Pharmacists' role in multidisciplinary diagnosis and treatment in adverse reactions: A case report of interferon alfa-2b induced severe lupus.

RATIONALE: Various side effects of interferon alfa-2b (IFN-α2b) have been reported. However, no relevant research has been conducted on the identification and treatment scheme selection for IFN-α2b induced severe systemic lupus erythematosus (SLE). PATIENT CONCERNS: A 41-years-old man with a long history of hepatitis B who developed severe active SLE after IFN-α2b therapy for 24 months, with complete and persistent remission of clinical and laboratory abnormalities after IFN-α2b withdrawal, was not observed. DIAGNOSIS: The patient was diagnosed with interferon-associated lupus by a multidisciplinary team involving pharmacists, and lupus nephritis by renal biopsy. INTERVENTIONS: Methylprednisolone (40 mg/day) with intravenous cyclophosphamide (600 mg/body weight) was initiated and the symptoms were partially relieved. Cyclophosphamide was increased from 600 mg to 850 mg at the pharmacist's recommendation. OUTCOMES: The patient showed a favorable response to these therapies. LESSONS: Clinical pharmacists collaborated with other members of the health care team to diagnose and treat adverse reactions, resulting in improved patient management.

The impact of pharmacist oriented mode on risk control in a Chinese centralized intravenous admixture service centre.

Centralized intravenous admixture service (CIVAS) centres, which are pharmaceutical departments found in Chinese hospitals, provide high-quality intravenous fluids and pharmaceutical services for patients, and errors in their working procedures can lead to adverse consequences. Pharmacists, the primary CIVAS centre personnel, play a role in risk control; however, to date, the effect of pharmacists' participation in risk management has not been reported. The main aim of this study was to evaluate the pharmacist's role in risk control and evaluate its impact. A retrospective observational study was designed to assess the principal working process in the CIVAS centre of a provincial healthcare setting. Errors in the main working process were identified, and intervention measures were formulated. The pharmacist intervention effect was evaluated by assessing the identification rate of improper prescriptions; the incidence rate of drug preparation, compounding, packaging and delivery process errors; and expenditures on wasteful drugs. There was a higher identification rate for improper prescriptions after the intervention (P < 0.05), while the incidence of drug preparation (P < 0.05), admixture (P < 0.05), and packaging and delivery errors (P < 0.01) was significantly lower; the total wasteful medication expenditure was also dramatically reduced. The potential creativity of pharmacists in error control can provide dependable intravenous drugs for patients and reduce the running expenditures for CIVAS.

Different effects of nine clausenamide ennatiomers on liver glutathione biosynthesis and glutathione S-transferase activity in mice.

AIM: To study the effects of nine synthetic clausenamide with different stereo structures on liver glutathione (GSH) biosynthesis and glutathione S-transferase (GST) activity in mice. METHODS: The nine test compounds were racemic mixtures and their ennatiomers of clausenamide, neoclausenamide and epineoclausenamide. Mice were administered clausenamide 250 mg/kg once daily for 3 consecutive days, ig, and were killed 24 h after the last dosing. The mouse liver cytosol GSH and GST were determined with related biochemical methods. RESULTS: Nine clausenamides exhibited different effects on liver GSH and GST. Of nine clausenamides, only (+) and (+/-)clausenamide markedly increased liver cytosol GSH content. The mechanism of increasing liver GSH content of (+)clausenamide is mainly due to stimulating the key limiting enzyme gamma-glutamylcysteine synthetase (gamma-GCS) activity for GSH biosynthesis. The other test clausenamides had no such effect on liver GSH. All of the nine clausenamides induced a significant increase of GST activity. CONCLUSION: The effects of clausenamide ennatiomers on liver GST and GSH varied with the alterations of their spatial structures. (+)Clausenamide stimulated liver GSH biosynthesis through enhancing gamma-GCS activity.