Geriatric pharmacy plays a critical role in enhancing the rational use of medications among the elderly, thereby contributing to their health and longevity.Geriatric pharmacy services are a vital component of this field, significantly promoting appropriate medication use within the elderly population.This article introduces the concept and objectives of geriatric pharmacy services, analyzing their unique characteristics from four key perspectives: pharmacokinetic and pharmacodynamic changes, multimorbidity and polypharmacy leading to adverse drug reactions, medication safety awareness, and challenges related to medication adherence.Additionally, the article discusses the primary components of geriatric pharmacy services, including foundational, optimization, and enhanced services.Furthermore, it presents strategies for the effective development of geriatric pharmacy, such as expanding the coverage of these services, increasing the workforce capable of delivering them, and promoting national age-friendly reforms, with the aim of providing reference points for the advancement of geriatric pharmacy services in China.

Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Geriatric pharmacy plays a critical role in enhancing the rational use of medications among the elderly, thereby contributing to their health and longevity.Geriatric pharmacy services are a vital component of this field, significantly promoting appropriate medication use within the elderly population.This article introduces the concept and objectives of geriatric pharmacy services, analyzing their unique characteristics from four key perspectives: pharmacokinetic and pharmacodynamic changes, multimorbidity and polypharmacy leading to adverse drug reactions, medication safety awareness, and challenges related to medication adherence.Additionally, the article discusses the primary components of geriatric pharmacy services, including foundational, optimization, and enhanced services.Furthermore, it presents strategies for the effective development of geriatric pharmacy, such as expanding the coverage of these services, increasing the workforce capable of delivering them, and promoting national age-friendly reforms, with the aim of providing reference points for the advancement of geriatric pharmacy services in China.

Local anesthetics are a class of medications that can reversibly block the occurrence and transmission of sensory nerve impulses in the local administration area, which are widely used in clinic for skin and mucous membrane anesthesia, peripheral nerve block anesthesia, spinal nerve anesthesia, and the treatment of chronic pain. The adverse reactions of local anesthetics mainly include allergic reactions, cardiotoxicity, and neurotoxicity. The new dosage forms of local anesthetics include cutaneous administration and sustained-release formulations. The advantage of cutaneous administration is to achieve surface local anesthesia, avoid liver first pass effect, reduce local damage and stimulation caused by injection anesthesia, and improve patient tolerance. The sustained-release dosage form can help maintain a longer lasting anesthetic effect, avoid excessive blood drug concentration caused by rapid absorption of local anesthetic drugs, and thus reduce adverse drug reactions.

Local anesthetics are a class of medications that can reversibly block the occurrence and transmission of sensory nerve impulses in the local administration area, which are widely used in clinic for skin and mucous membrane anesthesia, peripheral nerve block anesthesia, spinal nerve anesthesia, and the treatment of chronic pain. The adverse reactions of local anesthetics mainly include allergic reactions, cardiotoxicity, and neurotoxicity. The new dosage forms of local anesthetics include cutaneous administration and sustained-release formulations. The advantage of cutaneous administration is to achieve surface local anesthesia, avoid liver first pass effect, reduce local damage and stimulation caused by injection anesthesia, and improve patient tolerance. The sustained-release dosage form can help maintain a longer lasting anesthetic effect, avoid excessive blood drug concentration caused by rapid absorption of local anesthetic drugs, and thus reduce adverse drug reactions.

Objective:To evaluate the efficacy and safety of Biapenem in very elderly patients(≥85 years old)with respiratory infections, and to provide a basis for rational use of Biapenem.Methods:A retrospective study was conducted on patients ≥85 years old, who had received Biapenem and undergone relevant laboratory tests from January 2016 to December 2017.Results:A total of 194 patients, with an average age of (88.5±3.1)years were enrolled.The rate of clinical effectiveness for infection treatment was 66.5%(129/194).Logistic regression analysis showed that blood urea nitrogen(BUN)≥8.2 mmol/L( OR=2.404, 95% CI: 1.425-4.065, P=0.001)and Biapenem monotherapy( OR=1.995, 95% CI: 1.175-3.386, P=0.006)were independent risk factors for treatment failure, while other factors, such as underlying diseases, body temperature, previous drug use, alanine aminotransferase levels and aspartate aminotransferase levels, showed no clear association with clinical outcomes.BUN showed significant elevations from pretreatment(8.6 ± 5.1)mmol/L to post-treatment(10.3 ± 9.8)mmol/L( t=-3.362, P=0.001).Adverse drug reactions were observed in 11.9%(23/194)patients, and all these were mild or intermediate. Conclusions:Biapenem is efficacious and safe when used for the treatment of respiratory infections in very elderly patients, and BUN level monitoring during treatment is recommended.

