临床药师参与1例儿童化疗导致突破性恶心呕吐的治疗体会

目的:通过临床药师参与1例化疗导致突破性恶心呕吐的治疗,了解儿童化疗导致恶心呕吐的类型、初始止吐方案的选择以及突破性呕吐、难治性呕吐的药物选择及用药监护.方法:临床药师与医师共同讨论病例,协助制定治疗方案,关注方案实施过程.结果:结合临床药师会诊建议,医师调整治疗方案后患儿恶心呕吐症状逐渐减轻,身体状况良好后出院.结论...     

临床药师参与治疗严重高钾血症的药学实践体会

目的：探讨临床药师在临床治疗严重高钾血症中发挥的作用。方法：通过参与1例严重高血钾的药物治疗,探讨心血管专业临床药师在临床上可以发挥的作用,为临床药师提高药学监护水平和药物疗效提供参考。结果：临床药师参与临床治疗可以帮助医师用药更规范、合理,提高治疗效果,降低病死率。结论：临床药师在临床发挥作用和参与临床药物治疗有必要性。     

外科药师参与化疗相关性恶心呕吐的管理实践

目的 研究外科药师参与的多学科管理模式对围术期化疗相关性恶心呕吐(chemotherapy-induced nausea and vomiting, CINV)发生情况及化疗依从性的影响。方法 138例就诊于广州医科大学附属第二医院接受围术期化疗的患者,根据是否进行CINV多学科管理分为干预组和对照组,比较两组患者化疗全程期CINV发生情况及化疗依从性的差异。结果 138例患者中,干预组72例,对照组66例,干预组的CINV发生率明显低于对照组(恶心发生率51.4%vs 78.8%,P<0.001;呕吐发生率2.8%vs 19.7%,P=0.002),CINV严重程度明显低于对照组(P<0.001),化疗依从性明显高于对照组(98.6%vs 89.4%,P<0.001)。结论 外科药师参与的多学科管理模式可显著降低围术期CINV的发生率,并显著提高患者化疗依从性。     

癌性疼痛治疗伴持续恶心呕吐的药学监护

<正>癌症疼痛指癌症、癌症相关性病变及抗癌治疗所致的疼痛^[1]。为提高癌痛规范化治疗水平,改善肿瘤患者生存质量,WHO出台了癌症疼痛管理指南,各个国家也制定了相应的癌痛规范化处理的原则、共识,但文献报道,在不同国家,仍有部分癌症患者的疼痛没有得到有效的控制。药师在深入临床工作的过程中也发现,医护人员往往将工作的重点放在癌症治疗上。很多医护人员对药物的使用存在一定不足,对治疗过程中药物引起的不良反应也缺乏系统的分析。因此,临床工作中迫切需要接受过专业培训的临床药师参与到癌痛治疗的工作中,发挥药学专业能力,     

临床药师参与主动脉夹层治疗的药学实践

主动脉夹层是主动脉内的血液经内膜撕裂口流入囊性变性的中层,形成夹层血肿,随血流压力的驱动,逐渐在主动脉中层内扩散的危急重症,具有起病急、病情凶险、死亡率高的特点。急性期患者无论是采取介入或手术治疗,首先均应给予强化内科药物治疗。临床药师全程参与了1例主动脉夹层患者的药学监护,将体会总结如下。     

临床药师参与临床药学实践的意义

目的临床药学实践是每一位临床药师都应该参与的必要学习项目，临床药学工作应面向患者，一名优秀的临床药师，其应有全面的知识结构且具备独立的临床药学工作能力，能够合理的协助医生为患者用药，在最大限度上，合理安排患者用药，使患者早日康复，同时，在临床诊疗过程中，建立健全医药结合制度，逐步让广大患者意识到临床药师的地位。本文首先阐述了临床药师进行药学实践前的知识准备，并阐述了进行临床药学实践过程的意义。     

临床药师参与儿童严重脓毒症药学监护的实践

目的：通过参与严重脓毒症患儿的药物治疗实践,探讨临床药师参与抗感染治疗和开展药学监护的方法。方法：临床药师参与PICU收治的严重脓毒症患儿的治疗过程,参与制定治疗方案,根据治疗反应和病情变化及时调整方案。结果：通过临床药师对患儿药物治疗过程的药学监护,使患儿获得完善的个体化治疗,及时发现患儿的药物治疗问题,促进临床合理用药,提高患儿用药的安全性、有效性。结论：临床药师深入临床后,努力将药学理论知识优势和临床实践相结合,不断提高药物治疗水平,获得临床认可,在治疗团队中实现自己的价值。     

