Avobenzone USP

合集下载

美国药典(USP34)附录-171英文

美国药典(USP34)附录-171英文

171VITAMIN B12 ACTIVITY ASSAYUSP Reference Standards 11—USP Cyanocobalamin RS.Assay Preparation— Place a suitable quantity of the material to be assayed, previously reduced to a fine powder if necessary and accurately measured or weighed, in an appropriate vessel containing, for each g or mL of material taken, 25 mL of an aqueous extracting solution prepared just prior to use to contain, in each 100 mL, 1.29 g of disodium phosphate, 1.1 g of anhydrous citric acid, and 1.0 g of sodium metabisulfite. Autoclave the mixture at 121for 10 minutes. Allow any undissolved particles of the extract to settle, and filter or centrifuge, if necessary. Dilute an aliquot of the clear solution with water so that the final test solution contains vitamin B12 activity approximately equivalent to that of the Standard Cyanocobalamin Solution which is added to the assay tubes.Standard Cyanocobalamin Stock Solution— To a suitable quantity of USP Cyanocobalamin RS, accurately weighed, add sufficient 25 percent alcohol to make a solution having a known concentration of 1.0 µg of cyanocobalamin per mL. Store in a refrigerator.Standard Cyanocobalamin Solution— Dilute a suitable volume of Standard Cyanocobalamin Stock Solution with water to a measured volume such that after the incubation period as described for Procedure, the difference in transmittance between the inoculated blank and the 5.0-mL level of the Standard Cyanocobalamin Solution is not less than that which corresponds to a difference of 1.25 mg in dried cell weight. This concentration usually falls between 0.01 ng and 0.04 ng per mL of Standard Cyanocobalamin Solution. Prepare a fresh standard solution for each assay.Basal Medium Stock Solution— Prepare the medium according to the following formula and directions. A dehydrated mixture containing the same ingredients may be used provided that, when constituted as directed in the labeling, it yields a medium comparable to that obtained from the formula given herein.Add the ingredients in the order listed, carefully dissolving the cystine and tryptophane in the hydrochloric acid before adding the next eight solutions in the resulting solution. Add 100 mL of water, mix, and dissolve the dextrose, sodium acetate, and ascorbic acid. Filter, if necessary, add the polysorbate 80 solution, adjust the solution to a pH between 5.5 and 6.0 with 1 N sodium hydroxide, and add purified water to make 250 mL.L-Cystine 0.1 gL-Tryptophane 0.05 g1 N Hydrochloric Acid 10 mLAdenine-Guanine-Uracil Solution 5 mLXanthine Solution 5 mLVitamin Solution I 10 mLVitamin Solution II 10 mLSalt Solution A 5 mLSalt Solution B 5 mLAsparagine Solution 5 mLAcid-hydrolyzed Casein Solution 25 mLDextrose, Anhydrous 10 gSodium Acetate, Anhydrous 5 gAscorbic Acid 1 gPolysorbate 80 Solution 5 mLAcid-Hydrolyzed Casein Solution— Prepare as directed under Calcium Pantothenate Assay 91.Asparagine Solution— Dissolve 2.0 g of L-asparagine in water to make 200 mL. Store under toluene in a refrigerator.Adenine–Guanine–Uracil Solution— Prepare as directed under Calcium Pantothenate Assay 91.Xanthine Solution— Suspend 0.20 g of xanthine in 30 mL to 40 mL of water, heat to about 70, add 6.0 mL of 6 N ammonium hydroxide, and stir until the solid is dissolved. Cool, and add water to make 200 mL. Store under toluene in a refrigerator.Salt Solution A— Dissolve 10 g of monobasic potassium phosphate and 10 g of dibasic potassium phosphate in water to make 200 mL. Add 2 drops of hydrochloric acid, and store under toluene.Salt Solution B— Dissolve 4.0 g of magnesium sulfate, 0.20 g of sodium chloride, 0.20 g of ferrous sulfate, and 0.20 g of manganese sulfate in water to make 200 mL. Add 2 drops of hydrochloric acid, and store under toluene. Polysorbate 80 Solution— Dissolve 20 g of polysorbate 80 in alcohol to make 200 mL. Store in a refrigerator.Vitamin Solution I— Dissolve 10 mg of riboflavin, 10 mg of thiamine hydrochloride, 100 µg of biotin, and 20 mg of niacin in 0.02 N glacial acetic acid to make 400 mL. Store, protected from light, under toluene in a refrigerator.Vitamin Solution II— Dissolve 20 mg of para-aminobenzoic acid, 10 mg of calcium pantothenate, 40 mg of pyridoxine hydrochloride, 40 mg of pyridoxal hydrochloride, 8 mg of pyridoxamine dihydrochloride, and 2 mg of folic acid in dilute neutralized alcohol (1 in 4) to make 400 mL. Store, protected from light, in a refrigerator.Tomato Juice Preparation— Centrifuge commercially canned tomato juice so that most of the pulp is removed. Suspend about 5 g per L of analyticalfilter-aid in the supernatant, and filter, with the aid of reduced pressure, through a layer of the filter-aid. Repeat, if necessary, until a clear,straw-colored filtrate is obtained. Store under toluene in a refrigerator.Culture Medium— [NOTE—A dehydrated mixture containing the same ingredients may be used provided that, when constituted as directed in the labeling, it yields a medium equivalent to that obtained from the formula given herein. ]Dissolve 0.75 g of water-soluble yeast extract, 0.75 g of dried peptone, 1.0 g of anhydrous dextrose, and 0.20 g of potassium biphosphate in 60 mL to 70 mL of water. Add 10 mL of Tomato Juice Preparation and 1 mL of Polysorbate 80 Solution. Adjust the solution with 1 N sodium hydroxide to a pH of 6.8, and add water to make 100 mL. Place 10-mL portions of the solution in test tubes, and plug with cotton. Sterilize the tubes and contents in an autoclave at 121for 15 minutes. Cool as rapidly as possible to avoid color formation resulting from overheating the medium.Suspension Medium— Dilute a measured volume of Basal Medium Stock Solution with an equal volume of water. Place 10-mL portions of the diluted medium in test tubes. Sterilize, and cool as directed above for the Culture Medium.Stock Culture of Lactobacillus leichmannii— To 100 mL of Culture Medium add 1.0 g to 1.5 g of agar, and heat the mixture, with stirring, on a steam bath, until the agar dissolves. Place approximately 10-mL portions of the hot solution in test tubes, cover the tubes suitably, sterilize at 121for 15 minutes in an autoclave (exhaust line temperature), and allow the tubes to cool in an upright position. Inoculate three or more of the tubes, by stab transfer of a pure culture of Lactobacillus leichmannii.* (Before first using a fresh culture in this assay, make not fewer than 10 successive transfers of the culture in a 2-week period.) Incubate 16 to 24 hours at any selected temperature between 30and 40but held constant to within ±0.5, and finally store in a refrigerator.Prepare fresh stab cultures at least three times each week, and do not use them for preparing the inoculum if more than 4 days old. The activity of the microorganism can be increased by daily or twice-daily transfer of the stab culture, to the point where definite turbidity in the liquid inoculum can be observed 2 to 4 hours after inoculation. A slow-growing culture seldom gives a suitable response curve, and may lead to erratic results.Inoculum— [NOTE—A frozen suspension of Lactobacillus leichmannii may be used as the stock culture, provided it yields an inoculum comparable to a fresh culture. ]Make a transfer of cells from the Stock Culture of Lactobacillus leichmannii to 2 sterile tubes containing 10 mL of the Culture Medium each. Incubate these cultures for 16 to 24 hours at any selected temperature between 30and 40but held constant to within ±0.5. Under aseptic conditions, centrifuge the cultures, and decant the supernatant. Suspend the cells from the culture in 5 mL of sterile Suspension Medium, and combine. Using sterile Suspension Medium, adjust the volume so that a 1 in 20 dilution in saline TS produces 70% transmittance when read on a suitable spectrophotometer that has been set at a wavelength of 530 nm, equipped with a 10-mm cell, and read against saline TS set at 100% transmittance. Prepare a 1 in 400 dilution of the adjusted suspension using Basal Medium Stock Solution, and use it for the test inoculum. (This dilution may be altered, when necessary, to obtain the desired test response.)Calibration of Spectrophotometer— Check the wavelength of the spectrophotometer periodically, using a standard wavelength cell or other suitable device. Before reading any tests, calibrate the spectrophotometer for 0% and 100% transmittance, using water and with the wavelength set at 530 nm.Procedure— Cleanse meticulously by suitable means, followed preferably by heating at 250for 2 hours, hard-glass test tubes, about 20 mm × 150 mm in size, and other necessary glassware because of the high sensitivity of the test organism to minute amounts of vitamin B12 activity and to traces of many cleansing agents.To test tubes add, in duplicate, 1.0 mL, 1.5 mL, 2.0 mL, 3.0 mL, 4.0 mL, and 5.0 mL, respectively, of the Standard Cyanocobalamin Solution. To each of these tubes and to four similar empty tubes add 5.0 mL of Basal Medium Stock Solution and water to make 10 mL.To similar test tubes add, in duplicate, respectively, 1.0 mL, 1.5 mL, 2.0 mL, 3.0 mL, and 4.0 mL of the Assay Preparation. To each tube add 5.0 mL of Basal Medium Stock Solution and water to make 10 mL. Place one complete set of standard and assay tubes together in one tube rack and the duplicate set in a second rack or section of a rack, preferably in random order.Cover the tubes suitably to prevent bacterial contamination, and sterilize the tubes and contents in an autoclave at 121for 5 minutes, arranging to reach this temperature in not more than 10 minutes by preheating the autoclave, if necessary. Cool as rapidly as practicable to avoid color formation resulting from overheating the medium. Take precautions to maintain uniformity of sterilizing and cooling conditions throughout the assay, since packing tubes too closely in the autoclave, or overloading it, may cause variation in the heating rate.Aseptically add 0.5 mL of Inoculum to each tube so prepared, except two of the four containing no Standard Cyanocobalamin Solution (the uninoculated blanks). Incubate the tubes at a temperature between 30and 40held constant to within ±0.5, for 16 to 24 hours.Terminate growth by heating to a temperature not lower than 80for 5 minutes. Cool to room temperature. After agitating its contents, place the container in a spectrophotometer that has been set at a wavelength of 530 nm, and read the transmittance when a steady state is reached. This steady state is observed a few seconds after agitation when the reading remains constant for 30 seconds or more. Allow approximately the same time interval for the reading on each tube.With the transmittance set at 100% for the uninoculated blank, read the transmittance of the inoculated blank. If the difference is greater than 5% or if there is evidence of contamination with a foreign microorganism, disregard the results of the assay.With the transmittance set at 100% for the uninoculated blank, read the transmittance of each of the remaining tubes. Disregard the results of the assay if the slope of the standard curve indicates a problem with sensitivity.Calculation— Prepare a standard concentration-response curve by the following procedure. Test for and replace any aberrant individual transmittances. For each level of the standard, calculate the response from the sum of the duplicate values of the transmittances (∑) as the difference, y = 2.00 –∑. Plot this response on the ordinate of cross-section paper against the logarithm of the mL of Standard Cyanocobalamin Solution per tube on the abscissa, using for the ordinate either an arithmetic or a logarithmic scale, whichever gives the better approximation to a straight line. Draw the straight line or smooth curve that best fits the plotted points.Calculate the response, y, adding together the two transmittances for each level of the Assay Preparation. Read from the standard curve the logarithm of the volume of the Standard Preparation corresponding to each of those values of y that falls within the range of the lowest and highest points plotted for the standard. Subtract from each logarithm so obtained the logarithm of thevolume, in mL, of the Assay Preparation to obtain the difference, x, for each dosage level. Average the values of x for each of three or more dosage levels to obtain x = M', the log-relative potency of the Assay Preparation. Determine the quantity, in µg, of USP Cyanocobalamin RS corresponding to the cyanocobalamin in the portion of material taken for assay by the equation antilog M = antilog (M' + log R), in which R is the number of µg of cyanocobalamin that was assumed to be present in each mg (or capsule or tablet) of the material taken for assay.Replication— Repeat the entire determination at least once, using separately prepared Assay Preparations. If the difference between the two log potencies M is not greater than 0.08, their mean, M, is the assayed log-potency of the test material (see Vitamin B12 Activity Assay under Design and Analysis of Biological Assays 111). If the two determinations differ by more than 0.08, conduct one or more additional determinations. From the mean of two or more values of M that do not differ by more than 0.15, compute the mean potency of the preparation under assay.*Pure cultures of Lactobacillus leichmannii may be obtained as No. 7830 from the American Type Culture Collection, 10801 University Blvd., Manassas, VA 20110.Auxiliary Information—Please check for your question in the FAQs before contacting USP.Topic/Question Contact Expert CommitteeGeneral Chapter Curtis Phinney1-301-816-8540 (DSN05) Dietary Supplements - Non-BotanicalsReference Standards Lili Wang, Technical Services Scientist 1-301-816-8129 RSTech@USP32–NF27 Page 125。

