Analysis of the Application of Antifungal Drugs in Haematologic Patients from a Third Grade Class A Hos-pital during 2013-2014 / 中国药房

OBJECTIVE:To provide reference for the formulation of correct antifungal treatment strategy,and to promote stan-dard use of antifungal agent. METHODS:A retrospective survey was conducted for 138 haematologic patients from May 2013 to May 2014 in a third grade class A hospital,of whom all had used antifungal drugs during hospitalization. We collected all patients' information and analyzed it statistically. RESULTS:Of 138 haematologic patients,3 were proven IFD (all were Candida infec-tion),6 were probable IFD,12 were possible IFD,and 117 were undefined IFD. The positive rates of fungi pathogenic detection, fungal smear,G-test,and GM-test were 15.3%,9.4%,6.4% and 23.4% respectively. 6 kinds of antifungal were used,and vori-conazole had the highest frequency,followed by fluconazole,itraconazole,amphotericin B,caspofungin and micafungin. 62.3%patients used only one kind of antifungal,but 15.9% patients used 2 or more kinds of antifungal. The average medication course was 20.5 days(1 day to 125 days). Irrational drug use showed improper drug selection,unreasonable dose,and replacing antifun-gal with insufficient basis. CONCLUSIONS:The antifungal use in haematologic patients in the hospital is consistent with the re-quirements of guidelines,but there are still some issues as insufficient antifurgal drug treatment course to be further standardized.

Effects Evaluation of Antibacterial Drug Prescriptions Comment in Outpatient and Emergency Depart-ment of a Hospital / 中国药房

OBJECTIVE:To provide reference for rational use of antibacterial drugs in the clinic. METHODS:In retrospective study,outpatient and emergency antibacterial drugs prescriptions were randomly selected from a hospital during 2013-2014,and then analyzed statistically. DDDs of antibacterial drugs were analyzed by using DDD method. RESULTS:From 2013-2014,the ap-plication rate of antibacterial drugs in the hospital declined substantially from 13.8% to 11.9%,and the rate of irrational use dropped from 2.7% to 1.2%. The application rate of antibacterial drugs was higher in pediatric department,emergency department and urology department;drug cost per capita was higher in infectious department,nephrology department and emergency depart-ment. The application rate of antibacterial drugs in pediatric department decreased greatly in 2014,compared with 2013,maintain-ing about 40%. The application rate of antibacterial drugs in emergency department during Jan.-Sept. in 2014 was lower than corre-sponding period in 2013,and that of the hospital during Jan.-Sept. in 2014 was lower than corresponding period in 2013,but dur-ing Oct.-Dec. in 2014 was slightly higher than corresponding period in 2013. Single type of antibacterial drugs were mainly used in outpatient department,accounting for 91.50% and 90.77% of antibacterial drug prescriptions in 2013 and 2014;two-drug account-ed for 8.44% and 9.11%. The top 3 antibacterial drugs in the list of DDDs during 2013-2014 were roxithromycin,cefuroxime and cefminox. CONCLUSIONS:The use of antibacterial drugs is up to the requirements of Nation Special Rectification Actirity for Clin-ical Application of Antibacterial Drugs in 2013. The prescription comment improve the quality of antibacterial drug prescriptions and rational use index greatly in outpatient department,but the application rate of antibacterial drugs is too high in some depart-ment. There still is irrational use of antibacterial drugs.

Investigation on the Cognition,Evaluation and Demand of Medical Staff to the Clinical Pharmacy Work in Same Secondary and Tertiary Medical and Health Institutions in Xi’an City / 中国药房

