Introduction Recently, China initiated an ambitious healthcare reform aiming to provide affordable and equitable basic health care to all by 2020. To meet these goals, new policies issued by China's Ministry of Health mandate clinical pharmacy services be integrated into China's hospitals. This review aims to highlight the impact of clinical pharmacy services on the quality use of medicines in hospitals in China. Methods Both English and Chinese databases were used. For the English databases, Web of Science, Medline, International Pharmaceutical Abstracts and Embase were searched using the following keywords ('pharmacists' OR 'pharmacy' OR 'pharmaceutical services/pharmaceutical care') AND ('China'). For the Chinese database, Chinese Biomedical Literature Database on disc was searched using the following keywords ('clinical pharmacist' OR 'clinical pharmacy' OR 'pharmaceutical care' OR 'pharmaceutical services'). Articles were then retrieved from WanFang database and China Knowledge Resource Integrated Database. Results A total of 75 published papers were included in this review. The majority of studies were conducted in the inpatient setting (68%), which included clinical pharmacy interventions such as educating doctors and patients, evaluating and monitoring the implementation of hospital policies and/or reviewing medications on the ward. In the outpatient setting, the majority of studies conducted involved educating patients. Clinical pharmacy services frequently focused on antimicrobials (44%). More than half of these studies employed an administrative intervention alongside the clinical pharmacy service. Conclusion Clinical pharmacy services in China, with its unique healthcare system and cultural nuances, appear to positively influence patient care and the appropriate use of medications. From the published literature, it is expected that clinical pharmacy services can make a strong contribution to China's healthcare reform with further governmental and educational support.
Warfarin,one of the coumarins,is widely used as an oral anticoagulant in clinic because of the effects of both anticoagulation and thrombolysis.Since there are markedly interindividual and interethnic differences in plasma concentration and therapeutic efficacy of warfarin,how to use it rationally and safely by doctors has been becoming a key problem in clinical practice.In this review,we summarized the reasons for resulting in the interindividual difference in drug response under the maintenance dosage of warfarin from pharmacogenomic point of view.We also reviewed the influences of genetic polymorphisms of gene differences,such as CYP2C9 and VKORC1,in drug response and therapeutic efficacy of warfarin.Then,we introduced the latest clinical progress in the model of warfarin maintenance dose,which is based on pharmacogenomics research result and clinical data,to provide a new view for the individualized treatment.
Tacrolimus(FK506),a widely used immunosuppressant,exerts a key effect in patients with organ transplantation.The drug requires therapeutic monitoring due to its narrow therapeutic index and great inter-individual variability.FK506 is known to be a substrate of CYP3A and P-glycoprotein(P-gp).FK506 is metabolized by CYP3A and transported by P-gp.The difference in expression level and the bioactivity of these proteins may explain individual variations of FK506 pharmacokinetics.The differences in bioactivities of CYP3A and P-gp are believed to be due to CYP3A and MDR1 genetic mutation.Therefore,genetic variations of CYP3A and MDR1 may play an important role in the inter-individual variability of FK506.In this article,we reviewed the effect of CYP3A and MDR1 gene polymorphisms on pharmacokinetics of FK506 in patients with organ transplantation.
Objective Pharmacists participate in clinical treatment,to determine the status of drugs in the overall treatment,the relationship between drug therapy and other treatment,to provide a reference for future clinical pharmacists to carry out related diseases Pharmacy Services.Methods The clinical pharmacist and full participation the drug treatment process one cases of deep cervical space infections.Results The patients successively after the surgical intervention,antibiotic therapy,clinical pharmacists in the disease changes in treatment recommendations.Patients with healed thing because the result of collective efforts of the doctors,nurses,and pharmacists.Conclusion Clinical pharmacists should actively cooperate with the doctors involved in clinical treatment in order to achieve pharmacists value.Ensure that patients with medication is safe,effective,economical and reasonable.
