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The “eighteen antagonisms” of Chinese medicinals have been regarded as taboos in the field of traditional Chinese medicine （TCM）， and the connotations have gradually been narrowed down in the development of TCM. From the historical perspective， “eighteen antagonisms” are not an absolute taboo in terms of the combination of medicinals， and the existing types of antagonism medicinals are also worth further discussion. From the perspective of toxicological effects， the toxicology of the “eighteen antagonisms” mainly comes from the enhancement of the toxic and side effects of a certain herb， rather than the combination of two herbs. From the perspective of pharmacodynamic actions， the combination of some antagonism medicinals can achieve therapeutic effects that cannot obtained by conventional medicinals， which is feasible and reasonable in clinical practice. Therefore， it is believed that the application of combining some antagonism medicinals based on “eighteen antagonisms” is of positive significance. Moreover， strict combination， processing and decoction methods should be noted in the use of antagonism medicinals. All mentioned above will provide reference for the correct recognition and use of the combination of “eighteen antagonisms”， and broaden the combination thinking for the treatment of clinical diseases with TCM.
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@# The “eighteen antagonisms” of Chinese medicinals have been regarded as taboos in the field of traditional Chinese medicine （TCM）， and the connotations have gradually been narrowed down in the development of TCM. From the historical perspective， “eighteen antagonisms” are not an absolute taboo in terms of the combination of medicinals， and the existing types of antagonism medicinals are also worth further discussion. From the perspective of toxicological effects， the toxicology of the “eighteen antagonisms” mainly comes from the enhancement of the toxic and side effects of a certain herb， rather than the combination of two herbs. From the perspective of pharmacodynamic actions， the combination of some antagonism medicinals can achieve therapeutic effects that cannot obtained by conventional medicinals， which is feasible and reasonable in clinical practice. Therefore， it is believed that the application of combining some antagonism medicinals based on “eighteen antagonisms” is of positive significance. Moreover， strict combination， processing and decoction methods should be noted in the use of antagonism medicinals. All mentioned above will provide reference for the correct recognition and use of the combination of “eighteen antagonisms”， and broaden the combination thinking for the treatment of clinical diseases with TCM.
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Objective:To investigate whether the adverse reactions of Xuebijing injection (XBJJ) are mainly pseudoallergic reactions and explore the influencing factors of its pseudoallergic reactions. Method:Mouse model of pseudoallergic reaction was used to study the anaphylactoid reaction of XBJJ which at 0.5, 1 and 2 times of the highest clinical concentration. Next, we compared the differences in pseudoallergic reactions caused by XBJJ for different storage times after preparation. Specifically, XBJJ was prepared into different concentrations, stored for 10 minutes, 2.5 hours, 6 hours and 24 hours, and then injected into the tail vein of mice. Finally, three different injection speeds of 3 seconds, 45 seconds and 90 seconds were selected for XBJJ injection, and then the differences in the paeudoallergic reactions induced by XBJJ in mice under different injection speeds were compared. Result:XBJJ induces pseudoallergic reactions in mice when the drug concentration is higher than the clinically recommended concentration. Compared with storage for 10 minutes after preparation, the degree of pseudoallergic reaction in mice induced by the same concentration of XBJJ increased with the extension of storage time. In addition, when XBJJ was injected in 3 s (the injection rate was 0.083 mL·s<sup>-1</sup>), it produced the strongest pseudoallergic reaction. Conclusion:The adverse reactions induced by XBJJ are mainly pseudoallergic reactions. Excessive storage time after preparation and fast injection speed of XBJJ will lead to aggravation of pseudoallergic reactions in mice. When XBJJ is used clinically, it should strictly follow the usage, dosage, concentration, and drip rate recommended in the drug instruction manual. Rational drug use is of positive significance for improving the safety of XBJJ.
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Because coronavirus disease 2019(COVID-19) is highly contagious and serious, it has posed a major threat to public health worldwide. The curative effects of integrated traditional Chinese medicine and Western medicine in the treatment of COVID-19 have been widely recognized and confirmed. However, medical workers shall pay attention to drug-induced heart injury in clinical application. Based on the guideline from the Diagnosis and Treatment Plans for COVID-19(trial seventh edition), taking the recommended drugs as examples, by Western medicine, traditional Chinese medicine, Chinese herbal injection and integrated traditional Chinese and Western medicine, the study analyzed the basic characteristics of recommended drugs for cardiac injury by means of literature review and bioinformatics methods, and summarized cardiac adverse reactions, toxicity mechanisms, combined pharmacotherapy, special population and drug monitoring, focusing on the clinical manifestations, toxic components, targets and regulatory mechanisms of drug-induced cardiac injury. The findings suggested being vigilant to drug-induced cardiac injury during the treatment of COVID-19, playing the advantages of clinical pharmacists and clinical Chinese pharmacists, improving the knowledge reserve of pharmacovigilance, strengthening the prescription review, medication notification and medication monitoring, promoting rational drug use and paying attention to special populations and high-risk groups. The study aims to provide suggestions and reference for pharmacovigilance and pharmaceutical care for front-line doctors and pharmacists against COVID-19, in order to avoid the occurrence of drug-induced heart injury for patients with COVID-19.