USP泼尼松校正片说明书(中英文对照)

USP泼尼松校正片说明书(中英文对照)

Certificate(证书)PREDNISONE TABLETS(泼尼松片)USP Catalog No.: 1559505USP Lot No.: R031Y1(10 mg nominal prednisone content per tablet) (每片含泼尼松10mg)FOR DISSOLUTION PERFORMANCE VERIFICATION TEST (PVT) 用于溶出性能确认实验Period of validity: This certificate of USP Prednisone Tablets Lot R031Y1 is valid through June 30th, 2017.有效期:USP泼尼松片批号R031Y1的证书有效期到2017年6月30日The USP Prednisone Tablets RS is provided for use in the Performance Verification Test for USP Apparatus 1 and 2 with 1 liter vessels in the USP General Test Chapter on DISSOLUTION <711> and DRUG RELEASE <724>, APPARATUS SUITABILITY. Store in a dry place. Store the tablets at controlled room temperature not exceeding 25°.USP泼尼松标准片用于采取USP中方法1和方法2对1升溶出杯,进行USP通用测试部分溶出(711)和释放(724)项目的性能能确认实验,药品贮藏在干燥,温度低于25℃环境中。

Dissolution Medium: We recommend preparing the medium as follows:Heat a suitable amount of water, while stirring gently, to about 41-45°. Filter under vacuum through a 0.45-μm-porosity filter into a suitable filtering flask equipped with a stirring device. Seal the flask and continue to apply vacuum while stirring for an additional five minutes. Measured vacuum should be less than 100 mbar. The temperature of the Dissolution medium should not fall below 37° prior to the initiation of the test.溶出介质:推荐介质准备(操作)如下:(脱气纯化水)加热适量水同时轻轻搅拌到约41~45℃。

