临床药师下临床的实践与体会

目的探讨临床药师在血液科促进合理用药的工作方式。方法介绍我院临床药师深入血液科,促进合理用药的工作内容与体会。工作内容主要是参与医生交接班会及查房、书写药历、提供用药咨询、收集药品不良反应、开展治疗药物监测等。结果通过上述工作,可协助临床医生制定和调整药物治疗方案,给患者提供充分的用药指导,监测药品不良反应,充分发挥临床药师在临床合理用药中的作用。结论临床药师深入临床可使临床用药更加合理、安全、有效。     

鼻咽癌患者使用注射用奈达铂不良反应1例

目的 探讨临床药师在肿瘤患者化疗过程中的不良反应监测.方法 临床药师通过掌握化疗药物的药理作用、不良反应监测以及防范措施,对1例鼻咽癌患者过敏性休克的处理.结果 临床药师在化疗药物所致的不良反应处理及监测、防范中,与临床医生共同制定方案,以患者化疗方案及执行情况作为药学监护的切入点,开展护士的用药教育,建立医药护三者良好的沟通机制,共同维护患者的用药安全.结论 临床药师参与化疗药物治疗过程,可以协助临床避免不良反应,使用药更加安全、有效、合理.     

临床药师开展苦碟子注射液药学监测情况及分析

目的：探讨临床药师参与临床用药监测的工作实践和作用。方法开展苦碟子注射液用药监测工作,密切监护患者用药情况及其引发的药物不良反应,及时分析原因,提出合理用药建议。结果临床充分采纳临床药师所提苦碟子注射液用药建议,完善了临床诊疗方案,显著降低苦碟子注射液不良反应发生率。结论临床药师在全面展开药学工作的同时,还要与护士和医生进行有效的沟通,保障药物的安全使用。     

临床药师在药物不良反应监测中的作用

目的探讨安全用药的措施。方法通过总结分析临床药师在药物不良反应监测中的作用。结果与结论临床药师是医师与药师之间的纽带,在临床用药及药物不良反应监测中发挥着越来越重要的作用。     

冠状动脉搭桥术后侵袭性真菌感染患者一例药学监护

目的:探讨临床药师在心外科实施药学监护、参与治疗方案制订的工作切入点。方法:通过对1例冠状动脉搭桥术后侵袭性真菌感染的患者进行药学监护,分析抗真菌感染治疗方案、抗真菌药物不良反应监测与处理、患者用药指导,评估抗真菌药物使用情况,讨论抗真菌感染治疗的个体化用药方案的重要性。结果:通过药学监护,临床药师为临床提供了合理用药建议及不良反应处置意见。结论:临床药师以药学监护为工作切入点,促进临床药师融入医生护士共同组成的治疗团队,有利于保证患者用药安全、有效、经济。     

北京市22家医院临床药学服务对象满意度调查

目的:了解临床药学服务对象对临床药师工作的满意度,为评价临床药师工作质量提供依据.方法:应用问卷调查法调查北京市22家医院临床药学服务对象对其所在医院临床药师工作的满意度,回收问卷进行统计分析.结果:①医生最希望临床药师提供的药学知识为适应症,药物不良反应及发生率,药物不良反应及用药过量的处置对策;护士最希望临床药师提供的药学知识为用法用量、注意事项,不良反应及用药过量的处置对策,注射药物的配伍变化;患者最希望临床药师提供的药学知识为用法用量、药物不良反应和注意事项.②大部分医生和护士认为临床药师的工作内容主要是"提供药品信息、用药咨询、进行药物不良反应监测".③对临床药师的工作评价、专业知识水平的评价以及对临床药师沟通技能的评价都是认为好的占最多数,认为不尽人意的只占极少数.④50.0%以上的医生和护士对临床药师提出用药建议的采纳率大于50%.⑤大部分患者遇到有关药物问题时,首先选择咨询的对象是医生;患者在与临床药师沟通中最常见的障碍是信息不全面.⑥医生、护士及患者都认为临床药师最应改善的方面为相关疾病知识和相关药物知识.结论:临床药师的工作得到了服务对象一定程度的肯定,但仍有许多需要改善的地方.     

