Drug utilisation in Dutch nursing homes

Objective: To quantify and evaluate drug utilisation in a sample of Dutch nursing homes. Methods: A retrospective analysis of computerised medication data of 2355 residents aged 65 years and over from six nursing homes in the Netherlands was performed. For each therapeutic drug group, the number of users was determined. The ten therapeutic groups used most frequently were investigated further. For these, patient characteristics, use of therapeutic subgroups, the average daily dosages and the chronicity of drug use were determined. Chronicity was expressed as the percentage of treatment days divided by the number of residents' days in the nursing home. Results: During the study period, 89%, 77% and 56% of the study population used a drug from the anatomical therapeutic chemical (ATC) main group N (nervous system), A (alimentary tract and metabolism) and C (cardiovascular system), respectively. Eight of the ten therapeutic drug groups prescribed most frequently were used for more than 50% of the time. In particular, psycholeptic drugs, diuretics and laxatives were used chronically (83%, 81%, and 80% of the nursing home stay, respectively). Except for a few drug groups, such as laxatives and diuretics, the prescribed daily dosages were relatively low. Twenty-eight percent of the residents received loop diuretics; these were prescribed in relatively high dosages. Conclusion: Drug utilisation in the nursing homes was high and many drugs were used chronically. In view of the risk of possible adverse effects and drug–drug interactions, the prescribing and dosage of psycholeptic drugs, laxatives, loop diuretics and ulcer-healing drugs should be re-evaluated, carefully. Received: 11 March 1999 / Accepted in revised form: 19 September 1999     

流浪精神疾病患者住院期间精神药物使用的一日调查

目的：调查分析本院救治病区流浪精神疾病住院患者的药物治疗情况,为临床合理用药提供参考。方法：采用一日法,对精神患者的药物使用日剂量、联合用药情况、治疗方案等方面进行统计分析。结果：351例精神疾病患者中,药物使用日剂量排序前3位的药品为利培酮208例（38.5%）、氯丙嗪51例（9.4%）、苯海索44例（8.1%）;本院第二代抗精神病药物占主导地位,利培酮是首选治疗药物;精神药物的使用以单药为主,有207例（59.0%）,二联用药112例（32.0%）。结论：本院救治病区精神药物的使用结构合理,基本符合我国目前精神药物的应用趋势。     

新疆地区7家医院2007～2009年精神药品利用分析

目的:评价新疆地区医院精神药品的应用情况及趋势。方法:采用回顾性调查方法,对新疆地区7家综合性医院2007～2009年精神药品的应用数据及相关指标进行统计、分析。结果:咪达唑仑注射液、曲马多缓释片和曲马多注射液分列销售金额的前3位,艾司唑仑片、阿普唑仑片、氯硝西泮片分列用药频度的前3位,曲马多注射液用药频度呈减少趋势。结论:该地区精神药品应用趋于合理,但仍需进一步规范临床用药。     

Psychotropic drugs and sidman avoidance in rats: IRT distribution changes

The effects of d-amphetamine, caffeine, chlorpromazine, diazepam and pentobarbital on Sidman avoidance responding (R-S interval, 30 sec; S-S interval, 3 sec) in rats, especially on the interresponse time (IRT) distribution, were studied. d-Amphetamine and caffeine increased the total number of responses. Short IRTs were increased, while longer ones were decreased. Chlorpromazine, diazepam and pentobarbital all increased the number of shocks delivered. After chlorpromazine, no marked change was observed in the total number of responses. However, response bursts and escape responses increased, while IRTs between 3 and 30 sec decreased. After diazepam and pentobarbital, the burst response scarcely increased, and the IRTs in the 3–15 sec range decreased, while the IRTs longer than 33 sec increased. These changes were more marked after diazepam than after pentobarbital. Total number of responses was decreased by both drugs. The present results suggest that in utilizing the Sidman avoidance procedure for psychotropic drug assessment, changes in the IRT distribution give a more precise profile of the drug than is afforded by the total number of responses and shocks delivered.     

