OBJECTIVE To improve the efficiency and quality of dispensed oral drug management in the inpatient pharmacy， and ensure the safety of drug use in patients. METHODS SWOT （strength， weakness， opportunity， threat） analysis method was used to analyze the internal strengths and weaknesses， as well as the external opportunities and threats in the construction of a closed-loop management system for dispensed oral drugs in the inpatient pharmacy of our hospital， and propose improvement strategies. RESULTS & CONCLUSIONS A refined， full-process， closed-loop traceability management system for dispensed oral drugs in the inpatient pharmacies was successfully established， which is traceable in origin， trackable in destination， and accountable in responsibility. After the application of this system， the registration rate of dispensed drug information and the correctness rate of registration content both reached 100%. The proportion of overdue drug varieties in the same period of 2024 decreased by 77.78% compared to March 2020， the inventory volume decreased by 29.50% compared to the first quarter of 2020， the per-bed medication volume decreased by 32.14% compared to the first quarter of 2020； the average workload per post in the same period of 2023 increased by 49.09% compared to 2019， the dispensing accuracy rate reached 100%， and the improvement rate of quality control problem increased by 25.25% compared to 2021. This system effectively improves the safety and accuracy of dispensed oral drug management in the inpatient pharmacy.

Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique

Bupivacaine is a long-acting local anesthetic widely used clinically,but its 6-8 hours duration is insufficient for postoperative analgesia.Designing drug dosage forms to prolong the action time of local anesthetics is the research content of local anesthetics.In 2011,the FDA approved a bupivacaine liposome preparation based on DepoFoam TM technology:Exparel,which can be used for more than 72 hours.This article reviewed the clinical safety research of Exparel and the research progress of its application in clinical postoperative analgesia.

Originally used as an antimalarial drug,hydroxychloroquine is now widely used in the treatment of rheumatic immune diseases due to its cost-effectiveness,safety,and efficacy.In addition to its immunomodulatory effects,hydroxychloroquine also exhibits anti thrombotic,anti-hypolipidemic,and anti-hypoglycemic properties.Hydroxychloroquine blood levels are correlated with clinical outcomes and adverse reactions,and can reflect patient compliance.However,due to the complex pharmacokinetic profile of hydroxychloroquine,significant inter-individual differences in blood concentration exist even with the administration of the same dosage.This study investigates the factors affecting the blood concentration of hydroxychloroquine in terms of physiological factors,pathological factors,metabolic enzyme gene polymorphisms,and drug-related factors.The aim is to provide a reference for rational clinical use and the development of individualized dosing.

Intestinal microorganisms and their metabolites are involved in the pathogenesis and progression of various cardiovascular diseases,especially in the progression of heart failure.This paper mainly discussed the gut microbial metabolites trimethylamine oxide(TMAO)participated in the pathological process of heart failure,and application value of TMAO in heart failure patients.This paper introduced the change characteristics of intestinal flora and its metabolites in heart failure patients,illu-minated the TMAO-mediated inflammatory response,and the related signal pathways and mechanism of myocardial hypertrophy and heart failure.High levels of TMAO are associated with poor outcomes in patients with heart failure indicating a good predictive value for the prognosis of heart failure.Regulating TMAO levels through diet,probiotics and prebiotics,antibiotics,fecal transplan-tation,and other pathways is expected to be a potential treatment for heart failure.

Objective To retrospective analyze the use of inpatients taking sacubitril/valsartan in Nanjing Drum Tower Hospital,and to provide references for rational clinical application.Methods The relevant data of inpatients taking sacubitril/valsartan in our hospital were systematically collected from July 2019 to September 2021,and the rationality of drug use was eval-uated.Results A total of 2 682 cases were collected,and 868 cases(32.36%)of them involved 918 times of irrational drug use.The specific situations of irrational drug use included off-label use(182 times),irrational usage and dosage(389 times),irrational conversation of drugs(251 times),and irrational drug use for special populations(96 times).Conclusion The use of sacubitril/valsartan exists in unreasonable situations in our hospital.Clinical pharmacists should participate in medication man-agement to a certain extent,strengthen the pharmaceutical care of patients,and improve the rational rate of drug use.

Objective To analyze the current situation and characteristics of risk factors in antithrombotic therapy(in-cluding antiplatelet and anticoagulant treatments)at home and abroad,and to provide a theoretical basis for the prevention and treatment of thrombosis or bleeding associated with antithrombotic therapy.Methods The literature on risk factors of an-tithrombotic therapy published in Chinese databases(China Journal Full-text Data,Wanfang Database,VIP Database)and Eng-lish databases(PubMed,Web of Science,MEDLINE)from January 2011 to November 2021 was searched and bibliometric analy-sis was performed.The visualization analysis was performed using VOS viewer software.Results A total of 595 publications were included in the analysis.The top three countries for English publications were the USA,China,and Japan.The type of stud-ies were predominantly cohort studies,with sample sizes mostly being below 1 000.Risk factors for antithrombotic therapy are cat-egorized into those affecting antiplatelet drugs,warfarin,and new oral anticoagulants.Age,gender,renal function,and combination of antithrombotic drugs are common risk factors,and different risk factors of antithrombotic drugs also have their characteristics.Conclusion While there is substantial research on risk factors in antithrombotic therapy globally,the sample size needs to be improved.Pharmacists should provide individualized medication services based on different drugs and different groups to ensure medication safety for patients.

