临床药师对肿瘤患者药学服务实践的病例分析

摘 要 目的：通过参与肿瘤患者个体化治疗实践,探讨临床药师提高用药合理性的工作方法。方法: 临床药师参与肿瘤患者个体化治疗,发现不良药物相互作用,调整肾功能不全患者用药剂量,治疗肿瘤患者伴发感染或癌痛,纠正不恰当合并用药等。结果: 临床药师提供全程化药学监护,根据患者个体化信息,提供用药建议,提高治疗效果,避免药物潜在不良反应或不良事件发生。结论: 临床药师深入临床提供药学服务,参与制定肿瘤患者个体化治疗方案,可切实提高临床合理用药水平。     

1例哮喘急性发作伴抑郁症患者的药学监护

摘 要 目的：探讨临床药师对哮喘急性发作患者开展药学监护的方法与思路。方法：临床药师通过了解哮喘急性发作的治疗原则,分析治疗方案,参与1例哮喘急性发作伴抑郁症患者的治疗过程并实施药学监护,关注药物不良反应及治疗窗,协助临床医生制定适合患者的个体化用药方案。结果：临床药师通过对治疗全程的药学监护和医嘱干预,识别了药品不良反应的发生,优化了治疗方案,提高了药物治疗效果。结论：临床药师在临床治疗中应积极开展药学监护,协助医师制定个体化治疗方案,以利于提高患者用药的安全性和有效性。     

2例PCI术后患者抗血小板治疗的药学监护

摘 要 目的：探讨临床药师参与抗血小板药物治疗的作用,以优化抗血小板药物治疗方案。方法：临床药师参与2例抗血小板治疗方案的分析,基于现有的指南和临床研究,考虑用药经济性,制定个体化抗血小板治疗方案。结果：临床药师基于循证证据,结合患者的具体情况,参与制定药物治疗方案可以提高药物治疗水平。结论：临床药师积极开展药学监护,优化抗血小板治疗方案,有利于用药有效性、经济性及安全性。     

临床药师参与1例左上肺腺癌伴骨转移患者的止痛用药方案实践

摘 要 目的：探讨临床药师在止痛用药方案中的药学服务作用和药学监护模式。方法: 临床药师通过参与1例左上肺腺癌伴骨转移患者的止痛用药诊疗过程,分析患者治疗过程中止痛药物使用的合理性及相应的药学监护内容。结果: 临床药师在癌痛患者药学监护过程中,及时发现并协助医生解决问题,为临床提供合理性建议。结论:临床药师开展的癌痛患者止痛用药监护,有助于促进癌痛治疗的个体化和规范化,在癌痛合理用药和减少药物不良反应等方面发挥着重要的药学作用。     

1例华法林药源性肾损伤的用药分析和药学监护

摘 要 目的：通过临床药师参与华法林给药方案的设计,探讨华法林个体化给药的合理方式。方法: 临床药师参与1例华法林抗凝过度致肾损伤患者的用药方案的优化和药学监护。结果: 确定符合患者特点华法林个体化用药方案,患者病情得到缓解,用药依从性提高。结论:临床药师参与个体化给药过程,有利于增强临床药物治疗效果和发挥临床药师的作用。     

1例结核性脑膜炎患者治疗的药学监护与分析

目的：探讨1例结核性脑膜炎患者的药学监护和用药。方法：临床药师以疗效、药物不良反应为切入点,对患者病情进行分析并协助医师制定个体化用药方案,监护患者接受治疗的全过程。结果：在临床医师和临床药师的共同参与下,患者的病情逐渐好转,最终痊愈出院。结论：临床药师可以发挥自己的专业特长,协助临床医师优化治疗方案,实施药学监护,促进临床合理用药。     

1例老年急性髓细胞白血病伴支气管扩张患者的药学监护

摘 要 目的:探讨急性髓细胞白血病伴支气管扩张患者治疗中的药物治疗方案及药学监护要点。方法：通过对1例老年急性髓细胞白血病伴支气管扩张患者诊治过程实施药学监护,分析患者的治疗方案,根据患者的病情变化提供用 药建议,监护患者安全用药,促进了药物的合理化使用。结果：药师应根据患者的具体情况,将药学理论和临床实践相结合,提高药物治疗水平,真正做到治疗个体化。结论：通过实施药学监护可以促进合理用药和个体化给药,避免不良反应的发生。     

1例瓣膜置换联合冠状动脉旁路移植术后患者抗栓治疗的药学监护

摘 要 目的：探讨临床药师对冠状动脉旁路移植术（CABG）合并瓣膜置换的患者实施药学监护的方法和思路。 方法：临床药师对1例CABG合并瓣膜置换术后的患者进行查房密切观察和药学教育,参与个体化抗栓方案的制定,规范患者用药问题,监测疗效与药品不良反应,给患者提供用药教育。结果：通过药师治疗全过程中细致的药学监护和医嘱干预,确定符合患者特点的抗栓方案,避免不良反应的发生,提高患者治疗的依从性和药物治疗效果。结论：临床药师积极开展药学监护,协同临床医师优化给药方案,有利于患者用药的安全性和有效性。     