2013年1～6月我院门诊精神药品使用分析

目的：了解我院门诊精神药品的使用情况,以提高门诊处方质量和合理用药水平。方法：采用WHO推荐的用药频度（DDDs）和药物利用指数（DUI）等参数,对我院2013年1～6月心身科门诊处方20407张进行回顾性分析。随机抽取1030张处方进行合理用药点评。结果：我院门诊使用的10种精神药品的DUI≤1。女性患者使用量所占比例高于男性患者,占56.31%,且主要分布在18～39岁;使用频率较高的依次是盐酸帕罗西汀片、盐酸舍曲林片、盐酸文拉法辛缓释片。结论：我院精神药品使用基本合理,无滥用现象,但仍存在用药时间过长、联合用药明显、个别药物使用频率高等现象,需要进一步加强管理,确保处方用药合理。     

HPLC法同时监测5种抗精神病药血药浓度

目的:建立以高效液相色谱法同时监测氯丙嗪、氯氮平、氯硝西泮、地西泮、阿普唑仑血药浓度的方法。方法:用乙酸乙酯提取血清中的药物,并进样分析,其中色谱柱为NovapakC18,流动相为甲醇-乙腈-水-三乙胺-冰醋酸(16∶36.5∶47.5∶0.03∶0.02),检测波长为254nm,流速为1.5mL.min-1,柱温为50℃,灵敏度为0.01AUFS。结果:血清中5种药物检测浓度均在0.03～100μg·mL-1范围内线性关系良好,方法回收率为88.6%～98.7%,日内和日间精密度小于5.0%。结论:本方法简便、快速、灵敏、准确、用血量少,可用于临床用药监护以及急性药物中毒快速定性和定量分析。     

住院患者应用第二类精神药品情况分析

目的：评估深圳市妇幼保健院住院患者第二类精神药品的用药情况,为,临床管理和合理用药提供参考。方法：对我院2006-2008年第二类精神药品应用金额、用量、用药频度等进行统计和分析。结果：我院第二类精神药品消耗金额和用量逐年上升,我院住院患者用药频度较高的依次为盐酸曲马多注射液、苯巴比妥钠注射液、地西泮注射液。结论：应合理应用精神药品,减轻患者负担。     

Psychotropic drug use in nursing homes – diagnostic indications and variations between institutions

OBJECTIVE: Psychotropic drug use among nursing home residents with regard to diagnostic indications and patient- and institution characteristics was analysed. METHODS: A cross-sectional study of medication data from 1552 residents at 23 nursing homes in Bergen, Norway, was performed. Psychotropic drug use (neuroleptics, anxiolytics, hypnotics, antidepressants, and two sedative antihistamines) was analysed with regard to prevalence, diagnostic indications, duration of use, and general patient- and institution characteristics. RESULTS: Psychotropic drugs were taken on a daily schedule by 59% of all residents, most commonly as long-term treatment. Antidepressants (in 70% selective serotonin re-uptake inhibitors) were used by 31%, neuroleptics by 23%, and benzodiazepines by 22% of all the residents. Neuroleptics were given for non-psychotic behavioural and psychological symptoms in 66% of the cases. Sleeping disorders were most commonly treated with long-acting benzodiazepine hypnotics. Psychotropic drug use decreased with increasing patient age. Drug use patterns varied greatly between the different nursing homes: the prevalence of neuroleptic use varied from 0 to 61% of the residents, and antidepressant use varied from 10 to 63%. In nursing homes providing relatively more physician staff time, the residents were more likely to use antidepressants. CONCLUSIONS: Psychotropic drugs are used by a majority of nursing home residents as long-term symptomatic treatment. The great variations between the institutions can only to a small extent be explained by quantitative differences between the institutions.     

福州市医疗机构麻醉、精神药品现场考核结果及分析

目的:为医疗机构加强和规范麻醉药品和第一类精神药品管理提供参考。方法:通过参加现场考核,收集、整理福州市各级医疗机构关于麻醉药品、第一类精神药品的管理制度、组织活动记录、人员资格、培训记录、专用处方和管理表格、仓贮状况和安全措施等方面的资料和数据,并对结果进行分析。结果:个别医疗机构存在管理法规落实不到位、管理组织松散、安全意识淡薄、处方不规范等现象。结论:医疗机构要加强麻醉药品、第一类精神药品的管理法规的落实,健全管理组织,强化安全措施,加强人员培训,简化环节和手续,发挥计算机管理的优势。     