消化道肿瘤术后化疗相关性恶心呕吐防治的信息化外科药学实践

目的:探索化疗相关性恶心呕吐信息化药学平台联合外科药学服务对消化道肿瘤术后化疗患者的作用和效果。方法:外科药师参与化疗相关恶心呕吐信息化药学平台的建设,包括用药信息库和阶梯式用药路径的构建和应用;外科药师对外科医生、护士和患者提供差异化的化疗相关性恶心呕吐药学服务。外科药师在胃肠外科进行临床实践,并收集药学干预前后大肠癌术后化疗患者的病例资料。比较两组化疗患者的恶心呕吐防治效果,进一步优化药学服务,实现药学转型新形式。结果:共入组患者85例,分别为干预前41例和干预后44例,干预后化疗相关急性呕吐和延迟性呕吐的控制有效率均高于干预前,差异有统计学意义(P=0.009和P=0.039);干预后患者的用药依从性高于干预前,差异有统计学意义(P=0.000)。结论:信息化药学平台联合外科药学服务对大肠癌术后患者化疗相关恶心呕吐的防治效果显著,不仅利于外科药师在药学服务转型中积累实践经验,也为医院药学的信息化建设提供了新思路。     

临床药师参与晚期肺癌患者靶向治疗的药学实践

目的 探讨临床药师在晚期肺癌患者靶向治疗中的作用。 方法 临床药师参与1例晚期肺癌患者靶向治疗的过程,结合药物用法用量、药物相互作用、药物不良反应等提出药学建议,提供个体化的药学服务。 结果 临床药师参与晚期肺癌患者靶向治疗的药学监护,及时发现和处理患者治疗过程中潜在的问题,预防了不良结局的发生。 结论 临床药师参与晚期肺癌患者的靶向治疗,可提高患者治疗的安全性和有效性,促进药物的合理使用。     

临床药师参与药学实践的几点感受

临床药师人才匮乏是现阶段阻碍医院临床用药合理规范的关键,如何尽快培养具有较为全面的知识结构和一定独立工作能力的临床药师是目前大家关心的问题。根据近几年临床药师参与心血管专业临床药学实践过程,并结合临床病例,将工作体会报道如下。     

Management of chemotherapy-induced nausea and vomiting

Cancer chemotherapy is associated with numerous toxicities such as nausea and vomiting (emesis). The frequency, onset, and duration of emesis depend largely on the emetogenic potential of specific agents. An exact mechanism for chemotherapy-induced emesis (CIE) is not known but is thought to occur through several noxious actions and numerous neuronal pathways. The three types of CIE are acute, delayed, and anticipatory. Nonchemotherapy causes of emesis should be considered before diagnosing CIE. Once the diagnosis is established, antiemetic regimens should be recommended based on characteristics of the patients and the agents. Phenothiazines, butyrophenones, cannabinoids, metoclopramide, corticosteroids, and benzodiazepines have been successful in preventing and treating CIE. Combinations of these drugs have also been successful and are still being investigated for improved emetic protection with fewer adverse reactions. Investigational agents such as serotonin antagonists may prove to be effective with few toxic effects. Despite the minimal information available on delayed and anticipatory nausea and vomiting, attempts should be made to treat them. Suggested guidelines for the management of CIE have been developed.     

Risk-benefit of antiemetics in prevention and treatment of chemotherapy-induced nausea and vomiting