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Humans , Betacoronavirus , Cardiotoxicity , Coronavirus Infections , Drug Therapy , Drugs, Chinese Herbal , Heart Injuries , Medicine, Chinese Traditional , Pandemics , Pharmacovigilance , Pneumonia, ViralABSTRACT
Objective@#To investigate the utilization of antibacterial drugs in the old community-acquired pneumonia (CAP) with chronic obstructive pulmonary disease(COPD) in our hospital.To analyze the rational application of antibacterial drugs, thus to provide a powerful reference for clinical diagnosis and treatment.@*Methods@#From June 2011 to June 2013, 100 patients with COPD and CAP were selected in Xiaolan People's Hospital.The average age was (76.95±6.57) years old, including 62 males and 38 females.The utilization of antibacterial drugs was investigated by retrospective study in the patients.@*Results@#In the course of treatment, the rate of using the antibacterial drugs in 100 patients was 100%, concerning 13 varieties of 5 major categories, including β-lactam (including β-lactam/β-lactamase inhibitors), quinolones, carbapenems, macrolides, aminoglycosides.The largest frequency was piperacillin/sulbactam, up to 92.Ceftezole, cefotian and azithromycin were less than 0.9 for DUI in DDDS ordering 10 drugs, it showed that the frequency was insufficient or the dosage was too small.For example, insufficient frequency of cephalosporin once a day and small dosage of azithromycin 0.25g once a day.Combination with two kinds of antimicrobial drugs was common, it was relatively rational between the combination of drugs, usually cephalosporins+ quinolones, β-lactam/β-lactamase inhibitors+ quinolones, β-lactam/β-lactamase inhibitors+ macrolides.@*Conclusion@#The etiology of 100 elderly patients with COPD and CAP in our hospital is mainly Gram-negative bacteria.The anti-infection treatment is mainly cefdiazine and piperacillin/sulbactam, and the combined drug was mainly quinolones.The drug regimen and treatment course are reasonable, there is a high prognosis in the patients.
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Objective To investigate the utilization of antibacterial drugs in the old community-acquired pneumonia (CAP) with chronic obstructive pulmonary disease(COPD) in our hospital.To analyze the rational application of antibacterial drugs,thus to provide a powerful reference for clinical diagnosis and treatment.Methods From June 2011 to June 2013,100 patients with COPD and CAP were selected in Xiaolan People's Hospital.The average age was (76.95 ±6.57) years old,including 62 males and 38 females.The utilization of antibacterial drugs was investigated by retrospective study in the patients.Results In the course of treatment,the rate of using the antibacterial drugs in 100 patients was 100％,concerning 13 varieties of 5 major categories,including β-lactam (including β-lactam/β-lactamase inhibitors),quinolones,carbapenems,macrolides,aminoglycosides.The largest frequency was piperacillin/sulbactam,up to 92.Ceftezole,cefotian and azithromycin were less than 0.9 for DUI in DDDS ordering 10 drugs,it showed that the frequency was insufficient or the dosage was too small.For example,insufficient frequency of cephalosporin once a day and small dosage of azithromycin 0.25g once a day.Combination with two kinds of antimicrobial drugs was common,it was relatively rational between the combination of drugs,usually cephalosporins + quinolones,β-lactam/β-lactamase inhibitors + quinolones,β-lactam/β-lactamase inhibitors + macrolides.Conclusion The etiology of 100 elderly patients with COPD and CAP in our hospital is mainly Gram-negative bacteria.The anti-infection treatment is mainly cefdiazine and piperacillin/sulbactam,and the combined drug was mainly quinolones.The drug regimen and treatment course are reasonable,there is a high prognosis in the patients.
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A large number of gut flora communities have colonized in the intestine, which is crucial to the metabolism of foreign compounds such as drugs. In recent years, the gut flora has been widely regarded as the "invisible organ" of the body. By reviewing the pertinent literature at home and abroad, classifications and functions of intestinal flora and its influence on the chemical composition and chemical metabolism of Chinese medicine are analyzed in the article. Understanding the impact of intestinal flora on drug metabolism and the process of drug conversion has great significance in guiding clinical rational drug use and individual therapy, evaluating toxicity and promoting drug discovery and development, and providing theoretical guidance for the study of the effects of intestinal flora on drug metabolism in the plateau environment.
