时辰药理学在临床给药护理中的实用价值

为研究机体的昼夜节律对药物作用和体内过程的影响。分别对临床给药护理中的几种常用药物的时辰给药方法进行了阐述，提示在临床给药护理中应充分认识、理解和掌握时辰药理学的有关知识及规律，根据时辰用药，使同等剂量的药物发挥最大的治疗作用。     

论时间治疗学在高血压病药物治疗中的应用

论述血压的昼夜节律性及时间治疗学在高血压病药物治疗中的应用。提出在临床护理中应充分认识、理解和掌握时辰药理学的有关知识及规律，通过时辰用药，使用同等剂量的药物发挥最大的治疗作用，而使其不良反应降低到最低限度。     

时辰药理学及其在中医药中的应用

时辰药理学表明药物的代谢动力学、药效和不良反应具有节律性,临床上根据时辰药理学进行择时给药,可以减小剂量同时达到减毒增效的用药目的。中医时辰治疗是依据人体阴阳消长等节律性变化进行治疗,也是中医学整体观念,辨证施治,因人因时因地制宜的重要体现,具有重要的临床意义。     

1例冠心病合并心房颤动高血压患者的药学服务

目的探讨临床药师在冠心病合并心房颤动（房颤）高血压患者的治疗中如何开展药学服务,以保证患者用药安全有效。方法临床药师参与1例冠心病合并房颤高血压患者的治疗,实施全程化药学监护,包括监测抗凝强度、血压、心室率等指标,根据监护结果提出药物剂量调整及药物选择使用建议,并按照人体生物节律和药物作用时辰制定最佳给药方案,同时对患者进行用药教育。结果临床药师通过提供个体化药学服务,及时发现和解决患者药物治疗中存在的问题,提高了治疗效果和患者用药依从性,改善了患者预后及生活质量。结论该冠心病合并房颤高血压患者的药物治疗方案有效合理。临床药师在促进临床合理用药、提升疾病治疗水平方面可发挥积极作用。     

论时间治疗学在高血压病药物治疗中的应用

论述血压的昼夜节律性及时间治疗学在高血压病药物治疗中的应用。提出在临床护理中应充分认识、理解 和掌握时辰药理学的有关知识及规律,通过时辰用药,使用同等剂量的药物发挥最大的治疗作用,而使其不良反应 降低到最低限度。     

静脉麻醉临床药理学研究进展

设置药物效应隔室及药代-药效统一模型是研究静脉麻醉药在机体内未达稳态状态下的药理学方法。KeO为药物离开药效隔室速率常数,反映了急性用药药物效应的瞬时特征。消除半衰期在判断药物作用恢复中具有一定的局限性,而每次输注结束血浆药物浓度的敏感半衰期(context-sensitive halftime)能较为精确地反映药物作用恢复情况,对合理选择用药及制定给药方案具有重要的意义。     

静脉麻醉临床药理学研究进展

设置药物效应隔室及药代－药产统一模型是研究静脉麻醉药在机体内未达稳态状态下的药理学方法。Ｋｅ０为药物离开效隔室速率常数，反映了急性用药药物效应的瞬时特征。消除半衰期在判断药物作用恢复中具有一定的局限性，而每次输注结束血浆药物浓度的敏感半衰期 为精确地反映的作用恢复情况，对合理选择用药及制定给药方案具有重要的意义。     

“指导性预习”在药理学教学中的应用与探讨

药理学是研究药物与机体相互作用规律及机制的科学,连接医学基础与临床的重要桥梁学科,一方面以生理学、生物化学、病理生理学等基础学科为基础阐明药物的药理作用及原理,另一方面又能够为临床实践中合理用药提供理论依据,在医学系统教育以及临床     

