常见的错误服药方法及正确应用

在我国．据统计每年有500万人因服药方法错误而住进医院，其中20万人因此丧命；每年500万聋儿中也有50万是由原因所致。口服给药是常用的给药途径之一。要想使药物顺利到达胃肠道。发挥药物的疗效，我们应纠正日常生活中常见的错误的服药方法。     

干粉吸入剂的粉末定量分装设备浅析

干粉吸入剂是一种新兴呼吸道给药剂型,其吸入粉末的分装装置不同于常见的口服固体粉末分装装置。本文综述国际上常用的干粉吸入剂的粉末定量分装装置,包括标准定量器装置装置、真空滚筒分装装置、Xcelodose精确粉末微定量装置等,同时介绍几种较新的、处于研发阶段的粉末分装装置。     

正确使用常用口服药品是治疗的关键

口服药品是经胃肠道吸收而作用用于全身,或滞留在胃肠道作用于胃肠局部。口服是较安全、方便和经济的用药方法。但应注意使用方法如次数、时间、服法等问题。     

影响慢性阻塞性肺疾病和哮喘患者吸入剂使用因素的研究

哮喘和慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)为常见呼吸系统疾病,全世界约有3亿哮喘患者,40岁以上人群约有10%患有COPD[1-2]。据文献报道,我国哮喘的总体发生率为0.92%~3.23%,低于其他国家;COPD的发病率为5%~13%,高于其他国家报道的4%~10%[3-8]。使用吸入剂与全身用药治疗比较,具有给药剂量小、起效     

不同雾化吸入方式的正确选择

药物的疗效及安全性不仅与药物本身的化学结构有关，而且同一药物因剂型差异，给药途径不同也会对其疗效及安全性产生较大的影响。口服给药和注射给药虽然是大多数治疗药物采用的给药途径，但这两种给药方式部有其缺点。譬如，有些口服给药的药品由于其强首过效应，在进入体循环之前就被代谢而减效或失效，为了保证疗效不得不加大给药剂量，从而增加了因药品剂量引起的不良反应的发生率；     

双黄连注射剂的临床使用方法研究

目的：探讨双黄连注射剂的应用方法及不同用法之间疗效和不良反应的关系，为临床合理用药提供参考。方法：通过对2001年8月至2002年11月我院住院和门诊应用双黄连注射剂的不同应用方法进行统计分析。结果：黄连注射剂的雾化、腔内注射效果优于静脉注射给药。不良反应的发生率明显低于注射给药。双黄连注射剂的静脉给药，选用合理给药方法能有效降低不良反应的发生率。结论：优化双黄连注射剂的临床应用方法可以提高药物的治疗效果，降低其不良反应的发生率。     

口服特异性生物粘附给药系统常用材料的研究进展

根据目前国内外相关文献报道，对口服特异性生物粘附给药系统的常用材料及其制备方法进行了综述，并对它们在口服给药系统中的潜在应用进行了探讨，旨在为研究开发新型口服给药系统提供新的思路和方法。     

吡罗昔康口服和局部给药后药物动力学和局部组织的分布

目的 研究大鼠吡罗昔康局部给药的药物传递和机理。方法 大鼠分别局部给药和口服4mg吡罗昔康后，用HPLC法测定局部给药部位的皮肤、肌肉、关节和血液的药物浓度。结果 口服给药后，Tjoint/Plasma和Tmus/Plasma比值保持恒定，大部分的时间其值介于0．06和0．2。比较而言，局部给药后，Tjoint/Plasma和Tmus/Plasma比值分别介于0．2到1．26和1．89到5．4之间。比值远远大于口服给药。结论 数据表明局部给药后，到达局部深层组织的吡罗昔康来自于药物的直接渗透；当药物的靶向部位在局部时局部给药优于口服给药。     

