药源性牙龈增生

目的 探讨药源性牙龈增生的致病机制及其防治方法，为临床合理用药提供参考。方法 检索国内外有关文献，进行文献综述。结果 引起药源性牙龈增生的药物主要有钙拮抗剂、抗癫痫药物和免疫抑制剂环孢素A等。致病机制多种多样，但主要与降低牙龈成纤维细胞表面α2β1整合素与胶原的亲和力、降低胶原的吞噬作用，从而导致Ⅰ型胶原的堆积有关。合理选药和保持口腔卫生是预防牙龈增生的有效方法，牙龈切除仍然是治疗严重牙龈增生的主要方法。结论 药源性牙龈增生可影响咀嚼、语言、刷牙和美容，但一般无严重的临床后果，医务工作者和患者对药源性牙龈增生都应有所认识。     

药物引起的牙龈增生

牙龈增生是牙龈的一种特发性炎症反应,其临床主要表现为:病损主要累及牙间乳头和缘龈,只有少数严重病例波及附着牙;增生牙龈呈桑葚状,或有小的分叶,质地坚实,呈淡粉红色,一般不出血,不痛;病损可累及全口牙龈,但上下前牙区较重.其临床诊断主要为:牙龈纤维瘤与药物性牙龈增生.     

药源性胃肠疾病

药物引起的胃肠器官的不良反应(ADR)非常普遍.胃肠疾病中大约20%是由药物引起的.据英国黄卡片资料显示:在1996年所收到的ADR中,涉及到胃肠(GI)的为17.5%,其中严重反应占14.5%.其损害包括功能障碍、中毒、溃疡、穿孔和出血等.涉及的器官可以是从口腔、食管到直肠的任何部位.临床药师认为,用药病人有大约25%有胃肠ADR,涉及的药物面较宽,既有处方药又有非处方药.常见的药物有阿司匹林和非甾体抗炎药(NSAIDs).     

药源性味觉障碍

药源性味觉障碍是指药物所致味觉丧失、味觉异常和味觉减退.目前有上百种药物可引起味觉障碍.抗感染药物、心血管药物、神经精神疾病用药、抗肿瘤药物是最常见的致味觉障碍药物.体内锌离子浓度降低可能是药源性味觉障碍的主要机制之一.药源性味觉障碍能影响患者的食欲、营养摄入、生活质量与情绪状况,尤其是用药依从性.因此,医师应关注临床发生的药源性味觉障碍.     

药源性心力衰竭

药源性心力衰竭发病急，进展快，必须及时识别和处理。本文综述了临床常用药物引起心力衰竭的发病机理、致病药物、临床特点及防治方法。指出抗心律失常药、抗肿瘤药、降压药、拟交感胺等４大类３５种药物可引起心力衰竭。药物既可导致急性左心衰竭，亦可引起充血性心力衰竭，值得临床用药时警惕。     

合理用药预防小儿药源性疾病

药物可以治病也可以致病。究其原因，除了药物本身的性质，与病人的生理因素，病理状态等有关，其中年龄是影响药物作用的一个重要因素，小儿机体发育未完善，不良反应及药源性疾病发生率比较高，必须加以重视，采取预防措施，避免或减少药物不良反庆和药源性疾病的发生。     

药源性急性胰腺炎

文章综述了近几年国外关于引起药源性急性胰腺炎方面的报道，具体介绍了有关抗菌药物、抗胆碱脂酶药物、抗肿瘤等药物引起急性胰腺炎的情况，提示临床医师应引起重视。     

药源性颅内压增高

颅内压增高是一种临床综合征，许多药物也可引起，尽管一般表现为良性，但严重者可致脑疝形成而危及生命。对引起颅内压增高的药物，发病机制，临床表现，诊断及治疗方法进行了综述。     

临床药理学讲座（6） 掌握药物的肝,肾毒性知识避免药源性疾病发生

1.3.2 抗生素和磺胺类1.3.2.1 四环素类(四环素、土霉素、强力霉素、甲烯土霉素、二甲胺四环素):常期口服或静脉滴注较大剂量时,可引起间接性肝细胞毒型的肝损害,甚至导致致死性肝脂肪化。     

药物不良反应与药源性疾病

药物具有两重性,人们提到药物只注重药物的治疗作用而忽视药物的不良反应与药源性疾病。了解药物的不良反应及其危害,掌握不良反应的防治方法。了解常见的药源性疾病及其危害。通过此文让人们认清药物不仅能治病,同时也能致病。以便患者更好的使用药物。     

