头孢哌酮钠/舒巴坦钠致急性造血停滞

患者女,71岁。因“肝功能异常1年,乏力尿黄1周”,于2004年10月15日入院。诊断为自身免疫性肝病,给予保肝、降酶、退黄、支持治疗,病情好转。入院时检查血象3系均正常:WBC9.30×109/L、N0.566;RBC3.54×1012/L,HGB127g/L;PLT131×109/L。B超示:脾不大。入院后2周(10月27日)发现双下肺炎症,即加用头孢哌酮钠/舒巴坦钠(优普酮)4g,1次/12h抗感染治疗。4d后检测血常规:WBC4.27×109/L,RBC2.36×1012/L,HGB81g/L,PLT32×109/L。1周后复查:WBC3.10×109/L,RBC2.15×1012/L,HGB74g/L,PLT20×109/L。行骨穿检查,骨髓片检查示增生…     

甲巯咪唑致严重粒细胞缺乏

患者女,35岁。因“咽痛、发热1d”于2004年5月4日入院。患者确诊为甲状腺功能亢进3个月,给予甲巯咪唑30mg,3次/d口服。入院前1d出现咽部疼痛、发热(体温39.5℃),全身乏力。血常规显示:WBC0.8×109/L,N0.07,L0.78,M0.15,Hb124g/L,PLT90×109/L。中性粒细胞<0.5×109/L,淋巴细胞相对增多。入院后,查体:咽部有黏膜白斑及红肿,悬雍垂出现溃疡,T39.7℃。给予粒细胞集落刺激因子(特尔津)150μg,皮下注射,1次/d。同时给予左氧氟沙星0.4g,1次/d;氯唑西林3.0g,2次/d,静滴。4d后因体温未下降,血培养示阴性,停用氯唑西林换用头孢他啶,但体温仍高…     

重组人白细胞介素-11致不良反应3例

案例1,患者男,63岁,主因"直肠癌术后2年余,复发3月余"入院化疗.查体:T 36.2 ℃,P 72次/分,R 18次/分,BP 105/69 mmHg,疼痛NRS 0分,查体:心、肺(-).腹部平坦,腹部可见一长约10 cm长手术瘢痕,左下腹可见造瘘口,腹软,无压痛、反跳痛,肝脾未触及,肝肾区无叩痛,移动性浊音(-),肠鸣音正常.双下肢无浮肿.于2015年9月6日查血常规:WBC 1.81×109/L,NEUT 0.84×109/L,LYM 0.68×109/L,RBC 2.75×1012/L,HGB 97 g·L-1,PLT 80×109/L,遂给予重组人粒细胞集落刺激因子升高白细胞及注射用重组人白介素-11(rhIL-11,巨和粒,齐鲁制药有限公司,批号:201503003SK)3 mg ih qd 升血小板治疗.     

红花注射液致过敏性休克1例

1临床资料 患者,女,53岁,因食欲不振、恶心、周身乏力7d于2004年3月9日以慢性肾功能不全收入院.体检:神志清,贫血貌,消瘦体质,体温36℃,脉搏92次/min,血压120/80mmHg.血常规示白细胞12.18×109/L,血红蛋白94g/L,血小板316×109/L;尿常规示红细胞( ).入院后遵医嘱给予5%葡萄糖250mL,红花注射液20mL静滴,1次/d.     

利奈唑胺致全血细胞减少

1例68岁女性患者,因感染性心内膜炎口服利奈唑胺0.6 g,2次/d,半个月后感觉疲乏、倦怠,血常规检查示白细胞4.18×109/L,红细胞3.23×1012/L,血红蛋白76 g/L,血小板40×109/L,遂停药。11 d后血象恢复正常,再次口服利奈唑胺0.6 g,2次/d,用药14 d复查血常规,白细胞3.50×109/L,红细胞2.51×1012/L,血红蛋白71 g/L,血小板36×109/L,遂再次停药。停药后患者连续5 d发热(体温最高时38.5℃),伴咳嗽、咯黄痰及鼻塞,遂入院。入院后未给予抗感染药物,先后3次输注浓缩红细胞(每次400 ml)。血常规示:白细胞5.90×109/L,红细胞3.33×1012/L,血红蛋白95 g/L,血小板158×109/L,故在入院第21天给予利奈唑胺0.6 g静脉注射,2次/d。入院第36天复查血常规,白细胞2.30×109/L,红细胞2.21×1012/L,血红蛋白61 g/L,血小板29×109/L,遂再次停用利奈唑胺。先后3次输注悬浮红细胞(每次400 ml),皮下注射重组人粒细胞集落刺激因子150μg,1次/d,共4 d。应患者要求准予出院。     

