Reactive metabolites is one of the main causes of drug-induced liver injury (DILI). After entering the body, some drugs can be metabolized by liver to generate drug reactive metabolites, which can deplete glutathione, and in turn bind to macromolecules such as proteins or nucleic acids in the body, alter biomacromolecule function, induce cellular oxidative stress and the body′s immune response, interfere with the body′s normal physiological function, and produce hepatotoxicity. Reactive metabolites mediated DILI may be not the action of one mechanism, but the combined effects of multiple mechanisms. This article reviews the production process of drug reactive metabolites, the mechanism of liver injury, and the means of prevention and treatment, providing an important reference for clinical safe drug use.

Reactive metabolites is one of the main causes of drug-induced liver injury (DILI). After entering the body, some drugs can be metabolized by liver to generate drug reactive metabolites, which can deplete glutathione, and in turn bind to macromolecules such as proteins or nucleic acids in the body, alter biomacromolecule function, induce cellular oxidative stress and the body′s immune response, interfere with the body′s normal physiological function, and produce hepatotoxicity. Reactive metabolites mediated DILI may be not the action of one mechanism, but the combined effects of multiple mechanisms. This article reviews the production process of drug reactive metabolites, the mechanism of liver injury, and the means of prevention and treatment, providing an important reference for clinical safe drug use.

OBJECTIVE:To evaluate the effects of quality control circle(QCC)in improving the compliance of asthma/COPD outpatients handling inhaler devices. METHODS:By simple random sampling method,90 asthma/COPD outpatients receiving Tiotropium bromide powder for inhalantion,Salmeterol xinafoate and fluticasone propionate powder for inhalantion and Budesonide and formoterol fumarate powder for inhalantion were selected from our hospital during Apr. to Nov. 2015. The reasons for poor com-pliance of handling inhaler devices were analyzed by QCC. The countermeasures were formulated to improve the compliance,in-cluding clinical pharmacist education,follow-up,issuing education manuals,developing WeChat consulting. Operation step score of inhaler devices,compliance score and activity ability score of QCC members were analyzed statistically before and after QCC. RESULTS:After the development of QCC,operation step score of inhaler devices and compliance score in 90 asthma/COPD outpa-tients increased from 7.7 and 7.7 before activity to 8.8 and 9.3 after activity,the achievable rate of compliance was 114.3%,and the improvement rate was 20.8%. The sense of honor,responsibility,self-confidence,QCC techniques,communication and coordi-nation,team cohesion of all members were all improved obviously. CONCLUSIONS:QCC activity improves the compliance of asthma/COPD outpatients handling inhaler devices and shows the professional service level of clinical pharmacists,which is of sig-nificance to the improvement of pharmaceutical care.