Clinical Rational Drug Use Research Articles

The role of pharmacy intravenous admixture service in safe and rational clinical drug use

Objective To explore the effect of pharmacy intravenous admixture service(PIVAS) in safe and rational clinical drug use in our hospital.Method Retrospectively analyzed the situation of clinical drug use in PIVAS.Result In 2012,there were 566 irrational medical orders in PIVAS in total,554(97.88％) corrected by doctors among them.Conclusions PIVAS can enhance the communication among doctors,pharmacists and nurses,improve the quality of injections by sterile admixture,the level of drug management and occupational protection,and play a core role in safe and rational clinical drug use. Key words: Pharmacy intravenous admixture service; Rational clinical drug use; Medication safety

English

This research aimed to analyze the factors of heart cerebrovascular drugs that can lead to adverse reactions (ADRs) and to promote rational clinical drug use. Reports on cases of heart cerebrovascular diseases were collected in our hospital in 2001 to 2010, and medication and the clinical manifestations of the adverse reactions were analyzed. The incidence of adverse reactions was related with age, gender, routes of administration, dosage forms and other factors. The adverse reactions of heart cerebrovascular drugs were mainly related to dosage forms, the injections were especially more likely to cause adverse reactions, and the clinical manifestations were diversified. It was therefore suggested that doctors and patients pay more attention to the adverse drug reactions in the whole medication process.   Key words: Heart cerebrovascular, Chinese patent drugs, adverse reactions.

Analysis on 85 case reports of adverse drug reactions

This study investigated the occurrence and characteristics of adverse drug reactions (ADR) in our hospital and provide references for clinical rational drug use. We collected the 85 case reports of adverse drug reactions in our hospital in 2010 and made retrospective statistical analysis on them. The varieties of anti-infective drugs used are the most used. It also had the highest proportion of adverse drug reactions; the common symptom of adverse drug reactions is skin and accessory damage. Adverse drug reactions are affected by many factors, and relevant departments should strengthen ADR monitoring, to reduce or avoid the occurrence of adverse drug reactions.

English

Blood stasis, that is, the decrease of blood flow velocity and the increase of blood viscosity indicates hemorheological abnormalities and pharmacokinetic difference of drugs. Therefore, it is very important to investigate the pharmacokinetics of drugs in patients with blood stasis syndrome, which may influence absorption, distribution, metabolism, and excretion of drugs in blood. The aim of this study was to compare the pharmacokinetics of 140 mg hydroxysafflor yellow A (HSYA) in healthy subjects and patients with blood stasis syndrome due to stable angina pectoris (SAP), and indentify the therapeutic regimen for patients and promote clinical rational drug use. This study was carried out in 12 healthy volunteers and 24 patients with blood-stasis syndrome due to SAP using a single-dose of HSYA (140 mg) under fasting conditions. Venous blood samples were drawn through indwelling cannula from each volunteer prior to drug administration and at 0.5, 1, 1.25, 1.5, 2.0, 2.5, 3, 3.5, 4, 5, 6, 8, 10, 12, and 15 h after the drug administration. Plasma obtained after centrifuge was analyzed to determine HSYA by high-performance liquid chromatography (HPLC). HSYA pharmacokinetics have a significant difference between healthy subjects and patients with blood-stasis syndrome due to SAP: ratios of Cmax and AUC(0-∞) were 116.5% (105.0 to 134.2)and 132.2% (116.5 to 153.7), respectively; mean terminal half-life (t1/2) was 4.2 h as compared to 2.5 h in healthy subjects. The blood stasis syndrome has an impact on the pharmacokinetic parameters including Cmax, AUC0-∞, and t1/2, and dose adjustment should be required for patients with blood-stasis syndrome. Key words: Hydroxysafflower yellow A, safflower, pharmacokinetics differences, blood stasis.

A multicenter study on the application of Six Sigma management in clinical rational drug use by pharmacist intervention

The status of outpatient irrational prescription drug use before and after pharmacist interventions in 6 large scale hospitals was investigated to determine the underlying reasons and to promote rational clinical drug use. Materials and methods: The 5-step DMAIC method (define, measure, analyze, improve, control) in Six Sigma management was utilized to investigate irrational drug use in prescriptions. The statistical software package SAS9.1.3 was adopted to analyze the results, determine possible reasons that could lead to irrational drug use, and then intervene accordingly. Statistics before and after the intervention were compared to analyze the function and effect of Six Sigma management in rational drug use via pharmacist intervention. Results: Irrational drug use rates (defect rates) before and after the intervention were 8.56% and 4.46% (P < 0.001), the Z value increased from 2.82 to 3.01, and the differences were significant. Conclusion: Six Sigma management will be able to computerize and refine hospital management, thereby ultimately improving service quality.