BOSCH Forum 6 系列 60 x 60 cm 烤箱说明书

BOSCH Forum  6 系列 60 x 60 cm 烤箱说明书

Serie 6, Forno con vapore daincasso, 60 x 60 cm, AcciaioHRG5785S6Accessori integrati1 x Teglia da forno smaltata, 1 x Griglia combinata, 1 x Leccarda universale smaltataAccessori opzionaliHEZ317000 Teglia per pizza, HEZ327000 Pietra per pane e pizza, HEZ531000 Leccarda bassa 455x375x30 mm (LxPxA), HEZ531010 Leccarda antiaderen 455x375x30mm (LxPxA), HEZ532000 Leccarda profonda 455x375x38 mm (LxPxA), HEZ532010 Leccarda antiaderen 455x400x38mm (LxPxA), HEZ538000 Guide telescopiche clip a 1 livello, HEZ629070 Teglia per grigliare adatta a pirolisi, HEZ634000 Griglia combinata 455x375x31 mm (LxPxA), HEZ638000 Guide telescopiche clip a 1 livello, HEZ660050 Accessory, HEZ664000 Griglia combinata 455x375x59 mm (LxPxA), HEZ915003 Pirofila in vetro con coperchio 5,4 l., HEZG0AS00 Cavo di collegamento 3m • 30 programmi automatici di cottura: cucinare sarà semplicissimo grazie ai programmi con impostazioni già preselezionate.• Controllo digitale LCD bianco: semplice da utilizzare grazieall'accesso diretto alle funzioni addizionali, suggerimenti di temperatura ed indicazioni di temperatura.• Autopulizia pirolitica: pulizia del forno senza sforzo• Porta piatta con sistema SoftMove: SoftOpen e SoftClose, apertura e chiusura ammortizzate• Termosonda PerfectRoast: rileva la temperatura interna della pietanza con una precisione al grado e al secondo.Dati tecniciTipologia costruttiva del prodotto: .....................................Da incasso Sistema di pulizia: ....................................................................Pirolisi Dimensioni del vano per l'installazione (AxLxP): 585-595 x 560-568 x 550 mmDimensioni (AxLxP): ............................................595 x 594 x 548 mm Dimensioni del prodotto imballato (AxLxP): .......670 x 690 x 660 mm Materiale del cruscotto: ...................................................acciaio inox Materiale porta: ..........................................................................vetro Peso netto: ..............................................................................40.0 kg Volume utile: .................................................................................71 l Metodo di cottura: ...........rigenerazione cibi, Scongelamento, Grill a superficie grande, Aria calda delicata, aria calda, Riscaldamento statico, Funzione pizza, Cottura a bassa temperatura, grill ventilato Materiale della cavità: .................................................................Altro Regolazione della temperatura: .........................................elettronica Numero di luci interne: (1)Lunghezza del cavo di alimentazione elettrica: .....................120.0 cm Codice EAN: (4242005165926)Numero di vani - (2010/30/CE): (1)Classe di efficienza energetica: .........................................................A Energy consumption per cycle conventional (2010/30/EC): ........0.99 kWh/cycleEnergy consumption per cycle forced air convection (2010/30/EC):0.81 kWh/cycleIndice di efficienza energetica (2010/30/CE): ..........................95.3 % Potenza: ..................................................................................3600 W Corrente: .....................................................................................16 A Tensione: .............................................................................220-240 V Frequenza: ...........................................................................50; 60 Hz Tipo di spina: ..........................................................................Schuko Accessori inclusi: 1 x Teglia da forno smaltata, 1 x Griglia combinata, 1 x Leccarda universale smaltataSerie 6, Forno con vapore daincasso, 60 x 60 cm, AcciaioHRG5785S6Caratteristiche principali- Forno con 9 funzioni di cottura: MultiCottura HotAir 3D, Riscaldamento superiore e inferiore, Grill ventilato, Grill a superficie grande, Funzione pizza, Cottura a bassa temperatura, Scongelamento, Aria calda delicata, rigenerazione cibi- Funzioni combinabili con gli impulsi di vapore: aria calda 3D, grill ventilato, riscaldamento statico (resistenza inferiore e superiore)- Display digitale LCD bianco- Volume cavità: 71 l- Regolazione della temperatura da 30 °C a 275 °C- Autopulizia pirolitica- Programmi automatici: 30Altre caratteristiche- Temperatura porta max. 30 °C- Riscaldamento rapido- Illuminazione interna alogena, Illuminazione disinseribile- Orologio elettronico con impostazione inizio e fine cottura- Porta a ribalta, Porta con chiusura ammortizzata SoftClose, SoftMove: grazie ad un meccanismo di ammortizzazione intelligente, la porta si apre e si chiude delicatamente e silenziosamente- Termosonda PerfectRoast- HomeConnect readyAccessori- Accessori: 1 leccarda smaltata bassa, 1 griglia combinata, 1 leccarda universale profonda smaltataEtichetta energetica- Assorbimento massimo elettrico: 3.6 kW- Classe di efficienza energetica (acc. EU Nr. 65/2014): A(in una scala di classi di efficienza energetica da A+++ a D)- Consumo energetico per ciclo durante funzionamento convenzionale:0.99 kWh- Consumo energetico per ciclo durante funzionamento ventilato:0.81 kWh- Numero di cavità: 1 Tipo di alimentazione: elettrica Volume della cavità:71 lSerie 6, Forno con vapore da incasso, 60 x 60 cm, Acciaio HRG5785S6。

埃尔迪诺·特雷夫斯·阿什比的2016年埃迪诺·特雷夫斯·阿什比说明书

埃尔迪诺·特雷夫斯·阿什比的2016年埃迪诺·特雷夫斯·阿什比说明书

Château Chantalouette - PomerolChâteau Chantalouette is the second wine of Château de Sales. Owned by the same familyfor over five centuries, the 116 acre estate is the largest in the appellation and boasts the onlytrue castle of Pomerol.Certified of «High Environmental Value» (HVE) since 2020, Château Chantalouettepractices virtuous viticulture that integrates and develops biodiversity. The viticultural approach is traditional:the vineyard is ploughed regularly and cultivated with respect for the environment; cover cropping and green harvest are practised with great care.The grapes are harvested by hand at optimal maturity of each bloc. 2016 CHÂTEAU CHANTALOUETTE 2nd wine of Château de SalesAppellation: Pomerol Owner: GFA Château de Sales President:Marine Treppoz GM: Vincent Montigaud Winemaker: Frédéric Laborde Vineyard size:116 acres Average vine age:25 years Soil Types: Small gravel and iron-rich loess Vineyard grape varietals: 70% Merlot - 15% Cabernet Franc - 15% Cabernet Sauvignon Viticulture:Certified «HVE» «Culture raisonnée» Soil tilling (4 ways). Vine growth management adapted to the climatic conditions Harvest: Manual Winemaking: In thermo-regulated concrete vats Ageing: Partly in barrelHARVEST DATES: The harvest took place between 27 September and 14 October in radiant sunshine, with cool nights.2016 VARIETAL MIX:• 72 % Merlot• 11 % Cabernet Franc• 11 % Cabernet SauvignonVINTAGE REPORT:2016 was an exceptional year, marked byradical changes in weather patterns: wetand cool weather from January to June wasfollowed by a summer heatwave and drought,some more-than-welcome rain in earlySeptember, then sunshine, hot days and coolnights from mid-September until the end ofthe harvest. A cool and very damp springfollowed a wet winter. Three-quarters of theyear’s rain fell between January and June,replenishing the groundwater. Flowering started at the end of May, later than usual, and was extended and rather uneven.Temperatures jumped 10° C in late June as summer set in, with virtually no more rain until mid-September. It was hot andvery dry, with a period of drought between 24 June and 12 September; 15mm of rain fell in August.Veraison occurred late and slowly, favoured by fine late-season weather; mid-veraison took place between 8 and 18 Au-gust. September was also hot but rain on 13 and 14 September set off the ripening process, enabling the grapes to matureslowly and gently in ideal conditions.MATURING: 1/3 in oak barrels 2/3 in vatsTASTING NOTES: The wine is red with purple highlights. The intense nose reveals red berry aromas, delicately comple-mented by spice and vanilla notes. A very supple attack leads into a well-balanced and complex mid-palate on fresh redfruit flavours, especially cherry. Notes of spice and cocoa appear with airing, sustained by velvety, well-integrated tannins,ushering in a long and harmonious finish.。

艾贝宁的临床应用

艾贝宁的临床应用

忌】对本品及其成份过敏者禁用
【注意事项】
有报道迷走神经张力高的或不同给药方式(如快速静脉注射或推注)的 健康青年志愿者给予本品后发生心动过缓和窦性停搏
治疗可能包括减少或停止本品输注,增加静脉液体的流速,抬高下肢, 以及使用升高血压的药物(静脉给予抗胆碱能药物。例如,格隆溴铵、 阿托品)
患有晚期心脏传导阻滞和/或严重的心室功能不全的患者给予本品时 应该小心谨慎
设定:1h,3.75ml
艾贝宁®—常用剂量和方法
➢ 全麻术前/术中
补液,全身麻醉前/麻醉诱导后,给予病人的艾贝宁,静脉、泵 注,维持到手术0.2~0.7μg/kg/h结束前30min,注意镇痛药量适当 节30%~50%
➢ 局麻手术
补液,手术开始前10~20min,给予1~1.5μg/kg/h艾贝宁,静脉、 泵注,达到满意镇静程度后,逐渐减量到0.3~0.5μg/kg/h,维持到 手术结束
剂量依赖性镇静和抗焦虑(脑和蓝斑核) 具有镇静及镇痛作用(脊髓和脊髓上部位) 减少血浆儿茶酚胺浓度 中枢性降压和减慢心率 利尿(抑制ADH分泌和拮抗ADH肾小管作用) 抑制涎腺分泌
艾贝宁®—术前用药
作为术前用药减轻焦虑提供镇静 预防喉镜检查及支气管镜检查引起心律失常和心肌缺血 抑制气管插管引起交感反应 困难气道的镇静 减少诱导药物用量 减少围术期心血管发病率和死亡率
另一研究也发现,在术中静脉给予1µg·kg-1右美托咪定, 可明显降低术后寒战的发生率(15% VS 5%)
艾贝宁®—用法用量
➢ 负荷剂量1μg/kg ,静脉泵注10 min ➢ 继而以0.2~0.7 g·kg-1·h-1的速度维持 ➢ 滴定至药效
小贴士:静脉、泵注,维持到手术结束前30min注意镇痛药量适 当节俭 30%~50%

