Clinical pharmacists' opportunities to reduce inappropriate prescription of QT‐prolonging medications: calls to action

All biologically active agents carry the potential to lead to adverse reactions in certain individuals, including serious cardiac adverse reactions. Since 2005, there has been an international regulatory landscape governing the investigation of a new drug's propensity to lead to the polymorphic ventricular tachycardia Torsades de Pointes (Torsades), a rare but potentially fatal occurrence. When a regulatory agency considers it appropriate, warning information is placed in a medicine's patient information leaflet (label) concerning drug‐induced QT interval prolongation, a phenomenon associated with Torsades. In busy hospital settings, however, prescribers, including cardiologists, make injudicious prescribing decisions that put patients at risk. The science of cardiac safety, including the clinical trials that generate the information about QT prolongation in patient information leaflets, is frequently not part of the curriculum at Schools of Pharmacy. Given that medication‐induced cardiotoxicity is extremely serious, we advocate that schools integrate the science of cardiac safety into existing therapeutics/therapeutic medication monitoring courses. Given their expert knowledge of pharmacology, pharmacists working as part of a hospital's clinical team would then be even better placed to review prescribing decisions concerning medications that prolong the QT interval, and alert prescribers in cases where reassessing their decisions seems prudent. National pharmacy societies or other pertinent professional societies could create practice guidelines to support graduates once employed as clinical pharmacists. Clinical pharmacists are well placed to be influential arbiters of safer prescribing decisions. Cardiac safety education during their pharmacy training and practice guideline support from professional societies during their careers can optimize this role.     

Prevalence and associated factors of psychoactive substance use among university students in the West Bank,Palestine

Abstract

University students are at higher risk of using psychoactive substances (PS). The aim of this study was to provide insight into the extent and the pattern of PS use among students in four main universities in the West Bank, Palestine. The most frequent lifetime substance uses were smoking tobacco (41.6% for cigarettes and 50% for hookah), drinking alcohol (5.4%), and using illicit drugs (3.0%). The frequency of use was higher among males, with higher income, orphans, or whose parents experienced more conflict in their relationship. Cannabis, synthetic cannabinoids, and amphetamines were the most common used illicit drugs. Factors determined the danger of using PS were the initiation age, availability of money and substances, substances types, frequency of use, and using multiple substances at the same time. Escaping from problems and peer pressure was the most important motives to substances use. Students who manifested a history of violence were significantly more likely being substance users whatever is the substance in question. Overall, PS use is common among Palestinian university students despite them being knowledgeable about the dangers of substance use. The results of this study demonstrate an urgent need for the development of intervention and immediate attention of local authorities.     

The Importance of Teaching Ethics in Pharmacy Education

All pharmacy faculty members should have a general understanding of the field of ethics, regardless of whether they have received any formal training, since instruction and training in ethical decision-making is an accreditation expectation. Additionally, whether they recognize it or not, pharmacy faculty members are involved in ethical decision-making on an almost daily basis. The aims of the current commentary are to expand on a basic approach to ethical decision-making using examples involving students or faculty members in each of the triad areas of teaching, research, and service, and serve as a starting point to enable all faculty to teach students how to work through an ethical dilemma. This commentary will focus on the initial steps involved in determining whether an ethical dilemma exists, determining the facts related to the dilemma by identifying technical facts and legal constraints, and identifying the principles and values that play a role in the situation and decide which are in conflict. References are provided for more in-depth review of ethics subject matter beyond the scope of this commentary.     

21世纪医院药学工作与临床药师培养

以药物提供为特点的传统医院药学工作模式在21世纪将面临生存危机,临床药学或药学监护是21世纪医院药学工作的主要内容.解决临床药师缺乏的问题是临床药学与药学监护工作的关键,也是医院药学工作模式转变的关键.临床药师培养的基本途径有:本科教育、毕业后教育、继续教育、研究生教育等.本科教育作为临床药师培养的基本方式是十分必要的;毕业后教育和继续教育是目前本科教育规模小而采取的临床药师培养的有效方法;研究生教育应该成为师资培养和临床药学工作骨干与学科带头人的重要途径.临床药师培养应明确为病人服务的宗旨.     

