高效液相色谱法测定复方辛伐他汀烟酸缓释片的有关物质

目的 建立复方辛伐他汀烟酸缓释片有关物质检查的HPLC方法.方法 采用C18柱,以乙腈-0.1%磷酸溶液(50∶50)为流动相A,0.1%磷酸的乙腈溶液为流动相B,梯度洗脱,对辛伐他汀的有关物质进行检测;以乙腈-0.05mol·L-1磷酸二氢钠溶液(磷酸调pH至2.5)(1∶99)为流动相,对烟酸进行检测.结果 在建立的色谱条件下,辛伐他汀、烟酸峰与其相关杂质峰均能完全分离.结论 本法简便、准确、专属性强,可用于本品的有关物质检查.     

我院电子处方的使用对儿科门诊处方质量的影响

目的：探讨电子处方的使用对儿科门诊处方质量的影响。方法：我院2013年9月开始实施电子处方制度,从我院儿科门诊2013年8月至2014年2月单数日期处方中,每月随机抽取300张处方进行回顾性分析（2013年9月后均抽取电子处方）,计算处方合格率,统计分析不合理处方情况。结果：我院儿科门诊2013年8月至2014年2月各月份的处方合格率依次为64.00%、80.67%、88.00%、87.33%、91.67%、96.33%、97.67%。不规范处方、用药不适宜处方、超常处方三类不合理处方均在电子处方制度实施（2013年9月）后大幅减少,甚至已杜绝。结论：电子处方质量远高于手写处方,电子处方能对医师不合理处方行为进行主动干预,有效减少用药差错和医疗纠纷的发生,虽然成本较高,对医务工作者要求较严格,但仍值得各级医疗机构推广使用。     

The comparative bioavailability of an extended-release niacin and lovastatin fixed dose combination tablet versus extended-release niacin tablet, lovastatin tablet and a combination of extended-release niacin tablet and lovastatin tablet

Lovastatin and extended-release (ER) niacin in a fixed dose combination (Advicor) is approved for the treatment of dyslipidemia. Since both drugs are extensively metabolized, this study investigated the bioavailability and pharmacokinetics of their co-administration following single-dose administration. In a 4-way crossover study 40 subjects received: two 1000/20 Advicor tablets (ADV), two 1000 mg niacin ER tablets (NSP), two 20mg lovastatin tablets (Mevacor; MEV), and two niacin ER 1000 mg tablets with two lovastatin 20mg tablets (NSP+MEV). Plasma was assayed for niacin, nicotinuric acid (NUA), lovastatin, lovastatin acid and HMGCoA reductase inhibition. Urine was assayed for niacin and its metabolites, NUA, N-methylnicotinamide and N-methyl-2pyridone-5-carboxamide. Least square mean ratios and 90% confidence intervals for C(max) and AUC((0-t)) were determined for NSP+MEV versus MEV or NSP, ADV versus MEV or NSP, and ADV versus NSP+MEV. Co-administration of niacin and lovastatin did not significantly influence C(max) and AUC((0-t)) of lovastatin, niacin, NUA and total urinary recovery of niacin and metabolites. A 22 to 25% decrease in lovastatin acid C(max) was observed while lovastatin acid AUC((0-t)) was not affected. The HMGCoA reductase inhibition C(max) and AUC((0-t)) were not affected indicating that the difference in lovastatin acid C(max) was not clinically relevant.     

门诊处方分析抗高血压药物的使用情况

目的分析我院门诊处方了解抗高血压药物的使用。方法对样本资料中的口服抗高血压药进行统计和分析。结果门诊抗高血压药处方中,总处方数为35777张,含各种抗高血压药物处方1572张;年龄偏大者易发生高血压并发其他疾病;用药类别前3位:CCB、ARB、ACEI;抗高血压药物前5位为:非洛地平缓释片、硝苯地平缓释片)、美托洛尔、依那普利、厄贝沙坦;DDDs排序前5位药品:非洛地平缓释片、硝苯地平缓释片、依那普利、氨氯地平、厄贝沙坦;二联用药444张,占28.2%,三联用药处方102张,占6.5%,四联用药处方4张,占0.3%。结论我院近年来,抗高血压药应用基本合理。     

儿童抗癫痫药物超说明书用药调查分析

目的:了解抗癫痫药物在儿童患者中超说明书用药的情况,并分析原因,为儿童抗癫痫药物的合理使用提供参考.方法:分层随机抽取2012年9月-2013年8月的抗癫痫药物门诊处方,参照药品说明书的内容,判断使用抗癫痫药物的处方是否存在超说明书用药,统计分析超说明书用药的类型,计算超说明书用药发生率.结果:2 400张处方中,超说明书用药共955张,占所有处方的39.79%,主要是超适应证和超年龄用药.抗癫痫药物超说明书用药比例由高到低分别是:唑尼沙胺片(100%)、左乙拉西坦片(95.19%)、拉莫三嗪片(48.08%)、丙戊酸钠片(43.33%)等.结论:抗癫痫药在儿童癫痫患者中超说明书用药的发生率较高,尤其是唑尼沙胺和左乙拉西坦.其中大部分超适应证用药是有循证医学依据的,并非医师盲目用药.儿童用药的特殊性也是造成超说明书用药的重要原因.应尽可能规范超说明书用药行为,促进临床合理用药.     

Formulary-control procedures in a staff-model health maintenance organization

Efforts to promote cost-effective drug prescribing in a health maintenance organization (HMO) through (1) revision of the formulary, (2) education, and (3) drug-use evaluations (DUEs) are described. New programs and procedures to promote more cost-effective prescribing were implemented in 1987 at a staff-model HMO with seven health-care centers and 40,000 members. Support to the pharmacy and therapeutics committee in developing formulary recommendations was enhanced, the formulary was revised and the number of listed drugs reduced by half, the focus of pharmacists was changed from purchasing and inventory control to education of physicians about cost-effective prescribing, and the most expensive drug categories were identified and educational efforts instituted. During the next two years substantial changes in the prescribing of oral contraceptives, nonsteroidal anti-inflammatory drugs, antiulcer agents, and anti-infectives, but not antihypertensive drugs, were identified through DUEs. Evaluation of cost savings was limited by the lack of an automated, integrated patient database, and it was difficult to assess the effect of changes in patient population. Revision of the formulary coordinated with enhanced educational efforts and DUEs resulted in more cost-effective prescribing in an HMO without placing severe restrictions on physicians or patients.     

Evaluation of antibiotics for home care programs

A number of antimicrobial agents have been used successfully to treat patients with chronic infectious diseases in the home health care environment. This diversity in types of antibiotics used reflects more than ten years' development of active home medical care programs. With continuing experience, it is clear that the number and types of antibiotics available on formulary for routine use in home programs can be condensed. Since a patient should in most cases be treated in the home environment with the same antibiotic that has demonstrated efficacy and safety upon initial therapy during hospitalization, the selection of available antibiotics will affect the hospital's formulary selection process. This process must critically evaluate the documented efficacy and safety of each agent, since the drug's primary use will be in a relatively uncontrolled environment, devoid of continuous professional assessment. The beta-lactam antibiotics appear to be preferred agents for outpatient use, particularly as monotherapy. These agents offer desirable in vitro activity and potency, ease of administration, overall efficacy, and safety. However, despite a preference for beta-lactam antibiotics, additional and alternative agents must be routinely available in program formularies.