Author: XXX XXX XXX

Keywords rational drug use

With the development of society, how to use drugs safely, effectively and rationally has become a hot spot of social concern. In recent years, there have been many reports and discussions about adverse drug reactions, which have attracted attention from all sides. The clinical requirements for drugs are not only limited to the therapeutic effect on diseases, but also require the drugs used to treat diseases with as few ADR as possible. According to the WHO report, nearly 65,438+0/7 deaths worldwide are caused by irrational drug use [65,438+0]. In China, according to the statistics of relevant departments, the incidence of adverse drug reactions of inpatients is about 20%, and 1/4 is caused by antibiotics. Every year, the economic loss caused by drug-resistant bacteria infection caused by abuse of antibiotics reaches10 billion yuan [2].

Rational drug use always goes hand in hand with rational treatment, which is an ancient and novel topic and an eternal topic for hospital pharmacists. The purpose of hospital pharmacy work is to serve patients as the center and promote clinical scientific medication based on clinical pharmacy, and its core is to ensure the safety of clinical medication. At present, it is recognized that the basic elements of rational drug use are: using drugs safely, effectively, economically and appropriately according to the systematic knowledge and theory of contemporary drugs and diseases [2].

Combined with clinical practice and literature, the common clinical adverse drug reactions and safe medication were discussed.

1 Abuse of antibiotics leads to irrational drug use.

Nowadays, frequent medical disputes, iatrogenic or drug-induced incidents and high medical and drug costs have become problems faced by most countries and regions. China also has many similarities in these aspects. The practice of rational drug use is difficult and slow, which has not attracted enough attention. In fact, adverse drug reactions have become the main killer of human health, and the abuse of antibiotics has become very common in China. According to some data, the utilization rate of antibiotics in inpatients in tertiary hospitals in China is about 70%, 80% in secondary hospitals and 90% in primary hospitals [3]. The abuse of antibiotics not only leads to the high utilization rate of drugs and the sharp rise of medical expenses, but also brings serious consequences to clinical treatment. At present, few doctors have a systematic and comprehensive understanding of antibiotics, and their use is very blind. When choosing antibiotics, we don't think about it, don't pay attention to pathogenic examination, stick to "foreign, new and expensive", blindly use broad-spectrum antibiotics in large doses, or use several antibacterial drugs at the same time, which leads to a large number of drug-resistant bacteria, more and more refractory infections and higher medical expenses. Many seriously infected people died in clinic, mostly because antibiotics were ineffective in drug-resistant infections. Antibiotics rank first in ADR.

For example, more than 90% of upper respiratory tract infections are caused by viruses, but there are not a few people who use antibiotics clinically. The consequence of abuse is that bacterial drug resistance is enhanced, the efficacy of antibiotics is reduced or even lost, and finally human beings have no medicine available; Microscopically, it will cause drug-induced damage to the patient's body. Because there are many flora in the human body, under normal circumstances, they restrict each other and form a balance, and the abuse of antibiotics may cause damage to some beneficial flora, making some harmful bacteria or viruses take advantage of it, leading to double infection and even death. In addition, the clinical division is too detailed, and doctors lack correct knowledge of antibacterial drugs; It is difficult to obtain correct drug information; Doctors' lack of comprehensive pharmaceutical knowledge is also an important reason for medication errors. For a long time, people have become accustomed to taking antibiotics as a standing medicine at home when they have a slight headache and brain fever. However, some patients take the initiative to prescribe good drugs and expensive drugs, which leads to waste of resources and bacterial resistance.

It can be seen that rational drug use is not only a medical problem, but also a problem that clinicians need to pay attention to. To achieve rational drug use, doctors, patients, pharmacists and drug management departments need to cooperate with each other.

2. Improve the awareness of self-protection and prevent the occurrence of adverse drug reactions.

The causes of adverse drug reactions are very complicated and difficult to predict. Mainly including drug factors, patients' own factors and other factors.

2. 1 drug factors (1) the function of the drug itself: if a drug has more than two functions, one of them may become a side effect. For example, ephedrine has both antiasthmatic and excitatory effects, which can cause insomnia when used to prevent and treat bronchial asthma. (2) Adverse drug effects: Some drugs themselves are harmful to some tissues and organs of the human body. If glucocorticoids are used in large quantities for a long time, it can cause capillary degeneration and bleeding, leading to petechiae and ecchymosis on skin and mucosa. (3) Drug quality: Impurities mixed in the production process or improper storage can cause adverse drug reactions. (4) Drug dosage: If the dosage is too large, poisoning reaction and even death may occur. (5) Influence of dosage forms: Different dosage forms of the same drug will lead to different absorption in the body, that is, different bioavailability. If the dosage is not mastered, it will also cause adverse reactions.

