonists and integrin antagonists. The authors now await promising results, which can confirm the therapeutic value of these novel emerging drugs for treating allergic conjunctivitis.     

益生菌与过敏性疾病的预防和治疗进展

目的：探索益生菌在过敏性疾病的预防和治疗中的作用。方法：通过查阅近3年来关于益生菌预防和治疗过敏性疾病方面的文献,主要从动物实验、人体临床试验以及可能的治疗机制等方面详述了益生菌与过敏性疾病防治的相关性。结果：动物实验相关文献表明：益生菌对过敏性疾病的预防和治疗有一定的疗效。临床研究相关文献调研结果也表明：益生菌对过敏性鼻炎、特应性皮炎、哮喘和食物过敏等疾病具有一定的治疗效果。对过敏性疾病有治疗效果的益生菌为鼠李糖杆菌、嗜酸乳杆菌、双歧杆菌等,益生菌单一菌种和混合益生菌都能起到治疗作用。结论：益生菌能够对过敏性疾病起到预防和治疗的作用,尤其是在生命早期,或者降低宿主患过敏性疾病的概率,或者使患者的过敏症状减轻甚至消除。但依然存在着诸多问题,需要继续投入大量工作进行更深入的研究。     

Fighting against COVID-19: Innovative strategies for clinical pharmacists

BackgroundClinical pharmacists’ routine task is carrying out pharmaceutical care to ensure patients' safe and reasonable medication use. However, under public health emergencies, such as the outbreak of COVID-19, the work strategies of clinical pharmacists need to be modified according to the rapid spread of the disease, where information and resources are usually lack to guide them.ObjectiveTo retrieve and investigate the prevention and control measures of clinical pharmacists during the outbreak of novel coronavirus, summarize the roles and responsibilities of clinical pharmacists, and to propose innovative strategies for developing pharmacy services under the epidemic.MethodsThe Chinese and English databases, self-media network, website of professional society or medical institution, and clinical trial center platforms were searched, and clinical pharmacists involved in the work against COVID-19 were surveyed and interviewed. Investigate the challenges and needs of frontline medical staffs for treating patients, and formulate strategies based on the actual medical environment.ResultsClinical pharmacists play a vital role in leading the industry to formulate work instructions, provide frontline medical staff with drug information, and develop innovative pharmacy services to promote the rational use of medicines with collaborative teamwork and close communication according to the epidemic situation of COVID-19. Anti-epidemic work indeed has driven the development of remote pharmacy services.ConclusionFacing public health emergencies, clinical pharmacists can give full play to their professional expertise, analyze the current situation rationally, formulate telehealth strategies swiftly, and work in a united and efficient manner to provide innovative pharmacy services to ensure medication safety and rational use of medicine.     

Adverse reactions to β-lactam antimicrobials

Introduction: Beta-lactam antibiotics are among the most clinically useful antimicrobials used in medicine. Unfortunately, adverse events related to their use remain poorly understood by many clinicians and, in particular, the misdiagnosis of β-lactam allergy and misunderstanding of crossreactivity among members of the β-lactam antibiotics may effectively eliminate a whole class of antimicrobials from use and require the use of broader spectrum agents with less well-established safety profiles.

Areas covered: This review describes the range, diagnosis and management of adverse events associated with β-lactam antimicrobials, particularly focusing on recognition, diagnosis and management of true allergy and risk of cross-sensitivity between β-lactam antibiotics. A literature review was undertaken using PubMed, focusing primarily on literature published in the past 10 years relating to β-lactam adverse events and allergy.

Expert opinion: Beta-lactams are generally safe drugs and serious adverse events are rare and allergy is overdiagnosed. Accurate diagnosis can usually be achieved through careful history and in some instances skin or in vitro testing is required. Even among individuals with true immediate-type allergy to penicillin, most cephalosporins are readily tolerated and desensitization is usually an option in cases where no alternate antimicrobials are available. Other allergic reactions (Type II, III and IV) are rare and avoidance of the culprit agent is generally recommended. Nonallergic or morbilliform rashes are generally not allergic in nature and should not prompt drug or class avoidance. Other adverse events are frequently dose-related and can be avoided by appropriate dosing and consideration of renal function.     

Assessing the prevalence and characteristics of self-reported penicillin allergy in Saudi Arabian population: A nationwide cross-sectional study

IntroductionBeing allergic to penicillin can lead to the overuse of broad-spectrum antibiotics, contributing to the growing problem of multidrug resistance. Knowing the exact allergy history is essential as some circumstances may allow reinitiating penicillin. This study focused on assessing the prevalence and characteristics of self-reported penicillin allergy in the Saudi Arabian population.MethodsWe conducted a nationwide cross-sectional study via an electronic self-administered questionnaire directed toward the Saudi Arabian general adult population. Variables about respondent demographics as well as type and characteristics of the allergy were collected.ResultsOne hundred ninety-three out of 2022 participants who completed the survey (9.5%) reported allergy to penicillin, with the most reported reaction being anaphylaxis in 89 participants (46.1%), non-anaphylaxis reported by 69 participants (35.8%). Twenty-two participants (11.4%) were identified as not having a true allergy due to reporting a tolerability issue or a non-penicillin-type agent. About 38% reported that the allergy occurred more than ten years ago.ConclusionThis is the first study to report the prevalence and characteristics of self-reported penicillin allergy in Saudi Arabia. The data from this study provides valuable information to consider starting in-hospital penicillin de-labeling programs and providing evidence for healthcare providers to consider re-challenging certain qualified patients.     

289例胰岛素不良反应病例分析

目的:分析胰岛素不良反应病例发生的特点,为临床合理用药提供参考。方法:从2004年1月～2012年11月江苏省药品不良反应数据库中检索出胰岛素的不良反应病例,采用描述性分析的方法,对药品不良反应累及的系统、怀疑药品的种类等进行统计分析。结果:共检索出符合条件的病例报告表289例,其中男143,女146例。短效、超短效胰岛素,胰岛素类似物不良反应所占比例较大。药品不良反应累及的系统/器官主要有皮肤及其附件损害、代谢和营养障碍、全身性损害。其中283例通过治疗均好转或痊愈,2例病例留有皮下脂肪萎缩后遗症,4例未好转。结论:胰岛素引起的不良反应累及的系统/器官较多,常多个不良反应同时发生,临床上要进行密切的用药监护,关注少见的不良反应,确保用药安全。