武汉地区34家医院2011-2013年抗高血压药应用分析

目的:为临床合理用药和科学管理提供参考。方法:采用世界卫生组织推荐的限定日剂量为指标的分析方法,对武汉地区34家医院2011-2013抗高血压药有关数据进行统计、分析。结果:武汉地区2011-2013年抗高血压药销售金额和用药频度逐年增加,钙通道阻滞药(CCB)的销售金额和用药频度最高,构成比均达到40%左右,其次是血管紧张素Ⅱ受体拮抗药(ARB)和血管紧张素转换酶抑制剂(ACEI),新型复方制剂的销售金额和用药频度也明显增加。单药品种销售金额排名前3位的分别是氨氯地平、左旋氨氯地平和缬沙坦,用药频度居于前3位的是氨氯地平、硝苯地平和非洛地平。结论:武汉地区CCB、ARB、ACEI、肾上腺素受体阻滞药和利尿药最常用,符合目前抗高血压用药原则,临床应用基本合理。     

2008—2011年湖北医药学院附属太和医院抗高血压药应用分析

目的:了解我院抗高血压药的应用情况,为医院药品管理和临床合理用药提供参考。方法:提取2008—2011年我院抗高血压药的应用数据,采用限定日剂量(DDD)法对药品销售金额、用药频度(DDDs)和限定日费用(DDC)进行回顾性分析。结果:2008—2011年血管紧张素Ⅱ受体阻断剂(ARB)销售金额居首位;2009—2011年钙通道阻滞剂(CCB)DDDs排序居首位;2009—2011年氨氯地平销售金额排序居首位;2010、2011年氨氯地平DDDs排序居首位。结论:我院抗高血压药应用合理,CCB、ARB的地位越来越重要。     

武汉地区2009~2011年抗结核药用药分析

摘 要 目的:了解武汉地区2009～2011年抗结核药的应用情况及发展状况,为临床合理用药提供参考。方法: 对2009~2011年武汉地区32家入网医院抗结核药的用药金额、用药频度（DDDs）、日均费用（DDC）等进行统计分析。结果:2011年武汉地区抗结核药年用药金额及DDDs 较前2年增幅较大,经典抗结核药DDDs仍居主导地位,中成药结核丸的应用激增。结论:武汉地区医院抗结核药应用基本符合我国目前抗结核药的发展现状,中成药的广泛使用尚需药物经济学评价。     

2009-2011年武汉地区32家医院化痰止咳平喘中药应用分析

目的:了解化痰止咳平喘中药在区域医院的使用情况,为其临床合理应用提供参考。方法:对2009-2011年武汉地区32家医院化痰止咳平喘中药的总销售金额、用药频度(DDDs)、日均治疗费用(DDC)、排序比进行统计、分析。结果:2009-2011年,武汉地区32家医院化痰止咳平喘中药的销售金额逐年增长,DDDs排序前3位的品种没有变化,销售金额和DDC排序前15位的品种变化不大,多个品种的排序比接近1,同步性良好。结论:2009-2011年武汉地区32家医院化痰止咳平喘中药的使用相对合理。     

2009～2011年武汉地区抗肿瘤分子靶向治疗药物应用分析

目的:了解武汉地区医院抗肿瘤分子靶向治疗药物的使用情况与特点。方法:对武汉地区32家医院2009～2011年抗肿瘤分子靶向治疗药物的应用品种、销售金额、用药频度(DDDs)及日均费用(DDC)等进行回顾性统计和分析。结果:武汉地区抗肿瘤分子靶向治疗药物销售金额与DDDs呈逐年增长趋势,DDC相对稳定。结论:2009～2011年武汉地区抗肿瘤分子靶向治疗药物应用状况和发展趋势较为合理。     

我院2009～2011年住院药房口服抗高血压药应用分析

目的了解我院口服抗高血压药物的应用情况,为临床合理用药提供参考。方法采用限定日剂量分析方法,对我院2009～2011年口服抗高血压药物的药品名称、销售金额、用药频度、日均费用等指标进行统计分析。结果近3年我院住院患者使用抗高血压药物销售金额前3位一直是钙离子拮抗剂(CCB)、血管紧张素受体阻滞剂(ARB)、血管紧张素转换酶抑制剂(ACEⅠ);用药频度前3位一直是CCB、利尿剂、ARB;单品种排序中销售金额前2位一直是硝苯地平控释片(拜心同)、氨氯地平片(络活喜),第3位2009年为左旋氨氯地平片,后由培哚普利片(雅施达)替代;用药频度前3位一直是硝苯地平控释片、氨氯地平片和螺内酯片。结论我院口服抗高血压药物使用基本合理。     

我院2010年抗高血压药物用药分析

目的 了解医院抗高血压药物使用情况,为临床合理用药提供参考.方法 对医院2010年抗高血压药的用药金额、用药频度、日用药金额、构成比等情况进行统计分析.结果 钙通道阻滞剂在用药频度和用药金额上均居首位,单品种用药频度最高的是依那普利,用药金额最高的是左旋氨氯地平.结论 抗高血压药物应用以长效钙通道阻滞剂为主,使用基本合理.     

我院门诊抗高血压药用药分析

目的通过分析该院门诊抗高血压药临床应用情况,为合理选择抗高血压药提供临床依据。方法应用金额排序法和用药频度(DDDs)排序法,对该院门诊2009年1月～2010年12月所应用的抗高血压药的品种、用药金额、DDDs等指标进行统计分析。结果用药金额和频度排在前三位的药物均为钙离子拮抗剂(CCB)、血管紧张素转换酶抑制剂(ACEI)、β受体阻滞剂;DDDs排在前五位的药物硝苯地平缓释片、尼群地平、卡托普利和氨氯地平。结论该院门诊高血压用药基本合理,基本符合目前高血压治疗原则。     

上海市黄浦区中心医院2009-2011年口服抗高血压药物用药分析

目的：了解上海市黄浦区中心医院口服抗高血压药的应用情况。方法：对2009-2011年口服抗高血压药的品种、用药金额、用药频度、日均费用等指标进行回顾性分析。结果：抗高血压药用量呈增长趋势,日均费用降低;血管紧张素受体拮抗剂和钙拮抗剂是降压治疗主流药物,主要品种用药金额序号和用药频度序号比值为0.3～3.5。结论：该院口服抗高血压药使用结构基本合理,开发质优价廉的药物对防治高血压具有重要意义。     

某院2008至2010抗高血压药物的药物利用分析

目的了解我院抗高血压药物的用药现状及发展趋势。方法对我院2008至2010年抗高血压药物的销售金额、使用频度、日人均费用等进行回顾性分析。结果 2008至2010年我院购药金额增长与用药人次增长基本同步,总体CCB类购药金额最高,ARB类用药人次最多;氨氯地平/兰迪单药用药人次最高,硝苯地平/心痛定日人均费用最低。结论我院抗高血压药物结构基本合理,符合国内抗高血压药物使用指南的基本要求。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.