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Objective To provide reference for the adjustment of provincial health insurance directory by comparing the differences between 2017 and 2009 edition of National Health Insurance Directory(NHID) and exploring the characteristics of NHID adjustment. Methods The Excel 2016 was used to carry out a comparative analysis of the drugs included in the two editions of NHID from the 4 aspects such as classification,drug name,dosage form and payment range. Results The adjustments of NHID in 2017 include drug variety,payment range,drug classification and coding.A total of 339 drugs were added, of which 133 were chemical drugs with a growth rate of 11.4%,and 206 were Traditional Chinese Medicine with a growth rate of 20.0%.In addition,dosage form was added in 149 drug varieties.The adjustment mainly focuses on chronic diseases such as hypertension and diabetes,serious diseases such as cancer,innovative drugs,and pediatric drugs. Conclusion The adjustment of 2017 edition of NHID embodied the policy thinking of "filling,selecting,supporting innovation and encouraging competition". Moreover,the drug classification,name and coding are more scientific and reasonable.
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Objective To analyze the therapeutic effect of combined administration of pilocarpine and timolol eye drops in the treatment of glaucoma, and to summarize the rational administration of the two drugs.Methods The study was conducted by animal experiment.The study was conducted from January 2016 to February 2016.Fifty New Zealand white rabbits were randomly divided into 5 groups: pilocarpine group, timolol group, conventional administration group, pilocarpine+timolol group, timolol group and pilocarpine group.each group had 10 New Zealand white rabbits, according to different modes of administration,,the changes in intraocular pressure after 10, 20, 30, 40, 60, 90, 120, 150, 180 and 240 min after the first administration were compared.Results Intraocular pressure changes with time points after administration of different administration methods, There was no significant difference of IOP changes in pilocarpine group and timolol group single drug.pilocarpine+timolol timolol group changes with time continuing to reduce intraocular pressure of rabbits, compared with the conventional dose group, pilocarpine+timolol group and timolol pilocarpine+group alkali group of intraocular pressure, intraocular pressure and good control effect,the difference was statistically significant (P<0.05).There was no significant difference between in the adverse reactions between pilocarpine group, timolol group, routine administration group, pilocarpine+timolol group, timolol group and pilocarpine group.ConclusionThe treatment of glaucoma can be treated with pilocarpine and timolol eye drops, pilocarpine+timolol compared with pilocarpine, timolol simple treatment, conventional administration of several modes of administration, from the continuous reduction of intraocular pressure time Point of view, lowering the intraocular pressure longer, fewer adverse reactions, with high therapeutic safety, worthy of clinical promotion and application.
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Objective To analyze the clinical application of TCM decoction pieces for heat clearing in the First Affiliated Hospital of Xi'an Jiaotong University; To promote rational administration of TCM decoction pieces, and guarantee patients' medication safety. Methods By using Microsoft Office Excel 2013 software, use frequencies, classifications of pharmacological actions and doses of TCM decoction pieces for heat clearing (DHC) from 2013 to 2015 of the First Affiliated Hospital of Xi'an Jiaotong University were analyzed. Results In our hospital, from 2013 to 2015, in top 15 DHC, the amounts of clearing away heat and toxin were more than 40%, and which of the average doses exceeded the upper limit of pharmacopoeia dosage, were more than 30%. The part that overdoes frequencies greater than 30% were 11.0% of the total, nevertheless, the part that not exceeded was 39.0% of the total. Conclusion The use of medicine for heat clearing should be carefully dialectical, paying attention to the rationality of medication. The dose should be careful and effectively regulated.
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Objective To analyze the clinical application of TCM decoction pieces for heat clearing in the First Affiliated Hospital of Xi'an Jiaotong University; To promote rational administration of TCM decoction pieces, and guarantee patients' medication safety. Methods By using Microsoft Office Excel 2013 software, use frequencies, classifications of pharmacological actions and doses of TCM decoction pieces for heat clearing (DHC) from 2013 to 2015 of the First Affiliated Hospital of Xi'an Jiaotong University were analyzed. Results In our hospital, from 2013 to 2015, in top 15 DHC, the amounts of clearing away heat and toxin were more than 40%, and which of the average doses exceeded the upper limit of pharmacopoeia dosage, were more than 30%. The part that overdoes frequencies greater than 30% were 11.0% of the total, nevertheless, the part that not exceeded was 39.0% of the total. Conclusion The use of medicine for heat clearing should be carefully dialectical, paying attention to the rationality of medication. The dose should be careful and effectively regulated.