Objective To systematically evaluate the risk of major bleeding and major adverse cardiac events(MACE)in patients with acute coronary syndrome(ACS)after combined use of novel oral anticoagulants(NOAC)and antiplatelet therapy. Methods Randomized controlled trials( RCTs)about NOAC treatment for ACS patients with basic antiplatelet therapy in related databases(up to July 2018)were searched. The outcome indicators included major bleeding events ( safety indicators ) and MACE ( effectiveness indicators). Quality of methodology was evaluated using bias risk assessment tool of Cochrane collaboration networks. Meta﹣analysis was performed using RevMan 5. 3 software. Results A total of 6 RCTs were entered,including comparative studies of single antiplatelet therapy(SAPT)or dual antiplatelet therapy(DAPT)combined with NOAC and combined with placebo or warfarin,involving 20 070 patients. Drugs used in the trial group included apixaban,rivaroxaban,and dabigatran etexilate. The quality evaluation showed that 4 of the 6 RCTs were with low risks of bias and 2 with high risks of bias. The meta﹣ analysis showed that the risk of clinical major bleeding events in patients in the SAPT+NOAC group was significantly higher than that in the SAPT+placebo group[3. 14%(44/1 402)vs. 1. 07%(19/1 770), RR＝3. 47,95% CI:2. 01﹣5. 97,P﹤0. 001]. The incidence of clinical major bleeding events in patients in the DAPT+NOAC group was significantly higher than that in the DAPT+placebo group[5. 72%(387/6 761)vs. 2. 79%(251/8 984),RR＝2. 59,95% CI:1. 73﹣3. 86,P﹤0. 001],but significantly lower than that in the DAPT+warfarin group[17. 22%(422/2 450)vs. 25. 68%(627/2 442),RR＝0. 68, 95% CI:0. 56﹣0. 82,P﹤0. 001]. The risk of MACE in patients in the SAPT+NOAC group was significantly lower than that in the SAPT+placebo group[8. 61%(121/1 405)vs. 12. 20%(217/1 779),OR＝0. 69, 95% CI:0. 55﹣0. 88,P ＝0. 003];there were no significant differences in the risks of MACE between patients in the DAPT+NOAC group and the DAPT+placebo group or DAPT+warfarin group(P﹥0. 05 for both). Conclusions Combination of anticoagulants and SAPT or DAPT in ACS patients may all increase the risk of clinical major bleeding,but combination of SAPT and NOAC may reduce the risk of MACE,and should be used after weighing. For patients who must be treated with triple antithrombotic therapy,DAPT combined with NOAC can be chosen and warfarin should be avoided.

Objective To systematically evaluate the risk of major bleeding and major adverse cardiac events(MACE)in patients with acute coronary syndrome(ACS)after combined use of novel oral anticoagulants(NOAC)and antiplatelet therapy. Methods Randomized controlled trials( RCTs)about NOAC treatment for ACS patients with basic antiplatelet therapy in related databases(up to July 2018)were searched. The outcome indicators included major bleeding events ( safety indicators ) and MACE ( effectiveness indicators). Quality of methodology was evaluated using bias risk assessment tool of Cochrane collaboration networks. Meta﹣analysis was performed using RevMan 5. 3 software. Results A total of 6 RCTs were entered,including comparative studies of single antiplatelet therapy(SAPT)or dual antiplatelet therapy(DAPT)combined with NOAC and combined with placebo or warfarin,involving 20 070 patients. Drugs used in the trial group included apixaban,rivaroxaban,and dabigatran etexilate. The quality evaluation showed that 4 of the 6 RCTs were with low risks of bias and 2 with high risks of bias. The meta﹣ analysis showed that the risk of clinical major bleeding events in patients in the SAPT+NOAC group was significantly higher than that in the SAPT+placebo group[3. 14%(44/1 402)vs. 1. 07%(19/1 770), RR＝3. 47,95% CI:2. 01﹣5. 97,P﹤0. 001]. The incidence of clinical major bleeding events in patients in the DAPT+NOAC group was significantly higher than that in the DAPT+placebo group[5. 72%(387/6 761)vs. 2. 79%(251/8 984),RR＝2. 59,95% CI:1. 73﹣3. 86,P﹤0. 001],but significantly lower than that in the DAPT+warfarin group[17. 22%(422/2 450)vs. 25. 68%(627/2 442),RR＝0. 68, 95% CI:0. 56﹣0. 82,P﹤0. 001]. The risk of MACE in patients in the SAPT+NOAC group was significantly lower than that in the SAPT+placebo group[8. 61%(121/1 405)vs. 12. 20%(217/1 779),OR＝0. 69, 95% CI:0. 55﹣0. 88,P ＝0. 003];there were no significant differences in the risks of MACE between patients in the DAPT+NOAC group and the DAPT+placebo group or DAPT+warfarin group(P﹥0. 05 for both). Conclusions Combination of anticoagulants and SAPT or DAPT in ACS patients may all increase the risk of clinical major bleeding,but combination of SAPT and NOAC may reduce the risk of MACE,and should be used after weighing. For patients who must be treated with triple antithrombotic therapy,DAPT combined with NOAC can be chosen and warfarin should be avoided.

