某院15000张门诊抗菌药物处方点评及其不合理用药原因分析

目的:分析医院门诊抗菌药物处方点评及其不合理用药原因。方法:选取2017年1—12月31日期间门诊医生开具的抗菌药物处方15 000张作为研究对象,点评其合理用及其不合理原因。结果:15 000张门诊抗菌药物点评处方中,不合理用药处方100张占0.67%,主要以用药不适宜为主;抗菌药物用药处方中不合理用药多出现在急诊科、内科;第2代头孢菌素类抗菌药物用药处方的不合理用药率为最高。结论:门诊抗菌药物的使用属基本合理,但仍需医院加强管理,进一步提高抗菌药物临床用药的合理性。     

某医院门诊197张抗菌药物处方用药与不合理原因分析

目的：分析医院门诊抗菌药物处方用药存在的问题与不合理的原因,为门诊患者抗菌药物合理使用提供参考。方法：抽取2021年度柳州市潭中人民医院门诊抗菌药物处方1 200张（每月100张）,点评与分析处方用药的合理性和不合理的原因。结果：1 200张处方中,存在不合理原因用药处方197张（占16.42%）,主要表现为用法用量不合理、品种选择不合理、联合用药不适宜、无指征用药、用药疗程不合理和围术期预防用药不合理。结论：医院门诊抗菌药物的使用存在诸多不合理使用现象,医院行政部门应加强门诊医师的抗菌药物相关知识培训与学习,药师应充分发挥宣教、审方和干预等作用,以促进门诊患者抗菌药物使用的合理性、安全性。     

某院内科门诊克拉霉素处方点评及其潜在药物相互作用分析

目的:分析医院门诊内科克拉霉素处方用药的合理性和药物联合使用情况,为临床合理用药提供参考.方法:通过医院信息系统(HIS),调取2020年10月-12月门诊内科含克拉霉素处方871张,分析其用药的合理性及不合理用药的原因.结果:871张含克拉霉素处方中,处方用药对象主要为30～60岁年龄段人群;以消化内科和普通内科患者为主,处方诊断项主要是幽门螺旋杆菌感染;不合理处方原因主要为"抗菌药物使用欠合理""临床诊断书写不全";与质子泵抑制剂联用处方占87.14％,具有潜在的药物相互作用的联合用药处方较为普遍.结论:医院门诊内科患者,克拉霉素使用存在不合理用药现象,行政部门应加强对临床抗菌药物合理使用和联合用药的管理,提高临床对可能存在潜在药物相互作用的认识和药师的审方能力,以促进临床克拉霉素用药的合理性和安全性.     

某中医院11213张门急诊抗菌药物处方的不合理情况分析

目的：分析医院门急诊抗菌药物处方的点评结果和不合理用药的原因类型,为临床抗菌药物的合理使用提供参考。方法：通过医院合理用药系统,抽取2020年1月—2021年12月南京市江宁中医院门急诊抗菌药物处方11 213张作为研究资料,依据相关权威资料对抗菌药物处方进行合理用药点评,分析点评结果和不合理用药的原因类型,并提出了相应对策。结果：点评结果显示,11 213张门急诊抗菌药物处方中有不合理处方1 518张（不合理率为13.54%）,其中以急诊外科（314张,占20.69%）、急诊内科（263张,占17.33%）、门诊儿科（152张,占10.01%）和门诊妇科（107张,占7.05%）的不合理处方最多;不合理原因类型以临床诊断书写不全（646张,占41.25%）、联合用药不适宜（303张,占19.35%）和无适应证用药（242张,占15.45%）为主。结论：医院门急诊在抗菌药物使用方面存在一定的不合理情况,医院行政部门应当对主要科室加强管理,定期开展处方点评,以确保患者的用药安全。     

某院门急诊5659张抗菌药物处方不合理用药原因分析

目的:分析医院门急诊抗菌药物的使用情况以及不合理用药原因,以促进临床合理使用抗菌药物提供参考。方法:抽取2019年1—6月间医院门急诊患者的处方97 749张(门诊95 865张,急诊1 884张),统计与分析门急诊患者抗菌药物的使用情况及其不合理使用的原因。结果:97 749张处方中,涉及不合理用处方5 659张占5.79%,不合理处方5 659张占抗菌药物处方30.61%;门急诊患者抗菌药物不合理使用原因主要有用药适应证不适宜、遴选药品不适宜、药品剂型或给药途径不适宜、用法用量不适宜、重复用药以及存在配伍禁忌等现象。结论:医院门急诊患者抗菌药物的使用情况,虽然有些指标达到相关部门要求,但仍然存在诸多不合理使用现象,医院应该加强行政干预管理,规范抗菌药物的合理使用,以减少耐药菌株的产生。     