临床药师在1例药物性牙龈增生患者诊治中发挥的作用

目的：探讨临床药师在1例药物性牙龈增生患者诊治中发挥的作用,为临床药师开展工作提供参考。方法：临床药师参与临床查房和会诊,通过询问患者病史和用药史,从病理学、药理学角度分析患者出现牙龈增生的异常反应。结果：临床药师经过综合分析后,判断为药物性牙龈增生并建议医生调整治疗方案。结论：临床药师在治疗团队中要充分发挥自己的职业专长,协助医生和护士解决用药的相关问题,保证患者合理用药,实现临床药师的价值。     

药源性骨质疏松的发病原因、致病药物及防治

骨质疏松是骨强度受到损害而致骨折风险增加的骨骼疾病,可严重降低患者的生活质量与健康状况。导致药源性骨质疏松的常见药物包括口服抗凝药、钙调磷酸酶抑制剂、强效利尿药、质子泵抑制剂、噻唑烷二酮类降糖药、芳香酶抑制剂、蛋白酶抑制剂、糖皮质激素和抗癫痫药等。致病机制为药物通过促进骨吸收、抑制骨形成、抑制骨矿化影响正常骨代谢。骨密度测定可用于诊断药源性骨质疏松。防治药源性骨质疏松的有效措施包括合理用药,定期监测骨密度,缩短用药疗程,给予患者钙剂、维生素D制剂、双膦酸盐类药物、降钙素、选择性雌激素受体调节剂等药物治疗。     

Sodium channel antagonists for the treatment of migraine

Introduction: Migraine has a strong social impact, influencing both quality of life and work productivity. Therapeutic approach of migraine consists of a multimodal program of pharmacotherapy and behavioral therapy in order to reduce the risk of chronification. Indications for the use of preventive therapy are three or more attacks per month, significant disability, attack duration that is > 90 min.

Areas covered: In this review, studies conducted on sodium channel antagonists for the prophylaxis of migraine are selected using the International Classification of Headache Disorders (ICHD)-I and -II diagnostic criteria for migraine and are open-label and placebo-controlled studies.

Expert opinion: Several sodium channel antagonists, such as valproic acid, topiramate, lamotrigine, zonisamide, carbamazepine and oxcarbazepine, are widely used in migraine although without similar level of efficacy. Among these antiepileptic drugs, valproic acid and topiramate seem to be more effective in migraine, as reported in the majority of controlled studies. In spite of their high efficacy rate, important side effects should be always monitored, especially depression, cognitive functions, weight gain, sleepiness and dizziness. The usefulness of this class drug will be dramatically improved by using ongoing data on individual pharmacogenomics profile.     

69例药物性肝炎的临床分析

目的:探讨药物性肝炎的临床特点.方法:回顾分析了2006～2011年收治的69例确诊为药物性肝炎患者的临床资料.结果:引起药物性肝炎的常见药物是中草药、抗结核药、抗生素、抗肿瘤药等.结论:引起药物性肝炎的药物种类多,许多临床常见的药物可引起肝脏损害,应加强临床用药指导及药物性肝炎的防治.     

Calcium antagonists and deep gingival pockets in the population-based SHIP study

AIM: Gingival overgrowth is a common undesired side-effect in patients taking calcium channel blockers. Different reports have suggested that the drug-induced gingival hyperplasia may aggravate inflammatory periodontal disease. However, representative epidemiological data are lacking. We investigated the association between the intake of calcium antagonists and periodontitis in a population-based analysis including the most important risk factors of periodontitis. METHODS: In a cross-sectional epidemiological investigation involving 4290 subjects aged 20-80 years, we recorded periodontal risk factors and identified participants using calcium antagonists. Periodontal parameters, attachment loss, probing depth and number of teeth were assessed. In a subgroup analysis with matched pairs, 456 subjects using calcium antagonists and 456 without were compared for periodontal status. RESULTS: Subjects treated with calcium antagonistic drugs had significantly deeper gingival pockets than their drug-free counterparts. This was observed in the total population of 4290 and confirmed by logistic regression analyses (P < 0.001) controlled for the known risk factors of periodontitis (age, sex, smoking, education). In the matched-pair analysis only the probing depth was increased: extent probing depth > or = 4 mm median 23.5 vs. 17.0% (P < 0.001); mean probing depth 3.0 +/- 0.8 vs. 2.7 +/- 0.9 mm (P < 0.001). No differences were found in extent and severity of clinical attachment loss and in the number of teeth. The risk of gingival overgrowth was aggravated in smokers. CONCLUSION: In the general population, treatment with calcium antagonists leads to gingival overgrowth without an aggravation of periodontal disease. Interaction with smoking indicates the multifactorial background of the undesired effect of calcium antagonists.     