2.2 Patients' own reasons (1) Gender: There are more men than women with drug dermatitis, the ratio is about 3 ∶ 2; Granulopenia is more common in women than in men. (2) Age: Old people and children have different reactions to drugs from adults, and are prone to adverse reactions due to slow metabolism and excretion of drugs; Infants and young children are immature, sensitive to some drugs and prone to adverse reactions. The survey found that the incidence of adverse reactions in people under 60 years old was 5.9% (52/887), and that in the elderly over 60 years old was15.85% (113/713) [4]. (3) Individual differences: Different races have different sensitivities to the same drug, and different individuals of the same race have different reactions to the same drug. (4) Disease factors: When the liver and kidney function declines, the drug action can be enhanced and prolonged, which is easy to cause adverse reactions.

2.3 Other factors (1) irrational drug use: misuse, abuse and improper prescription compatibility. These will all lead to adverse reactions. (2) Long-term medication: it is easy to have adverse reactions, even accumulation and poisoning. (3) Combined medication: The incidence of adverse reactions was 3.5% when two or more drugs were used, 65,438+00% when six or more drugs were used, and 80% when 65,438+05 drugs were used [5]. (4) Drug reduction or withdrawal: Drug reduction or withdrawal can also cause adverse reactions. For example, in the treatment of severe rash, stopping taking glucocorticoids or reducing the dosage too quickly will lead to rebound phenomenon.

All kinds of drugs may have adverse reactions, and traditional Chinese medicine is no exception, but the degree is different, or the probability of happening to different people is different. When there are adverse drug reactions, there is no need to be too alarmed. Patients must read the instructions carefully when taking drugs. If there are serious adverse reactions or those not specified in the instructions, you should report them to the doctor in time.

3 How to use drugs safely

(1) Don't trust drug advertisements. Some drug advertisements exaggerate the efficacy of drugs, but make no mention of the adverse reactions of drugs, which is misleading. (2) Don't blindly believe in new drugs, expensive drugs and imported drugs. Some patients think that all new drugs, expensive drugs and imported drugs must be good drugs, and it is not appropriate to prescribe drugs by name in hospitals or buy drugs in pharmacies without knowing the condition. (3) Take the medicine in strict accordance with the prescribed usage and dosage. Read the instructions carefully before taking the medicine, and don't increase the dose by yourself. Especially for traditional medicines, many people think that it doesn't matter to eat more and eat less. The larger the dose, the better. This is an important reason for the prevalence of irrational drug use. (4) Drug addicts should improve their awareness of self-protection. If you have abnormal feelings or symptoms after taking the medicine, you should stop taking the medicine and accept the diagnosis and treatment of the clinician. What needs to be warned to users here is that some people have suspicious adverse reactions after taking the medicine, so don't jump to conclusions easily. Experienced professional technicians should carefully analyze and evaluate the causal relationship.

With people's increasing concern about health and quality of life, the harm of adverse drug reactions has attracted more and more attention from the whole society. The state is establishing and improving the monitoring and reporting system of adverse drug reactions, so as to avoid and reduce all kinds of harm caused by adverse drug reactions as much as possible. Therefore, people should adopt the attitude of not taking drugs casually without illness, using drugs rationally in case of illness, correctly treating adverse drug reactions, using drugs correctly and keeping drugs, and constantly improve the level of drug use to achieve truly safe, effective, economical and appropriate rational drug use.

refer to

1 Xu nianhui, Lin Guosheng, Jeff, etc. Discussion on the experience of rational application of antibacterial drugs. Chinese journal of nosocomiology, 2002,12 (2):143-144.

2 Tang Jingbo. Evaluation and practice points of rational drug use. Abstract of the symposium on clinical rational drug use in the whole army,1990,64.

Liu Zhensheng, Jin Dapeng and Chen Zenghui. Hospital infection management. Beijing: Military Medical Science Press, 2000,314.

4 Sun Dingren. Adverse drug reactions, 2nd edition. Beijing: People's Health Publishing House, 1998, 103.

5 Cao Quanying. Possible side effects caused by combination medication. Today's China Journal of Medicine, 2003,3 (24): 42.