奈韦拉平片USP说明书

奈韦拉平片USP说明书

HIGHLIGHTS OF PRESCRIBING INFORMATIONThese highlights do not include all the information needed to use VIRAMUNE safely and effectively. See full prescribing information for VIRAMUNE.VIRAMUNE® (nevirapine) tablets, for oral useVIRAMUNE® (nevirapine) oral suspension, for oral useInitial U.S. Approval: 1996WARNING: LIFE-THREATENING (INCLUDING FATAL)HEPATOTOXICITY and SKIN REACTIONSSee full prescribing information for complete boxed warning.∙Fatal and non-fatal hepatotoxicity (5.1)∙Fatal and non-fatal skin reactions (5.2)Discontinue immediately if experiencing:∙Signs or symptoms of hepatitis (5.1)∙Increased transaminases combined with rash or other systemic symptoms (5.1)∙Severe skin or hypersensitivity reactions (5.2)∙Any rash with systemic symptoms (5.2)Monitoring during the first 18 weeks of therapy is essential. Extra vigilance is warranted during the first 6 weeks of therapy, which is the period of greatest risk of these events. (5)---------------------------INDICATIONS AND USAGE---------------------------- ∙ VIRAMUNE is an NNRTI indicated for combination antiretroviral treatment of HIV-1 infection in adults and in pediatric patients 15 days and older. (1)Important Considerations:∙ Initiation of treatment is not recommended in the following populations unless the benefits outweigh the risks. (1, 5.1)o adult females with CD4+ cell counts greater than 250 cells/mm3o adult males with CD4+ cell counts greater than 400 cells/mm3∙ The 14-day lead-in period must be strictly followed; it has been demonstrated to reduce the frequency of rash. (2.4, 5.2)------------------------DOSAGE AND ADMINISTRATION--------------------- ∙ If any patient experiences rash during the 14-day lead-in period, do not increase dose until the rash has resolved. Do not continue the lead-indosing regimen beyond 28 days. (2.4)∙ If dosing is interrupted for greater than 7 days, restart 14-day lead-in dosing. (2.4)Adults Pediatric Patients*(≥16 yrs) (≥15 days)First 14days200 mg once daily 150 mg/m2 once dailyAfter 14days200 mg twice daily 150 mg/m2 twice daily*Total daily dose should not exceed 400 mg for any patient. ---------------------DOSAGE FORMS AND STRENGTHS--------------------- ∙200 mg tablets (3)∙50 mg per 5 mL oral suspension (3)------------------------------CONTRAINDICATIONS------------------------------ ∙ Patients with moderate or severe (Child-Pugh Class B or C, respectively) hepatic impairment. (4.1, 5.1, 8.7)∙ Use as part of occupational and non-occupational post-exposure prophylaxis (PEP) regimens, an unapproved use. (4.2, 5.1)-----------------------WARNINGS AND PRECAUTIONS----------------------- ∙ Hepatotoxicity: Fatal and non-fatal hepatotoxicity has been reported.Monitor liver function tests before and during therapy. Permanentlydiscontinue nevirapine if clinical hepatitis or transaminase elevationscombined with rash or other systemic symptoms occur. Do not restartnevirapine after recovery. (5.1)∙ Rash: Fatal and non-fatal skin reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and hypersensitivity reactions,have been reported. Permanently discontinue nevirapine if severe skinreactions or hypersensitivity reactions occur. Check transaminase levels immediately for all patients who develop a rash in the first 18 weeks of treatment. (5.2)∙ Monitor patients for immune reconstitution syndrome and fat redistribution. (5.5, 5.6)-----------------------------ADVERSE REACTIONS------------------------------ ∙ The most common adverse reaction is rash. In adults the incidence of rash is 15% versus 6% with placebo, with Grade 3/4 rash occurring in2% of subjects. (6.1)∙ In pediatric subjects the incidence of rash (all causality) was 21%. (6.2) To report SUSPECTED ADVERSE REACTIONS, contact Boehringer Ingelheim Pharmaceuticals, Inc. at (800) 542-6257 or (800) 459-9906 TTY, or FDA at 1-800-FDA-1088 or /medwatch.-----------------------------DRUG INTERACTIONS----------------------------­Co-administration of VIRAMUNE can alter the concentrations of other drugs and other drugs may alter the concentration of nevirapine. The potential for drug interactions must be considered prior to and during therapy. (5.4, 7, 12.3)----------------------USE IN SPECIFIC POPULATIONS---------------------­∙ No dose adjustment is required for patients with renal impairment with a creatinine clearance greater than or equal to 20 mL per min. Patients on dialysis receive an additional dose of 200 mg following each dialysistreatment. (2.4, 8.6)∙ Monitor patients with hepatic fibrosis or cirrhosis carefully for evidence of drug induced toxicity. Do not administer VIRAMUNE to patientswith Child-Pugh B or C. (5.1, 8.7)See 17 for PATIENT COUNSELING INFORMATION and Medication Guide.Revised: 01/2014FULL PRESCRIBING INFORMATION: CONTENTS WARNINWARNING G: LIFLIFE E-THREATE-THREATENINGNING (INCLU(INCLUD D INING G FATAL)FATAL)HEPATHEPATO O T O X I C I TY and SKITY and SKIN RN RE E ACTIONSACTIONS1INDICATIONS ANDINDICATIONS AND U U SAGESAGE2DOSADOSAGE AND AGE AND AD D MINISTRATIONMINISTRATION2.2.11Adult PatientsAdult Patients2.2.22Pediatric PPediatric Pa a tientstients2.2.33M onitoronitori i ng of Patientsng of Patients2.2.44Dosage AdjustDosage Adjustm m e nt nt3DOSADOSAGEGE F F O RMRMS ANDS AND STRENSTRENG G THSTHS4CONTRCONTRA A INDICINDICA A TIONSTIONS4.4.11 HepaticHepaticI m pairpairm m e nt nt4.4.22Post-Post-E E xposurxposure Pre Prophyophylaxislaxis5WARNINWARNING G S ANS AND D PREPRECAUTICAUTIO O NSNS5.5.11HepatotoxicityHepatotoxicity nda Hepatic ImHepatic Impairmpairme e nt nt5.5.22Skin ReactionsSkin Reactions5.5.33ResistanceResistance5.5.44Dr Drug Iug In n ter teractionsactions5.5.55ImmImmuneune Reconstitution SyndroReconstitution Syndrom m e5.5.66Fat RedistributionFat Redistribution6ADVERSE REAADVERSE REAC C TIONSTIONS6.6.11Clinical TriClinical Tria a l Expel Experience in Adult Patrience in Adult Patientsients6.26.2 Clinical TriClinical Tria a l Expel Experience in Pediatrience in Pediatric ric PatientsPatients6.6.33 Post-Post-M M ar arketingketingE x perperi i enceence7DRUGDRUG INTERACTIOINTERACTION N SFULL PFULL PR R ESCRIESCRIBING INBING INFORMFORMATIONATION 8USE IN SUSE IN SP P ECIFIECIFIC C POPOPULATIOPULATION N S8.8.11Pr Pregnancyegnancy8.8.33NurNursing Msing Mo o therthers s8.8.44Pediatric UsPediatric Use e8.8.55GeriatGeriatric Useric Use8.8.66 RenalRenalImImpairmpairme e nt nt8.8.77 HepaticHepaticI m pairpairm m e nt nt1010 OVEOVER R D O S A GEGE1111 DESCRIPTIDESCRIPTIO O N1212 CLINICAL PCLINICAL PH H A RMACOLRMACOLO O GYGY12.12.11MechanisMechanism m of of ActActi i on on12.12.33PharmPharmacokineticsacokinetics12.12.44M i cr crobiologyobiology1313 NONNONC C LINICAL TOXLINICAL TOXI I C O LOGYLOGY13.13.11Carcinogenesis, Mutagenesis,Carcinogenesis, Mutagenesis, Im Impairmpairme e nt of Fertilitnt of Fertility y13.13.22AnimAnimal al T T oxicologoxicology y and/orand/or PharPharm m acoacologylogy1414 CLINICAL STUCLINICAL STUD D IESIES14.14.11 AdultAdult PatientsPatients14.14.22 PediatrPediatri i c PatientsPatients1616 HOW SHOW SU U PPLIEPPLIED/STORD/STORAGEAGE ANAND HANDLIND HANDLING G1717 PATIENT COPATIENT COUNSELINGUNSELING INFORMATIOINFORMATION N*Sec*Secti tio o n s or sor su u bs bsectecti i o n s omomitt itted fred fromom thethe fu full ll prescribiprescribing ng in info formatrmati i o n areare no not t l l i s t ed ed..WARNINWARNING G: LIFLIFE E-THREATE-THREATENINGNING (INCLU(INCLUD D INING G FATAFATAL)L) HEHEP P A TOTTOTO O X I CITYCITY and SKINand SKIN REACREACTIONSTIONS HEPATOTOXICITY:Severe, life-threatening, and in some cases fatal hepatotoxicity, particularly in the first 18 weeks, has been reported in patients treated with VIRAMUNE. In some cases, patients presented with non-specific prodromal signs or symptoms of hepatitis and progressed to hepatic failure. These events are often associated with rash. Female gender and higher CD4+ cell counts at initiation of therapy place patients at increased risk; women with CD4+ cell counts greater than 250 cells/mm3, including pregnant women receiving VIRAMUNE in combination with other antiretrovirals for the treatment of HIV-1 infection, are at the greatest risk. However, hepatotoxicity associated with VIRAMUNE use can occur in both genders, all CD4+ cell counts and at any time during treatment. Hepatic failure has also been reported in patients without HIV taking VIRAMUNE for post-exposure prophylaxis (PEP). Use of VIRAMUNE for occupational and non-occupational PEP is contraindicated [see Contraindications (4.2)]. Patients with signs or symptoms of hepatitis, or with increased transaminases combined with rash or other systemic symptoms, must discontinue VIRAMUNE and seek medical evaluation immediately [see Warnings and Precautions (5.1)].SKIN REACTIONS:Severe, life-threatening skin reactions, including fatal cases, have occurred in patients treated with VIRAMUNE. These have included cases of Stevens-Johnson syndrome, toxic epidermal necrolysis, and hypersensitivity reactions characterized by rash, constitutional findings, and organ dysfunction. Patients developing signs or symptoms of severe skin reactions or hypersensitivity reactions must discontinue VIRAMUNE and seek medical evaluation immediately. Transaminase levels should be checked immediately for all patients who develop a rash in the first 18 weeks of treatment. The 14-day lead-in period with VIRAMUNE 200 mg daily dosing has been observed to decrease the incidence of rash and must be followed [see Warnings and Precautions (5.2)]. MONITORING:Patients must be monitored intensively during the first 18 weeks of therapy with VIRAMUNE to detect potentially life-threatening hepatotoxicity or skin reactions. Extra vigilance is warranted during the first 6 weeks of therapy, which is the period of greatest risk of these events. Do not restart VIRAMUNE following clinical hepatitis, or transaminase elevations combined with rash or other systemic symptoms, or following severe skin rash or hypersensitivity reactions. In some cases, hepatic injury has progressed despite discontinuation of treatment.INDICATIONSANDUSAGEVIRAMUNE is indicated for combination antiretroviral treatment of HIV-1 infection in adults and in pediatric patients 15 days and older [see Clinical Studies (14.1, 14.2)].Additional important information regarding the use of VIRAMUNE for the treatment of HIV-1 infection:∙ Based on serious and life-threatening hepatotoxicity observed in controlled and uncontrolled trials, VIRAMUNE should not be initiated in adult females with CD4+ cell counts greater than 250 cells/mm3 or in adult males with CD4+ cell counts greater than 400 cells/mm3 unless the benefit outweighs the risk [see Boxed Warning and Warnings and Precautions (5.1)].