1例瓣膜置换联合冠状动脉旁路移植术后患者抗栓治疗的药学监护

摘 要 目的：探讨临床药师对冠状动脉旁路移植术（CABG）合并瓣膜置换的患者实施药学监护的方法和思路。 方法：临床药师对1例CABG合并瓣膜置换术后的患者进行查房密切观察和药学教育,参与个体化抗栓方案的制定,规范患者用药问题,监测疗效与药品不良反应,给患者提供用药教育。结果：通过药师治疗全过程中细致的药学监护和医嘱干预,确定符合患者特点的抗栓方案,避免不良反应的发生,提高患者治疗的依从性和药物治疗效果。结论：临床药师积极开展药学监护,协同临床医师优化给药方案,有利于患者用药的安全性和有效性。     

1例原发性血小板增多症致颅内静脉窦血栓形成患者的抗血栓治疗分析及药学监护

目的 探讨临床药师在原发性血小板增多症致颅内静脉窦血栓形成患者的抗血栓治疗方案选择以及药学监护中的作用。方法 临床药师参与1例原发性血小板增多症致颅内静脉窦血栓形成患者的药物治疗。治疗期间，临床药师协助医师制定抗血栓治疗方案，为患者制定药学监护计划并实施药学监护，评估药物疗效，监测药物不良反应，开展用药教育。结果 经过抗凝、脱水降颅压、控制癫痫等治疗后，患者无头痛、恶心、呕吐，无肢体抽搐，左侧肢体乏力改善，好转出院。治疗过程中未出现皮肤瘀斑、鼻出血、牙龈出血以及黑便等药物不良反应。结论 临床药师对静脉窦血栓形成患者进行全程的药学监护，可提高药物治疗的有效性、安全性以及患者的依从性。     

1例脑卒中急性期患者抗血小板治疗的分析与药学监护

摘 要 目的：为临床抗血小板治疗致胃溃疡患者的药学监护及处理方法提供参考。方法: 临床药师参与1例脑卒中急性期患者抗血小板治疗的药学监护,通过药物重整和患者教育的方式,在抗血小板治疗、降压、护胃等方面提出药学建议。结果: 患者胃出血得到控制,血压控制在目标值以内。结论:临床药师通过对患者的用药监护,保证患者的用药安全性,提高患者用药依从性,从而提高临床治疗的效果。     

慢病药学门诊的规范化工作模式探索及实例分析

目的 探索慢病药学门诊的工作模式。方法 通过介绍慢病药学门诊服务模式及1例高血压伴失眠患者就诊实例,阐述慢病药学门诊各就诊步骤的服务要点。结果 通过对患者进行药物重整,用药教育及生活方式指导等药物治疗管理,患者改善了症状,提高了对疾病的认识及用药依从性。结论 慢病药学门诊规范工作模式具有一定可行性。     

甘肃省榆中县夏官营镇老年高血压患者用药依从性调查分析

目的：充分了解影响农村地区老年高血压患者用药依从性的因素,为提高高血压患者用药依从性提供参考。方法：对甘肃省兰州市榆中县夏官营镇912名65岁以上居民进行健康体检,对所筛选出的高血压患者的用药依从性问题进行现场问卷调查。结果：老年高血压患者用药依从性好、尚可、差所占比例分别为36.12%、28.49%和35.04%;用药依从性不佳的主要原因为记忆力减退和家属督促不力;对药物疗效完全了解、部分了解、不了解者分别占50.52%、31.87%和17.61%。结论：甘肃省兰州市榆中县夏官营镇老年高血压患者用药依从性较差,对药物疗效等相关知识了解程度不高,不按时服药的老年高血压患者较多。提示医、药、护人员要深入社区,加强对老年高血压患者的健康教育,对患者家属加强督促,使患者认识到药物治疗对控制血压的重要性,提高用药依从性。     

1例重度骨髓抑制肿瘤患者的药学监护

摘 要 目的:探讨临床药师在治疗重度骨髓抑制的肿瘤患者中实施药学监护的意义。方法: 临床药师利用药学专业知识,结合检验结果、药敏结果、药物特点、用药经验及药物不良反应等方面的知识协助医生合理选择药物并实施药学监护。结果:通过对该患者实施全程的药学监护,与医生良好的配合,提高了用药的科学性、合理性,同时提高了患者的依从性,最终顺利的完成治疗。结论:临床药师通过对患者的药学监护,可以协助临床避免不良事件的发生,使患者用药更加安全、有效和合理。     

药学干预对社区高血压患者用药依从性的影响

目的 探究药学干预下社区高血压患者的药物治疗依从性,为患者的安全有效用药提供指导,亦为转型期的二级医院临床药师探索药学服务新路径提供参考。方法 采用药师干预与不干预对照试验方法,比较药师干预前后干预组与对照组高血压患者临床治疗依从性、血压变化和生活方式改善依从性。结果 经过12个月实验,药师干预组高血压患者的临床治疗依从性和生活方式改善依从性均明显高于对照组（P<0.05）,收缩压和舒张压也都有明显降低（P<0.05）。结论 药学干预对社区高血压患者用药依从性有积极的影响。     

1例哮喘急性发作伴抑郁症患者的药学监护

摘 要 目的：探讨临床药师对哮喘急性发作患者开展药学监护的方法与思路。方法：临床药师通过了解哮喘急性发作的治疗原则,分析治疗方案,参与1例哮喘急性发作伴抑郁症患者的治疗过程并实施药学监护,关注药物不良反应及治疗窗,协助临床医生制定适合患者的个体化用药方案。结果：临床药师通过对治疗全程的药学监护和医嘱干预,识别了药品不良反应的发生,优化了治疗方案,提高了药物治疗效果。结论：临床药师在临床治疗中应积极开展药学监护,协助医师制定个体化治疗方案,以利于提高患者用药的安全性和有效性。     

1例急性心肌梗死并发消化道出血患者的药学监护

摘 要 目的：小结1例急性心肌梗死并发消化道出血患者的药学监护,分析监护效果。方法: 从急性心肌梗死、消化道出血的疾病特点及患者的自身因素出发,临床药师为患者实施个体化的药学监护。 结果: 药学监护提高了患者用药依从性和治疗的有效和安全性。结论:临床药师参与用药实践可提高药物使用的安全性、合理性。     

1例静脉药瘾者感染性心内膜炎抗感染用药分析及监护

摘 要 目的：对1例静脉药瘾者感染性心内膜炎患者抗感染治疗过程进行分析,探讨临床药师在临床治疗中发挥作用。方法：对患者住院期间进行药学监护,协助医师制订有效的个体化用药方案,根据患者病情变化调整治疗方案并监护其疗效和药品不良反应。结果：通过药师在整个过程中细致的药学监护及医嘱干预,患者病情得到改善。结论：开展药学监护,协同临床医师优化给药方案,有利于患者的用药安全有效。     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

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.

     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.