门诊抗菌药物处方调查分析

目的：了解我院门诊处方书写质量,调查门诊抗菌药物合理用药情况。方法：采用回顾性调查方法,抽取2009年门诊处方172540张,统计抗菌药物使用情况,并进行分析。结果：172540张处方中,使用抗菌药物处方90720张,使用率为52．58％,其中单一用药占69．59％,二联用药占22．34％,三联用药占8．07％。存在书写不规范处方8219张,占抗菌药物处方的9．06％,不合理用药处方7738张,占抗菌药物处方的8．53％。结论：我院门诊处方书写质量与用药情况总体较好,但仍存在少数问题：医院应加强对抗菌药物合理使用的监控,如通过处方点评等干预措施,促进临床抗菌药物合理使用和处方质量的提高。     

男性科门诊抗菌药物不合理应用分析

目的了解我院男性科门诊抗菌药物的使用情况,为抗菌药物合理使用提供建议。方法随机抽取2009年我院门诊男性科处方,进行统计分析（不包括局部用药）。结果共审核处方2764张,其中使用抗菌药物处方2517张,存在不合理用药处方1931张。结论我院男性科门诊处方抗菌药物应用频率高,存在诸多不合理用药现象,医院应进一步加强对门诊抗菌药物使用的管理,及时纠正不合理用药现象,促进合理用药。     

某院儿科门诊3467张抗菌药物处方用药及不合理用药的原因分析及其对策

目的:分析医院儿科门诊抗菌药物处方用药及不合理用药的原因及其对策,为儿科患者安全用药提供参考。方法:抽取2018年7月—2019年7月间儿科门诊抗菌药物用药处方3 467张,统计其抗菌药物联用情况、给药途径、用药频度(DDDs)和不合理用药处方;分析其用药的合理性及不合理用药处方的原因。结果:3 467张抗菌药物用药处方中,其中2 597张处方使用单一品种抗菌药物占74.91%,2种抗菌药物联用处方858张占24.75%,3种抗菌药物联用处方12张占0.35%;各抗菌药物给药途径均为口服给药、静脉给药;阿奇霉素、头孢克肟的DDDs较高;不合理用药处方497张占14.34%,主要为给药时间间隔不合理。结论:医院儿科门诊抗菌药物处方用药基本符合《抗菌药物临床应用指导原则》要求,但仍存在不合理用药现象,主要表现为给药时间间隔不合理等,应加强临床医师及药师专业知识培训,健全抗菌药物管理制度,以确保患者抗菌药物使用的合理性、有效性、安全性。     

我院皮肤科门诊抗菌药物不合理应用分析

目的：分析医院皮肤科门诊抗菌药物不合理用药原因,为进一步规范本院抗菌药物的使用管理提供参考。方法：随机抽取我院2008年度每月11—20日皮肤科门诊处方（18岁以上患者）共计19905张,对使用抗菌药物处方的抗菌药物DDDs、DUI、处方的诊断与用药相符性、联合用药不合理性及单张处方不合理项进行统计分析。结果：使用抗菌药物处方为5034张,占总抽查处方的25．29％。其中,不合理处方1449张,占使用抗菌药物处方的28．78％。结论：医院门诊抗菌药物不合理应用情况表现形式多样,应加强干预和管理。     

抗菌药物不合理使用情况分析与对策

目的调查、分析抗菌药物不合理使用情况并制定相应的对策加以预防。方法随机抽取笔者所在医院2010年门诊各科处方2000张,进行调查分析。结果 2000张门诊处方中使用抗菌处方1123张,门诊抗菌药物使用率为56.15%,抗菌药物使用三高一低问题十分突出,其中抗菌药物使用不合理300张,占比26.71%。结论临床抗菌素用药不合理率偏高,应引起重视。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.