∙ The 14-day lead-in period with VIRAMUNE 200 mg daily dosing must be strictly followed; it has been demonstrated to reduce the frequency of rash [see Dosage and Administration (2.4) and Warnings and Precautions (5.2)].1If rash persists beyond the 14-day lead-in period, do not dose escalate to 200 mg twice daily. The 200 mg once-daily dosing regimen should not be continued beyond 28 days, at which point an alternative regimen should be sought.2 DOSAGE AND ADMINISTRATION2.1 Adult PatientsThe recommended dose for VIRAMUNE is one 200 mg tablet daily for the first 14 days, followed by one 200 mg tablet twice daily, in combination with other antiretroviral agents. The lead-in period has been observed to decrease the incidence of rash. For concomitantly administered antiretroviral therapy, the manufacturer’s recommended dosage and monitoring should be followed.2.2 Pediatric PatientsThe recommended oral dose for pediatric patients 15 days and older is 150 mg/m2 once daily for 14 days followed by 150 mg/m2 twice daily thereafter. The total daily dose should not exceed 400 mg for any patient.Height (cm) x Wt (kg)Mosteller Formula: BSA (m2) =3600Table 1 Calculation of the Volume of VIRAMUNE Oral Suspension (50 mg per 5 mL) Required for PediatricDosing Based on Body Surface and a Dose of 150 mg/m2BSA range (m2) Volume(mL)0.06 – 0.12 1.250.12 – 0.25 2.50.25 – 0.42 50.42 – 0.58 7.50.58 – 0.75 100.75 – 0.92 12.50.92 – 1.08 151.08 – 1.25 17.51.25+ 20VIRAMUNE suspension should be shaken gently prior to administration. It is important to administer the entire measured dose of suspension by using an oral dosing syringe or dosing cup. An oral dosing syringe is recommended, particularly for volumes of 5 mL or less. If a dosing cup is used, it should be thoroughly rinsed with water and the rinse should also be administered to the patient.2.3 Monitoring of PatientsIntensive clinical and laboratory monitoring, including liver enzyme tests, is essential at baseline and during the first 18 weeks of treatment with VIRAMUNE. The optimal frequency of monitoring during this period has not been established. Some experts recommend clinical and laboratory monitoring more often than once per month, and in particular, would include monitoring of liver enzyme tests at baseline, prior to dose escalation, and at two weeks post-dose escalation. After the initial 18­week period, frequent clinical and laboratory monitoring should continue throughout VIRAMUNE treatment [see Warnings and Precautions (5)]. In some cases, hepatic injury has progressed despite discontinuation of treatment.2.4 Dosage AdjustmentPatients with RashDiscontinue VIRAMUNE if a patient experiences severe rash or any rash accompanied by constitutional findings [see Boxed Warning and Warnings and Precautions (5.2)]. Do not increase VIRAMUNE dose if a patient experiences mild to moderate rash without constitutional symptoms during the 14-day lead-in period of 200 mg/day (150 mg/m2/day in pediatric patients) until the rash has resolved [see Warnings and Precautions (5.2)]. The total duration of the once daily lead-in dosing period should not exceed 28 days at which point an alternative regimen should be sought.Patients with Hepatic EventsIf a clinical (symptomatic) hepatic event occurs, permanently discontinue VIRAMUNE. Do not restart VIRAMUNE after recovery [see Warnings and Precautions (5.1)].Patients with Dose InterruptionFor patients who interrupt VIRAMUNE dosing for more than 7 days, restart the recommended dosing, using one 200 mg tablet daily (150 mg/m2/day in pediatric patients) for the first 14 days (lead-in) followed by one 200 mg tablet twice daily (150 mg/m2 twice daily for pediatric patients).Patients with Renal ImpairmentPatients with CrCL greater than or equal to 20 mL per min do not require an adjustment in VIRAMUNE dosing. The pharmacokinetics of nevirapine have not been evaluated in patients with CrCL less than 20 mL per min. An additional 200 mg dose of VIRAMUNE following each dialysis treatment is indicated in patients requiring dialysis. Nevirapine metabolites may accumulate in patients receiving dialysis; however, the clinical significance of this accumulation is not known [see Clinical Pharmacology (12.3)].3 DOSAGE FORMS AND STRENGTHSTablets: 200 mg, white, oval, biconvex, tablets embossed with 54 193 on one sideOral suspension: 50 mg per 5 mL, white to off-white oral suspension4 CONTRAINDICATIONS4.1 Hepatic ImpairmentVIRAMUNE is contraindicated in patients with moderate or severe (Child-Pugh Class B or C, respectively) hepatic impairment [see Warnings and Precautions (5.1) and Use in Specific Populations (8.7)].4.2 Post-Exposure ProphylaxisVIRAMUNE is contraindicated for use as part of occupational and non-occupational post-exposure prophylaxis (PEP) regimens [see Warnings and Precautions (5.1)].PRECAUTIONSAND5 WARNINGSThe most serious adverse reactions associated with VIRAMUNE are hepatitis/hepatic failure, Stevens-Johnson syndrome, toxic epidermal necrolysis, and hypersensitivity reactions. Hepatitis/hepatic failure may be associated with signs of hypersensitivity which can include severe rash or rash accompanied by fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, facial edema, eosinophilia, granulocytopenia, lymphadenopathy, or renal dysfunction.The first 18 weeks of therapy with VIRAMUNE are a critical period during which intensive clinical and laboratory monitoring of patients is required to detect potentially life-threatening hepatic events and skin reactions. The optimal frequency of monitoring during this time period has not been established. Some experts recommend clinical and laboratory monitoring more often than once per month, and in particular, include monitoring of liver enzyme tests at baseline, prior to dose escalation and at two weeks post-dose escalation. After the initial 18-week period, frequent clinical and laboratory monitoring should continue throughout VIRAMUNE treatment. In addition, the 14-day lead-in period with VIRAMUNE 200 mg daily dosing has been demonstrated to reduce the frequency of rash [see Dosage and Administration (2.1)].5.1 Hepatotoxicity and Hepatic ImpairmentSevere, life-threatening, and in some cases fatal hepatotoxicity, including fulminant and cholestatic hepatitis, hepatic necrosis and hepatic failure, have been reported in patients treated with VIRAMUNE. In controlled clinical trials, symptomatic hepatic events regardless of severity occurred in 4% (range 0% to 11%) of subjects who received VIRAMUNE and 1% of subjects in control groups.The risk of symptomatic hepatic events regardless of severity was greatest in the first 6 weeks of therapy. The risk continued to be greater in the VIRAMUNE groups compared to controls through 18 weeks of treatment. However, hepatic events may occur at any time during treatment. In some cases, subjects presented with non­specific, prodromal signs or symptoms of fatigue, malaise, anorexia, nausea, jaundice, liver tenderness or hepatomegaly, with or without initially abnormal serum transaminase levels. Rash was observed in approximately half of the subjects with symptomatic hepatic adverse events. Fever and flu-like symptoms accompanied some of these hepatic events. Some events, particularly those with rash and other symptoms, have progressed to hepatic failure with transaminase elevation, with or without hyperbilirubinemia, hepatic encephalopathy, prolonged partial thromboplastin time, or eosinophilia. Rhabdomyolysis has been observed in some patients experiencing skin and/or liver reactions associated with VIRAMUNE use. Patients with signs or symptoms of hepatitis must be advised to discontinue VIRAMUNE and immediately seek medical evaluation, which should include liver enzyme tests.Transaminases should be checked immediately if a patient experiences signs or symptoms suggestive of hepatitis and/or hypersensitivity reaction. Transaminases should also be checked immediately for all patients who develop a rash in the first 18 weeks of treatment. Physicians and patients should be vigilant for the appearance of signs or symptoms of hepatitis, such as fatigue, malaise, anorexia, nausea, jaundice, bilirubinuria, acholic stools, liver tenderness or hepatomegaly. The diagnosis of hepatotoxicity should be considered in this setting, even if transaminases are initially normal or alternative diagnoses are possible [see Boxed Warning and Dosage and Administration (2.3)].If clinical hepatitis or transaminase elevations combined with rash or other systemic symptoms occur, permanently discontinue VIRAMUNE. Do not restart VIRAMUNE after recovery. In some cases, hepatic injury progresses despite discontinuation of treatment.The patients at greatest risk of hepatic events, including potentially fatal events, are women with high CD4+ cell counts. In general, during the first 6 weeks of treatment, women have a 