亚砷酸致儿童室性心动过速

患儿男,13岁。因面色苍白、乏力10余天,发热1周,于2000年5月17日入院。既往健康,查体:T38.2℃,P102次/min,R24次/min,BP104/70mmHg(1mmHg=0.133kPa),体重34kg。贫血貌,全身浅表淋巴结未触及,心界不大,HR100次/min,律规整、心音有力无杂音,双肺未闻及啰音，肝脏肋弓下2.0cm,脾脏肋弓下1.5cm,躯干及肢体可见散在小出血点。血常规:Hb46g/L,WBC2.46×109/L,N0.62、L0.36、M0.02,PLT4.8×109/L。骨髓细胞学检查:增生明显活跃,原始及早幼粒细胞占55%,诊断:急性非淋巴细胞型白血病(M3型),肝功、尿常规及心电图检查均正常。入院第5天开始…     

重组人粒细胞集落刺激因子致发热2例

例1男,55岁。直肠癌术后半年,准备进行第2疗程化疗,于2004年3月18日15:00入院。查体:T36.5℃,P80次/min,R20次/min,BP l20/80mmHg(1mmHg=0.133kPa),神志清楚,一般状况良好。血常规示WBC3.2×109/L,入院后1h给重组人粒细胞集落刺激因子300μg皮下注射。注射后6h患者出现寒战,T38.9℃。给予清热解毒II号(本院自制剂,主要成分为柴胡)肌注,物理降温。4h后体温逐渐下降至正常。停药1d,再次给予重组人粒细胞集落刺激因子300μg,同时肌注地塞米松2mg,连续2d测WBC为7.8×109/L。未再出现发热、寒战等不良反应。例2男,55岁。结肠癌术后化疗1…     

维生素K1注射液致发热2例的原因分析

例1女,25岁。因慢性肾炎,于2003年10月20日入院。住院诊断:慢性肾炎,轻度系膜增生性肾小球肾病,既往无药物过敏史。入院查体:T36.5℃,P80次/min,BP115/80mmHg(1mmHg=0.133kPa),查体无阳性体征。实验室检查:WBC5.2×109/L,N0.54,Hb104g/L,PLT209×109/L,尿蛋白定量153mg/24h,胸透未见异常。为进一步明确诊断,于入院后第5天在B超引导下行“肾穿刺活检术”。手术顺利,术后常规臀部肌内注射维生素K1注射液10mg,2次/d。术后第2天,患者出现发热、寒战,体温39.2℃,双侧臀部注射部位皮肤发红、痛痒、片状红斑,其中最大面积约为(5.0×6.0)cm…     

葛根素注射剂致急性溶血性贫血合并肝、肾损害

患者男,68 岁。因双下肢动脉硬化闭塞症,右股-股动 脉人工血 管架桥术 后 4 个月复 查,于 2004 年2月12日入院。查体:T 36.4℃,BP 130/80 mmHg (1mmHg = 0.133 kPa),心 肺( )。 既 往 无 药 物 过 敏史 。 实 验 室 检 查 :RBC 4.53 ×1012/L,ALT 16 U/L ,AST 25 U/L ,BUN 7.0 mmol/L ,Cr 100 μmol/L。给予葛根 素注射剂 (麦普 宁)500 mg溶于 0.9% 氯 化钠注射液 250 mL 中 ,于每日 10:00 开始静点 ,1 次 /d;同 时给 予 血塞 通( 三七 总 皂苷 )0.5 g,1 次 /d;前 列地尔(凯时 )10 μg,1 次 …     

卡马西平治疗带状疱疹神经性疼痛致过敏性休克一例

<正>患者女,62岁,主因"右侧额面部片状疱疹伴剧烈疼痛2d"入院,既往体健。患者表情痛苦,右侧眶上、前额、颞部及外耳道内可见片状疱疹。查:体温36.5℃,脉搏76次/min,呼吸18次/min,测血压124/86mmHg(1mmHg=0.133kPa)。诊断:带状疱疹。入院后查血常规:白细胞6.40×109/L,红细胞4.32×1012/L,血红蛋白为:125g/L,血小板计数62×109/L。肝、肾功能检查均未见异常。询问患者无过敏史,行神经阻滞治疗,卡马西平200mg口服,3次/d,饭后服用。次日午饭     

高效液相色谱法测定膦甲酸钠氯化钠注射液中膦甲酸钠的含量

目的建立HPLC法测定膦甲酸钠氯化钠注射液中膦甲酸钠含量的方法.方法采用阴离子交换柱(Waters IC Pak A柱,50 mm× 4.6 mm,5 μm);以0.05 mol·L-1邻苯二甲酸氢钾溶液(取邻苯二甲酸氢钾0.204 g,加水适量,振摇使溶解,加1mol·L-1硝酸溶液5 mL,加水稀释至2 000 mL,摇匀即得)为流动相;流速1.4 mL·min-1,检测波长290nm.结果本方法在0.98～4.90g·L-1浓度范围呈良好线性关系(r=0.999 4),进样重现性RSD为0.71%(n=5),平均回收率为98.93%.结论本法简便、快速、结果准确可靠,可用于膦甲酸钠氯化钠注射液中膦甲酸钠的含量测定.     