OBJECTIVE:To investigate the cognition,evaluation and demands of medical staff to the clinical pharmacy work in the secondary and tertiary medical and health institutions in Xi’an city,and provide reference for further promoting the develop-ment of the local clinical pharmacy work. METHODS:20 secondary and tertiary medical and health institutions in Xi’an city were randomly selected to conduct a random sampling questionnaire for physicians,nurses (senior nurses),pharmacists (non-clinical pharmacist)and other medical technicians. And the results were statistically analyzed. RESULTS:Totally 1 020 questionnaires were sent out,851 were effectively received with effective recovery of 83.4%. 45.9% respondents knew clinical pharmacy,and“Col-league”was the main channel;34.3% thought clinical pharmacy“only maintained normal operation. 74.7% surveyed medical staff,92.6% surveyed pharmacists and 70.6% surveyed physicians thought clinical pharmacists“should”take round with the doc-tors and nurses;44.3% respondents showed“dissatisfaction”and“general satisfaction”with the clinical pharmacy work in their hospitals. 48.5% respondents would take the initiative to consult the clinical pharmacist for medication;45.5% respondents partial-ly accepted the drug information provided by clinical pharmacists. There were significant differences in the investigation results in aspects of respondents’understanding level and channel for clinical pharmacy,cognition for development situation of clinical phar-macy,evaluation for clinical pharmacists participating round,demand for consulting the medication,acceptance for drug informa-tion provided by clinical pharmacists,and other items(P<0.05). CONCLUSIONS:The cognition and effect of clinical pharmacy work on medical staff need to be further strengthened,clinical pharmacists should also have solid clinical knowledge and the knowl-edge of medicine to meet the demand of medical staff in different positions,the acceptance of medical staff to the pharmaceutical care needs to be further improved. Clinical pharmacists should earnestly fulfill their job functions through various efforts to promote rational drug use.

Risk Factors Study for Lung Cancer Patients with Chemotherapy-induced Severe Neutropenia / 中国药师

Objective:To discuss the risk factors in lung cancer patients with chemotherapy-induced severe neutropenia to provide reference for clinical drug use. Methods:A retrospective analysis was performed for the patients with lung cancer,and the risk factors of severe neutropenia were statistically analyzed and found out. Results:The results of single factor experiments showed that the incidence of severe neutropenia was related with radiotherapy history,cycles of chemotherapy and the use time of granulocyte colony factor. Based on a binary logistic regression analysis,the history of radiotherapy and the use of granulocyte colony factor were the significant risk factors of severe neutropenia in the lung cancer patients. Conclusion:For the patients with radiotherapy history,it is better to choose chemotherapy drugs with lower toxicity,decrease drug dosage or preventively use granulocyte colony factor. The rational use of rhG-CSF can alleviate chemotherapy-induced severe neutropenia.

Determination of ATP, ADP and AMP in Cardiac Muscle of Rats with Heart Failure by HPLC / 中国药师

Objective:To establish the determination method for ATP, ADP and AMP in the myocardial tissue of rats and research the changes of ATP, ADP and AMP in heart fallure rats. Methods: A Thermo Hypersil C18 (250 mm × 4. 6 mm,5 μm) column was used. The solution of 0. 68% potassium dihydrogen phosphate and 0. 116% soduim hydroxide was applied as the mobilie phase; The detection wavelength was at 254 nm. The SD rats randomly divided into 2 groups received saline and adriamycin by intraperitoneal in-jection for 6 weeks, respectively. The heart tissue was withdrawn for homogenate. The contents of ATP, ADP and AMP in rat heart tis-sue were determined by HPLC. Results:The calibration curves were linear from 0. 625μg·ml-1 to 40μg·ml-1 for ATP, ADP and AMP. The limit of detection and limit of quantification were 0. 625μg·ml-1(r>0. 99). The precision of RSD was less than 9. 50%. The accuracy was 93. 2%-108. 0%. The method stability (RSD) was from 3. 0% to 14. 0%. The content of ATP in heart fallure mod-el group induced by adriamycin was significantly lower than that in saline group,while that of ADP were much higher than that in saline group(P<0. 01) and AMP. Conclusion:The HPLC method for the content determination of ATP, ADP and AMP in myocardial tissue meets the requirements of the determination of biological samples, which can be used to study the effects of anthracycline-based antitu-mor drugs in heart fallure rats.

Pharmaceutical Care on a Patient with Intestinal Obstruction Induced by High Dose of Morphine / 中国药师

Objective:To analyze the drug use of a patient with intestinal obstruction induced by high dose of morphine to explore the role of clinical pharmacists during the therapeutic process. Methods:The dose titration of morphine, choice of analgesic drugs and dose conversion were adjusted by doctors and pharmacists using NRS scores of dynamic assessment for the patient. The pharmaceutical care was implemented for the patient induced by high dose of morphine. Results:The pharmaceutical supervision by clinical pharma-cists improved medication compliance of the patient. After fentanyl patches were used to replace morphine, the intestinal obstruction was relieved in the patient and the quality of life was improved. Conclusion:Clinical pharmacist can promote the rational use of opi-oids for patients with intestinal obstruction. The successful treatment of the patient with intestinal obstruction provides the reference for patients with intractable pain treated by opioids.