我院2012～2013年质量问题药品分析

目的为促进医院药品质量的提高提供参考。方法对我院2012年4月1日至2013年3月31日期问内收集的所有质量问题药品进行统计，分析药品质量问题出现的原因与规律。结果在收集资料的一年里，质量问题药品金额共计25293．59元，数量共计777件。金额占本院西药库入库总金额的不到0．04％。结论药品流通的各个环节都会对药品质量产生影响，加强每个环节的把关，才能有效降低药品质量问题的发生。     

我院开展临床药学工作的点滴体会

随着时代的发展,人类的进步,人们对卫生保健的要求也有了很大的提高,药学部门要建立以患者为中心的药学管理工作模式;开展以合理用药为核心的临床药学工作,参与临床查房、会诊;开展药物不良反应监测;开展合理用药监测;定期开展药学信息的收集和整理,建立药品信息网络.     

心房颤动的社区管理

心房颤动是临床常见的心律失常,可导致脑栓塞、心力衰竭及心源性猝死等严重并发症,严重威胁人类的身体健康。该文介绍心房颤动的分类、并发症、抗心律失常药物治疗、射频消融治疗、抗凝治疗以及心房颤动的上游治疗,以增强社区医生对心房颤动的认识。     

我院临床医师临床试验管理规范培训的经验介绍

目的提高本院临床试验质量及临床医师的临床试验管理规范（GCP）意识。方法我院通过选派骨干参加省级、国家级学习班,邀请相关科研单位及GCP资深专家等方式对我院临床医师进行培训。结果通过以上措施,提高了我院临床医师的GCP意识,确保了我院新药临床试验的质量。结论GCP是设计、实施、记录和报告设计人类对象参加的试验国际性伦理和科学质量标准,GCP培训是新药临床试验中的一个不可缺少的环节。     

浅谈药品分类管理对医院药剂科发展的影响

目的阐述药品分类管理对医院药剂科发展的影响。方法对国内文献资料进行归纳、分析和总结。结果药品分类管理制度的有效实施将对我国县级以上医院的药剂科产生重大影响。结论实施药品分类管理制度,可促使医院药剂科的管理重点由传统的“以药品为中心”的模式向“以病人为中心”的模式转化,有利于医院药剂科健康快速地发展。     

我院开展社区药学服务初探

目的探讨如何利用三甲医院资源优势开展社区药学服务。方法介绍4个试验小区开展多种形式的药学服务,针对不同人群开展合理用药和药品不良反应知识讲座;讲解假药、劣药的识别,药品名称、剂型、规格的识别,药品的储藏保管;讲解药物与食物的关系,饮食与健康的关系;对社区高血压居民实行健康教育,提高服药依从性;充分利用网络、通讯工具为居民服务。结果通过开展多种形式的社区药学服务,增加了社区居民对药物不良反应及合理用药的认识,提高了社区居民服药的依从性,缓解了医患关系并为医院创造了经济效益。结论医院药学人员利用其自身优势,开展社区药学服务,服务于患者,服务于广大社区居民,既可提升药师在公共健康中的作用,又能满足日益提高的公众健康需求,是医改形势发展的必然结果。     

安慰剂与住院时间对转氨酶的影响

目的观察住院时间10天以上并多次服用安慰剂后的健康志愿者引起的转氨酶变化趋势。方法在2个新药I期临床试验中，对多次服用安慰剂、住院时间为2天或13天的16名健康志愿者多次进行转氨酶检查。结果住院时间为13天且多次服用安慰剂的受试者，ALT呈逐渐升高的趋势；但AST无明显变化。多次服用安慰剂但住院时间为2天的受试者，ALT和AST均无明显变化。结论对住院时间长的新药I期临床试验，应考虑安慰剂可能引起的转氨酶升高，避免在判断试验药物是否产生肝损害时，出现偏差。