The development of effective antiemetic prophylaxis is one of the most significant steps forward in the area of supportive care. Fifteen years ago, patients receiving chemotherapy had to face the fact that nausea and vomiting were inevitable adverse effects, which could only be partially prevented by treatment with antiemetics such as dopamine (DA) D2 receptor antagonists and corticosteroids. The first group of drugs specifically developed as antiemetics was the serotonin (5-hydroxytryptamine [5-HT](3)) receptor antagonists. These drugs have dramatically improved prophylaxis of chemotherapy-induced emesis, particularly when used in combination with a corticosteroid. This combination has resulted in a significant decrease in the number of patients vomiting, whereas the improvement in the prophylaxis of nausea has been less successful. Another group of antiemetics, the neurokinin (NK) 1 receptor antagonists, has recently been developed, and the first drug in this class, aprepitant, has been approved by the FDA and the EU authorities. Studies have showed that patients benefit from the use of this drug in combination with standard antiemetic therapy (5-HT 3 receptor antagonist plus a corticosteroid), both in the acute and delayed phase of nausea and vomiting induced by cisplatin-based chemotherapy. This development has not only led to improved efficacy but also to a decreased risk associated with the use of antiemetics. One of the problems with traditional antiemetics, for example, the DA D2 receptor antagonists, is the risk of unpleasant adverse effects including restlessness and dystonic reactions. To avoid these adverse effects, combination with benzodiazepines or antihistamines was necessary, often resulting in sedation. Modern research also includes pharmacogenomic investigations. This has led to speculation about the importance of drug-drug interactions involving antiemetics through competition for metabolism by the cytochrome P450 isoenzymes. The worst possible interaction would be a decrease in the effect of different cytotoxins but there is no evidence that such interactions are of importance in daily clinical practice. Guidelines are useful tools in the optimisation of antiemetic prophylaxis but, unfortunately, implementation of the evidence-based recommendations is far from successful. A prerequisite for further optimisation of antiemetic prophylaxis is updating of the guidelines, including recommendations for the use of NK 1 receptor antagonists (aprepitant), followed by implementation of these recommendations in the clinic. Future research must include 'the difficult trials' focusing on the remaining groups of patients with severe chemotherapy-induced nausea and vomiting, including patients with refractory and breakthrough emesis.     

Current pharmacotherapy for chemotherapy-induced nausea and vomiting in cancer patients

Introduction: Nausea and vomiting are two of the most frequent and troubling side effects patients experience during chemotherapy, interfering with compliance with cancer therapies and quality of life. While newly available treatments have improved our ability to manage nausea and vomiting, anticipatory and delayed nausea and vomiting are still major problems for patients receiving chemotherapy. Many cancer patients consider delaying future chemotherapy cycles and some contemplate stopping chemotherapy altogether because of their fear of experiencing further nausea and vomiting.

Areas covered: The purpose of this article is to provide an overview of the pathopsychophysiology of chemotherapy-induced nausea and vomiting (CINV), the recommended guidelines for treatment, and current agents in late-stage clinical trials, and future research needs to address the continued challenges of treatment-related nausea and vomiting.

Expert opinion: Despite advances in pharmaceutical and behavioral therapies, and the provision of standard clinical guidelines for effectively managing CINV, patients continue to experience it. Moreover, control of nausea, acute and delayed, and anticipatory nausea and vomiting remains an important, unmet need among cancer patients. It is critical to focus attention on better understanding the mechanisms underlying nausea, anticipatory symptoms and delayed symptoms.     

帕洛诺司琼治疗化疗呕吐的临床研究进展

帕洛诺司琼是第一个获准用于预防迟发性化疗所致恶心、呕吐（chemotherapy-induced nausea and vomiting,CINV）的5-羟色胺3（5-HT3）受体拮抗剂。通过比较,发现帕洛诺司琼治疗急性期CINV至少同第一代5-HT3受体拮抗剂同样有效,对延迟性CINV的疗效优于第一代5-HT3受体拮抗剂。本文综述了帕洛诺司琼的临床研究进展,并探讨了多剂量给予帕洛诺司琼的安全性和有效性。     

Granisetron: new insights into its use for the treatment of chemotherapy-induced nausea and vomiting