Whether the loss-of-function allele CYP3A5*3 variant is associated with significantly impaired metabolism of cyclosporine A (CsA) in transplant patients is still controversial because of the lack of prospective, large-scale clinical studies performed among diversely ethnic populations.This meta-analysis was designed to determine whether the CYP3A5*3 variant could affect CsA blood concentrations and the rate of acute rejection in renal transplant recipients.All relevant publications were retrieved online from 1966 to March 2010, in which 14 studies were chosen, and 1821 renal transplant patients were enrolled. The results showed that there were significant differences in the CsA dose-adjusted trough concentration (C0) between the CYP3A5*3/*3 and CYP3A5*1/*1 carriers [weighted mean difference (WMD): 10.06 mug/l per mg/kg, 95% confidence interval (CI): 3.12-17.00, P=0.004] and between the non-CYP3A5*1 allele carriers and the CYP3A5*1 allele carriers (WMD: 8.32 mug/l per mg/kg, 95% CI: 3.16-13.49, P=0.002). In addition, a subgroup analysis stratified by ethnicity indicated that a significant difference in CsA dose-adjusted C0 was observed between the non-CYP3A5*1 allele carriers and the CYP3A5*1 allele carriers in Asian patients, but not in Caucasian patients. Moreover, a significant difference in the mean daily dose was observed between the non-CYP3A5*1 allele carriers and the CYP3A5*1 allele carriers (WMD: -0.19 mg/kg, 95% CI: -0.31 to -0.07, P=0.002). However, the meta-analysis suggested that there was little or no association of the CYP3A5*3 variant with the acute rejection rate in renal transplant patients treated with CsA [odds ratio=0.94, 95% CI: 0.57-1.54, P=0.80].We concluded that the CYP3A5*3 variant could be associated, to a certain extent, with increased CsA dose-adjusted C0 in blood and reduced mean daily doses, but that this genetic variant allele seemed to have little effect on the acute rejection rate in renal transplant patients taking CsA.
A 30-year-old male patient received IV infusions of lysine acetylsalicylate 0.9 g dissolved in 0.9% sodium chloride injection 100 ml, ceftriaxone 4.0 g and dexamethasone 5 mg together dissolved in 0.9% sodium chloride injection 250 ml, and Qingkailing injection 30 ml dissolved in 5% glucose injection 250 ml once daily for 2 days in a local clinic for common cold. On day 3 of the drugs withdrawal, the patient developed rash on multiple parts of both hands, accompanied by pruritus. The next day, he developed fever and his body temperature rose to 40 ℃. Over the next few days, the rash gradually spread to his whole body and herpes appeared. Laboratory tests showed that alanine aminotransferase 1 012 U/L, aspartate aminotransferase 413 U/L, total bilirubin 92.5 μmol/L, and direct bilirubin 72.1 μmol/L. Seven days after the onset of rash, the area of skin lesions, blisters, and exfoliation respectively reached 60%-70%, 20%-30%, and >30% of his body surface area. The patient was diagnosed with toxic epidermal necrolysis complicated with liver injury. The IV infusions of methylprednisolone and immunoglobulin and symptomatic support treatments including timely skin care, hepatoprotective drugs, and anti-infection drugs were given, and his skin lesions gradually improved. After 7 days of treatments, methylprednisolone was changed to be taken orally and gradually reduced to discontinuation. Symptomatic treatments such as hepatoprotective therapy lasted for more than 3 weeks. After 40 days, his skin lesions healed.
Key words:
Ceftriaxone; Anti-inflammatory agents, non-steroidal; Stevens-Johnson syndrome; TCM injection
OBJECTIVE: To explore an approach and methods for the pharmaceutical care for renal transplant recipients with pneumonia so as to improve the therapeutic efficacy.METHODS: Appling the method of pharmaceutical care recommended by Joint Commission on Accreditation of Health Care Organizations with consideration of the characteristics of clinical pharmacy in China to draw up an approach and methods of pharmaceutical care for renal transplant recipients.RESULTS CONCLUSION: Pharmaceutical care for renal transplant recipients could apparently make the use of drugs more safely,effectively and economically as well as improving patients' prognosis.It is necessary for renal transplant recipients with pneumonia to receive pharmaceutical care provided by clinical pharmacists.
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