Overview of pharmacoeconomic studies on traditional Chinese medicines and western medicines in treatment of stroke

In recent years, pharmacoeconomic studies have drawn increasing attention from experts in clinical medicine, pharmacy, health economics and health management. Their findings play an important role in drug pricing, drafting of the List of Essential Medicines and rational selection of clinical drugs. The essay summarizes the literatures published in recent years concerning pharmacoeconomics of traditional Chinese medicines on stroke, in order to make clear the current development of the latest studies on traditional Chinese medicines on treating stroke and rehabilitation methods and provide basis for further studies on pharmacoeconomics of traditional Chinese medicines on stroke and reference for rational clinical drug use.

Simultaneous Determination of the Combined Drugs of Ceftriaxone Sodium, Metronidazole, and Levofloxacin in Human Urine by High‐Performance Liquid Chromatography

To develop a new high-performance liquid chromatography (HPLC) method for simultaneous determination of the combined drugs (ceftriaxone sodium, metronidazole, and levofloxacin) in human urine. Ceftriaxone sodium, metronidazole, and levofloxacin were separated on a Kromasil 100-5 C18 (250 mm × 4.6 mm, 5 μm, AKZO NOBEL, Bohus, Sweden) analytical column, using the mobile phase consisted of 1.5 mM KH(2) PO(4) (pH 4.5) with 0.0125% triethylamine-methnol (70:30, v/v). Ceftriaxone sodium, metronidazole, and levofloxacin were detected by a photodiode-array detector at 247, 320, 292 nm, respectively. Under optimal conditions, the effective separation of ceftriaxone sodium, metronidazole, and levofloxacin was achieved. A good linearity with the correlation coefficients more than 0.999 was demonstrated. The detection limits of ceftriaxone sodium, metronidazole, and levofloxacin were 0.05, 0.01, and 0.25 μg/ml, respectively, and the average recoveries in human urine were in the range from 97.73 to 100.7% with the average relative standard deviation (RSD) in the range of 2.5% and 3.0%. The proposed method was sensitive, accurate, and rapid. This work may provide a reference for clinical rational drug use and methodology for the pharmacokinetics study of the combined drugs.

Discussion on clinical pathway management and rational use of drugs

Discussion on clinical pathway management and rational use of drugs

Investigation and analysis on the adverse reactions caused by 12 kinds of commonly used traditional Chinese medicine injections

This study was aimed to explore the characteristics and rules of the adverse drug reactions (ADR) caused by the 12 kinds of traditional Chinese medicine injections and to provide reference for rational clinical drug use. Retrospective study methods are adopted to make statistical analysis on the cases of ADR caused by the 12 kinds of commonly used traditional Chinese medicine injections, such as Chuanhuning, Yanhuning, Chuanxiongzine, Bupleurum, etc. reported in the knowledge resource database in the China Hospital Knowledge Database (CHKD) from 2006 to 2010. The ADR of these 12 kinds of traditional Chinese medicine injections have high incidence in elderly patients and occur mostly within 30 min after drug usage; this results mainly as systemic damage, manifested as allergic reaction, severe case can cause allergic shock, and each traditional Chinese medicine injection has its own features. The clinical medical care personnel shall learn more about the ADR of traditional Chinese medicine injections and reduce or avoid the occurrence of ADR. Key words: Traditional Chinese medicine injection, adverse drug reaction, rational drug use.

Literature analysis on 12 cases of allergic shock caused by lomefloxacin

The objective of this work is to investigate the characteristics and laws of clinical application of lomefloxacin causing allergic shock and promote rational clinical drug use. We retrieve the medical journals published domestically and make statistical analysis on the cases of allergic shock caused by lomefloxacin. Our results revealed that the incidence of allergic shock in patients of 18 to 60 years old is high, without difference in gender, and for injections, it occurs within 10 min, while for oral preparations, it occurs later. Conclusively, allergic shock caused by lomefloxacin is related to many factors, and clinical care personnel should pay more attention to it. Key words: Lomefloxacin, allergic shock, literature analysis

Evaluation point of rational drug use of traditional Chinese medicine in market

Minimizing the underlying risk and maximizing the benefits of drag users, by using drags under a safe, efficient and economical principle, is both the requirement and purpose of clinical rational drug use. This paper evaluates the clinical application of traditional Chinese medicine (TCM) in the market based on its characteristics, considering if the drugs are safely applied, if the medicine has an anticipated effect, and if the medicine is properly priced. This paper also brings the idea of establishing an evaluation system integrated with the characteristics of TCM to monitor the clinical application of TCM after going into the market and thus further optimizes the clinical instructions of applying TCM and helps to guide the appropriate usage of TCM.