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AIM:To provide rational evidence for the administration of warfarin in clinic by investigating the utilization of warfarin in our hospital.METHODS:By retrospective analysis,the prescription of warfarin in our hospital was obtained from November 2016 to February 2017 from the system for clinical pharmacist.The general situation of the inpatient,the diagnosis of disease,the use of warfarin,and the combination of drugs and the number of International Normalized Ratio (INR) were statistically and descriptively analyzed.RESULTS:In this investigation,200 patients were included,of whom 53％ were males and 47％ were females with an average age of (55.28 ± 13.56) years.Only 21％ of the average INR values reached the predicted range (2 ＜ INR ＜ 3) during hospitalization and the average dose of warfarin was (2.62 ± 0.60)mg.In patients with INR ＜ 2,there were 66.92％ of patients combined with more than one kind of drugs,which decreased the effect of warfarin.In patients with INR ＞ 3,there were 80％ of patients combined with more than one kind of drugs,which increased the effect of warfarin.CONCLUSION:The rate of warfarin compliance is low and the warfarin-drug interactions exert a great influence on the patients whose INR value did not reach the predicted range.Thus,to keep the drug safety of patients,more attention should be paid on drug interactions and direct personalized medicine using professional knowledge of pharmacy.
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Objective To evaluate the rationality of medication in Pediatric Intensive Care Unit (PICU).Methods The medication of 46 children in PICU of the First Affiliated Hospital of Sun Yat-Sen University with the average age of (34.74 ±45.5) months during May 3, 2011 and December 5, 2011 were retrospectively analyzed.The study was conducted statistically on the basis of pharmacopoeia, medical documents and other related medical materials.Results Among 46 ca-ses, irrational drug use was found in 28 patients (60.87%).A total of 100 irrational drug using habits such as potential drug interactions and incompatibility were presented.Compatibility taboo and pDDIs top four drugs were16 cases of furosemide (16%), 12 cases of vancomycin and dexamethasone (12%), 11 cases of midazolam injection (11%), and 9 cases of Phe-nobarbital (9%).Conclusion According to the characteristics of pediatric medication, pharmacists should take advantage of drug synergy when vigilant about the side effects of multi -medication, especially paying close attention to the potential inter-action of some commonly-prescribed drugs as well as reducing the prescriptions of multi -medications in order to improve the rationality of drug use in PICU.
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OBJECTIVE: To evaluate the application profiles and the conformance of clinical diagnostics and instructions indications, relative clinical treatment guidelines of intravenous immunoglobulin(PH4) in our hospital from 2011 to 2012. In addition, the management measures for clinical use in the case of market supply shortage were discussed. METHODS Age, gender, diagnosis, dose, and treatment duration of 650 patients using IVIg in our hospital from 2011 to 2012 were analyzed retrospectively. According to the drug instructions, Chinese Pharmacopoeia Clinical Medication Notice 2010 and relative domestic and foreign clinical treatment guidelines, we evaluated the rationality of medication and the conformance of clinical diagnoses and instruction indications. RESULTS In our 750 valid cases, there were 351 male patients (46. 8%) and 400 female patients (53.2%). Average age of these patients was 30.5 years old (0-101 years). The use of IVIg was distributed in 20 clinical departments of our hospital. Total dosage was 45 842.5 g. Per capita dosage was 61.1 g(2.5-572.5 g). Total cost was 8.396 million yuan. Diseases sorting by sum dosage were systemic lupus erythematosus, myasthenia gravis, Guillain-Barre syndrome, immune thrombocytopenia, polymyositis/dermatomyositis, anti-N-methyl-D-aspartate receptor encephalitis, lymphoma, systemic vasculitis, chronic inflammatory demyelinating polyneuropathy, drug rash, etc. Per capita daily dose was 13.3 g. Per capita course of treatment was 4.5 d (1-32 d). CONCLUSION Among the hospitalized patients using IVIG from 2011 to 2012, 616 cases meet the indications of instruction, accounting for 82. 1%; 134 cases were beyond the indications, accounting for 17.9%. According to the latest domestic and international guidelines, 580 cases corresponded with the recommendations of guidelines, accounting for 77.3%; 18 cases were not recommended by guidelines, accounting for 2.4%; 152 cases were not mentioned in guidelines, accounting for 20.3%. Since the IVIG is rare and the market supply is once lacking, the effective management measures made by our hospital play an important role in ensuring the rational administrations.