生物信息学(5):药物设计与生物信息学

药物基因组学（pharmacogcnomics）是20世纪90年代末发展起来的基于功能基因组学（functional genomics）与分子药理学的一门科学。它从基因水平研究基因序列的多态性与药物效应多样性之间的关系。即研究基因本身及其突变体对不同个体药物作用效应差异的影响，并以此为平台开发药物．指导合理用药，提高用药的安全性和有效性。避免不良反应。减少药物治疗的费用和风险。     

骨质疏松症治疗药物的分类与用药选择

骨质疏松症是影响老年骨骼健康的主要疾病，其致残率和致死率高，严重影响着患者的生活质量和寿命，并给家庭和社会带来巨大人力和经济负担。随着人口老龄化进程的加剧，骨质疏松症越来越为社会所关注，抗骨质疏松药物研究已成为热点。传统的分类方法是按药物作用机制进行分类，种类繁多的药物使临床用药选择困难。治疗过程中应该既要考虑药物作用机制又要考虑患者个体机能，本着方便选择用药的原则进行了重新分类。     

Hypertension and survival in chronic hemodialysis patients--past lessons and future opportunities

There is substantial controversy surrounding the benefits of control of hypertension in hemodialysis patients. Unlike the general population, some studies suggest that higher blood pressure in hemodialysis patients offers a survival advantage, what is termed as "reverse epidemiology." To critically analyze the relationship between total and cardiovascular mortality and blood pressure, peer-reviewed, published studies in hemodialysis patients were analyzed. Consideration of the world-wide experience suggests that analysis of incident cohorts reveal a clear link between elevated blood pressure and mortality. Increased pulse pressure, which is primarily due to increased systolic pressure, is also associated with cardiovascular morbidity and mortality. The counterintuitive relationship between blood pressure and mortality appears, in part, to be due to methods of data analysis. When data are analyzed with systolic or diastolic blood pressure as separate models, not conjointly, inverse relationship between blood pressure and total and cardiovascular mortality is generally seen. When both systolic and diastolic blood pressure are considered together, systolic blood pressure or increased pulse pressure assumes a major importance in predicting cardiovascular events whereas diastolic blood pressure retains the inverse relationship. Control of hypertension in hypertensive dialysis patients is associated with improved survival. Furthermore, the use of antihypertensive drug treatment is associated with improved survival regardless of blood pressure control. Low predialysis blood pressure is associated with increased cardiovascular deaths and deaths within 2 years from malignancy or withdrawal from dialysis. These data suggest that hypertension needs to be better controlled in hypertensive hemodialysis patients. Better methods of assessment of blood pressure control, consideration of cardiac structure and function, and performance of randomized controlled trials of pharmacologic and nonpharmacologic strategies are needed to establish benefits and determining goal blood pressure in hemodialysis patients.     

Current medicinal approaches to the treatment of rheumatoid arthritis

Aspirin, nonacetylated salicylates, and numerous other nonsteroidal antiinflammatory drugs (NSAIDs) are used in rheumatoid arthritis (RA) patients to decrease joint inflammation and improve function. The choice of medication and its optimum dosage must be individualized because of marked intersubject variations in drug metabolism, excretion, antiinflammatory and analgesic efficacy, and susceptibility to adverse effects. Equivalent doses of aspirin and of nonacetylated salicylates are equally antiinflammatory in RA, although the nonacetylated salicylate is a poor inhibitor of prostaglandin synthesis. Chronopharmacology studies suggest that many patients may have better efficacy and fewer side effects with evening doses than with morning doses of certain NSAIDs; however, the optimum time must be individualized by trial and error because some patients do better with other regimens. The gastric, renal, and platelet adverse effects of NSAIDs are related to their inhibition of prostaglandin synthesis, and tend to be related to dose and intensity of therapy. Various strategies can minimize the impact of these side effects, such as coadministration of gastric protectants or the use of short half-life NSAIDs to decrease the duration of preoperative NSAID withdrawal needed to ensure adequate platelet coagulation during surgery. An intramuscular analgesic NSAID is now available and is reported to be equivalent to morphine sulfate in some painful postsurgical conditions. Although associated with many problems, chronic corticosteroid therapy is, or has been, a major therapeutic component for many RA patients who consequently are unable to respond adequately to the stresses of general anesthesia and surgery because of complete or partial adrenal insufficiency. These patients must be given appropriate supplemental corticosteroid therapy perioperatively.     

Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--9. Control of intraoperative hypertension with diltiazem

Intraoperative hypertension over 160 mmHg systolic and sinus tachycardia over 100 bpm are often observed during total intravenous anesthesia with droperidol, fentanyl and ketamine. Fifty-seven surgical patients who developed hypertension over 160 mmHg systolic during various operative procedures under this type of anesthesia were given diltiazem intravenously to overcome the situation. Their blood pressure and heart rate decreased soon after the administration of diltiazem. The rate pressure product was reduced significantly. Neither preoperative hypertension nor difference of doses between 5 mg and 10 mg of diltiazem had any significant relationship with hypotensive effect of intravenous diltiazem. But the higher the systolic-pressure was just before the administration of diltiazem, the more effective diltiazem was. No adverse effects with this drug was observed. We can conclude that intravenous diltiazem in a dose of 5 mg or 10 mg may be repeatedly given to overcome hypertension or sinus tachycardia during this type of anesthesia without any adverse effects.     

Baroreflex stimulation in the treatment of hypertension

PURPOSE OF REVIEW: It is not uncommon for hypertension to be resistant to the effects of medical therapy, and this poses a significant risk of adverse cardiovascular events. Electrical stimulation of the carotid sinus is a novel treatment for hypertension, and has been shown to reduce blood pressure by activating the baroreflex and reducing sympathetic tone. RECENT FINDINGS: Evidence suggests that the baroreceptors play a more important role in long-term blood pressure regulation than was once believed. It appears that the baroreflex attenuates chronic hypertension in large part by inhibiting renal sympathetic tone. Animal and human studies have demonstrated a safe and effective lowering of blood pressure with chronic electrical stimulation of the carotid sinus, and have generated enthusiasm for implantable carotid sinus stimulators in the treatment of hypertension. SUMMARY: Electrical baroreflex stimulation appears safe and effective, and may represent a useful adjunct to medical therapy in patients with resistant hypertension.     

Analysis of hypertension in children post renal transplantation —a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

Hypertension is common in children after renal transplantation and is associated with multiple factors. Data regarding the prevalence of post-transplant hypertension and the relationship between immunosuppressive drugs and the presistence of hypertension in a large population of North American children have not been available. This study was designed by the North American Pediatric Renal Transplant Cooperative Study to evaluate in a large diverse multicenter population of children the prevalence of hypertension post transplantation, the type of antihypertensive medication used to treat this hypertension and to determinc the relationship between the blood pressure control and the immunosuppressive therapy. Analysis of 277 patients showed the following: (1) 70% of recipients required antihypertensive medications 1 month post transplant compared with 48% pre transplant; the incidence decreased to 59% at 24 months; (2) the majority of children received multiple drug therpay to control blood pressure; (3) hypertension can be controlled effectively despite inherent etiological factors, such as allograft source, prior hypertension and immunosuppressive therapy.     

Vascular compliance and arterial calcification: impact on blood pressure reduction

PURPOSE OF REVIEW: The aim of this article is to review the relationship between vascular calcification and difficult to control hypertension. This does not address antihypertensive treatment of drug resistant hypertension per se. RECENT FINDINGS: Vascular calcification occurs in a variety of common hypertension scenarios. Basic mechanisms of how and why vessels calcify are reviewed including new genetic insights. The potential for contributing to or improving calcification through drug therapies for nonhypertensive disorders is reviewed. SUMMARY: Vascular calcification is common and easily recognized. Studies that target its clinical consequences (arterial stiffness) as primary treatment goals are needed.     