哌拉西林钠他唑巴坦钠致抽搐

1例26岁男性患者,4年前行肾移植术,近5个月接受血液透析,因肺部感染给予哌拉西林钠他唑巴坦钠4.5 g加入0.9%氯化钠注射液100 ml、1次/d静脉滴注。第2次用药后5 h,患者突发抽搐、意识丧失、双眼上翻、双腿抽动。先后给予地西泮10 mg肌内注射及7 mg静脉注射,上述症状消失。     

Inhaled sodium metabisulphite induced bronchoconstriction: inhibition by nedocromil sodium and sodium cromoglycate.

1. The effects of nedocromil sodium and sodium cromoglycate on bronchoconstriction induced by inhaled sodium metabisulphite have been studied in eight atopic subjects, three of whom had mild asthma. 2. Nedocromil sodium (4 mg, 7.8 X 10(-6) M), sodium cromoglycate (10 mg, 24.1 X 10(-6) M) and matched placebo were administered by identical metered dose inhalers 30 min before a dose-response to sodium metabisulphite (5-100 mg ml-1) was performed. 3. Maximum fall in sGaw after placebo pre-treatment was -43.9 +/- 3.3% baseline (mean +/- s.e. mean). At the same metabisulphite concentration maximum fall in sGaw after sodium cromoglycate was -13.0 +/- 3.6% and after nedocromil sodium was +4.3 +/- 6.8%. Nedocromil sodium prevented any significant fall in sGaw even after higher concentrations of metabisulphite. 4. Both nedocromil sodium, 4 mg, and sodium cromoglycate, 10 mg, inhibited sodium metabisulphite induced bronchoconstriction but nedocromil sodium was significantly more effective. Relative in vivo potency of the two drugs is broadly in line with other in vivo and in vitro studies.     

头孢哌酮钠-舒巴坦钠致血小板减少

1名83岁男性患者因胆道系统感染,静脉给予注射用头孢哌酮钠-舒巴坦钠2.0g,1次/白天;1.0g,1次/晚上。用药6d内血小板进行性下降,由164×109/L下降到68×109/L。停用头孢哌酮钠-舒巴坦钠,改用左氧氟沙星治疗。1周后患者PLT恢复正常。     

哌拉西林钠他唑巴坦钠致白细胞减少

1例46岁女性患者,因术后颅内感染静脉滴注哌拉西林钠他唑巴坦钠4.5 g,1次/8 h。用药第13、15天外周血白细胞计数从用药前的10.61×109/L分别降至1.79×109/L和1.00×109/L。立即换用其他抗菌药物,同时给予重组人粒细胞巨噬细胞集落刺激因子(rhGM-CSF)150μg皮下注射,1次/d。改变治疗后4 d,血白细胞计数升至6.95×109/L。改变治疗后6 d脑脊液白细胞数由首次用药后15 d的8×106/L升至56×106/L,再次给予哌拉西林钠他唑巴坦钠4.5 g静脉滴注,1次/8 h,rhGM-CSF剂量未变。用药6 d颅内感染治愈,遂停用抗菌药物。治疗第2、5天白细胞计数分别为2.67×109/L和1.65×109/L。第8天停用rhGM-CSF后为5.75×109/L,第15天为4.56×109/L。     

Fondaparinux sodium

black triangle Fondaparinux sodium, a selective factor Xa inhibitor, is the first in a new class of antithrombotics. It binds selectively with high affinity to antithrombin III and specifically catalyses the inactivation of factor Xa. The elimination half-life of fondaparinux sodium permits once daily treatment. black triangle A randomised, double-blind, parallel-group, dose-ranging, multicentre phase IIb study in 933 eligible patients established that a subcutaneous dose of between 1.5 and 3mg of fondaparinux sodium has the optimum efficacy and safety profile for prophylaxis of venous thromboembolism in patients undergoing major orthopaedic surgery. black triangle Fondaparinux sodium, given to more than 3600 patients undergoing major orthopaedic surgery who participated in prospective, randomised, double-blind, multicentre phase III clinical trials, significantly reduced the incidence of venous thromboembolism, with an overall risk reduction of 55.2% compared with enoxaparin. black triangle Fondaparinux sodium was well tolerated by patients undergoing major orthopaedic surgery, and at the recommended clinical dose of 2.5mg has a similar tolerability profile, including bleeding events, to standard enoxaparin regimens. Fondaparinux sodium has not been reported to cause antibody-induced thrombocytopenia.     