医学大数据在药物基因组学领域中的应用与发展

摘 要随着药物基因组学研究的不断发展,医学大数据在药物基因组学领域中的应用越来越多。本文从建立大型药物基因组学数据库、借助电子健康档案与基因分型数据库开展药物基因组学研究、创建可促进研究成果向临床转化的大型知识库三个方面,介绍了医学大数据在药物基因组学领域中的应用与发展方向。     

药物基因组学与合理用药

药物基因组学是人类开始功能基因组学研究后出现的一门新兴的交叉学科,药物基因组学应用于临床药学是一个必然的趋势。临床药师作为药理学研究与临床实践间的信息中介,恰好成为从事药物基因组学研究的基本力量。将药物基因组学应用于临床药学是合理用药深入发展乃至实现个体化用药的必经之路.对于深入解释药物治疗的个体差异、减少药物不良反应、提高药物疗效等有重大意义。     

药物基因组学应用于临床药学是个体化用药的必然趋势

药物基因组学是人类进入功能基因组学研究后出现的一门新兴交叉学科,随着生物信息技术的飞速发展,药物基因组学应用于临床药学将是一个必然的趋势。临床药师作为药理学研究与临床实践间的信息中介,恰好成为从事药物基因组学研究的基本力量。将药物基因组学应用于临床药学是合理用药深入发展乃至实现个体化用药的必经之路．对于深入解释药物治疗的个体差异、减少药物不良反应、提高药物疗效等有重大意义。     

Integrating pharmacogenomics into pharmacy practice via medication therapy management: American Pharmacists Association

ObjectiveTo explore the application and integration of pharmacogenomics in pharmacy clinical practice via medication therapy management (MTM) to improve patient care.Data sourcesDepartment of Health & Human Services (HHS) Personalized Health Care Initiative, Food and Drug Administration (FDA) pharmacogenomics activity, and findings from the Utilizing E-Prescribing Technologies to Integrate Pharmacogenomics into Prescribing and Dispensing Practices Stakeholder Workshop, convened by the American Pharmacists Association (APhA) on March 5, 2009. Participants at the Stakeholder Workshop included diverse representatives from pharmacy, medicine, pathology, health information technology (HIT), standards, science, academia, government, and others with a key interest in the clinical application of pharmacogenomics.SummaryIn 2006, HHS initiated the Personalized Health Care Initiative with the goal of building the foundation for the delivery of gene-based care, which may prove to be more effective for large patient subpopulations. In the years since the initiative was launched, drug manufacturers and FDA have begun to incorporate pharmacogenomic data and applications of this information into the drug development, labeling, and approval processes. New applications and processes for using this emerging pharmacogenomics data are needed to effectively integrate this information into clinical practice. Building from the findings of a stakeholder workshop convened by APhA and the advancement of the pharmacist's collaborative role in patient care through MTM, emerging roles for pharmacists using pharmacogenomic information to improve patient care are taking hold. Realizing the potential role of the pharmacist in pharmacogenomics through MTM will require connectivity of pharmacists into the electronic health record infrastructure to permit the exchange of pertinent health information among all members of a patient's health care team. Addressing current barriers, concerns, and system limitations and developing an effective infrastructure will be necessary for pharmacogenomics to achieve its true potential.ConclusionTo achieve integration of pharmacogenomics into clinical practice via MTM, the pharmacy profession must define a process for the application of pharmacogenomic data into pharmacy clinical practice that is aligned with MTM service delivery, develop a viable business model for these practices, and encourage and direct the development of HIT solutions that support the pharmacist’s role in this emerging field.     

Pharmacogenomics training using an instructional software system

Objectives

To implement an elective course in pharmacogenomics designed to teach pharmacy students about the fundamentals of pharmacogenomics and the anticipated changes it will bring to the profession.

Design

The 8 sessions of the course covered the basics of pharmacogenomics, genomic biotechnology, implementation of pharmacogenetics in pharmacy, information security and privacy, ethical issues related to the use of genomic data, pharmacoepidemiology, and use and promotion of GeneScription, a software program designed to mimic the professional pharmacy environment.

Assessment

Student grades were based on completion of a patient education pamphlet, a 2-page paper on pharmacogenomics, and precourse and postcourse survey instruments. In the postcourse survey, all students strongly agreed that genomic data could be used to determine the optimal dose of a drug and genomic data for metabolizing enzymes could be stored in a safe place. Students also were more willing to submit deoxyribonucleic acid (DNA) data for genetic profiling and better understood how DNA analysis is performed after completing the course.

