苏州大学附属常熟医院滨江院区门诊糖皮质激素类药处方与合理用药分析

目的:了解苏州大学附属常熟医院滨江院区门诊糖皮质激素类药的使用情况,促进临床合理用药。方法:抽取该院门诊2013年7—12月的8 998张处方,对其中糖皮质激素类药在各科室的使用情况进行统计分析。结果:糖皮质激素类药在该院门诊各科室应用广泛,占9.02%。其中,皮肤科、耳鼻喉科、儿科、眼科和口腔科使用率分别为50.91%、28.48%、28.02%、15.78%和6.36%;糖皮质激素类药处方构成比排序前5位的科室分别是儿科(33.37%)、内科(23.52%)、耳鼻喉科(17.12%)、皮肤科(13.79%)和眼科(7.27%);<20岁的患者使用率最高(42.49%,345/812);醋酸泼尼松片使用频率最高(24.85%,206/829);使用患者男女比例为1.16∶1。结论:该院糖皮质激素使用情况基本符合《糖皮质激素类药临床应用指导原则》,较为合理,少数处方存在不合理应用现象。建议贯彻执行《糖皮质激素类药临床应用指导原则》,加强临床药学工作,提高用药合理性与安全性。     

某院门诊糖皮质激素类药物应用处方分析

目的:分析某院门诊糖皮质激素类药物的使用情况,促进合理用药。方法:随机抽取该院门诊2012年7-12月处方共计14 115张,对糖皮质激素类药物在各科使用情况包括科室分布、患者年龄分布、药物品种使用频率、合理性等进行统计分析。结果:糖皮质激素类药物在该院门诊各科均广泛使用,使用率为8.01%。其中,皮肤科使用率为48.50%,耳鼻喉科为25.75%,眼科为7.79%,儿科为6.73%,内科为5.40%;41~60岁患者使用率最高(占30.88%);地塞米松注射液使用率最高(占30.86%)。使用情况基本符合《糖皮质激素类药物临床应用指导原则》,较为合理,少数处方存在不合理应用的现象。结论:贯彻执行卫生部《糖皮质激素类药物临床应用指导原则》,加强临床药学工作,有助于提高用药的合理性与安全性。     

我院2010年门诊抗菌药物使用情况调查

目的:了解我院2010年门诊抗菌药物的使用情况,促进抗菌药物的合理使用。方法:2010年门诊处方每季度随机抽查一次,每次抽查连续3d的门诊全部处方,总计7932张,对抗菌药物使用情况进行分析评价。结果:使用抗菌药物的处方占抽查处方总数的31.24%,所使用的抗菌药物共7类。使用率排序前2位的科室依次为儿科(83.82%)、眼耳鼻喉科(54.80%)。使用率排序前3位的抗菌药物依次为头孢菌素类(50.44%)、大环内酯类(24.97%)、喹诺酮类(11.95%);抗菌药物单用处方占抗菌药物处方总数的95.88%,单病种类使用率最高的是上呼吸道感染,占25.91%。结论:我院门诊抗菌药物的使用基本合理,但临床使用抗菌药物的管理有待加强,同时应密切关注病原菌耐药问题。     

某“三甲”医院2011—2013年门诊糖皮质激素类药应用分析

目的：评价某＂三甲＂医院门诊糖皮质激素类药的使用情况,促进临床合理用药。方法：随机抽取该院2011年11月至2013年11月172 500张门诊处方,其中糖皮质激素处方22 425张,对处方中的药物品种、使用科别、给药途径以及不合理用药情况进行统计分析。结果：糖皮质激素类药在该院门诊使用广泛,处方使用率占13.00%,其中皮肤科使用率达34.00%,且注射用地塞米松磷酸钠的使用率最高（32.32%）,给药途径以静脉滴注方式最为常见,不合理处方比例为28.27%。结论：该院门诊糖皮质激素类药还存在不合理使用现象,医药人员应高度重视。     

某医院10800张儿科门诊处方中抗菌药物使用的相关因素分析

目的:分析某医院儿科门诊抗菌药物的使用现状,为抗菌药物合理用药提供参考。方法:抽取2017年度儿科门诊处方10 800张,统计与分析其使用抗菌药物的处方数及其种类、给药途径、联合用药、不合理用药处方等相关因素。结果:10 800张处方中,6 825张处方使用了抗菌药物(占63.19%),药物类别主要以头孢菌素类为主;使用频次排名前3位的抗菌药物分别为头孢克肟颗粒(20.50%)、注射用五水头孢唑林钠(16.94%)和注射用头孢噻肟钠舒巴坦钠(6.45%);口服给药占54.46%,注射给药占39.43%,外用给药占6.11%;单一用药处方4 644张占68.04%,二联用药处方2 181张占31.96%,未见三联用药现象;抗菌药物使用不合理处方258张占3.78%。结论:在医院儿科门诊中,抗菌药物的使用存在一些不合理现象,应加强干预与监管以确保患者用药的安全、有效。     