3-fold higher risk than men for symptomatic, often rash-associated, hepatic events (6% versus 2%), and patients with higher CD4+ cell counts at initiation of VIRAMUNE therapy are at higher risk for symptomatic hepatic events with VIRAMUNE. In a retrospective review, women with CD4+ cell counts greater than 250 cells/mm3 had a 12-fold higher risk of symptomatic hepatic adverse events compared to women with CD4+ cell counts less than 250 cells/mm3 (11% versus 1%). An increased risk was observed in men with CD4+ cell counts greater than 400 cells/mm3 (6% versus 1% for men with CD4+ cell counts less than 400cells/mm3). However, all patients, regardless of gender, CD4+ cell count, or antiretroviral treatment history, should be monitored for hepatotoxicity since symptomatic hepatic adverse events have been reported at all CD4+ cell counts. Co-infection with hepatitis B or C and/or increased transaminase elevations at the start of therapy with VIRAMUNE are associated with a greater risk of later symptomatic events (6 weeks or more after starting VIRAMUNE) and asymptomatic increases in AST or ALT.In addition, serious hepatotoxicity (including liver failure requiring transplantation in one instance) has been reported in HIV-1 uninfected individuals receiving multiple doses of VIRAMUNE in the setting of post-exposure prophylaxis (PEP), an unapproved use. Use of VIRAMUNE for occupational and non-occupational PEP is contraindicated [see Contraindications (4.2)].Increased nevirapine trough concentrations have been observed in some patients with hepatic fibrosis or cirrhosis. Therefore, carefully monitor patients with either hepatic fibrosis or cirrhosis for evidence of drug-induced toxicity. Do not administer nevirapine to patients with moderate or severe (Child-Pugh Class B or C, respectively) hepatic impairment [see Contraindications (4.1), Use in Specific Populations (8.7), and Clinical Pharmacology (12.3)].5.2 Skin ReactionsSevere and life-threatening skin reactions, including fatal cases, have been reported, occurring most frequently during the first 6 weeks of therapy. These have included cases of Stevens-Johnson syndrome, toxic epidermal necrolysis, and hypersensitivity reactions characterized by rash, constitutional findings, and organ dysfunction including hepatic failure. Rhabdomyolysis has been observed in some patients experiencing skin and/or liver reactions associated with VIRAMUNE use. In controlled clinical trials, Grade 3 and 4 rashes were reported during the first 6 weeks in 2% of VIRAMUNE recipients compared to less than 1% of placebo subjects.Patients developing signs or symptoms of severe skin reactions or hypersensitivity reactions (including, but not limited to, severe rash or rash accompanied by fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, facial edema, and/or hepatitis, eosinophilia, granulocytopenia, lymphadenopathy, and renal dysfunction) must permanently discontinue VIRAMUNE and seek medical evaluation immediately [see Boxed Warning]. Do not restart VIRAMUNE following severe skin rash, skin rash combined with increased transaminases or other symptoms, or hypersensitivity reaction.If patients present with a suspected VIRAMUNE-associated rash, measure transaminases immediately. Permanently discontinue VIRAMUNE in patients with rash-associated transaminase elevations [see Warnings and Precautions (5.1)].Therapy with VIRAMUNE must be initiated with a 14-day lead-in period of 200 mg per day (150 mg/m2 per day in pediatric patients), which has been shown to reduce the frequency of rash. Discontinue VIRAMUNE if a patient experiences severe rash or any rash accompanied by constitutional findings. Do not increase VIRAMUNE dose to a patient experiencing a mild to moderate rash without constitutional symptoms during the 14-day lead-in period of 200 mg per day (150 mg/m2/day in pediatric patients) until the rash has resolved. The total duration of the once-daily lead-in dosing period must not exceed 28 days at which point an alternative regimen should be sought [see Dosage and Administration (2.4)]. Patients must be monitored closely if isolated rash of any severity occurs. Delay in stopping VIRAMUNE treatment after the onset of rash may result in a more serious reaction.Women appear to be at higher risk than men of developing rash with VIRAMUNE.In a clinical trial, concomitant prednisone use (40 mg per day for the first 14 days of VIRAMUNE administration) was associated with an increase in incidence and severity of rash during the first 6 weeks of VIRAMUNE therapy. Therefore, use of prednisone to prevent VIRAMUNE-associated rash is not recommended.5.3 ResistanceVIRAMUNE must not be used as a single agent to treat HIV-1 or added on as a sole agent to a failing regimen. Resistant virus emerges rapidly when nevirapine is administered as monotherapy. The choice of new antiretroviral agents to be used in combination with nevirapine should take into consideration the potential for cross resistance. When discontinuing an antiretroviral regimen containing VIRAMUNE, the long half-life of nevirapine should be taken into account; if antiretrovirals with shorter half-lives than VIRAMUNE are stopped concurrently, low plasma concentrations of nevirapine alone may persist for a week or longer and virus resistance may subsequently develop [see Microbiology (12.4)].5.4 Drug InteractionsSee Table 4 for listings of established and potential drug interactions [see Drug Interactions (7)].Concomitant use of St. John's wort (Hypericum perforatum) or St. John's wort-containing products and VIRAMUNE is not recommended. Co-administration of St. John’s wort with non-nucleoside reverse transcriptase inhibitors (NNRTIs), including VIRAMUNE, is expected to substantially decrease NNRTI concentrations and may result in sub-optimal levels of VIRAMUNE and lead to loss of virologic response and possible resistance to VIRAMUNE or to the class of NNRTIs. Co­administration of VIRAMUNE and efavirenz is not recommended as this combination has been associated with an increase in adverse reactions and no improvement in efficacy.5.5 Immune Reconstitution SyndromeImmune reconstitution syndrome has been reported in patients treated with combination antiretroviral therapy, including VIRAMUNE. During the initial phase of combination antiretroviral treatment, patients whose immune system responds may develop an inflammatory response to indolent or residual opportunistic infections (such as Mycobacterium avium infection, cytomegalovirus, Pneumocystis jiroveci pneumonia, or tuberculosis), which may necessitate further evaluation and treatment. Autoimmune disorders (such as Graves’ disease, polymyositis, and Guillain-Barré syndrome) have also been reported to occur in the setting of immune reconstitution, however, the time to onset is more variable, and can occur many months after initiation of treatment.5.6 Fat RedistributionRedistribution/accumulation of body fat including central obesity, dorsocervical fat enlargement (buffalo hump), peripheral wasting, facial wasting, breast enlargement, and “cushingoid appearance” have been observed in patients receiving antiretroviral therapy. The mechanism and long-term consequences of these events are currently unknown. A causal relationship has not been established.REACTIONS6 ADVERSE6.1 Clinical Trial Experience in Adult PatientsBecause clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.The most serious adverse reactions associated with VIRAMUNE are hepatitis, hepatic failure, Stevens-Johnson syndrome, toxic epidermal necrolysis, and hypersensitivity reactions. Hepatitis/hepatic failure may be isolated or associated with signs of hypersensitivity which may include severe rash or rash accompanied by fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, facial edema, eosinophilia, granulocytopenia, lymphadenopathy, or renal dysfunction [see Boxed Warning and Warnings and Precautions (5.1, 5.2)].Hepatic ReactionIn controlled clinical trials, symptomatic hepatic events regardless of severity occurred in 4% (range 0% to 11%) of subjects who received VIRAMUNE and 1% of subjects in control groups. Female gender and higher CD4+ cell counts (greater than 250 cells/mm3 in women and greater than 400 cells/mm3 in men) place patients at increased risk of these events [see Boxed Warning and Warnings and Precautions (5.1)].Asymptomatic transaminase elevations (AST or ALT greater than 5X ULN) were observed in 6% (range 0% to 9%) of subjects who received VIRAMUNE and 6% of subjects in control groups. Co-infection with hepatitis B or C and/or increased transaminase elevations at the start of therapy with VIRAMUNE are associated with a greater risk of later symptomatic events (6 weeks or more after starting VIRAMUNE) and asymptomatic increases in AST or ALT.Liver enzyme abnormalities (AST, ALT, GGT) were observed more frequently in subjects receiving VIRAMUNE than in controls (see Table 3).Skin ReactionThe most common clinical toxicity of VIRAMUNE is rash, which can be severe or life-threatening [see Boxed Warning and Warnings and Precautions (5.2)]. Rash occurs most frequently within the first 6 weeks of therapy. Rashes are usually mild to moderate, maculopapular erythematous cutaneous eruptions, with or without pruritus, located on the trunk, face and extremities. In controlled clinical trials (Trials 1037, 1038, 1046, and 1090), Grade 1 and 2 rashes were reported in 13% of subjects receiving VIRAMUNE compared to 6% receiving placebo during the first 6 weeks of therapy. Grade 3 and 4 rashes were reported in 2% of VIRAMUNE recipients compared to less than 1% of subjects receiving placebo. Women tend to be at higher risk for development of VIRAMUNE-associated rash [see Boxed Warning and Warnings and Precautions (5.2)].。