OBJECTIVE To explore the role of clinical pharmacists participating in the standardized perioperative nutritional management process for pancreaticoduodenectomy （PD） on improving postoperative recovery in patients. METHODS The clinical data of 100 patients undergoing PD in the Department of Biliary and Pancreatic Surgery， Drum Tower Hospital Affiliated to Nanjing University School of Medicine from November 2019 to February 2021 were analyzed retrospectively. According to the different perioperative nutrition management plans， they were divided into clinical pharmacist intervention group （n＝51， clinical pharmacists intervened according to the standardized nutrition management process） and control group （n＝49， clinical pharmacists only performed preoperative nutrition evaluation， and clinical physicians took nutrition support according to the patient’s condition）. The differences in postoperative recovery index， economic evaluation index， hospitalization length， postoperative complications， and postoperative enteral nutrition support route were compared between 2 groups. RESULTS The time of postoperative diet， the first postoperative ventilation， the first postoperative defecation， and postoperative drainage time of abdominal drain were significantly earlier in the clinical pharmacist intervention group than in the control group （P＜0.05）； the hospitalization cost， medication cost， nutritional support cost， parenteral nutrition cost， albumin preparation cost， and the length of postoperative hospitalization were significantly lower/shorter in the clinical pharmacist intervention group than in the control group （P＜0.05）； there was no statistically significant difference in the incidence of postoperative complications between the two groups （P＞0.05）； there was statistically significant difference in the perioperative enteral nutrition support pathways between two groups （P＜0.05）. CONCLUSIONS Clinical pharmacists’ participation in perioperative nutritional management for PD can significantly reduce hospitalization costs and nutritional support costs， improve patients’ perioperative nutritional status， and shorten hospital stays. wanglina668@163.com

ABSTRACT OBJECTIVE To explore the correlation between HPLC fingerprint and analgesic efficacy of Zhejiang vinegar Corydalis Rhizoma, and to screen out the material basis of analgesic effect of Zhejiang vinegar Corydalis Rhizoma.METHODS Established HPLC fingerprint of Zhejiang vinegar Corydalis Rhizoma and dysmenorrhea model in rats. The weight loss rate, writhing response, serum malondialdehyde(MDA), estradiol(E2), prostaglandin E2(PGE2) and prostaglandin F2α(PGF2α) levels were used as the evaluation indexes of analgesic efficacy. Combined with chemometrics, the main active components of analgesic effect of Zhejiang vinegar Corydalis Rhizoma and the important components with great contribution to the content were screened.RESULTS The fingerprints of different batches of Zhejiang vinegar Corydalis Rhizoma were established, and nine components were identified; compared with the blank group, the weight loss rate, writhing reaction, MDA, E2 and PGF2α levels in the model group were significantly increased. Compared with the model group, the above indexs in the administration group was decreased. Compared with the blank group, the PGE2 level in the model group was significantly decreased. Compared with the model group, the PGE2 level in the administration group was significantly increased. The vinegar Corydalis Rhizoma produced in Zhejiang had a good analgesic effect, and the main active components of its analgesic effect were protopine, palmatine hydrochloride, and dehydrocorydaline. The important components with greater contribution to the content were tetrahydropalmatine, protopine, palmatine hydrochloride and stylopine.CONCLUSION The efficacy of Zhejiang vinegar Corydalis Rhizoma is the result of the combined action of multiple components, and each component has a strong correlation with the pharmacodynamic indexes. This study provides a reference for the screening of analgesic material basis of Zhejiang vinegar Corydalis Rhizoma.

Objective To mine temozolomide-related adverse drug event(ADE)signals in the real world and to provide a reference for the safe clinical use of temozolomide.Methods The U.S.Food and Drug Administration Adverse Event Reporting System(FAERS)was used to collect the ADE reporting data of temozolomide in the FAERS database from January 1,2004 to December 31,2022.The signal mining was performed using the report ratio method and Bayesian confidence interval progressive neural network method to analyze the occurrence of ADE.Results In the database,there were 24 725 ADE reports with temozolomide as the primary suspected drug,and a total of 300 ADE signals were identified,involving 23 system organ categories,and the top 5 were blood and lymphatic system diseases,systemic diseases and various reactions of administration sites,various examinations,various neurological diseases,various injuries,poisoning and procedural complications etc.the most frequently reported ADE signals included thrombocytopenia,low platelet count,neutral granulocytopenia,pancytopenia,convulsive attacks,and febrile neutropenia.42 new suspected adverse reactions were discovered,which were not recorded in the instructions,such as pseudomonas skin infection,herpetic meningoencephalitis,hypoglossal nerve paralysis,porokeratosis,etc.Conclusion The common adverse reactions of temozolomide in the real world are generally consistent with the instructions,but some new suspicious adverse reactions have been discovered.During clinical drug use,special attention should be paid to these new adverse reactions,and it is recommended to monitor patients'adverse reactions and take appropriate measures in a timely manner.