Detection and the antibiotic susceptibility analysis of mycoplasma and chlamydia in urogenital tract infections of 327 cases patients with tubal infertility

To explore the effects of mycoplasma and chlamydia infections on tubal infertilityand to assess the antibiotic susceptibility and resistance of female urogenital, and consequently to guide clinical rational drug use. 327 tubal infertility women as infertility group and 286 healthy pregnant women as control group were randomly selected, detected chlamydia trachomatis (CT), ureaplasma urealyticum (UU) and mycoplasma hominis (MH) in cervical secretions and drug resistance of UU and MH. CT infection rates (14.99%), UU infection rates (23.24%), UU + MH infection rates (29.05%),CT + UU + MH infection rates (9.17%) and total infection rates (88.99%) in infertility group is higher than those (order: 2.80%, 6.99%, 8.39%, 4.55%, 29.02%) in the control group, comparisons of two groups are statistically significant differences (P < 0.05), the susceptibility of UU to roxithromycin (sensitivity is 96.05%), josamycin (sensitivity is 96.05%), tetracycline (sensitivity is 82.89%), vibramycin( sensitivity is 92.11%) and clarithromycin (sensitivity is 96.05%) were relatively high and low to ciprofloxacin and acetyl spiramycin. The susceptibility of MH to josamycin (sensitivity is 95.83%), vibramycin (sensitivity is 91.67%), minocin (sensitivity is 83.33%) and actinospectacin (sensitivity is 75.00%) were relatively high and low to erythromycin, azithromycin, roxithromycin and clarithromycin. UU + MH was only sensitive to josamycin (sensitivity is 90.52%), high resistance (77.89% -91.58%) to erythromycin, azithromycin, acetyl spiramycin, ciprofloxacin, ofloxacin, azithromycin and clarithromycin. Infection of CT, UU, MH and tubal infertility have certain relevance,the rates of CT, UU and MH infection in tubal infertility patients higher than fertile people. For many commonantibacterial drugs, UU, MH and UU + MH has strong resistance, the etiology detection and using adapted antibios should be taken seriously in clinical treatment.

Research on the recent antimicrobial usage in seven hospitals of Guangzhou

Objective To provide reference for clinical safe and rational drug use. Methods The data of seven hospitals in Guangzhou from July 2005 to December 2007 were analyzed retrospectively, and frequency analysis method was used Results Quinolones rank first, the frequency of whose usage is 12.91%; while the frequency of the usage of cefuroxime is 7.14%. And the percentage of the use of drugs for basic national medical is 91.9% while the tablets is 49.37% and the injection is 69.66%.Conclusions People tend to abuse the advanced antibacterial more and more,and many antibacterials are included in the drugs for basic national medical. Besides, intelligent use of the injection should be given attention. Key words: Antibacterial; Analyses of medical application; Survey study

Blocking conversion of GABAergic inhibition as a potential mechanism of propofol-mediated brain protection following resuscitation

Animal experiments and clinical studies have indicated that propofol pretreatment significantly improves post-resuscitation recovery of neuronal functions. However, current theories on how propofol enhances the inhibitory effects of gamma-aminobutyric acid (GABA) cannot fully explain its protective action on the brain. Recent studies have suggested that during the process of resuscitation, the effect of GABA is converted from inhibitory to excitatory, via a mechanism that is closely associated with activation of microglia and downregulation of the K(+)-Cl(-) cotransporter 2 (KCC2). We propose a hypothesis that propofol protects the brain through inhibiting the conversion of GABAergic inhibition into excitation during resuscitation. Activation of microglia, downregulation of KCC2, and correlations between these effects and the protective actions of propofol, may reveal the molecular mechanisms of propofol-mediated brain protection. Further investigations into the protective mechanisms of general anesthetics on the brain represented by propofol will help to guide rational clinical drug use, and will contribute to the discovery and development of novel brain-protective drugs to prevent perioperative cardiopulmonary resuscitation-associated brain injury.