艾贝宁(二炮)

艾贝宁(二炮)

镇静 镇痛
抗交感
抗交感
通过高选择性激动位于中枢神经系统 通过高选择性激动位于中枢神经系统 及外周血管、脏器的a2 肾上腺素能受 及外周血管、脏器的a2 AR ,降低交感 体,降低交感神经活性 神经活性
国际麻醉学与复苏杂志, 2007,(06):540-543.
8
可乐宁
H Cl N N
右美托咪定
H CH3
艾贝宁——无呼吸抑制的镇静剂
•高选择性 α2 : α1=1620 :1
分布半衰期6 min,消除半衰期2.5 h 起效快 •作用在蓝斑核,引发并且维持自然非动眼睡眠 (NREM),患者可唤醒,体现更好的合作性
可唤醒
无呼吸抑制 抗交感
•激动脑桥和延髓的α2受体,抑制NE的释放 有效降低机体的应激反应,而无呼吸抑制
Hall JE, et al.Anesth Analg, 2000,90:699–705
临床应用1——DEX的镇静作用
一个随机、双盲、安慰剂对照研究,入选49 例行外科全麻手术患者,于麻醉前20min,静脉注 射0.18~1.8µg· -1· -1Dex或安慰剂,直至手术 kg h 结束,评估各组患者需要丙泊酚的剂量
维持剂量:0.3—0.6μg/kg/h
静脉泵注10—15min
手术结束前30—45分钟停药
局麻手术: 剖腹产手术 直接给予负荷剂量:0.3—0.6μg/kg,静脉泵注 10—15min (不需给维持剂量) ——同仁医院
27
局麻手术安镇临床体会
• 0.6-0.8ug/kg/10min,继之以0.4-0.6ug/kg/h维持 • 镇静效果好,血流动力学平稳,即使入睡也能唤醒配合术 者操作 • 术后有一定镇痛作用
24小时内的机械通气患者拔管前后连续使用

小妇人-读书分享课件

小妇人-读书分享课件

读书
分享会 READING SHARING
THANKS
FOR LISTENING
分享人:XXXXXXXXXX 天每开个放孩
;子
有的
的花
孩期
子不
是一
菊样
花,
,有
选的
择孩
在子
秋是
天牡
开丹
放花
;,
而选
有择
的在
➢ He who falls today may rise tomorrow.
孩春 子天
是开
梅放
花;
,有
选的
择孩
在子
冬是
天荷
开花
放,




我们,还在路上……
大女儿梅格生性爱美,对恋 爱充满憧憬; 二女儿乔独立自主,矢志 成为作家;
三女儿贝丝则是传统乖乖女,柔弱而惹人怜爱;小女 儿艾米则钟爱绘画。
故事追随这四位女性由女孩成长为小女人的岁月,讲述了 她们不羁的爱情经历及她们各自追寻不同理想与归宿的过 程。
读书
分享会 READING SHARING
经典段落
该作是一部以美国南北战争为背景,以19世纪美国新英格 兰地区的一个普通家庭四个姐妹之间的生活琐事为蓝本的 带有自传色彩的家庭伦理小说。小说受到当时的大思想家 爱默生的影响,强调了个人尊严与自立自律的观念;内容 平实却细腻,结构单纯而寓意深远,富有强烈的感染力。
《小妇人》是一本以女性角色为主,强调女权意识的半自 传体小说。文中注重表现女性意识,宣扬美好品质。
读书
分享会 READING SHARING
The little old woman: one is the happiest thing is that somebody

1例艾沙康唑致患者全血细胞减少的病例分析

1例艾沙康唑致患者全血细胞减少的病例分析

1例艾沙康唑致患者全血细胞减少的病例分析刘晓平1*,林小鲁1,李剑芳2 #(1.广州开发区医院药学部,广州 510730;2.中山大学孙逸仙纪念医院药学部,广州 510120)中图分类号 R969.3;R978.5文献标志码 A 文章编号 1001-0408(2024)07-0881-05DOI 10.6039/j.issn.1001-0408.2024.07.20摘要目的正确识别和应对艾沙康唑引起的全血细胞减少的不良反应,为该药的安全使用提供参考。

方法临床药师通过参与1例严重感染合并肾功能不全的患者使用艾沙康唑后出现全血细胞减少的病例分析,筛查患者住院期间所用药物,并结合药物的半衰期和相关文献,评估了该不良反应与艾沙康唑的关系及可能的发生机制。