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OBJECTIVE To investigate the usage of antibiotics in surgical department of Chest surgery in PLA General Hospital.METHODS The antibiotics usage status among 412 cases of patients during perioperative period was retrospectively analyzed.RESULTS The utilization of antibacterials took up to 100.00%.The average of treatment course was13.89 days,Aminoglycosides,cephalosporin and penicillins was the main kinds,single use accounted for 28.64%,the bigeminy for 35.93%,and trigeminy for 30.58%,the utilization with four or more kinds of drugs were 4.85%.The rational usage and irrational usage accounted for 64.57% and 35.43% respectively.CONCLUSIONS Clinicians should strengthen the management of antibiotics in perioperative period for rational use.
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OBJECTIVE To analyze the antibiotics usage in perioperative patients of oral surgery in our hospital.METHODS Adopted retrospective review,365 oral surgery inpatients with operation were investigated on medication,course of treatment,wound healing and so on.RESULTS The utilization of antibacterials accounted for 100%.Nitramisole,aminoglycosides,Cephalosporin and penicillins were the main kinds.Single use accounted for 18.63%(66 cases),the bigeminy for 43.29%(158 cases),the trigeminy for 27.12%(99 cases),the utilization with four or more drugs were 18.63%(40 cases);the average of treatment course was 8 days.CONCLUSIONS To strengthen the management of antibacterials,more education of the principle medicine,usage are helful for reducing surgical site infection.
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OBJECTIVE To observe the antibacterials usage of Orthopedic in PLA General Hospital.METHODS By retrospective review,326 inpatients with operation case were investigated randomly.the medication,course of treatment,wound healing and so on were analysed.RESULTS The utilization of antibacterials was 100%,average use time10.5d;The main types of aminoglycoside drugs were penicillins,cephalosporins in which the highest frequent usage were Etimicin Sodium Chloride Injection,nafcillin sodium for injection,injection,cefmetazole sodium,injection fusidic sodium,injection amoxicillin sodiumFlucloxacillin sodium.CONCLUSIONS Strengthening the management of antibacterials,specifing the principle of operation medicines are important for anti-infection after operation.
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OBJECTIVE:To explore the general pattern and the characteristics of the adverse drug reactions(ADR)induced by ?-lactamase inhibitor.METHODS:155 ADR cases induced by ?-lactamase inhibitor reported in 141 articles in the domestic periodicals between Jan.1996 and Jan.2008 retrieved from CHKD full-text data base were analyzed respectively.RESULTS:Among the total 155 ADR cases,81.94%(127 cases)were induced by sulbactam-contained ?-lactamase inhibitor.Systemic lesion was the most common manifestation of ADR,accounting for 42.58%(66 cases).The most serious manifestation of ADR was allergic shock,and death occurred in 9 cases.CONCLUSION:It is advisable to promote rational use of ?-lactamase inhibitor and strengthen ADR monitoring so as to reduce or avoid the occurrence of ADR.
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OBJECTIVE:To investigate the characteristics and regularities of adverse drug reactions(ADR) induced by anti-infective drugs in our hospital.METHODS:657 ADR cases induced by anti-infective drugs collected by the ADR monitoring center in our hospital in 2006 were classified and analyzed.RESULTS:13 categories(49 kinds) of anti-infective drugs were involved in the total 657 ADR cases.Of which,those patients aged above 60 years accounted for 30.14%.The ADR were chiefly induced by quinolones,followed by cephalosporins and penicillins etc,which chiefly manifested as lesion of skin and its accessories(53.12%),followed by the lesions of digestive system and nervous system etc.CONCLUSION:Multiple factors contributed to the ADR,to which great importance should be attached so as to reduce the incidence of ADR induced by anti-infectives.
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OBJECTIVE To investigate the clinical application of antibiotic agents in a hospital.METHODS A cross section investigation method was used to survey the clinical application of antibiotic agents for emergency,out-patient clinic and hospitalization patients in a hospital within a day.RESULTS The usage rate of antibiotic agents for emergency patients was the maximum(54.67%) and the percentage of drug combination was multitude(23.42%).It was involved in 10 categories of antibiotic agents,cephalosporin was used at most(61.92%).The usage rate of antibiotic agents in Department of Gynecology and Obstetrics(OG) was the maximum(37.96%).Department with top defined DDD rate was Respiration Medical Department(RMD,39.90%).The average rate of etiological examination in the whole hospital was 6.67%.CONCLUSIONS It is higher in the usage rate of antibiotic agents for emergency patients.It is much more usage of antibiotic agents in OG and RMD,furthermore,the antibiotic agents are excessively used and the rate of etiological examination is low.Management should be further strengthened for rational use of antibiotic agents.