在成人药理学教学中开设临床知识专题讲座的尝试及效果评价

目的:探索临床知识专题讲座法在成人药理学教学中的教学效果.方法:以临床医学专业2007级1班作为对照组,采用传统教学模式2班作为实验组,采用在总学时不变的前提下,增加7次临床知识专题讲座的教学模式.比较两组学生的理论考试成绩,并问卷调查学生对药理学教学中结合临床知识专题讲座的评价.结果:考试成绩分析显示实验组学生成绩明显优于与对照组(P<0.01),问卷调查结果显示实验组对教学效果评价分数高于对照组(P<0.05).结论:在成人药理学教学中结合临床知识专题的教学模式明显优于传统教学模式,适宜在成人药理学教学中推广应用.     

1例恶性综合征的药学监护

目的:运用药动、药理学知识,帮助临床制定治疗方案,探讨临床药师在临床治疗团队中的作用。方法:通过1例抗精神病药致恶性综合征的案例,临床药师全程跟踪患者情况,进行药学干预,调整治疗方案并进行药学监护。结果:患者病情好转出院。结论:临床药师在药源性疾病诊治中具有一定的作用。     

输液泵应用过程中的药学服务指导

目的:促进输液泵在临床治疗过程中的合理应用。方法:通过临床药师查房,应用药动学、药效学以及临床药理学知识对输液泵应用进行指导。结果与结论:临床药师通过对输液泵应用进行药学服务指导,可以提高输液泵输液的安全性和有效性,减少不良反应的发生。     

时辰药理学与临床合理用药

目的 介绍时辰药理学对临床合理用药的指导作用,提高合理用药水平.方法 参考相关文献资料并结合临床用药实际,从人体生物节律及药理学等角度汇总、分析给药时辰的重要性.结果 同一药物同等剂量因给药时间不同,作用也会不一样.结论 应根据时辰药理学确定最佳给药时间和剂量,以提高疗效,减少不良反应.     

时辰药理学与临床用药决策

目的：介绍时辰药理学对临床用药决策的指导作用，以提高合理用药水平。方法：参考国内外的有关文献，结合临床用药实际，从人体生物节律及药理学的角度，分析和阐述给药时辰的重要性。结果：药物具有最佳使用时间性。同一种药物，同一种剂量，在一天中的不同时间给药，产生的效果不同，甚至相差数十倍。结论：临床上若按照最佳给药时间来使用药物，既可提高药效，减少用药量，又可减少不良反应的发生。     

时辰药理学与合理用药问题的分析

目的:分析总结时辰药理学与合理用药之间的关系,为临床上用药按照药物的时辰药理性提供一个参考的价值,使临床用药更加合理科学。方法:依据各种文献,再根据临床实际情况,通过将各个方面关于时辰药理学合理用药的相关知识与临床用药情况进行综合后分析得出结论。结果:通过统计分析,各药物发挥作用都有其最佳时间,同种药物在不同时间段使用也发挥着不同的效果,在时间效果上有着很大的差异。结论:临床上应该根据药物的时辰药理学进行给药,将药物的药效发挥出最佳效果,使疗效进一步提升。     

时辰药理学的临床药学实践

目的介绍时辰药理学的临床药学实践方法及体会。方法从时辰药理学、知识准备、实践方法和案例分析体会来加以介绍。结果依据时辰药理学确定临床用药方案,可减少药物不良反应,提高药物疗效。结论时辰药理学用于临床药物治疗中,意义重大。     

环孢菌素A在小儿肾脏病中的应用

环孢菌素Ａ已广泛用于器官移植和自身免疫性疾病。在小儿肾脏病中环孢菌素Ａ主要用于肾移植及肾病综合征。本文重点讨论与环孢菌素Ａ实际应用有关的药理学和在小儿肾脏病中的临床知识。     

时辰药理学与临床合理用药

目的介绍时辰药理学对临床用药决策的指导作用,以提高合理用药水平。方法参考有关文献,结合临床用药实际,从人体生物节律及药理学角度,分析和阐述给药时辰的重要性。结果同一药物在1天中不同的时间给药,其疗效和毒性不同。结论根据人体生理活动的昼夜节律与药物作用的时间节律来指导临床制定最佳用药方案,可以更有效地提高疗效,减轻毒副作用。充分体现时辰用药的优越性。     