Talaporfin sodium

Importance of the field: Despite therapeutic advances, cancer remains the cause of an estimated 23% of deaths in the USA. New treatments for malignancy are greatly needed.

Areas covered in this review: Talaporfin sodium is a light-activated drug that causes tissue death through induction of apoptosis. Systemic antitumor effects mediated by CD8⁺ T cells have been demonstrated in preclinical studies, providing a mechanism for distant response of tumors noted in clinical trials. Talaporfin sodium is approved in Japan for early-stage endobronchial cancer. Phase I and II studies in solid tumors have shown tumor regression in patients refractory to other therapies. Phase III pivotal studies against hepatocellular carcinoma as monotherapy and liver-metastatic colorectal cancer in combination with chemotherapy are ongoing. Talaporfin sodium is also in studies in men with symptomatic benign prostatic hyperplasia. Substantial safety data from clinical trials so far indicate that the drug is well tolerated.

What the reader will gain: Talaporfin sodium has a broad safety profile and a mode of action that could affect growth in treated and untreated tumors.

Take home message: Clinical and preclinical studies indicate that talaporfin sodium treatment may offer a powerful option to synergize current therapies, as well as an alternative monotherapy in treating cancer.     

Danaparoid sodium

Danaparoid sodium (Orgaran, Organon) is a heparinoid glycosamino-glycuronan antithrombotic agent approved for the prophylaxis of post-operative deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients undergoing elective hip replacement surgery. Danaparoid is a low molecular weight heparinoid consisting of a mixture of heparan sulphate (84%), dermatan sulphate (12%) and small amounts of chondroitin sulphate (4%), whose antithrombotic activity has been well established. Its pharmacological effect is exerted primarily by inhibiting Factors Xa (FXa) and IIa (FIIa) at a ratio greater than heparin, with a minimal effect on platelet function. Danaparoid exhibits low cross-reactivity with heparin-induced antibodies when compared with heparin or low molecular weight heparins (LMWH), thereby making it an excellent choice for the management of heparin-induced thrombocytopenia (HIT). It has excellent bioavailability following s.c. injection. Danaparoid has little effect on routine coagulation tests (activated partial thromboplastin time [aPTT], prothrombin time [PT], and thrombin time [TT]). Patients with elevated serum creatinine should be monitored carefully. For its FDA approved indication (DVT prophylaxis during hip replacement surgery), its cost per day is approximately eight times more than LMWH. Even though monitoring is not routinely necessary according to the manufacturer for its approved indication, monitoring is frequently necessary when it is used in other clinical scenarios. Its higher cost than comparable therapies for DVT prophylaxis and the low availability of the FXa assay in most non-tertiary care hospitals has limited the widespread use of danaparoid. Danaparoid has been found to be effective in the treatment of HIT although this is an off label use, despite being the most frequent reason why danaparoid is used.     

Diclofenac sodium

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage of diclofenac sodium are reviewed. Diclofenac, the first nonsteroidal anti-inflammatory agent (NSAID) to be approved that is a phenylacetic acid derivative, competes with arachidonic acid for binding to cyclo-oxygenase, resulting in decreased formation of prostaglandins. The drug has both analgesic and antipyretic activities. Diclofenac is efficiently absorbed from the gastrointestinal tract; peak plasma concentrations occur 1.5 to 2.0 hours after ingestion in fasting subjects. Even though diclofenac has a relatively short elimination half-life in plasma (1.5 hours), it persists in synovial fluid. The drug is metabolized in the liver and is eliminated by urinary and biliary excretion. In clinical trials, diclofenac was as effective as aspirin, diflunisal, indomethacin, sulindac, ibuprofen, ketoprofen, and naproxen in improving function and reducing pain in patients with rheumatoid arthritis. For treatment of osteoarthritis, diclofenac was equivalent in efficacy to aspirin, diflunisal, indomethacin, sulindac, ibuprofen, ketoprofen, naproxen, flurbiprofen, mefenamic acid, and piroxicam. Diclofenac was as effective as indomethacin or sulindac in treating ankylosing spondylitis. The most frequent adverse effects reported for diclofenac were gastrointestinal, but these effects were fewer and less serious than occurred with aspirin or indomethacin; in addition, diclofenac caused fewer central nervous system reactions than indomethacin. Diclofenac is administered in divided doses with meals. The recommended total daily dosage is 100 to 150 mg (osteoarthritis and ankylosing spondylitis) or 150 to 200 mg (rheumatoid arthritis). Diclofenac is effective, but no more so than other NSAIDs. It is structurally distinct and offers another choice in the treatment of rheumatological conditions.