我院实施《麻醉药品、精神药品管理(暂行)规定》前后药品应用分析

目的:了解我院实施《麻醉药品、精神药品管理(暂行)规定》(简称《暂行规定》)前、后麻醉药品和精神药品的应用现状及趋势。方法:采用回顾性方法,对我院实施《暂行规定》前、后麻醉药品和精神药品的应用品种、销售金额、数量和用药频度(DDDs)等进行统计、分析。结果:我院麻醉药品和精神药品的销售金额及用量逐年增加。麻醉药品中吗啡缓释片和芬太尼注射液的DDDs一直排在前2位,芬太尼透皮贴的用量上升最快;盐酸哌替啶注射液的DDDs呈减少趋势。精神药品中艾司唑仑片和曲马多缓释片的DDDs排序稳居第1、2位,氯硝西泮片的DDDs稳步上升。结论:我院麻醉药品和精神药品在应用中,超剂量现象得到改善,用药基本合理,但仍存在阿片类药医疗用量不足、剩余药品回收困难、不良反应防治重视不够等问题,不足之处有待进一步改善。     

586例老年精神病患者用药调查分析

目的：了解我院住院老年精神病患者药物使用情况。方法：采用1日法对上海市精神卫生中心住院老年患者全部用药记录进行调查。结果：新型抗精神病药的使用正在逐步扩大,精神疾病首选单药治疗,对于部分难治性病例可使用合并治疗的用药原则基本保持不变;抗精神病药的使用剂量基本都在推荐的安全剂量之下。结论：我院住院老年精神病患者用药基本合理,药物选择多样化,新型化,安全使用精神病药已成为目前临床用药的趋势。     

护理干预对精神药物致糖脂代谢异常影响分析

目的：建立适用于服用精神科药物导致糖脂代谢异常全程指导体系,评估护理干预效果。方法将124例精神障碍服用精神药物患者分为研究组（n=62）和对照组（n=62）,两组分别接受系统护理干预和一般常规护理,采用自行设计的调查量表分别进行问卷调查,并记录对比。结果研究组对精神药物引起糖脂代谢异常的认识,患者饮食、运动、改变生活方式配合,康复期社会功能恢复,家庭康复等管理能力方面与对照组对比,差异有统计学意义（P＜0.01）。患者自我管理能力明显高于对照组（P＜0.01）。结论护理干预符合精神障碍患者及照料者获得专科知识的需要,对精神障碍患者康复指导效果明显。     

我院门诊第二类精神药品处方分析

目的：评估我院门诊第二类精神药品的用药情况，为临床管理和合理用药提供参考。方法：利用我院2006～2007年门诊部的第二类精神药品处方，采用限定日剂量（DDD）和药物利用指数（DUI）分析法，对第二类精神药品的应用进行统计分析。结果：我院门诊常用的6种第二类精神药品的DUl均〈1．0，使用频率较高的依次为艾司唑仑片、地西泮片、唑吡坦片、氯硝西泮片。结果及结论：第二类精神药品应用基本合理，但应用中存在各种不合理原因，有必要引起我们医药人员的高度注意．以促进临床合理用药。     

Therapeutic drug monitoring in psychiatry—is it worthwhile?

Although many drugs used in psychiatry can be assayed in body fluids, the measurement of agents such as the tricyclic antidepressants (TCAs) and the antipsychotic agents in the therapeutic setting remains controversial. This is due to both pharmacokinetic and pharmacodynamic factors. Pharmacokinetically, neither the TCAs nor the antipsychotics meet the criteria for therapeutic drug monitoring, because they undergo extensive first-pass metabolism to active metabolites, their mechanism of action probably involves alteration in receptor responsiveness, and at least for the TCAs protein binding is not constant. The pharmacodynamic end points in assessing depression and schizophrenia have also proved difficult to define; thus the relationship between plasma levels and clinical response has proved elusive. Lithium, alone, is suitable for therapeutic drug monitoring because it has a narrow therapeutic range, is not protein bound, is not metabolized, and there is serum level variability for the same dose. Besides this agent, plasma level measurement is unlikely to add any benefit to the patient in the clinical setting.