临床药师参与老年病科用药的实践与体会

临床药师为医护人员提供药品信息,对安全用药提出合理化建议,本文介绍专职临床药师在老年病科广泛参与临床药学实践的情况,包括参与临床查房、指导护士做好用药安全管理、提供药物信息、指导患者用药教育、监测不良反应及指导多种形式的全程化药学服务。为探讨临床药师在老年病科参与临床药物治疗的工作方法提供参考资料。     

临床药师在呼吸科的药学服务

临床药师通过在呼吸科参与患者个体化给药方案设计、患者用药教育和不良反应监测等药学服务,进一步提高患者的药物治疗效果,确保患者用药安全。由此,使临床药师的工作得到临床医师和患者的认可。     

临床药师对血液肿瘤科药物治疗的药学监护

目的探讨临床药师在血液肿瘤科开展药学服务的工作模式和切入点。方法结合血液肿瘤科临床药师在药物治疗、给药环节及患者用药教育等方面的工作体会,总结工作内容和模式。结果我院临床药师在药物治疗方案、药物相互作用、药品不良反应监测、对护士的指导、用药咨询和药患沟通等方面发挥了重要作用,取得了明显效果。结论临床药师只有深入临床,按照适宜的工作流程,才能切实做好临床药学服务。     

临床药师参与胃癌化疗过程的药学实践

目的：探讨临床药师在参与胃癌化疗过程中的作用。方法：通过临床药师参与胃癌化疗过程中的方案制定、方案调整、不良反应监测、患者教育等,阐述临床药师在胃癌化疗过程中的药学实践活动。结果：医师接受临床药师提出的用药建议,患者在临床药师指导下改善了用药依从性,治疗过程顺利。结论：临床药师在胃癌患者化疗过程中,应该从方案的制定、调整,药物不良反应的监测、患者的用药教育等方面,与医师形成良好的协作与沟通,为患者提供个体化的临床药物治疗。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

2-(Acetoxyphenyl)-(Z)-styryl sulfides as cyclooxygenase inhibitors

2-(Acetoxyphenyl)-(Z)-styryl sulfides are described as selective cyclooxygenase-2 (COX-2) inhibitors, useful for treating inflammation and COX-2-mediated disorders including neoplasia. 2-(Acetoxyphenyl)-(Z)-styryl sulfide is claimed to be the most potent COX inhibitor in the series with a COX-2 selectivity ratio of 33. This compound is also claimed to be superior to celecoxib (Celebrex^®, Pfizer) in inhibiting cell growth of colorectal carcinoma cells. In this evaluation, the COX inhibitory activity of this compound is compared to that previously disclosed for diarylheterocycles and 2-(acetoxyphenyl)alkyl sulfides. The validity of the DLD-1 cell line in the growth inhibition studies is questioned based on recent literature reports indicating the lack of COX-2 expression in this cell line.     

Sleep-disordered breathing with chronic opioid use

Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. μ-Opioids depress respiration and deaths related to illicit and non illicit chronic opioid use are not uncommon. Since 2001 there has been an emerging literature that suggests that chronic opioid use is related to central sleep apnoea of both periodic and non-periodic breathing types, and occurs in ～ 30% of these subjects. The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.     

Drug targets for cognitive enhancement in neuropsychiatric disorders

The investigation of novel drug targets for treating cognitive impairments associated with neurological and psychiatric disorders remains a primary focus of study in central nervous system (CNS) research. Many promising new therapies are progressing through preclinical and clinical development, and offer the potential of improved treatment options for neurodegenerative diseases such as Alzheimer's disease (AD) as well as other disorders that have not been particularly well treated to date like the cognitive impairments associated with schizophrenia (CIAS). Among targets under investigation, cholinergic receptors have received much attention with several nicotinic agonists (α7 and α4β2) actively in clinical trials for the treatment of AD, CIAS and attention deficit hyperactivity disorder (ADHD). Both glutamatergic and serotonergic (5-HT) agonists and antagonists have profound effects on neurotransmission and improve cognitive function in preclinical experiments with animals; some of these compounds are now in proof-of-concept studies in humans. Several histamine H3 receptor antagonists are in clinical development not only for cognitive enhancement, but also for the treatment of narcolepsy and cognitive deficits due to sleep deprivation because of their expression in brain sleep centers. Compounds that dampen inhibitory tone (e.g., GABA_A α5 inverse agonists) or elevate excitatory tone (e.g., glycine transporter inhibitors) offer novel approaches for treating diseases such as schizophrenia, AD and Down syndrome. In addition to cell surface receptors, intracellular drug targets such as the phosphodiesterases (PDEs) are known to impact signaling pathways that affect long-term memory formation and working memory. Overall, there is a genuine need to treat cognitive deficits associated with many neuropsychiatric conditions as well as an increasingly aging population.