基于Beers标准的门诊心内科老年患者潜在性不适当用药分析

目的调查我院门诊心内科老年患者潜在性不适当用药情况。方法以Beers标准(2012版)为主要依据,对我院4 320例门诊心内科老年患者的潜在性不适当用药进行分析。结果依据Beers标准,334例(7.73%)存在与药物相关的潜在性不适当用药,40例(0.93%)存在与疾病或状态相关的潜在性不适当用药,301例(6.97%)使用了老年慎用的药物;根据药学专业知识,判断出不适当用药359例(8.31%)。结论 Beers标准在评估老年患者潜在性不适当用药方面有重要的参考价值,但不能替代专业判断,需根据医院及患者实际情况进行综合分析。     

我院门诊老年患者潜在性不适当用药情况分析调查

目的:回顾性分析某院门诊老年患者潜在的不适当用药情况。方法:根据我国发布的中国老年人潜在不适当用药目录,对某院60岁以上的老年患者的门诊处方进行分析,评价其潜在性不适当用药的情况。结果:患者平均年龄76岁,平均用药4种,2936例(19%)存在潜在性不适当用药。结论:某院门诊老年患者存在潜在性不适当用药情况较严重,应采取有效措施保障老年患者用药安全。     

Beers判断标准在老年住院患者潜在性不适当用药评价中的应用

目的:调查我院老年住院患者潜在性不适当用药情况。方法:以Beers判断标准(2003年版)为依据,对我院426例老年住院患者的用药潜在风险进行评价,确定其潜在性不适当用药的发生率。结果:426例老年住院患者平均年龄74.8岁,平均用药8种,58例(13.6%)存在与药物相关的潜在性不适当用药,47例(11.0%)存在与疾病或状态相关的潜在性不适当用药。结论:我院老年住院患者潜在性不适当用药情况较严重,应采取多种措施预防其不合理用药。     

用Beers标准评价老年住院患者潜在性不适当用药

目的 :调查老年住院患者潜在性不适当用药情况。方法 :以2012年版Beers标准为主要依据,对年龄≥65岁的83例老年住院患者的潜在性不适当用药进行评价分析。结果 :83例患者的平均年龄为83岁,平均用药9种。其中35例(42.2%)存在与药物相关的潜在性不适当用药,9例(10.8%)存在与疾病状态相关的潜在性不适当用药,11例(13.3%)使用了老年患者需慎用的药物。Beers标准未包括的潜在性不适当用药为11例(13.3%)。结论 :老年住院患者潜在性不适当用药情况较为严重,应引起临床重视,以保证老年患者的用药安全。     

我院老年住院患者潜在不适当用药情况分析

目的回顾性分析我院老年住院患者潜在的不适当用药情况。方法以STOPP&START用药审核提示表为依据,对我院464份年龄≥65岁的老年住院患者病历进行评价,获得老年患者潜在性不适当用药情况。结果 464份老年住院患者平均年龄(78.7±6.9)岁,平均用药数量11种,85例(18%)存在潜在不适当用药现象共91项,127例(27%)存在处方遗漏现象共212项。结论以STOPP&START用药审核提示表可以筛查出老年住院患者潜在不适当用药情况,应作为临床处方的参考,保证老年人合理用药。     

门诊内科老年患者潜在性不适当用药影响因素的回顾性分析

目的:分析我院门诊内科老年患者潜在性不适当用药发生的影响因素。方法:采用回顾性分析方法,以Beers标准(2012版)为主要依据,对我院2014年门诊内科老年患者处方中潜在性不适当用药的发生情况进行统计分析,并对相关因素进行logistic回归分析。结果:依据Beers标准,有10.46%的老年患者至少存在1例不适当用药,Beers标准未包括的其他不适当用药占1.63%。年龄的增长、用药数量的增加、罹患疾病数量的增加及医生职称高低与潜在性不适当用药的发生呈正相关,而付款类型则呈负相关。结论:Beers标准对于指导老年人合理用药方面有重要作用,但不能完全依赖,仍需专业知识加以综合分析。实际工作中应通过对造成不合理用药的影响因素进行适当控制,以更好地指导临床用药安全。     

Beers标准评价我院门诊老年患者潜在性不适当用药

目的：回顾性分析我院门诊老年患者潜在的不适当用药情况。方法：以Beers标准（2012年版）为依据,对我院年龄≥60岁的老年患者的门诊处方进行分析,评价老年患者潜在性不适当用药的情况。结果：在调查的102284张处方中,与诊断或疾病无关的潜在性不适当用药处方7271张（7．11％）,其中含苯二氮萆类药物的处方3569张（49．09％）;与诊断或疾病相关的潜在性不适当用药处方78张（0．08％）;老年患者需慎用药物的处方1178张（1．15％）。结论：我院门诊老年患者与诊断或疾病无关的潜在性不适当用药情况较严重,特别是苯二氮革类药物,应采取多种措施预防其不合理用药。     

基于Beers标准的门诊老年慢性病患者潜在性不适当用药调查

摘 要 目的:了解某三级医院门诊老年患者的潜在性不适当用药情况。方法：对该院2013年门诊老年慢病患者的445张处方进行分析,借鉴美国Beers标准对老年慢性病患者的潜在用药风险进行综合评价。结果：患者平均年龄（77.85±7.03）岁,药品不良反应发生比例24.5%, 潜在性不适当用药的构成比为14.7%。结论：老年慢性病患者用药潜在性风险较大,Beers标准在预测老年患者不适当用药和药品不良反应上具有比较重要的应用价值, 中国可借鉴之构建老年人安全用药指南。     

心内科老年患者潜在不适当用药情况的回顾性分析及药学建议

目的 分析心内科老年住院患者潜在不适当用药（PIM）情况,探讨临床药师药学监护点。方法 随机抽取2021年心内科收治的年龄≥70岁的150例患者为研究对象,进行PIM和疾病状态下PIM的统计,通过单因素分析和多因素Logistic回归分析PIM的影响因素。结果 150例患者中存在PIM患者共123例（82.00%）,涉及A级警示药物12种323例次,B级警示药物13种65例次,心力衰竭和高血压疾病状态下PIM情况较为多见。多因素Logistic回归分析显示,罹患疾病数和用药品种数是老年患者PIM的独立危险因素（P <0.05）。临床诊断≥5种时,PIM风险达5.393倍（95%CI:1.303～22.328）;用药品种14～19种时,风险比为6.716(95%CI:1.517～29.728),用药品种≥20种,风险比为26.727(95%CI:6.637～107.625)。结论罹患疾病数和用药品种数是老年人PIM的独立危险因素,临床药师可提供药学监护和实验室技术支持,保障老年患者用药安全。     

天津医科大学总医院半年内老年患者潜在不适当用药及影响因素分析

目的 调查天津医科大学总医院老年住院患者潜在不适当用药情况,并对其影响因素进行分析。方法 以Beers标准（2015年版）为依据,对该院2017年1月~6月收治年龄≥ 65岁的1 800例老年住院患者的潜在不适当用药进行评价,利用χ²检验和多因素Logistic回归分析确定其影响因素。结果 依据Beers标准,614例（34.11%）老年患者存在潜在不适当用药955例次;罹患疾病数和联合用药数可促使潜在不适当用药的发生。结论 Beers标准是评估老年患者潜在用药风险的重要依据,临床治疗中应对造成不适当用药的相关影响因素进行适当控制,以促进合理用药,确保用药安全。     

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.     

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。     

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.     

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.     

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.     

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.