卡氏肺胞子菌肺炎合并脓毒症患儿的药学监护实践

目的 探讨临床药师在卡氏肺胞子菌肺炎合并脓毒症患儿治疗中的作用,为患儿的药物治疗及药学监护提供参考。方法 临床药师参与1例卡氏肺胞子菌肺炎合并脓毒症患儿的诊疗过程,协助临床医师调整治疗方案,同时对患儿进行个体化药学监护,针对重点药物进行用药指导,保证疗效,降低不良反应。结果 药师在卡氏肺胞子菌肺炎合并脓毒症患儿的药物治疗过程中可以发挥积极的作用：在病情急性期协助临床医师选择初始抗感染用药品种及剂型,在治疗过程中对可疑的药物不良反应进行药源性疾病的鉴别,提出处理建议。结论 临床药师积极实施药学监护,协同临床医师优化治疗方案,有利于提高患儿的用药安全性与有效性。     

临床药师参与儿童重症监护室患者抗感染药物治疗的药学监护

目的:临床药师通过参与儿童重症监护室(PICU)抗感染药物治疗实践,探讨临床药师参与抗感染治疗和开展药学监护的方法。方法:临床药师参与PICU患儿的治疗过程,开展抗感染治疗药学监护,根据患儿的治疗效果和病情变化,及时调整治疗方案。结果:临床药师通过对患儿抗感染治疗的药学监护,使患儿获得完善的个体化治疗,及时发现临床用药问题,提高患儿用药的安全性、有效性。结论:临床药师只有深入临床参与治疗过程,才能真正发挥临床药师的作用,使临床药学工作日趋成熟和完善。     

1例小儿重症肺炎抗感染治疗的药学监护实践

目的:探讨临床药师参与药物治疗方案的制定与药学监护的方法。方法:通过对1例重症肺炎患儿进行药学监护,了解临床药师参与药学临床实践的过程,协助医师为患儿提供个体化药物治疗方案。结果:临床药师的建议被临床医师采纳,患儿病情好转出院。结论:临床药师参与药物治疗,可提高疗效,确保患儿用药安全,使患儿受益。     

临床药师对1例难治性肺炎支原体肺炎合并肺栓塞患儿的药学监护实践

目的：探讨临床药师在难治性肺炎支原体肺炎合并肺栓塞患儿治疗中的作用,为肺栓塞患儿的药物治疗及药学监护提供参考。方法：临床药师参与1例难治性肺炎支原体肺炎合并肺栓塞患儿的诊疗过程,协助临床医师调整治疗方案,同时对患儿进行个体化药学监护,针对重点药物进行用药宣教,从而保证疗效,降低不良反应发生率。结果：通过临床药师的药学监护实践,提高了肺栓塞患儿用药的安全性、有效性,尽量避免了不良反应事件的发生。结论：临床药师积极实施药学监护,协同临床医师优化治疗方案,有利于患儿的用药安全与有效。     

临床药师参与COVID-19患儿抗病毒治疗的药学监护

目的通过参与新型冠状病毒肺炎(COVID-19)患儿的药物治疗实践,探讨临床药师参与COVID-19患儿的治疗和开展药学监护的方法。方法临床药师运用药学专业知识和最新的临床研究证据,参与和协助临床调整治疗方案,并对患儿家属进行用药教育。结果临床药师积极参与COVID-19患儿治疗过程的药学监护,及时发现患儿的药物治疗问题,提出合理化建议,并取得明显成效。结论临床药师参与COVID-19患儿药物治疗方案的制订,找到了融入临床治疗团队的切入点,将理论知识和临床实践相结合,优化药物治疗方案,既可提高临床药物治疗水平,又能提高患儿用药的安全性、有效性。     

临床药师对脓毒症重症肺炎患儿抗感染治疗的药学监护

目的:通过参与脓毒症重症肺炎患儿抗菌药物治疗过程,探讨儿科临床药师在抗菌药物合理使用中如何发挥作用。方法:临床药师对1例脓毒症重症肺炎患儿进行抗菌药物治疗监护,在患儿入院初期根据患儿情况建议临床不采用哌拉西林/他唑巴坦联用万古霉素方案,治疗中建议调整哌拉西林/他唑巴坦治疗剂量,并对抗真菌药物如制霉菌素在儿童特殊人群的使用 等进行药学监护。结果:临床药师对抗菌药物治疗情况判断正确,处理得当,协助临床医师正确合理地使用了抗菌药物。结论:临床药师参与脓毒症重症肺炎患儿临床抗菌药物治疗,进行药学监护,可以提高抗菌药物治疗效果,减少不良反应发生。     

1例重症支气管肺炎患儿药物治疗案例分析

目的:探讨临床药师在临床药物治疗中实施药学监护的方法。方法:临床药师参与1例重症支气管肺炎患儿的治疗过程,分析重症支气管肺炎的初始抗感染治疗、抗病毒治疗及雾化吸入治疗方案及药学监护重点。结果:临床药师通过在患儿抗感染、雾化吸入等治疗过程中提供合理的用药建议,使患儿获得了较好的治疗效果。结论:临床药师加入医疗团队,参与药物治疗过程,有助于提高药物治疗效果,及时发现、处理药物不良反应,降低患儿治疗费用。     

基于基因多态性调整华法林治疗儿童脑静脉窦血栓形成1例

目的：探讨临床药师在儿童脑静脉窦血栓形成治疗中的药学监护作用,为临床合理用药提供参考。方法：回顾性分析临床药师对1例儿童脑静脉窦血栓形成治疗中的药学监护过程。结果：临床药师通过分析患儿病情、华法林基因型和国际标准化比值,协助临床医师调整华法林用药方案,患儿康复出院。结论：临床药师基于基因多态性参与患儿华法林个体化抗凝方案的制定,有利于提高药物治疗水平,确保患儿用药安全、有效。     

临床药师参与1例低镁血症抽搐患儿会诊实践

目的:临床药师通过参与1例低镁血症抽搐患儿会诊的药学实践,探讨临床药师在药物治疗中的作用。方法:回顾性分析临床药师参与1例低镁血症抽搐病例的药物治疗过程。结果:临床药师通过提出会诊建议,提供相对合理的用药方案,使患儿病情得到有效控制。结论:临床药师参与药物治疗,及时进行药学监护,可提高患儿用药的安全性及有效性。     

临床药师对1例视神经炎伴病毒感染患儿的药学监护实践

目的：探讨临床药师在视神经炎伴病毒感染患儿治疗中的作用,为儿童视神经炎治疗中的药物选用提供参考。方法：临床药师运用药学专业知识和最新的临床研究证据,参与1例视神经炎伴病毒感染患儿的药学监护实践,协助临床调整治疗方案,并对患儿家属进行用药教育。结果：通过临床药师的药学监护实践,临床医师及时合理地调整用药方案,改变了不合理的用药习惯,保障了患儿用药安全。患儿经过治疗,病情好转出院。结论：临床药师实施药学监护,可优化药物治疗方案,促进激素及抗病毒药物等在儿童病毒感染诱发相关视神经炎治疗中的合理应用。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

Disease control in asthmatic children seen in private practice in Switzerland

ABSTRACT

Background: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice.

Methods: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2.

Results: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2.

Conclusions: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.