2012—2014年焦作市第二人民医院儿科门诊处方抗菌药物应用合理性分析

目的:分析儿科门诊抗菌药物处方使用现状,为儿科合理用药提供参考。方法:随机抽取河南省焦作市第二人民医院2012—2014年3年儿科门诊处方,对抗菌药物的销售金额、用药频度(DDDs)、限定日费用(DDC)等进行统计、分析。结果:该院2012—2014年儿科门诊处方中,抗菌药物使用率为26.2%,其中头孢菌素类和大环内酯类抗生素使用居多,给药途径以静脉滴注为主。不合理使用率为17.1%。结论:该院儿科门诊抗菌药物处方存在一些不合理用药现象,医生、药师需要加强专业知识学习,确保用药安全、有效、合理。     

我院门诊儿科糖皮质激素合理使用情况分析

目的 统计分析我院门诊儿科糖皮质激素类药物的应用情况,旨在为糖皮质激素类药物临床合理应用提供一定的参考依据.方法 选取2016年1月到2016年12月期间我院儿科门诊使用糖皮质激素治疗的300份病例资料作为研究对象,统计300份病例的糖皮质激素使用情况,包括给药途径、常用药物以及不合理用药分布等,为糖皮质激素类药物在儿科门诊中的临床应用提供参考依据.结果 300份糖皮质激素类药物处方中给药途径包括注射、口服、雾化吸入及其他,其中注射给药的有162份处方,其代表性药物为氢化可地松粉针,占83.3％;口服给药的有81份处方,其代表性药物为泼尼松片,占61.7％;雾化吸入给药的有54份处方,其代表性药物为布地奈德雾化液,占88.9％;其他给药途径的有3份处方.300份处方药中有25份存在不合理用药情况,比例为8.3％;其中适应证不适宜的有17例,占68.0％;遴选药品不适宜的有3例,占12.0％;用法用量不适宜的有2例,占8.0％;药品剂型或给药途径不适宜的有2例,占8.0％;重复给药的有1例,占4.0％.结论 我院儿科门诊糖皮质激素类药使用普遍合理,但存在部分不合理使用情况,有待加强管理,提高糖皮质激素在儿科门诊中的安全合理应用.     

我院儿科门诊抗菌药物使用分析

目的:了解本院抗菌药物在儿科门诊的使用现状及存在的问题.方法:随机抽取2007年9月～2008年6月每月连续10 d的儿科门诊处方,对抗菌药物使用情况进行统计分析,并评价用药合理性.结果:我院儿科门诊抗菌药物使用率为56.26%,涉及6类15个品种,头孢菌素类使用率最高(38.54%),其次为大环内酯类(33.58%)和青霉素类(21.39%);联合用药只占抗菌药物处方的10.62%;用药频度(DDDs)前10位的抗菌药物只有头孢曲松钠的药物利用指数(DUI)>1.0.结论:抗菌药物使用中仍存在一些问题,应加强抗菌药物合理使用的培训及管理,提高儿科抗菌药物合理应用水平.     

儿科门诊处方抗菌药物不合理使用分析

目的通过调查儿科门诊处方,探讨分析我院儿科门诊抗菌药物使用不合理情况。方法随机抽取2011年1～4月儿科门诊处方2 400张,统计分析抗菌药物使用率,使用频率、不合理使用等情况。结果抗菌药物使用率74.83%,单联使用抗菌药物占77.88%,二联使用抗菌药物占22.12%;抗菌药物使用频率排前3位的为:头孢菌素类,青霉素类,大环内酯类;不合理使用表现为药物选择不合理、重复用药、联用不当、溶媒选择不当等情况。结论儿科门诊存在抗菌药物使用率过高;抗菌药物注射剂使用过高;抗菌药物使用不合理情况,有关职能部门应加大抗菌药物使用监管力度。     

某院2013-2015年门诊糖皮质激素处方分析

目的:为临床合理使用糖皮质激素提供参考。方法:抽取某院2013年1月-2015年6月门诊各科室使用糖皮质激素的处方,对糖皮质激素使用情况、处方科室分布、药品使用频次、处方诊断分布等进行统计分析。结果:15 000张处方中,使用糖皮质激素的有1 562张,使用率为10.4%;其中判断为不合理的处方有189张,不合理率为12.1%。糖皮质激素使用比例最高的科室为耳鼻喉科(27.66%),不合理用药比例较高的是儿科(16.12%);使用频率最高的是地塞米松注射液(44.88%);使用糖皮质激素处方诊断最多的是急性支气管炎、支气管炎(267张处方)。结论:该院在糖皮质激素使用过程中存在不合理用药现象,应引起重视并进一步加强处方审核和点评,以确保糖皮质激素在临床使用的安全、有效。     

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。     

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.     

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.     

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.     

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.