钙也是双刃剑?

我国居民需安全有效的补钙和阻钙,为了科学应用钙制剂和钙阻断剂,作者提出钙有双向作用,犹如双刃剑,作者从介绍钙代谢基础知识入手,阐述过度补钙和细胞内钙超载的不良作用和可能的危害,以趋利避弊,更好地应用和发挥钙制剂和钙阻断剂的效用。     

药源性高血压的发病机制、致病药物及其防治

药源性高血压为常见药物不良反应之一,其发病机制包括交感神经活动亢进,肾性水钠潴留,肾素-血管紧张素-醛固酮系统激活,以及动脉弹性功能和结构改变。临床表现为血压升高、反跳现象,甚至出现高血压危象。高危因素包括高龄、性别、遗传原因、既往高血压病史、超重、钠敏感、基础疾病。高危人群应避免使用可致血压升高的药物;必须使用时,应从最小剂量开始并应监测血压水平。一旦出现高血压应立即停药或减少剂量,并予对症治疗。     

Heroin Epidemics

Abstract

Preclinical studies indicate that dihydropyridine-type calcium channel antagonists modulate dopamine neurotransmitter function and can reduce cocaine-reinforced behaviors. Amlodipine, a long-acting dihydropyridine-type calcium channel antagonist related to isradipine and nifedipine, was administered in open label fashion for 12 weeks to 26 cocaine-dependent patients. In subjects expressing cocaine craving, craving significantly declined during the course of the 12 weeks. Five individuals reported flushing, headache, fatigue, nocturia, nausea, and lightheadedness. No conclusions regarding efficacy can be made due to the small number of subjects and the openlabel design.     

药源性血小板减少症的发病机制和临床表现及防治

药源性血小板减少症是指药物使血小板计数低于正常范围(<100×109/L)引致出血等症状的疾病。药源性血小板减少症按发病机制至少有以下3种:骨髓抑制性、免疫性及非免疫性的血小板减少症。引致血小板减少症的常见药物有:肿瘤化疗药物、肝素、奎尼丁、奎宁、金盐、丙戊酸及抗菌药等。肿瘤化疗药物所致血小板减少症的发生率大体高于其他药物。药源性血小板减少症的体征和症状为皮肤瘀点、瘀斑、鼻出血和牙龈出血,严重者有消化道出血、血尿、阴道出血和颅内出血。药源性血小板减少症可选用以下方法治疗:停用可疑致病药物,给予泼尼松、免疫球蛋白及输注血小板,金盐或砷化物引起的血小板减少症可肌内注射二巯基丙醇以排出重金属离子。     

Effect of Rifaximin on Intestinal Bacterial Overgrowth in Crohn's Disease as Assessed by the H2-Glucose Breath Test

Summary

The occurrence of intestinal bacterial overgrowth in patients with Crohn's Disease (CD) has been described and antimicrobial treatment has been shown to be effective in reversing this condition. However, the mechanisms underlying the efficacy of antimicrobial therapy are still only partially known.

The aim of the present study was to evaluate the effect of a non-absorbable antibiotic (rifaximin) in comparison to placebo on bacterial overgrowth in patients with CD.

Methods Fourteen patients with inactive CD of the ileum and bacterial overgrowth, as assessed by the hydrogen breath test, were blindly allocated to receive rifaximin (1200?mg/day) or placebo t.i.d. for one week. A hydrogen breath test, and clinical and biochemical parameters were further performed 14 days and 30 days after starting treatment.

Results After 14 days, the hydrogen breath test proved to be negative in seven out of seven patients treated with rifaximin (p < 0.05), and in two out of seven in the placebo group (p = ns). After 30 days, the hydrogen breath test was positive in all patients of the rifaximin and placebo group, respectively. No changes in the CDAI score were documented in any patients.

Conclusions Short-term administration of rifaximin is effective in the therapy of bacterial overgrowth in patients with inactive CD of the ileum, thus suggesting that the control of luminal bacterial growth could be useful in the management of these patients. However, since we observed a decline with time in this positive effect, further studies are needed to identify the most appropriate therapeutic strategies.