肾移植术后免疫抑制药方案调整与患者教育的病例分析

目的探讨临床药师在肾移植术后免疫抑制药方案调整中的作用。方法临床药师参与1例肾移植术后免疫抑制药方案调整的过程,通过血药浓度监测、药物基因组学检测不断调整免疫抑制药他克莫司的给药剂量以及利用药物相互作用,使血药浓度达标。结果与结论临床药师通过参与整个治疗过程,利用治疗药物浓度监测、基因检测等在个体化用药中的作用和优势,提高治疗的疗效,避免药物不良反应的发生。     

抗糖尿病药物基因组学的研究进展

糖尿病是当前威胁全球的重要慢性疾病之一,药物在糖尿病治疗的过程中占有重要地位。药物基因组学确定了个人遗传信息的使用,以其指导药物治疗,已成为实现"个性化医学"的重要工具之一,并且在临床个体化用药、评估药物不良反应发生风险和指导新药研发方面起着越来越重要的作用。本文通过文献检索,对近几年抗糖尿病药物在基因组学方面的研究进展做一综述,以期对临床个体化用药提供参考。     

基因突变检测在个体化用药中的研究进展

随着药物基因组学的飞速发展,遗传因素对药物代谢个体差异的影响越来越受到重视。WHO提出21世纪,人类的健康问题将逐渐步入预防医学、预测医学和个体化医疗的"3P"时代,而这一理念已成为医学现实。临床药学是未来医院药学服务调整的重要方向,个体化给药是临床药学服务的最终目标。综述了近年来开展最多的与临床药物基因检测有关的项目,并对当前的个体化给药信息和医院药学部门开展基因检测工作的必要性和前瞻性做了深入的探讨。     

Pharmacogenomics and personalized medicine: a review focused on their application in the Chinese population

The field of pharmacogenomics was initiated in the 1950s and began to thrive after the completion of the human genome project 10 years ago. Thus far, more than 100 drug labels and clinical guidelines referring to pharmacogenomic biomarkers have been published, and several key pharmacogenomic markers for either drug safety or efficacy have been identified and subsequently adopted in clinical practice as pre-treatment genetic tests. However, a tremendous variation of genetic backgrounds exists between different ethnic groups. The application of pharmacogenomics in the Chinese population is still a long way off, since the published guidelines issued by the organizations such as US Food and Drug Administration require further confirmation in the Chinese population. This review highlights important pharmacogenomic discoveries in the Chinese population and compares the Chinese population with other nations regarding the pharmacogenomics of five most commonly used drugs, ie, tacrolimus, cyclosporine A, warfarin, cyclophosphamide and azathioprine.     

Stroke pharmacogenomics

Circulatory disease accounts for fifteen million deaths each year, of which stroke accounts for four and a half million- with an estimated nine million stroke survivors annually. The overall incidence rate of stroke is 2 to 2.5 per thousand adults with an approximate prevalence of 5 per thousand and an estimated 5-year risk of stroke recurrence of 15 to 40 percent. Conventional risk factors for stroke include: increasing age, hypertension, diabetes mellitus, smoking, increased body mass index, ischemic heart disease, heart failure, atrial fibrillation and lack of physical activity. Age is the strongest risk factor for both ischemic and haemorrhagic stroke with its incidence doubling for each successive decade after the age of fifty-five years. However, there is a substantial portion of patients with significant cerebrovascular disease who do not have any of these stroke risk-factors, leading to the speculation that there are other factors that have not been identified yet So as to improve diagnosis and treatment strategies, as well as to reduce the related public health burden, it could be helpful to successfully identify its extremely complex genetic determinants (polygenic, multiple genes play a role).

Pharmacogenetics is the field of pharmacology that deals with the influence of genetic variation on drug response by correlating gene expression and gene variants with the efficacy or toxicity of drugs. The principle drugs in stroke medicine are antithrombotics. The aim of this paper was to review the most commonly used drugs for stroke such as rtPA in the acute phase as well as antiplatelets and wafarin for secondary prophylaxis.     

Pharmacogenetics of chronic cardiovascular drugs: applications and implications

Cardiovascular disease continues to be a tremendous worldwide problem, and drug therapy is a major modality to attenuate its burden. At present, conditions such as hypertension, dyslipidaemia and heart failure are pharmacologically managed with an empirical trial-and-error approach. However, it has been suggested that this approach fails to adequately address the therapeutic needs of many patients, and pharmacogenetics has been offered as a tool to enhance patient-specific drug therapy. This review outlines pharmacogenetic studies of common cardiovascular drugs, such as diuretics, β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins and warfarin, ultimately highlighting considerations for future research and practice.