1 例老年肺癌患者的药学监护

目的　探讨临床药师如何对老年肺癌患者实施药学监护。方法　临床药师在患者住院期间药物治疗过程中对其进行药学监护,包括化疗方案的制订与评价,药物不良反应的监测,抗感染治疗药物的选择,同时对患者进行用药教育。结果　通过临床药师的药学监护,患者化疗过程中获得个体化的治疗方案,提高了药物治疗效果,减少了药物损害,使患者顺利完成治疗。结论　临床药师对患者进行药学监护,与临床医师密切合作,可进一步优化治疗方案,确保临床合理用药。     

临床药师参与肿瘤患者围化疗期抗肿瘤治疗的药学监护

目的:分析肿瘤患者围化疗期抗肿瘤治疗的用药方案和药学监护过程。方法:通过归纳整理抗肿瘤治疗患者给药顺序、剂量调整、用药不良反应及其处理措施,分析肿瘤患者围化疗期抗肿瘤治疗的药物调整及其药学监护过程。结果:在肿瘤患者围化疗期实施药学监护,可对患者治疗过程进行管理,以减少用药后不良反应的发生,充分发挥抗肿瘤药物的治疗效果。结论:临床药师参与肿瘤患者围化疗期抗肿瘤治疗中提供了针对性用药方案,并实施了药学监护,充分发挥了临床药师在抗肿瘤治疗中的作用。     

1例伊立替康联合化学治疗致严重不良反应后的药学监护

目的探讨对化疗药物引起不良反应的患者开展药学监护的方法。方法临床药师参与l例直肠癌患者应用伊立替康联合化疗出现严重不良反应的治疗,并进行药学干预、药学监护。结果通过对症和对因治疗后,患者安全度过化疗期。结论临床药师应加强药学监护,提高药物治疗的安全性和有效性。     

药物相关性肝衰竭患者使用糖皮质激素治疗1例的药学监护

目的探讨临床药师参与药物相关性肝衰竭患者药学监护模式及内容。方法通过参与1例药物相关性肝衰竭患者治疗过程,对治疗方案选择、不良反应监护、患者用药教育等方面开展药学监护工作。结果临床药师对患者实施药学监护,优化了治疗方案,提高合理用药水平,避免了因药物治疗对患者造成的潜在健康威胁。结论临床药师结合最新的循证证据,从治疗方案的选择、药品不良反应等方面开展药学监护,可提高特殊患者用药的安全性、有效性。     

1例妊娠合并宫颈癌伴发热患者的药学监护

目的 探讨妊娠合并宫颈癌伴发热患者的药学监护要点。方法 临床药师通过参与1例妊娠合并Ib2期宫颈癌伴发热患者的治疗,从药动学、药物不良反应等方面分析,结合患者特殊人群用药局限性和细菌用药特点与医师共同制订化疗、个体化抗感染治疗方案。结果 临床药师通过辅助决策协助医师进行用药监护,患者顺利分娩,感染得到有效控制,未出现相关化疗不良反应,加强了患者用药的安全性。结论 临床药师的参与提升了临床用药的合理性及药学监护效果。     

1例结肠癌晚期患者化疗联合靶向治疗的药学监护

目的：探讨结肠癌晚期患者化疗联合靶向治疗的方案及药学监护,促进药物合理应用。方法：以1例结肠癌晚期患者的诊治过程为例,针对化疗药物及靶向药物的选择、不良反应的处理等进行药学监护。结果：患者应用FOLFIRI方案联合贝伐珠单抗治疗,治疗过程中出现窦性心动过缓、腹泻等不良反应,通过药师的药学监护,及时发现并解决了患者药物治疗中的问题,为临床用药提供了建议。结论：临床药师对肿瘤患者进行药学监护,有利于安全、合理用药。     

临床药师对1例毛霉菌病伴天疱疮患者的药学监护

目的 通过临床药师参与1例毛霉菌病伴天疱疮患者治疗过程中的药学监护,探讨临床药师在治疗过程中作用。方法 临床药师对1例毛霉菌病伴天疱疮患者进行密切观察和随访,参与制定个体化的给药方案,监测疗效和药品不良反应,并给患者提供用药教育。结果 通过药学监护,明显提高了患者用药的安全性及有效性。结论 临床药师应切实发挥专业优势,指导、促进临床合理用药,为患者提供药学服务,保障患者用药安全、有效。     

对1例晚期胃癌患者的药学监护

目的通过临床药师参与临床查房、药物治疗的过程,逐渐建立临床及药学相结合的思维模式。方法以1例胃癌患者药物化疗进行全程药学监护,介绍临床药师从药物选择、用法用量、不良反应等进行全面分析的思维方法。结果通过对患者全程的药学监护实施,提高了临床药师的药物治疗思维能力。结论临床药师能更好地开展药学服务,保障患者用药安全、有效、经济、适当,最大限度提高患者生存期。     

1例肺血栓栓塞患者的药学监护

目的通过临床药师对1例肺血栓栓塞患者的药学监护,提高临床个体化用药安全性和有效性的相关工作。方法临床药师对患者进行全程药学监护,通过分析患者国际化标准比值异常波动的可能原因,监测凝血功能和不良反应,协助医师调整华法林的给药剂量。结果患者用药的疗效得到提高,药物不良反应大幅度降低。结论临床药师参与临床实践,通过对患者进行全程药学监护,协助医师共同制订治疗方案,可改善患者的药物治疗及临床个体化用药。     

1例肝硬化失代偿期并发自发性腹膜炎患者的药学监护

目的：通过临床药师对患者实施药学监护,保障肝硬化患者用药的安全有效。方法临床药师参与1例肝硬化失代偿期并发继发性腹膜炎患者的治疗,分别从抗病毒药物、利尿药及自发性腹膜炎抗菌药物选择等方面实施全程药学监护,提出药学建议并对患者进行用药教育。结果通过药学监护,明显提高了肝硬化患者用药的安全性、有效性,及时发现药物不良反应并避免再次发生。结论临床药师积极开展药学监护,协同临床医生优化用药方案,有利于患者的用药安全有效。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.