临床药师参与大剂量左旋氨氯地平中毒解救的药学实践

目的:探讨临床药师在左旋氨氯地平中毒解救中的工作模式。 方法:临床药师参与诊治1例左旋氨氯地平中毒致顽固性低血压,经钙剂拮抗、补液扩容、正性肌力药升压以及血液净化等治疗,并以呼吸机辅助通气后疗效不佳的患儿,运用药学知识,分析氨氯地平的药理学、药动学等药物特性,并参考国内外氨氯地平中毒救治方案的文献,提出了增加葡萄糖酸钙给药剂量,并加用高胰岛素/血糖正常的治疗方案,医师接受此方案。结果:改用该方案治疗5 d后,患儿症状明显好转,最终无后遗症出院。结论:临床药师在临床治疗团队中充分运用其扎实的药学知识,在临床药物治疗过程中起到重要作用。     

中国临床药理学发展概况与展望

临床药理学是研究药物与人体之间相互作用及其规律的一门科学,是涉及药理学、医学、药物学、生物学、护理学、毒理学、流行病学、遗传学、数学、统计学、经济学、社会和个体行为学等多学科的交叉学科或综合学科.主要研究内容包括人体(正常,病人)的药动学、药效学和遗传药理学、临床药物评价和Ⅰ、Ⅱ、Ⅲ、Ⅳ期临床试验、治疗药物检测、药物警戒、药物利用、药物流行病学、药物经济学、新药发现与开发等.以往认为临床药理学是药理学的分支学科,还有将药物临床试验等同于临床药理学,均难以涵盖临床药理学的研究内容.临床药理学是指导药物临床合理使用、新药临床安全性有效性评价以及新药发现与开发的科学基础.改革开放以来,中国临床药理学研究经历了知识普及与队伍培育、规范研究与不断提高、蓬勃发展与着力创新三个阶段,在指导临床合理用药、药物临床研究、新药创制、人才培养、国内外学术交流、著作教材和期刊建设以及学术组织建设等方面发挥了重要作用.该文就改革开放以来我国临床药理学发展概况与进展作一简要综述.     

Clinical pharmacology training in India: Status and need

Clinical pharmacologists undertake many tasks, and this makes defining a curriculum challenging. This is especially so under the changing circumstances in developing countries, where clinical pharmacology has an expanding role. The clinical pharmacologist may be responsible for conducting ethical clinical trials, supporting the needs of the generic drug industry, providing access to safe, effective and affordable medicines, guiding their rational use, achieving millennium development goals, and supervising medicines management standards for hospital accreditation. Clinical pharmacologists, including those in developing countries, have a great opportunity to contribute to public health and the growth of pharmaceutical industry, but at present, less clinical research is undertaken and fewer clinical trials are done than might be expected. Here we review clinical pharmacology training in India, consider the needs of different professionals contributing to clinical research and medicines utilization, and suggest ways in which current programs can be modified and new programs started. The conclusions are relevant to clinical pharmacology in both the developing and the developed world.KEY WORDS: Clinical pharmacology, clinical research, education, pharmaceutical medicines, training     

对临床药理学一些基本问题研究的思考

临床药理学是研究药物与人体相互作用及其规律的一门学科。临床药理学基本原理在药物的临床研究与评价、药物不良反应监测等方面做了大量工作,取得了明显进展。然而,对临床药理学的共性、关键性和前沿性的基本问题研究更应给予高度关注,在进一步做好常规性临床药理学服务工作的同时,积极加强临床药理学学术问题的探索,为临床安全有效合理用药提供理论支撑。药物相互作用、多药耐药(MDR)、遗传药理学、药物基因组学、药动学/药效学(PK/PD)模型、性别药理学、基于药物作用于人体病理组织细胞的药效学和分子机制的研究等临床药理学的共性、关键性和前沿性问题已引起人们的重视。本文就临床药理学研究的一些基本问题的思考作一简述。     

