临床药师参与个体化给药方案设计的临床实践与案例分析

目的：探讨临床药师参与临床药物治疗、进行个体化给药方案设计的临床实践和体会。方法：临床药师为3例特殊患者设计个体化给药方案。结果与结论：临床药师参与临床个体化给药方案设计工作,加强了与医护人员的合作,增强了患者用药的有效性、安全性。临床药师参与临床药物治疗对促进临床合理用药有重要意义。     

临床药师参与呼吸科个体化给药方案设计的案例分析

目的:探讨临床药师参与呼吸科患者个体化给药方案设计的临床实践。方法:对呼吸科肾功能不全以及使用环孢素、万古霉素等药品的特殊患者进行监测,并设计个体化给药方案。结果:临床药师参与临床个体化给药方案设计工作,提高了患者的药物治疗效果,减少了不良反应,确保患者用药安全,并使药师的工作得到临床认可。结论:药师通过个体化给药工作参与临床药物治疗,可逐步融入医疗团队,发挥临床药师的作用。     

1例服用厄洛替尼的肿瘤患者的药学监护

目的:探讨临床药师参与肿瘤科患者个体化给药方案设计的临床实践。方法:临床药师通过参与1例服用厄洛替尼的肿瘤患者的治疗过程,结合患者疾病特点、用药史、药物相互作用及药品不良反应等情况,协助医生选择合适的药物,提供个体化的药学服务。结果:临床药师参与临床个体化给药方案设计工作,提高了患者的药物治疗效果,减少了不良反应,确保患者用药安全,并使药师的工作得到临床认可。结论:临床药师参与临床治疗,有利于提高临床治疗水平,促进合理用药。     

临床药师参与救治万古霉素致急性肾功能衰竭的案例分析

目的探讨临床药师在临床患者个体化给药方案设计的作用。方法临床药师参与1例万古霉素致急性肾功能衰竭的救治,对用药情况和肾功能衰竭的原因进行分析,并设计个体化给药方案。结果成功救治了1例万古霉素致急性肾功能衰竭的患者,患者症状改善明显,血清尿素氮和肌酐下降,肾功能恢复正常,痊愈出院。结论临床药师通过参与个体化给药方案设计,使患者获得优良的药学服务,同时也提高了医院的整体医疗水平。     

临床药师参与万古霉素个体化治疗的实践与体会

目的:探讨临床药师参与患者万古霉素个体化用药方案制定的临床实践。方法:对使用万古霉素的患者进行血药浓度监测,设计个体化给药方案。结果:临床药师协助临床设计万古霉素的个体化给药方案,减少了不良反应的发生,提高了药物治疗水平。结论:临床药师通过参与个体化治疗工作,可协助医师做到合理用药,为患者提供高质量、全新的药学服务。     

临床药师参与万古霉素个体化治疗实践与体会

目的探讨临床药师在参与会诊万古霉素治疗中的工作模式,推动万古霉素个体化治疗。方法通过临床药师在万古霉素治疗案例会诊中发现的问题,调整优化给药方案,评估疗效,总结经验。结果临床药师结合患者个体情况协助临床设计万古霉素个体化给药方案,减少不良反应,提高药物治疗疗效。结论临床药师通过会诊参与万古霉素个体化治疗方案的制定,使万古霉素临床应用更加合理。     

临床药师对心肌梗死患者个体化用药方案设计的实践

目的:探索临床药师参与制定药物个体化治疗方案设计以及实施有效药学监护的思路。方法:以1例心肌梗死患者为例,从临床药师角度分析患者的病情特征和治疗原则,利用药学理论和循证药学的证据,与临床医师共同商讨和制定药物治疗方案,对患者实施药学监护。结果:临床药师参与对患者个体化治疗方案的制定,同时对患者进行密切的药学监护,提高了患者的药物治疗效果,减少了不良反应,确保患者用药安全,取得了满意的治疗效果。结论:临床药师通过参与个体化用药融入临床药物治疗团队,在对患者的治疗方面发挥越来越重要的作用,为特定患者选用适当的药物、适当的剂量和适当的时间的个体化用药方案将打破传统给药模式,从而进一步促进临床用药更加安全、有效、合理。     

临床药师协助儿科个体化给药方案设计的实践与体会

目的探讨临床药师协助儿科患者个体化用药方案制定的临床实践。方法对儿科药源性肝损害用药及使用丙戊酸钠、头孢他啶、ACEI等药品的患儿进行监测,并设计个体化给药方案。结果临床药师协助临床设计个体化给药方案,减少了药品不良反应的发生,提高了药物治疗水平。结论临床药师通过参与临床个体化给药工作,可协助医师做到合理用药,避免不良反应的发生,为患者提供高质量、全新的药学技术服务。     

尿毒症患者应用头孢他啶的药学服务

目的:探讨头孢他啶腹腔灌注治疗腹膜透析相关性腹膜炎的个体化给药方案和用药安全性。方法:临床药师通过对1名应用头孢他啶治疗腹膜炎的尿毒症患者血浆药物浓度和腹膜透析液浓度的监测,并运用循证医学证据,设计合理的给药方案。结果:临床药师为尿毒症患者提供头孢他啶的个体化给药方案,提高了患者用药的有效性和安全性。结论:临床药师为患者提供个体化药学服务,可以为医患双方提供合理的给药方案,并降低不良反应的发生。     

1例结核合并隐球菌性肺炎患者的药学监护

目的：探讨临床药师参与结核合并隐球菌肺炎患者治疗的药学监护切入点。方法：临床药师对1例结核合并隐球菌肺炎患者进行密切观察和随访,参与制定个体化的给药方案,监测疗效和药品不良反应,并给患者提供用药教育。结果：临床药师通过给患者提供药学监护,明显提高了药物治疗效果。结论：临床药师为患者进行个体化的药学监护,可协同医师优化药物治疗方案,保障患者用药安全、有效。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.