晚期结直肠癌一线化疗药应用合理性分析

目的:探讨福建省立医院(以下简称"我院")晚期结直肠癌患者一线化疗方案的选择和用药合理性,为临床合理使用化疗药提供参考。方法:对2012年我院接受化疗的晚期结直肠癌初治患者一线化疗药的使用情况及合理性进行回顾性统计分析。结果:纳入研究的晚期结直肠癌初治患者共56例,初始化疗药的选择和使用不合理率达21.4%(12/56),不合理用药主要表现为化疗药剂量不足、药物使用顺序不当、选药错误等。结论:我院晚期结直肠癌初治患者一线化疗药的选择基本遵循了相关指南推荐,但在药物应用的细节上仍存在一些问题。肿瘤专业临床药师应掌握化疗方案中各种药物的剂量、溶剂、配制浓度、使用顺序等相关知识,协助医师、护士合理使用抗肿瘤药,最大程度地保障肿瘤患者用药安全。     

晚期结直肠癌一线化疗药的应用合理性分析

目的分析探讨晚期结直肠癌一线化疗药的选择和用药合理性,为晚期结直肠癌患者的化疗合理用药提供科学的指导和理论的支持。方法选取我院从2014年2月至2016年3月接受化疗的50例晚期结直肠癌的患者,对这些患者一线化疗药物的选择、使用情况以及合理性进行回顾性的统计分析。结果经过对这50例患者的一线化疗药物的选择、使用情况以及合理性进行回顾性统计分析发现,初始化疗药物的选择和使用的不合理率达到了30%,分析其中药物使用不合理的表现为药物使用顺序出错、剂量不足或是过多以及选药错误等。其中有4例是在溶剂选择上不合理,使用奥沙利铂选择0.9%氯化钠注射液作为溶剂;3例在药物使用顺序上不合理,亚叶酸钙于氟尿嘧啶后使用;5例是药物使用的剂量不当,奥沙利铂、伊立替康的医嘱存在用药剂量不足;另外3例患者是为化疗方案选择药物错误:使用FOLFIRI方案的医嘱和mFOLFOX6的医中,分别有2例和1例为化疗方案药物选择错误。结论我院在临床上对于晚期结直肠癌患者的一线化疗药物的选择和应用遵循了相关的医药使用指南,但是在给药治疗过程中,仍会出现一些问题,这也是医护人员在对患者给药治疗时,没有充分了解患者的实际情况,因此没有和患者的实际情况相结合进行给药。所以肿瘤临床医师应该全面、充分的掌握化疗过程中各种药物的相关知识,如药物的使用剂量、溶剂、配制溶度以及使用顺序等,并且应该与患者的实际情况相结合,适当调整药物的使用,最大程度的保证肿瘤患者的用药安全和减轻患者的化疗痛苦。     

结直肠癌化疗实施中的不合理用药分析

目的:促进结直肠癌化疗的规范化和个体化,保证患者化疗的安全、有效。方法:对50例结直肠癌化疗患者进行药学监护,分析总结在结直肠癌化疗方案的实施中存在的相关用药问题。结果:结直肠癌化疗的不合理用药包括:化疗前评估不完善;化疗方案设计不合理;化疗实施中存在若干问题。结论:临床药师可发现和解决结直肠癌化疗中的用药问题,保证临床合理用药。     

注射用化疗药物用药调查分析

目的:对首都医科大学附属北京天坛医院(以下简称我院)注射用化疗药物使用情况进行点评,以提高化疗药物临床应用的合理性及安全性。方法:由我院信息中心导出2016年1月至2017年11月使用注射用化疗药物的患者用药医嘱,通过我院HIS系统,统计化疗患者的一般资料、诊断、使用的化疗方案及其剂量、溶媒、药物浓度、给药次序、给药速度及辅助化疗药物的使用情况等。结果:我院2016年1月至2017年11月间使用注射用化疗药物的患者共992例,共计9744条医嘱。不合理医嘱533条(5.5%),涉及患者121例(12.2%)。涉及不合理医嘱最多的前3位药物分别为依托泊苷注射液(459条,86.1%)、注射用奈达铂(28条,5.3%)、注射用培美曲塞二钠(25条,4.7%)。不合理医嘱中出现的用药差错主要为溶媒选用不当(481条,90.2%)以及诊断与用药不符(25条,4.7%)。结论:我院注射用化疗药物使用情况基本合理,但有些方面仍需进一步改进以保证患者的用药安全。     

