伊布替尼致不良反应文献分析

目的：分析伊布替尼所致不良反应（ADRs）的发生情况及临床特点，为临床安全用药提供参考。方法：检索PubMed、Web of Science、中国知网数据库、维普中文科技期刊数据库、万方数据库、中国医院知识总库关于伊布替尼不良反应的文献并进行分析。结果：伊布替尼致ADRs的个案共41例，多发生在用药30d内（13例，31.7%）；伊布替尼致ADRs累及系统-器官以呼吸系统损害（13例，28.9%）、皮肤及附件损害为主（10例，22.2%）为主。结论：临床医师或药师应了解伊布替尼ADRs的发生规律和特点，尽量将ADRs的影响及危害降至最低，最大程度保障用药安全。     

What's new in the treatment of multidrug-resistant gram-negative infections?

Eradicating multi-drug resistant (MDR) organisms has been a major challenge in healthcare settings worldwide. Newly approved drugs and those currently in the pipeline may have a promising solution to this issue. The purposes of this review are to describe the various resistance mechanisms of Gram-negative bacteria and to provide a summary of the current literature available on the newer agents, such as ceftazidime/avibactam, ceftolozane/tazobactam, meropenem/vaborbactam, and other emerging agents used for the treatment of MDR Gram-negative infections. Given that MDR organisms confer resistance to treatment by various methods, including enzymatic degradation, efflux pumps, and porin mutation, an understanding of mechanisms of bacterial resistance combined with information on newer antimicrobial agents against MDR Gram-negative bacteria will further assist clinicians in determining the best suitable therapy for the treatment of various complicated infections.     

Evaluation for optimal dosing of vancomycin in patients with different physical types

The sufficient dose to obtain an optimal trough concentration of vancomycin (VCM) in patients with non-standard physical types remains controversial. In this study, we examined the relationship between the dose and physical type in patients in whom an optimal trough concentration was obtained among VCM-treated patients. We retrospectively investigated the dose of VCM and physical type in patients treated with VCM between January 2012 and January 2017 at two medical institutions (n = 272). The physical type was classified using the body mass index (BMI). Patients with a BMI of <18.5 kg/m² were assigned to the lean group, those with a BMI of 18.5–24.9 kg/m² were assigned to the standard group, and those with a BMI of ≥25 kg/m² were assigned to the obesity group. The mean doses of VCM per time (mg/kg) to achieve the target trough concentration of VCM, 15–20 μg/mL, were 19.8 ± 4.3, 16.5 ± 3.7, and 13.7 ± 2.7 mg/kg in the lean, standard, and obesity groups, respectively. The dose per time to achieve the target trough concentration decreased significantly in association with an increase of BMI. The upper limit of the recommended dose (15–20 mg/kg) or higher in lean patients, and the lower dose in obese patients than the recommended dose might be appropriate to achieve the target trough concentration when we calculated the dose per time based on actual body weight.     

Oral levothyroxine therapy postbariatric surgery: Biopharmaceutical aspects and clinical effects

Background

Bariatric surgery can lead to changes in the oral absorption of many drugs. Levothyroxine is a narrow therapeutic drug for hypothyroidism, a common condition among patients with obesity.

某院重点监控中成药的管理实践

目的：探索对中成药重点监控药品合理使用的有效药事管理措施。方法：基于药品销售金额、DDDs，和DUI为评价指标，通过四步筛选法确定中成药重点监控目录，结合用药合理性评价结果进行药事管控。通过对比监管前后某院医疗指标变化情况，对管理效果进行参考性评价。结果：在疗效相同的前提下，重点监控中成药的金额占比持续下降，中成药的药占比由24.4%下降至15.8%；中成药的人均药费由1 492.5元降至878.3元；而病种类数、收治人数、治愈率均无显著性差异。中成药的用药不合理使用率也大幅度下降。结论：通过建立重点监控中成药的管理措施，规范医疗机构药物使用并取得一定成效。为中成药的管理提供新的思路。     

Binding site comparisons for target-centered drug discovery

Introduction: The success of binding site comparisons in drug discovery is based on the recognized fact that many different proteins have similar binding sites. Indeed, binding site comparisons have found many uses in drug development and have the potential to dramatically cut the cost and shorten the time necessary for the development of new drugs.