The target of epidermal growth factor receptor inhibitor (EGFRI)is epidermal growth factor receptor (EGFR). EGFRI can block the activation and signal transduction of EGFR in tumor cells, inhibit the proliferation of tumor cells and induce apoptosis,thus having antineoplastic effect. EGFRIs are currently widely used as targeted anti-tumor drugs. EGFRI can act on skin keratinocytes,interfering with the growth,proliferation,differentiation,migration and adhesion of keratinocytes,causing growth arrest and premature differentiation of the keratinocytes in the basal layer,and often leading to adverse skin reactions. The incidence of EGFRI-related cutaneous adverse reactions was 40% to 90%. Common cutaneous adverse reactions include papulopustular rash,skin pruritus,dry skin,skin cracking,angiotelectasis,and changes of hair and nails. Most cutaneous adverse effects are reversible and dose-dependent. The incidence and severity of adverse skin reactions are closely related to the clinical efficacy of EGFRI. Therefore,the adverse skin reactions should be correctly recognized and should be managed separately according to the severity of the reactions. In general,grade 1 and grade 2 adverse skin reactions need not withdrawal or dosage adjustment of EGFRI,but severe adverse skin reactions may affect the patients＇quality of life,so EGFRI dosage should be reduced or discontinued,and EGFRI retreatment should be continued when the skin damage is improved.

Objective To systematically evaluate the correlation between sodium-glucose co-tran-sporter 2(SGLT2)inhibitors and fracture risk in type 2 diabetes mellitus(T2DM)patients. Methods The related databases were searched. The randomized controlled trials(RCTs)which the outcome index included fracture in T2DM patients treated with SGLT2 inhibitors from the inception to August 2017 were enrolled into the study. The documents were selected according to the inclusion and exclusion criteria. After the data extraction and evaluation of methodological quality of RCTs,Meta-analysis was conducted using Rev Man 5.3 software. Results A total of 12 RCTs involving 28 181 patients were entered,including 17 747 patients in the test group(SGLT2 inhibitors)and 10 434 in the control group. The drugs used in the test group were canagliflozin(7 RCTs)and empagliflozin(5 RCTs). The drugs used in the control group were non-SGLT2 inhibitors including metformin,glimetazide and/or placebo. The results of Meta-analysis showed that the incidence of fractures in the test group was significantly higher than that in the control group[5.05%(897/17 747)vs. 4.40%(459/10 434),RR=1.27,95%CI:1.14-1.42,P<0.01]. Subgroup analysis showed that the incidence of fractures in the canagliflozin group was significantly higher than that in the control group[6.21%(679/10 938)vs. 5.28%(365/6 913),RR=1.31,95%CI:1.15-1.48,P<0.01]. There were no significant differences in the incidence of fractures between the empagliflozin group and the control group[3.20%(218/6 809)vs. 2.67%(94/3 521),RR=1.44,95%CI:0.35-5.90, P=0.61]. Conclusions Canagliflozin(a kind of SGLT2 inhibitors)can increase the incidence of fractures. It is suggested that the risk assessment should be done before medication for the benefit of patients.