2012年河南省人民医院200例肿瘤患者化疗药应用合理性分析

目的：了解我院肿瘤患者化疗药使用情况,为临床合理用药提供参考。方法：随机抽取我院2012年200例肿瘤患者化疗病例,对其中不合理用药情况进行点评、分析。结果：共有44例患者存在用药不合理现象,主要表现为适应证不适宜、用药顺序错误、用法与用量不适宜及化疗方案不合理。结论：我院肿瘤患者化疗药不合理使用现象较为普遍,临床药师应及时将点评结果反馈给临床,对不合理用药行为进行干预与提醒,共同促进药物合理使用。     

基于药物基因组学指导转移性结直肠癌化疗药物个体化用药的研究现状

转移性结直肠癌患者的化疗反应存在较大的个体差异,这种差异可能由遗传和药物的相互作用等因素引起。基于药物基因组学指导转移性结直肠癌患者化疗方案的个体化用药有助于确保化疗疗效,降低药物不良反应。本文通过系统梳理转移性结直肠癌患者化疗药物基因组学相关内容及临床用药指南,并简要介绍了中药联合化疗药物在其治疗中的临床应用情况,以期为转移性结直肠癌患者的个体化治疗提供用药参考建议。     

肿瘤患者化疗用药合理性调查及药学监护

目的:为规范肿瘤患者化疗用药提供参考,并探讨其药学监护要点。方法:选取山东省4家三级甲等医院肿瘤化疗病历2 242份,调查化疗用药方案和药学监护情况,并对不合理用药原因进行分析,总结临床药学监护要点。结果:化疗用药不合理1295例,其中给药剂量不合理占26.87%,止吐药物不合理占14.44%,方案选择不合理占13.13%,药物选择不合理占10.89%,给药顺序不合理占10.04%。总结出6项化疗合理用药监护指标,即方案选择合理性、药物选择合理性、药物剂量合理性、给药时间和顺序合理性、溶剂浓度和途径合理性、辅助用药合理性,覆盖了肿瘤患者化疗用药全程。结论:通过对肿瘤患者化疗用药合理性的调查来规范用药过程的药学监护,有利于提高临床药师药学服务水平,促进临床合理用药。     

肺癌化疗出现严重药品不良反应的用药合理性分析

目的:了解并分析住院肺癌患者化疗期间出现严重药品不良反应(ADR)的用药情况。方法:对2006年6月-2010年9月我院132例住院肺癌患者化疗期间出现严重ADR病例的化疗方案及合并用药数据进行统计和分析。结果:132例患者共住院化疗604人/次,严重ADR的发生率为39.57%(239人/次)。其中化疗方案的不合理应用主要发生于肝肾功能损伤患者化疗药物的选择上(63人/次);联合用药不当主要是化疗药物与联合应用药物存在毒性相加(205人/次),其次是经细胞色素P4503A4酶代谢的化疗药物与其抑制剂或诱导剂联用(180人/次)。结论:肺癌患者化疗期间的联合用药不合理现象普遍存在,临床医师必须全面了解合并应用的药物可能存在的相互作用和ADR,加强ADR监测,进一步促进肺癌化疗的合理用药。     

某院胸外科2008-2010年恶性肿瘤患者化疗药物使用现状及合理性分析

目的:了解某院胸外科恶性肿瘤患者化疗药物的使用现状及合理性。方法:对某院2008-2010年接受全身化疗的恶性肿瘤患者化疗药物的使用情况及合理性进行回顾性统计、分析。结果:纳入研究的恶性肿瘤患者共计112人,412例次化疗方案。在861条化疗药物医嘱中,医嘱不合格率为30.0%,不合理用药现象主要表现为顺铂的给药剂量不足,卡铂的溶媒选择不当,以及化疗药物的给药浓度、给药顺序、化疗前预处理不当等。结论:该院胸外科恶性肿瘤患者化疗药物基本合理,但在部分药物的具体应用上,仍存在一定的不足,在今后的临床应用中仍有待改进。     

化疗患者的药学监护

目的:探讨临床药师对化疗患者开展药学监护工作的切入点。方法:对新疆医科大学附属中医医院2010年7-8月间出院的100例肿瘤患者的化疗方案及执行情况进行调查,主要包括化疗药物及辅助用药的溶媒、化疗药物的浓度、给药速度、化疗药物给药次序、化疗辅助用药的给药时机。结果:不合理情况为:溶媒不合理6例,给药速度不合理13例,化疗药物给药次序不合理19例,化疗辅助用药的给药时机不合理1例。结论:肿瘤科临床药师将药理学、药剂学知识融入药学监护中,以患者化疗方案及执行情况作为药学监护工作的切入点,开展护士的用药教育,建立医药护三者良好的沟通机制,共同维护患者的用药安全。     

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.     

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.