Areas covered: The authors review recent methods for comparing protein binding sites and their use in drug repurposing and polypharmacology. They examine emerging fields including the use of binding site comparisons in precision medicine, the prediction of structured water molecules, the search for targets of natural compounds, and their application in the development of protein-based drugs by loop modeling and for comparison of RNA binding sites.

Expert opinion: Binding site comparisons have produced many interesting results in drug development, but relatively little work has been done on protein–protein interaction sites, which are particularly relevant in view of the success of biological drugs. Growth of protein loop modeling for modulating biological drugs is anticipated. The fusion of currently distinct methods for the comparison of RNA and protein binding sites into a single comprehensive approach could allow the search for new selective ribosomal antibiotics and initiate pharmaceutical research into other nucleoproteins.     

An evaluation of sodium oxybate as a treatment option for narcolepsy

Introduction: Narcolepsy is a lifelong central nervous system (CNS) disorder characterized by excessive daytime sleepiness, cataplexy, disturbed nocturnal sleep, hypnagogic hallucinations, and sleep paralysis. Treatment is symptomatic and challenging. Current therapies with wake promoting agents, stimulants, and antidepressants improve symptoms but residual sleepiness or cataplexy may persist. Drug tolerance may develop. Adverse drug effects limit therapy. In the United States, sodium oxybate has been approved to treat daytime sleepiness and cataplexy in adults with narcolepsy since 2002. In 2018, it was approved for children ages 7–17 years with cataplexy with narcolepsy.

Areas covered: This drug review includes an overview of narcolepsy, current pharmacotherapy, drug chemistry, pharmacodynamics, pharmacokinetics, and metabolism of sodium oxybate. Published results from 11 randomized control trials are reviewed. Databases searched included PubMed, Google Scholar, Lexi-Comp, Scopus, Science, and Ovid.

Expert opinion: Sodium oxybate is an effective therapy for excessive daytime sleepiness and cataplexy in adults and children ages 7–17 years. It is also an effective therapy for disrupted nocturnal sleep. Sodium oxybate improves narcolepsy symptoms and enhances quality of life in narcolepsy patients.     

Pharmacotherapeutic options for complex regional pain syndrome

Introduction: Complex regional pain syndromes (CRPS) are rare painful conditions characterized by considerable variability in possible triggering factors, usually traumatic, and in the clinical scenario. The limited knowledge of the pathophysiological mechanisms has led to countless treatment attempts with multiple conservative and surgical options that act by different mechanisms of action.

Areas covered: In this narrative review, the authors discuss key points about CRPS definitions, diagnostic criteria and pitfalls, pathophysiological hypotheses, and treatment strategies with particular reference to pharmacotherapy. The article was based on a literature search using PubMed while the available guidelines for the management of CRPS were also examined.

Expert opinion: According to the quality of evidence, pharmacological interventions for CRPS seem to be more effective all the more so when they act on peripheral mechanisms, particularly on nociceptive pain, and when applied early in the disease, while reliable evidence about central mechanisms of chronic pain in CRPS is lacking. In our opinion, drug therapy should be preferred as early as possible, particularly in warm forms of CRPS to prevent significant functional limitation, psychological distress, and social and economic fallout.     

新型冠状病毒肺炎（COVID-19）患者抗病毒用药监护的研究进展

为提高抗病毒药物在新型冠状病毒肺炎(COVID-19)患者尤其是需要多药联合患者中的合理性和安全性,结合《新型冠状病毒肺炎诊疗方案(试行第七版)》提到的抗病毒药物,通过查阅文献、搜集各抗病毒药物说明书和MCDEX合理用药信息支持系统的相关信息,总结这些抗病毒药物的临床药动学特征、药物相互作用及不良反应信息,提出合理的用药监护建议。从药动学和药物相互作用角度加强抗病毒药物在COVID-19患者中的用药监护,可提高药物使用安全性,保障患者的合理用药。