Conclusions

An elective course in pharmacogenomics equipped pharmacy students with the basic knowledge necessary to make clinical decisions based on pharmacogenomic data and to teach other healthcare professionals and patients about pharmacogenomics. For personalized medicine to become a reality, all pharmacists and pharmacy students must learn this knowledge and these skills.     

On pharmacogenomics in pharmacy benefit management

Recently, the separate trajectories of pharmacy benefit management and pharmacogenomics converged. Pharmacogenomic tests have become more widely available for clinical use and at costs within the range of typical health care services. Pharmacy benefit payers continue to seek the precision they can apply to their coverage policies and clinical programs that pharmacogenomics offers. We describe how pharmacogenomics can now make sense as part of a pharmacy benefit and also how pharmacogenomics can be applied in a benefit coverage policy and clinical programs. Detail is provided on clinical program development and implementation processes featuring pharmacogenomics. We also discuss the research needed to support ongoing program development involving pharmacogenomics and describe the current roles of benefit payers and administrators in these research efforts. The legal and ethical dimensions of applying pharmacogenomics in pharmacy benefits are covered and in particular how benefit payers and administrators need to navigate between genetic exceptionalism and applicable laws and regulations. Finally, some thoughts are provided on future opportunities and challenges for pharmacogenomics in pharmacy benefit management and pharmacy in general.     

基于药物基因组学与血药浓度监测指导的个体化用药研究

传统的药物治疗模式遵循的是药物的群体治疗,忽略了药物处置与效应的个体差异,未能做到精准的个体化治疗。随着精准用药概念的提出,新型药物治疗模式-个体化用药逐渐引起重视。本文通过对近年来医院个体化用药的重要手段（药物基因组学与血药浓度监测）进行综述,概述药物基因组学与血药浓度监测的发展与不足之处,举例阐述将药物基因组学与血药浓度监测有机结合指导个体化用药的作用与意义,为医院药学中个体化用药的发展与精准用药提供重要思路与参考。     

Metabolomics in pharmacology - a delve into the novel field of pharmacometabolomics

ABSTRACT

Introduction: Pharmacometabolomics is an emerging science pursuing the application of precision medicine. Combining both genetic and environmental factors, the so-called pharmacometabolomic approach guides patient selection and stratification in clinical trials and optimizes personalized drug dosage, improving efficacy and safety.

Areas covered: This review illustrates the progressive introduction of pharmacometabolomics as an innovative solution for enhancing the discovery of novel drugs and improving research and development (R&D) productivity of the pharmaceutical industry. An extended analysis on published pharmacometabolomics studies both in animal models and humans includes results obtained in several areas such as hepatology, gastroenterology, nephrology, neuropsychiatry, oncology, drug addiction, embryonic cells, neonatology, and microbiomics.

Expert opinion: a tailored, individualized therapy based on the optimization of pharmacokinetics and pharmacodynamics, the improvement of drug efficacy, and the abolition of drug toxicity and adverse drug reactions is a key issue in precision medicine. Genetics alone has become insufficient for deciphring intra- and inter-individual variations in drug-response, since they originate both from genetic and environmental factors, including human microbiota composition. The association between pharmacogenomics and pharmacometabolomics may be considered the new strategy for an in-deep knowledge on changes and alterations in human and microbial metabolic pathways due to the action of a drug.     

Application of Genomic Principles to Pharmacotherapy of Cancer

Objectives. To teach first-year (P1) pharmacy students to apply the principles of pharmacogenomics underlying clinical pharmacotherapeutics to cancer patients.Design. Using polymerase chain reaction (PCR) and high-resolution melting analysis of deoxyribonucleic acid (DNA) from colorectal cancer cell lines to determine the presence of somatic mutations for an oncogenic marker, students formulated the proper course of treatment for a patient with similar tumor genomics.Assessment. In a postintervention survey, students highly rated the effectiveness of the laboratory session for learning pharmacogenomics, and subsequent examination scores reflected retention of principles and understanding of clinical application.Conclusion. The pharmacogenomic laboratory exercise prepared students to understand how genetic markers give clinical insight into the appropriate application of drugs in oncology pharmacotherapy. Further, the session inspired their interest in learning more about pharmacogenomics and their professional roles in personalized medicine.     

临床药物个体化治疗技术体系研究进展

临床药物个体化治疗是精准医疗的重要组成部分,代表现代医学的最新发展趋势,旨在保障患者用药安全、有效和经济。近年来随着分子生物学、基因组学和生物信息学技术的进步,临床药物个体化治疗已开始利用药物基因组学、治疗药物监测等技术获得一些良好的治疗效果,新兴的类器官技术也在肿瘤药物治疗领域崭露头角。综述临床药物个体化治疗技术体系研究进展,以期为相关研究和治疗提供参考。