吸入剂AZ-004进入Ⅲ期临床

Alexza制药公司治疗精神分裂急性激越症状和双极性疾病的吸入制剂AZ-004（Staccato loxapine，洛沙平）（I）已开始Ⅲ期临床试验。该公司的Staccato系统使用手握式、化学加热、单剂量给药吸入装置将药物气雾化以适合吸入肺部。     

规范用好抗微生物基本药物

本文对《国家基本药物目录（基层医疗卫生机构配备使用部分）》（2009年版）中的33种抗微生物药和《上海市基层医疗卫生机构增补药物目录》（2010年版）中增补的15种抗微生物药进行抗菌特点和临床定位分析,以促进临床规范应用而充分发挥这些药物在防治感染性疾病中的作用。     

Applications of capsule dosing techniques for use in dry powder inhalers

Dry powder inhaler (DPI) devices that utilize two-piece capsules as the dose-holding system can require specialized dosing equipment to fill the capsules. Such products are known as 'premetered' because they contain previously measured doses in a dose carrier (the capsule). The capsule is either inserted into the device during manufacture or by the patient prior to use. The dose is inhaled directly from the device/premetered unit by the patient. Regardless of DPI design, the most crucial attributes are the reproducibility of the discharged dose and the particle size distribution of the drug within that dose. Filling inhalation powders into capsules often requires specialized equipment in order to handle the very low weights that are often contained in each dose. The equipment typically needs to incorporate in-process checks to confirm the filling process has been correctly performed, with the ability to reject any under- or over-filled capsules, in line with established quality criteria. In the majority of cases, such processing equipment is maintained in a temperature and humidity controlled environment to avoid moisture uptake and potential powder aggregation and, in particular, to ensure the powder is free flowing on introduction into the capsule. This ensures that the emitted dose is maximized and controlled according to industry guidelines and that the fine particle fraction provides an optimum clinical benefit. Several methods of dosing precise doses of powder into capsules are available and include dosator technology and tamp processes, as well as equipment that utilize the 'pepper-shaker' or 'pepper-pot' principle for the accurate dispensing of powders. This article reviews the suitability of each method with respect to dosing inhalation powder into capsules for use in DPI devices, and discusses why the pepper-pot principle could offer a number of clear benefits.     

Reverse water-in-fluorocarbon emulsions for use in pressurized metered-dose inhalers containing hydrofluoroalkane propellants

Pulmonary administration of drugs has demonstrated numerous advantages in the treatment of pulmonary diseases due to direct targeting to the respiratory tract. It enables avoiding the first pass effect, reduces the amount of drugs administered, targets drugs to specific sites and reduces their side effects. Reverse water-in-fluorocarbon (FC) emulsions are potential drug delivery systems for pulmonary administration using pressurized metered-dose inhalers (pMDI). The external phase of these emulsions consists of perfluorooctyl bromide (PFOB, perflubron), whereas their internal phase contains the drugs solubilized or dispersed in water. These emulsions are stabilized by a perfluoroalkylated dimorpholinophosphate (F8H11DMP), i.e. a fluorinated surfactant. This study demonstrates the possibility of delivering a reverse fluorocarbon emulsion via the pulmonary route using a CFC-free pMDI. Two hydrofluoroalkanes (HFAs) (Solkane(R) 134a and Solkane(R) 227) were used as propellants, and various solution (or emulsion)/propellant ratios (1/3, 1/2, 2/3, 1/1, 3/2, 3/1 v/v) were investigated. The insolubility of water (with or without the fluorinated surfactant F8H11DMP) in both HFA 227 and HFA 134a was demonstrated. PFOB and the reverse emulsion were totally soluble or dispersible in all proportions in both propellants. This study demonstrated also that the reverse FC emulsion can be successfully used to deliver caffeine in a homogeneous and reproducible way. The mean diameter of the emulsion water droplets in the pressured canister was investigated immediately after packaging and after 1 week of storage at room temperature. Best results were obtained with emulsion/propellant ratios comprised between 2/3 and 3/2, and with HFA 227 as propellant.     