Analgesic nephropathy: etiology, clinical syndrome, and clinicopathologic correlations in Australia.

Analgesic abuse is a major public health hazard in Australia, and analgesic nephropathy with consequent terminal renal failure is the underlying cause in 20% of the patients requiring dialysis and transplantation. Analgesics are invariably taken in the form of compounds and mixtures. In the aspirin-phenacetin-caffeine (APC) mixture, aspirin appears to be the major nephrotoxic agent and phenacetin appears to play a secondary and synergistic role. The renal disease associated with abuse of analgesics is characteristic and is part of a much wider clinical syndrome, the analgesic syndrome, which includes peptic ulcer disease (35%), anemia (60 to 90%), hypertension (15 to 70%), ischemic heart disease (35%), psychological and psychiatric manifestations, pigmentation, and possible gonadal- and pregnancy-related effects. The primary lesion in analgesic nephropathy is renal papillary necrosis (RPN), and this is a nephrotoxic effect common to all nonsteroid antiinflammatory agents. The most important factor in the management of patients with analgesic nephropathy is the cessation of analgesic abuse, and this leads to improvement and stabilization of renal function. A small proportion of patients will, however, deteriorate in relation to accelerated hypertension, persistent proteinuria, ischemic heart disease, and complications leading to nephrectomy. Patients with analgesic nephropathy are poor risk patients and have a poor prognosis, even after dialysis and transplantation.     

Primary hyperparathyroidism and hypertension

A causal relationship between hyperparathyroidism and hypertension has been presumed to exist. In order to determine the nature of any such relationship, 50 patients with primary hyperparathyroidism and diastolic hypertension undergoing surgical correction of hypercalcemia (study group) were compared to 50 matched eucalcemic patients with diastolic hypertension of similar magnitude undergoing equivalent elective surgery (control group). There were no significant differences in average preoperative diastolic pressures, average postoperative diastolic pressures, or the magnitude of early postoperative reduction in diastolic pressure between the study and control groups (P greater than 0.05). Bed rest may play a significant role in the early postoperative reduction in blood pressure frequently observed in patients undergoing correction of hyperparathyroidism.     

Acute pulmonary hypertension causes depression of left ventricular contractility and relaxation

BACKGROUND AND OBJECTIVE: The haemodynamic effects of acute pulmonary hypertension can be largely attributed to ventricular interdependence during diastole. However, there is evidence that the two ventricles also interact during systole. The aim of the present study was to examine the effects of acute pulmonary hypertension on both components of left ventricular systole, i.e. contraction and relaxation, using load-independent indices. METHODS: Ten pigs were instrumented with biventricular conductance catheters, a pulmonary artery flow probe and a high-fidelity pulmonary pressure catheter. Haemodynamic measurements were performed in baseline conditions and during stable pulmonary vasoconstriction induced by the thromboxane analogue U46619. Contractility was quantified using the end-systolic pressure-volume and preload recruitable stroke work relationships. The tau-end-systolic pressure relationship was used to assess load-dependency of relaxation. RESULTS: Acute pulmonary hypertension caused a decrease in the slope of the left ventricular preload recruitable stroke work relationship (from 6.64 +/- 1.7 to 5.19 +/- 1.9, mean +/- SD; P < 0.05), a rightward shift of the end-systolic pressure-volume relationship (P < 0.05), and an increase in the slope of the tau-end-systolic pressure relationship (from -0.15 +/- 0.5 to 0.35 +/- 0.17; P < 0.05). The diastolic chamber stiffness constant of both ventricles increased during pulmonary hypertension (P < 0.05). CONCLUSIONS: In the present model, acute pulmonary hypertension impairs left ventricular contractile function and relaxing properties. The present study provides additional evidence that, besides the well-known diastolic ventricular cross talk, systolic ventricular interaction may play a significant role in the haemodynamic consequences of acute pulmonary hypertension.