(A) to provide clinicians with information on rational drug use
Clinicians urgently need to know the information of rational drug use. Clinical pharmacy should not blindly prescribe drugs to doctors, but enthusiastically provide pharmaceutical information for clinic. The main contents should be:
1. Prescription and case analysis, examples of rational or irrational drug use.
2. Monitor adverse drug reactions, drug-induced diseases and drug interactions.
3. The rescue medication scheme and analysis of critical and difficult diseases.
4. Drug analysis of pesticide poisoning.
5. Drug quality and efficacy.
6. Experience and problems of injection mixing.
7. The efficacy of new use of old drugs and dosage form reform.
8. The relationship between traditional Chinese medicine preparation and biopharmaceutics and curative effect.
10. Evaluation and clinical application of new drugs.
(B) the key work of clinical pharmacy
1. With the development of new drugs, there are more and more varieties of drugs and the compatibility of prescriptions is more complicated. In order to ensure rational drug use and improve the curative effect, we should focus on the clinical drug use and conduct specific analysis and research to avoid the harm caused by unreasonable drug use and drug abuse, reduce drug-induced diseases and achieve the purpose of active treatment.
2. Promote the combination of drugs to encourage pharmacists to enter the clinic, actively participate in rational drug use, formulate individualized drug delivery plans, be a good doctor's staff, accumulate clinical data and experience to reduce adverse drug reactions, and provide clinical drug consultation and guidance for rational drug use.
3. Carry out clinical drug monitoring, and study the relationship among biological body fluid, blood drug concentration and toxicity, so as to obtain the best drug administration scheme, improve drug use effect and reduce adverse reactions. The Nanjing General Hospital of Nanjing Military Region has set up a number of TDM classes, which has played a very good role in promoting the improvement of clinical drug monitoring technology. On the basis of clinical drug concentration monitoring, it has been further developed to clinical detection of free drugs and active metabolites, realizing a new leap in monitoring technology.
4. China's ADR reporting system has been gradually established, and it has established contact with the World Health Organization. The pilot work is in progress. In 1988, 10 medical units in Beijing and Shanghai received 67 1 ADR reports. About 100 kinds of drugs were involved, and some rare adverse drug reactions were also found. The establishment of 65438-0989 National Adverse Drug Reaction Monitoring Center prepared the conditions for the early establishment of the national reporting system.
5. With the development of clinical pharmacy research, the rise of clinical pharmacy has promoted a number of hospital pharmacy research projects and achieved remarkable results. 1989 hospital pharmacy research achievement reached 16, among which Nanjing General Hospital of Nanjing Military Region won the National Science and Technology Progress Award; Ruijin Hospital of Shanghai Second Medical University won the Science and Technology Progress Award of the Ministry of Health for "Study on the Treatment of Acute Promyelocytic Leukemia by All-trans Acid Induction Differentiation"; Navy 4 1 1 Hospital and Naval Pharmacy Center "Research and Application of Chemical Constituents of Traditional Chinese Medicine Codonopsis pilosula" won the Military Science and Technology Progress Award; Huashan Hospital of Shanghai Medical University "Clinical Application of Musk Baoxin Pills in Treating Coronary Heart Disease" won the state administration of traditional chinese medicine Science and Technology Progress Award. These units and individuals have made due contributions to improving the level of hospital pharmacy and clinical application. Therefore, as long as we attach importance to the research of the subject and make unremitting efforts, we will certainly reap results and talents.
6. Improve the quality of pharmaceutical personnel to adapt to the change of pharmaceutical mode.
(3) prescription analysis and evaluation
Prescription analysis is identified as one of the items for examining doctors. Prescriptions and medical records record the doctor's medication history. Whether it is reasonable or not is clear at a glance. Prescriptions and cases are written evidence that doctors give drugs to patients and should bear legal responsibility. The level of prescription drugs directly reflects the medical level of doctors. Prescription analysis is not only a window for clinical pharmacists to discover the relationship between drugs and people, but also one of the important items for assessing doctors.
(four) clinical observation results as an evaluation
The observation results of clinical pharmacists provide scientific basis for evaluating new and old drugs.
Drug interaction sometimes brings harm, but it can also enlighten people and teach them how to avoid harm and get good results. The study of clinical pharmacy and clinical theory can provide scientific basis for evaluating new and old drugs, eliminating and screening drugs.
(5) Rational drug use plan
Problems in clinical pharmacy In order to study a reasonable administration scheme, it is necessary to determine the blood drug concentration. Frequent blood drawing brings pain to patients and troubles to doctors and nurses. When the exact dose of toxic and side effects of a drug is unknown and it is urgent to save the patient, should it be given according to the "prescription dose" in the book or according to the empirical dose? How to distinguish responsibility when there is an accident? -It involves both law and ethics.
[Edit this paragraph] (6) To guide clinical rational drug use
1. Guiding rational drug use Clinical pharmacy is a subject that studies patients' rational drug use to prevent and treat diseases. The basis of actual combat is that the same drug has different functions, such as different bioavailability; Different curative effects, that is, different individuals can not get the same curative effect and toxicity with the same drug. Special attention should be paid to the primary patients with low liver and kidney function in therapeutic index. Personalize the use of drugs.
2. Experimental Manual The most basic principle of clinical pharmacy is pharmacokinetics, and the most basic experiment is to determine the blood drug concentration. Pharmacokinetics has a history of more than 60 years since 1937 put forward the atrioventricular model, but it was not paid attention to at that time. Until the 1960s, pharmacology and clinic raised a series of questions, namely the above differences, and the determination of drug content developed greatly in the 1970s. The application of computer has promoted the rapid development of pharmacokinetics. Therefore, it can be said that clinical pharmacy is the product of the combination of clinical difference practice and pharmacokinetics theory.
3. Individualized sensitive monitoring technology is used to monitor the blood drug concentration of some patients with low therapeutic index or poor liver and kidney function, and then computer is used to fit the in vivo model to find out the kinetic parameters, so as to guide doctors to achieve the best curative effect and poisoning when using drugs, and truly achieve individualized medication.
4. Routine monitoring drugs should be institutionalized. In several university medical centers in the United States, the drugs to be monitored by inpatients are: gentamicin, tobramycin, phenytoin sodium, theophylline and digoxin (the above five drugs account for 80~85% of all monitored drugs). There are phenobarbital, Tongjingning, bupropion, ethimine, salicylate, lidocaine, quinidine, procainamide, N~ acetyl procainamide, digitalis glycoside, propyl valerate, amikacin and vancomycin. In some laboratories, the total number of blood drug concentration determinations is 7 145 times a year, with an average of 20 samples per day.