On the use of dry powder inhalers in situations perceived as constrained.

Dose delivery from dry powder inhalers (DPIs) are dependent on the inhalation effort of the patient. Some patient groups, including asthmatic children, patients with acute asthma, and patients with advanced chronic obstructive pulmonary disease (COPD) are perceived as having problems in readily inhaling from a DPI in an efficient way; this opinion is based on alleged low inhalation flows. A review of the literature however shows that these groups can use a DPI in an efficient way and gain good clinical effect from its use. Particularly, it has been shown that children can generate a good peak inhalation flow through a DPI, albeit a lower inhaled volume. Similarly, patients with acute asthma can use a DPI in an efficient way, even reaching a better clinical effect with the DPI than with a pressurized metered dose inhaler with a spacer. Finally, it was shown that patients with severe COPD can generate the inhalation flows needed to generate an efficient drug aerosol from a DPI. Collectively, the discussed patient groups seem to perform as well as other subjects when it comes to their ability to generate an adequate inhalation flow through a DPI.     

Survey of pharmacists’ attitudes towards interchangeable use of dry powder inhalers

Background It is a common cost-containment practice in some countries to dispense a cheaper, generic version of a prescribed medication. This presents few problems for most medications. However, dry powder inhalers used in asthma and COPD vary markedly in design and method of operation, so generic substitution may not be acceptable to patients or healthcare professionals. Patients dispensed an unfamiliar device in which they have received no training, risk poor inhalation technique with the potential for inadequate dosing and loss of disease control. Objective To assess the views of pharmacists towards interchangeable use of dry powder inhalers. Setting Community pharmacists in Australia, Canada, France, Germany, and the UK. Method Following exploration of the key issues with international opinion leaders in respiratory management, a structured web questionnaire was developed for use in computer assisted web interviews. Fieldwork was carried out in March and April 2005. Main outcome measure: Responses to the web questionnaire were analysed by percentage of respondents or by mean or median score, as appropriate to the question. Results A total of 254 pharmacists were included in the study. Just 6% of pharmacists considered that dry powder inhalers are interchangeable, with a high level of concern shown about interchangeable use (median score of 6 on a scale of 1, not at all concerned, to 7, extremely concerned). Patient confusion was the main concern, expressed by 77% of respondents. Pharmacists also envisaged substitution having an adverse impact on pharmacy stock levels (72%), patient device handling (70%), pharmacist workload (63%), patient compliance (56%) and outcomes for the patient (51%), with pharmacists in Germany having a particularly negative view and those in France generally the most positive. Despite the generally negative view of pharmacists about interchangeable use of dry powder inhalers, overall only 22% would contact the prescribing physician often/very often for approval of the substitution. Conclusion The study showed that only a small minority of pharmacists believe that dry powder inhalers can be used interchangeably, with the majority concerned about generic substitution of these products. Pharmacists in Germany were particularly negative about the interchangeable use of dry powder inhalers.     

教育前后干粉吸入器使用不正确的影响因素分析

目的统计本院门诊呼吸科哮喘和慢性阻塞性肺疾病患者干粉吸入器的不正确使用情况,分析影响教育前后不正确使用的因素。方法共217例患者纳入研究。在药师面对面教育前后,对患者正确使用吸入装置的能力进行评分,评价影响不正确使用的因素,统计结果采用SPSS22.0软件进行分析。结果教育前后正确率分别为8.8%和59.0%,影响教育前不正确使用的因素有年龄、学历、疾病、吸入药物、是否第一次使用干粉吸入剂及是否只有一种吸入剂。影响教育后不正确使用的因素有年龄和吸入药物。结论教育患者正确使用吸入器,是医务人员的职责和责任。医师选择适合患者的吸入装置,药师在固定的场所应提供面对面吸入器使用方法培训,并且长期随访。