Instruction in clinical pharmacology: changes in the wind

We have presented some views on past, present and potential trends for teaching clinical pharmacology in the medical curriculum. Clinical pharmacology as subject matter in the medical curriculum has been operationally defined for our purposes as: (1) the application of fundamental principles of basic pharmacology to rational drug therapy in humans; and (2) the application of appropriate nuances of the human pharmacology of individual drugs to their use in particular disease states. In terms of improving the results of drug therapy, arguments were advanced for the importance of teaching clinical pharmacology at all levels in the medical curriculum and in postgraduate medical education. The introduction of so many new and potent pharmaceuticals over the past 25 years requires well educated and skilled medical practitioners adept and well versed in the fundamental principles of basic and applied pharmacology, so as to achieve the most prudent, effective and economically sound use of these drugs as possible. This creates a challenge to medical educators, particularly those involved in teaching clinical pharmacology, to devise innovative teaching techniques and curricular changes that foster these goals. In an attempt to address these challenges, we have reviewed some innovative teaching approaches and curricular reforms, both published and unpublished, that have already met with success, and we have also discussed some future trends in teaching both undergraduate and graduate physicians the fundamental principles of rational drug therapy. The challenges and issues involved in these future trends have been identified and will be addressed in subsequent articles in this journal. These will be concerned with teaching clinical pharmacology: (1) in basic medical pharmacology courses; (2) to upperclass medical students; and (3) in continuing medical education programs. Subsequent articles will also deal with new and innovative teaching modalities for clinical pharmacology and with the role of the drug industry in these modalities.     

Clinical research: the influence of the pharmaceutical industry

OBJECTIVE: The aim of the investigation is to throw light on the influence of the pharmaceutical industry on clinical research in Norway. The files of the five regional medical research ethics committees, which contain the application forms and the protocols of all the research projects on humans, were used as source for the statistics. The projects were first classified and registered in two groups: pharmacology/pharmacotherapy and others. Then the pharmacology/pharmacotherapy group was divided into projects sponsored or initiated by the industry and others. RESULTS: In the 3 years 1988-1990, the yearly average number of projects was 360. Sixty-two percent of the projects were pharmacology/pharmacotherapy; seventy-nine percent of these projects were conducted by the industry. The corresponding figures for the year 1997 were 747, 40% and 68%, respectively. We have not been able to find similar statistics from other countries. CONCLUSION: Our conclusion is that research in pharmacology/pharmacotherapy should be more independent of industry.     

Applications of stable isotopes in clinical pharmacology

This review aims to present an overview of the application of stable isotope technology in clinical pharmacology. Three main categories of stable isotope technology can be distinguished in clinical pharmacology. Firstly, it is applied in the assessment of drug pharmacology to determine the pharmacokinetic profile or mode of action of a drug substance. Secondly, stable isotopes may be used for the assessment of drug products or drug delivery systems by determination of parameters such as the bioavailability or the release profile. Thirdly, patients may be assessed in relation to patient-specific drug treatment; this concept is often called personalized medicine. In this article, the application of stable isotope technology in the aforementioned three areas is reviewed, with emphasis on developments over the past 25 years. The applications are illustrated with examples from clinical studies in humans.     

Regression to the mean: a potential source of error in clinical pharmacological studies

The design and interpretation of clinical trials in clinical pharmacology must avoid certain pitfalls to be useful in guiding drug therapy decisions. Here, we discuss one important problem in clinical trial design, the problem of regression to the mean. Because certain disease states tend to wax and wane in severity and because patients tend to present for treatment when disease activity is high, the expected course of the disease is improvement. Therefore, any treatment begun will appear to lessen disease activity. We give four examples of diseases where improper and inadequate recommendations for drug therapy have been made based on clinical trials that ignored the problem of regression to the mean: vasospastic angina, rheumatoid arthritis, chronic congestive heart failure, and renal stones. Studies of drug therapy in diseases such as these should be conducted with concurrent placebo controls rather than having each patient serve as his own control.     

精准药学教育与临床药理学专业培养的相互性

临床药理学学科的应用是实现精准药学的基石.本文从理论教学与技能实践角度,探讨在精准医疗背景下,以精准药学为导向,运用多元化教学方法,提升临床药理专业学生的综合素质,加强师资团队能力,培养适应精准医疗发展要求的临床药理学专业人才.     

左旋氨氯地平的临床药理及临床应用

本文综述了左旋氨氯地平的临床药理、近年来临床应用、不良反应及与其他药物联合应用的情况。     

青年教师药理学教学体会

药理学不仅是医学和药学的基础学科,也是一门桥梁学科,药理学教学质量的好坏直接影响到学生临床课的学习甚至将来的行医水平。作者总结药理学教学体会,旨在与青年教师交流共勉,藉此提高药理学教学质量。