Granisetron (Kytril^®, Roche) is a 5-hydroxytryptamine 3 (5-HT₃)-receptor antagonist indicated for the prevention of nausea and/or vomiting associated with initial and repeat courses of emetogenic chemotherapy, including high-dose cisplatin. Its indication expanded in August 2002, with approval from the FDA for the prevention and treatment of postoperative nausea and vomiting. Granisetron strongly and selectively binds to the 5-HT₃ receptor with a binding constant of 0.26 nM and exhibits a 4000 – 40,000 times greater binding affinity for the 5-HT₃ receptor than other binding sites, including other 5HT subtypes and adrenergic, histaminergic and opioid receptors. Its selectivity to the 5-HT₃ receptor over other receptor types is > 1000:1. Granisetron noncompetitively binds to the 5-HT₃ receptor and is associated with a long duration of action as shown by the inhibition of a 5-HT axonal response flare for up to 24 h. Granisetron is unique among the 5-HT₃-receptor antagonists because it is not metabolised via the cytochrome P450 (CYP) 2D6 pathway and is, therefore, less susceptible to variation in patient response because of factors such as pharmacogenomic differences. Granisetron and other 5-HT₃-receptor antagonists are first-line agents for acute chemotherapy-induced nausea and vomiting (CINV), whereas combination therapy with 5-HT₃-receptor antagonists, dexamethasone and neurokinin (NK)-1 receptor antagonism (i.e., with the recently approved aprepitant) is an effective approach to prevent delayed CINV. Granisetron has been shown to be an effective within-class rescue antiemetic for prophylactic failures, which may be linked to its pharmacological properties including non-competitive, insurmountable binding to the 5-HT₃ receptor. As with other 5-HT₃-receptor antagonists, granisetron is well-tolerated with adverse events of mild severity including headache, asthenia and constipation. Overall, data demonstrate that granisetron is an efficacious, safe and cost-effective member of the 5HT₃-receptor antagonist class for the prevention of CINV.     

Granisetron: new insights into its use for the treatment of chemotherapy-induced nausea and vomiting

Granisetron (Kytril, Roche) is a 5-hydroxytryptamine 3 (5-HT(3))-receptor antagonist indicated for the prevention of nausea and/or vomiting associated with initial and repeat courses of emetogenic chemotherapy, including high-dose cisplatin. Its indication expanded in August 2002, with approval from the FDA for the prevention and treatment of postoperative nausea and vomiting. Granisetron strongly and selectively binds to the 5-HT(3) receptor with a binding constant of 0.26 nM and exhibits a 4000 - 40,000 times greater binding affinity for the 5-HT(3) receptor than other binding sites, including other 5HT subtypes and adrenergic, histaminergic and opioid receptors. Its selectivity to the 5-HT(3) receptor over other receptor types is > 1000:1. Granisetron noncompetitively binds to the 5-HT(3) receptor and is associated with a long duration of action as shown by the inhibition of a 5-HT axonal response flare for up to 24 h. Granisetron is unique among the 5-HT(3)-receptor antagonists because it is not metabolised via the cytochrome P450 (CYP) 2D6 pathway and is, therefore, less susceptible to variation in patient response because of factors such as pharmacogenomic differences. Granisetron and other 5-HT(3)-receptor antagonists are first-line agents for acute chemotherapy-induced nausea and vomiting (CINV), whereas combination therapy with 5-HT(3)-receptor antagonists, dexamethasone and neurokinin (NK)-1 receptor antagonism (i.e., with the recently approved aprepitant) is an effective approach to prevent delayed CINV. Granisetron has been shown to be an effective within-class rescue antiemetic for prophylactic failures, which may be linked to its pharmacological properties including non-competitive, insurmountable binding to the 5-HT(3) receptor. As with other 5-HT(3)-receptor antagonists, granisetron is well-tolerated with adverse events of mild severity including headache, asthenia and constipation. Overall, data demonstrate that granisetron is an efficacious, safe and cost-effective member of the 5HT(3)-receptor antagonist class for the prevention of CINV.     

临床药师参与治疗鲍曼不动杆菌颅内感染患儿的药学实践

目的为临床救治重症难治性鲍曼不动杆菌颅内感染患儿提供用药参考。方法通过分析临床药师参与救治我院1例鲍曼不动杆菌颅内感染患儿提供的药学服务,根据患者的病情变化,临床药师结合药物的药理药化知识,查阅相关文献资料,与临床医师共同协商,制定出最优的药物治疗方案。结果通过临床医师及临床药师的共同努力,最终成功救治该患儿。结论临床药师的参与可以协助医师制订安全、有效的治疗方案。     

儿童化疗所致恶心呕吐预防方案的研究进展

化疗所致恶心呕吐(Chemotherapy-induced nausea and vomiting,CINV)是儿童肿瘤治疗过程中常见的不良反应。虽然CINV的控制目前已有显著的提高,但仍有许多肿瘤患儿正在经历化疗相关的恶心呕吐。目前国际上已有相关指南来针对儿童CINV止吐方案的合理使用给予推荐。本文旨在探讨儿童急性CINV预防和治疗方案的有效性和安全性,为临床儿童CINV的有效控制提供最新的证据。