Absorption and transportation characteristics of scutellarin and scutellarein across Caco-2 monolayer model / 中西医结合学报

Objective: To investigate the absorption and transepithelial transport characteristics of scutellarin and scutellarein in the human colonic adenocarcinoma cell (Caco-2) monolayer model. The influence factors on these two compounds' absorption were investigated, such as buffer solution, duration of culture, and inhibitors of multidrug resistance-associated protein 2 (MRP(2)), breast cancer drug resistance protein (BCRP) and P-glycoprotein (P-gp). Methods: By using Caco-2 monolayer as an intestinal epithelial cell model, the transport process was studied from apical (AP) side to basolateral (BL) side or from BL to AP. The two compounds were determined by high-performance liquid chromatography coupled with diode-array-detector detection. Transport parameters and apparent permeability coeffients (P(app)) were calculated. Results: The P(app) values of scutellarin and scutellarein were different in two buffer solutions, respectively. In phosphate buffered saline, scutellarin had no absorption from AP to BL, while its P(app) value was 0.74×10(-6) to 1.58×10(-6) cm/s from BL to AP. The P(app) values of scutellarein were 4.33×10(-6) to 6.79×10(-6) cm/s and 1.32×10(-6) to 2.56×10(-6) cm/s from AP to BL and from BL to AP, respectively. The P(app) value gradually decreased with time. The absorption of scutellarein was better than that of scutellarin. The scutellarin absorption was improved by verapamil, MK-571 and reserpine. The scutellarein absorption was improved by verapamil whereas its excretion was improved by MK-571. Conclusion: Absorption of scutellarin is difficult in Caco-2 monolayer cells, which contributes to its low bioavailability. Scutellarein absorption is better than scutellarin absorption. Scutellarein transepithelial transport is passive diffusion. The inhibitor of P-gp can improve scutellarin and scutellarein transportation. The inhibitors of MRP(2) and BCRP can promote transportation of scutellarin. The inhibitor of MRP(2) can promote efflux of scutellarein. The multidrug resistance-associated protein may be the second reason for low bioavailability of scutellarin.

Effect of taspine hydrochloride on skin wound healing in rats and its mechanism / 中西医结合学报

OBJECTIVE: To study the effect of taspine hydrochloride (TA/HCl) on skin wound healing in rats and its mechanism. METHODS: Bilateral round wounds were made on the backs of SD rats. The effect of TA/HCl on the skin wound was evaluated through determining closure time and contracting ability of the skin wound, observing histopathological characteristics and measuring contents of hydroxyproline (Hyp) and protein in the wound tissue. RESULTS: The closure time of the skin wounds was significantly shorter in the TA/HCl-treated groups than that in the model group. The percentages of wound contraction were higher in the TA/HCl-treated groups than that in the dimethyl sulfoxide (DMSO) control group of the same group (P<0.05 or P<0.01) on the 3rd to 14th days after wounding. The content of the protein in the wound tissue in the TA/HCl-treated group (2 mg/ml) was higher than that in the model group (P<0.05) on the 3rd to 7th days after wounding, and it arrived at the peak on the 7th day and gradually decreased to the normal level in skin tissue on the 14th to 21st days after wounding. The contents of Hyp in the wound tissues in the TA/HCl-treated groups were higher than that in the model group (P<0.05 or P<0.015) on the 3rd to 21st days after wounding, and they arrived at the peak on the 14th day and at the normal level in skin tissue on the 21st day. Histopathological test results showed that TA/HCl could promote the formation of newly born capillaries in the early period of the wound healing. CONCLUSION: TA/HCl has the ability of promoting skin wound healing in rats, and it can also accelerate the growth of newly born capillaries and raise the production of protein and collagen in wound tissue.

HPLC determination of mycophenolic acid in serum of early period of renal transplant patients / 西安交通大学学报(医学版)

Objective To establish a high-performance liquid chromatography method for determination of mycophenolic acid in human plasma.Methods The method was performed with C18 column(3.9mm?300mm).The mobile phase consisted of 40mmoL/L TBA solution-acetonitrile adjusted to pH 4 with orthophosphoric acid(55∶45,V∶V),with a flow rate 0.8mL/min.The UV detection wavelength was 254nm.Plasma samples were extracted with methanol.Results The linear concentration of the calibration curve ranged from 0.8 to 51.45mg/L(r=0.9998).The relative recoveries were between 95.5% and 109.2%,and the extraction recoveries were more than 90%.Relative standard deviation(RSD) of intraday and interday assays were both less than 10%.Conclusion The method is proved to be reliable and simple for monitoring mycophenolic acid in human plasma and bioequivalence research.