2011—2013年解放军第四六四医院住院药房心血管药物的使用情况分析

目的分析中国人民解放军第四六四医院住院药房心血管药物的用药情况。方法回顾性统计与分析2011—2013年解放军第四六四医院住院各类心血管药物用药金额、用药频度(DDDs)。结果心血管药物用药金额较为平稳,DDDs值呈现先升后降趋势,其中降血压药、防治心绞痛药、钙通道阻滞药的用药金额和DDDs值均较高,用药金额和DDDs值排名前10位药物也以上述3类药物居多。结论中国人民解放军第四六四医院住院心血管类药物应用基本合理;治疗高血压、冠心病和心绞痛的药物是临床常用药物,降脂药的用量呈现日渐增高趋势。     

某医院2007年前三个季度抗感染药物使用情况分析

目的了解医院住院药房2007年抗感染药物的应用情况。方法以抗感染药的消耗金额、用药频次（DDDs）、日治疗费用（DDC）对2007年抗感染类药物的使用数据进行分析,统计。结果抗感染类的品种使用最多的为头孢菌素类,其次为喹诺酮类。结论我院抗菌素类药物的使用基本合理,但仍有一些问题,需进一步规范。     

2007～2009年我院住院患者抗感染药使用情况分析

目的：评估我院住院患者抗感染药的应用情况,为临床合理用药提供参考。方法：对我院2007～2009年住院患者抗感染药的用药频度（DDDs）、销售金额、限定日费用（DDC）等数据进行统计、分析。结果：3年来我院住院患者抗感染药销售金额持续增长,但占我院全年药品销售比例基本不变,排序第1位的是头孢菌素类;用药频度（DDDs）排序前两位的是头孢菌素类和氟喹诺酮类;β-内酰胺酶抑制剂复合制剂的金额和DDDs上升明显。结论：头孢菌素类抗菌药物在我院住院患者的应用中占主导地位;应加强抗感染药的合理应用和规范化管理,控制细菌耐药率增长。     

1993年～2001年我院抗感染药物的应用频度分析

目的 :从经济学角度分析我院 1993年 1月～ 2 0 0 1年 12月抗感染药物的消费情况及变化趋势。方法 :利用计算机技术及电子表格软件Excel,统计分析近几年主要抗感染药品的用药频度 (DDDs)。结果 :抗感染药物的消费总金额逐年上升 ,β -内酰胺类药物居首位。用药频度 (DDDs)最高的是青霉素钠和头孢唑啉 ,消费金额增长最快的是添加 β-内酰胺酶抑制剂类的药物和喹诺酮类药物。结论 :抗感染用药逐渐向着高价药的方向发展 ,临床应该根据细菌培养的药敏试验情况 ,合理选用抗菌药物 ,避免滥用高价抗菌药物     

2000年朝阳医院抗感染类药物使用情况分析

通过对购药金额和DDDs进行排序统计,对2000年我院抗感染类药物的使用情况进行分析.结果表明头孢菌素类、喹诺酮类、青霉素类为应用最广泛的抗感染类药物,其中头孢菌素类药物在购药金额前10名中所占品种最多,喹诺酮类药物的DDDs值最大.     

我院2009-2011年小脑出血患者用药情况分析

目的:分析我院2009～2011年小脑出血患者的用药情况和特点。方法:采用药历统计软件对我院2009～2011年小脑出血患者的用药品种、销售金额、用药数量进行统计,并计算出各药DDDs、DDC和B/A值。结果:小脑出血患者主要使用的药物为抗感染药物、水热量电解质类药物、心血管系统药物。结论:多数药物为对症治疗药物,用药基本合理。     

2001年～2004年四川广安市6家医院抗感染药利用分析

目的:为抗感染药的应用、管理提供参考依据。方法:对四川广安市6家医院2001年～2004年抗感染药的销售金额、用药频度(DDDs)等数据进行统计、分析。结果:口服洛美沙星DDDs连续4年均居口服用药的前1、2位;异烟肼、利福平DDDs连续4年分别居前4、5位;注射用青霉素DDDs(2001年～2003年)居注射剂的首位。左氧氟沙星不论是销售金额,还是DDDs都呈后来居上之势。结论:该地区医疗机构抗感染药销售金额与药品销售总金额的比例同西南地区其它医疗机构接近,新品种较少,用药档次偏低。     

用DDDs分析2008年我院抗生素应用情况

目的了解2008年我院抗生素类药物的使用情况,为指导临床合理用药提供参考了。方法采用回顾性调查方法,收集我院2008年1月至2008年12月抗生素用药频度,应用统计学方法用药频度相关性进行分析,分析临床应用情况结果。头孢菌素类、喹诺酮类用药频率DDDs排序居前,仍为抗感染药物首选。DDDs排序居前的品种每日费用较低。结论住院药房抗生素应用基本合理,但应进一步加强对抗生素使用的监督管理,提高医务人员的业务水平。     

口腔医院住院患者抗菌药物使用分析

目的了解口腔医院住院患者抗菌药物使用情况,为促进合理用药提供参考。方法对北京大学口腔医院住院患者抗菌药物的使用金额和用量进行统计,采用金额分析法和用药频度(DDDs)分析法进行统计分析。结果3年间青霉素类和头孢菌素类药物的使用金额和用药频度(DDDs)排序均位于抗菌药物的前2位,注射用头孢呋辛钠和注射用阿莫西林克拉维酸钾的使用金额稳居前3位,前者和注射用青霉素钠的DDDs稳居前3位。结论本院抗菌药物使用较为合理。     

我院1999～2000年抗感染药物使用动态分析

应用DDDs排序法及金额排序法,以限定日剂量(Defined Daily Dose,DDD)为指标,对我院1999～2000年门诊和住院部抗感染药物的DDDs、金额、日用药金额情况等进行分析.分析结果显示二年来抗菌药物的使用规律变化不大,但用药随意性仍较大,门诊与住院部抗菌药物的使用存在很大差别.我院抗感染药物的使用基本合理,住院患者用药负担有望进一步减轻.     

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.