结果与结论患者全血细胞减少与艾沙康唑的关系评估为“可能相关”。

使用艾沙康唑时应提高警惕,避免同时联用相同机制或有潜在相互作用的药物。

如疗程大于2周或用药前血液系统异常或合并肝肾功能损害或需要联合使用相同机制的药物者,可考虑增加血常规监测频率。

关键词艾沙康唑;全血细胞减少;病例分析;药物不良反应Case analysis of a patient with isavuconazonium-caused pancytopeniaLIU Xiaoping1,LIN Xiaolu1,LI Jianfang2(1. Dept. of Pharmacy,Guangzhou Development District Hospital,Guangzhou 510730,China;2. Dept. of Pharmacy,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120, China)ABSTRACT OBJECTIVE To correctly identify and deal with the adverse drug reaction as pancytopenia caused by isavuconazonium and to provide reference for the safe use of isavuconazonium. METHODS Clinical pharmacists analyzed a case of severe infection and renal insufficiency who experienced pancytopenia after using isavuconazonium. Clinical pharmacists screened the drugs used during hospitalization and evaluated the relationship between this adverse drug reaction and isavuconazonium,as well as the possible mechanisms,based on the half-life of the drugs and relevant literature. RESULTS &CONCLUSIONS The relationship between pancytopenia and isavuconazonium was assessed as “possibly related”. When using isavuconazonium, attention should be paid to avoiding the combination of drugs with the same mechanism or potential interaction. For patients who have a course of treatment for more than 2weeks,have hematological abnormalities or complicated with liver and renal insufficiency,or should use it combined with other drug with same mechanism,it may be considered to increase the frequency of blood routine monitoring.KEYWORDS isavuconazonium; pancytopenia; case analysis; adverse drug reaction硫酸艾沙康唑是三唑类抗真菌药物艾沙康唑(一种14-α-去甲基化酶抑制剂)的水溶性前药,可被血浆中的酯酶(主要是丁基胆碱酯酶)快速水解成活性成分艾沙康唑和非活性裂解产物[1]。

加缪法语介绍

加缪法语介绍
- Click to add Text
Albert Camus
- de to add Text L'œuvre Click Camus comprend des piè Conten Conten ces de théâtre, des - des add Text romans, Click tonouvelles, des poèmes et des essais dans s ts - il développe lesquels Click to add Text un humanisme fondé sur la prise de - Click to add Text conscience de l'absurdité de la condition humaine mais aussi sur la révolte comme réponse à l'absurde, révolte qui conduit à l'action et donne un sens au monde et à l'existence.
ThemeGallery is a - Click to add Text Design Digital Conten Sa critique du mall & Contents totalitarisme soviétique lui a valu les - Click to add Text developed communistes et a conduit à la brouille avec - Click to add Text anathèmes des by Guild Design Inc. Content Content

替考拉宁USP标准

替考拉宁USP标准

Tartaric acid EUROPEAN PHARMACOPOEIA7.0TESTS Solution S .Dissolve 4.0g in carbon dioxide-free water R anddilute to 20mL with the same solvent.Appearance of solution .Solution S is not more opalescent than reference suspension II (2.2.1).Dextrins,gum,salts,sugars .To 2mL of solution S,add 2mL of ethanol (96per cent)R .The solution is clear.Add 1mL of ether R .The solution remains clear for at least 10min.Resins .To 5mL of solution S,add 5mL of water R .The mixture remains clear (2.2.1)for at least 15min.Loss on drying (2.2.32):maximum 12.0per cent,determined on 0.200g by drying at 105°C.Sulfated ash (2.4.14):maximum 0.1per cent,determined on 1.0g.STORAGEProtected from light.01/2008:0460corrected 6.0TARTARIC ACID Acidumtartaricum C 4H 6O 6M r 150.1[87-69-4]DEFINITION(2R ,3R )-2,3-Dihydroxybutanedioic acid.Content :99.5per cent to 101.0per cent (dried substance).CHARACTERSAppearance :white or almost white,crystalline powder orcolourless crystals.Solubility :very soluble in water,freely soluble in ethanol(96per cent).IDENTIFICATIONA.Solution S (see Tests)is strongly acid (2.2.4).B.It gives the reactions of tartrates (2.3.1).TESTSSolution S .Dissolve 5.0g in distilled water R and dilute to50mL with the same solvent.Appearance of solution .Solution S is clear (2.2.1)and not moreintensely coloured than reference solution Y 6(2.2.2,Method II ).Specific optical rotation (2.2.7):+12.0to +12.8(driedsubstance).Dissolve 5.00g in water R and dilute to 25.0mL with the same solvent.Oxalic acid :maximum 350ppm,calculated as anhydrous oxalicacid.Dissolve 0.80g in 4mL of water R .Add 3mL of hydrochloric acid R and 1g of zinc R in granules and boil for 1min.Allow to stand for 2min.Collect the liquid in a test-tube containing 0.25mL of a 10g/L solution of phenylhydrazine hydrochloride R and heat to boiling.Cool rapidly,transfer toa graduated cylinder and add an equal volume of hydrochloric acid R and 0.25mL of a 50g/L solutionofpotassium ferricyanide R .Shake and allow to stand for 30min.Any pink colour in the solution is not more intense than that in a standard prepared at the same time in the same manner using4mL of a 0.1g/L solution of oxalic acid R .Chlorides (2.4.4):maximum 100ppm.Dilute 5mL of solution S to 15mL with water R .Sulfates (2.4.13):maximum 150ppm.Dilute 10mL of solution S to 15mL with distilled water R .Calcium (2.4.3):maximum 200ppm.To 5mL of solution S add 10mL of a 50g/L solution of sodium acetate R in distilled water R .Heavy metals (2.4.8):maximum 10ppm.2.0g complies with test C.Prepare the reference solution using 2mL of lead standard solution (10ppm Pb)R .Losson drying (2.2.32):maximum 0.2per cent,determined on 1.000g by drying in an oven at 105°C.Sulfated ash (2.4.14):maximum 0.1per cent,determined on 1.0g.ASSAYDissolve 0.650g in 25mL of water R .Titrate with 1M sodium hydroxide using 0.5mL of phenolphthalein solution R as indicator,until a pink colour is obtained.1mL of 1M sodium hydroxide is equivalent to 75.05mgof C 4H 6O 6.01/2009:2358corrected 6.6TEICOPLANINTeicoplaninum3038See the information section on general monographs (cover pages)EUROPEAN PHARMACOPOEIA 7.0Teicoplanin DEFINITION Mixture of glycopeptides produced by certain strains of Actinoplanes teichomyceticus sp.;the 6principal components of the mixture are teicoplanin A 2-1to A 2-5and teicoplanin A 3-1.Fermentation product.Potency :minimum 900IU/mg (anhydrous and sodium chloride-free substance).CHARACTERS Appearance :yellowish,amorphous powder.Solubility :freely soluble in water,sparingly soluble in dimethylformamide,practically insoluble in ethanol (96per cent V/V ).IDENTIFICATION A.Infrared absorption spectrophotometry (2.2.24).Comparison :teicoplanin for identification CRS .B.Examine the chromatograms obtained in the test for composition and related substances.Results :the principal peaks (teicoplanins A 3-1,A 2-1,A 2-2,A 2-3,A 2-4and A 2-5)in the chromatogram obtained with the test solution are similar in retention time and size to the principal peaks in the chromatogram obtained with reference solution (a).TESTS Appearance of solution .The solution is clear (2.2.1)and not more intensely coloured than reference solution BY 3or B 4(2.2.2,Method I ).Dissolve 0.8g in 10mL of water R .pH (2.2.3):6.5to 7.5.Dissolve 0.50g in carbon dioxide-free water R and dilute to 10mL with the same solvent.Composition and related substances .Liquid chromatography (2.2.29):use the normalisation procedure.Test solution .Dissolve 0.100g of the substance to be examined in water R and dilute to 50.0mL with the same solvent.Reference solution (a).Dissolve 20mg of teicoplanin for identification CRS in water R and dilute to 10.0mL with the same solvent.Reference solution (b).Dilute 1.0mL of reference solution (a)to 10.0mL with water R .Dilute 1.0mL of this solution to 20.0mL with water R .Reference solution (c).Dissolve 50.0mg of mesityl oxide CRS in water R and dilute to 25.0mL with the same solvent.Dilute 1.0mL of the solution to 10.0mL with water R .Dilute 1.0mLof this solution to 100.0mL with water R .Column :—size :l =0.25m,Ø=4.6mm;—stationary phase :spherical end-capped octadecylsilyl silica gel for chromatography R (5μm).Mobile phase :—mobile phase A :mix 900mL of a 3.0g/L solution of anhydrous sodium dihydrogen phosphate R ,adjusted to pH 6.0with 1M sodium hydroxide ,and 100mL of acetonitrile R ;—mobile phase B :mix 300mL of a 3.0g/L solution of anhydrous sodium dihydrogen phosphate R ,adjusted to pH 6.0with 1M sodium hydroxide ,and 700mL of acetonitrile R ;Time(min)Mobile phase A (per cent V/V )Mobile phase B (per cent V/V )0-30100→500→5030-3150→1050→9031-351090Flow rate :2.3mL/min.Detection :spectrophotometer at 254nm.Injection :20μL.Identification:use the chromatogram supplied with teicoplaninfor identification CRS and the chromatogram obtained withreference solution (a)to identify the groups and impurities.Relative retention of groups and impurities with reference toteicoplanin A 2-2:—teicoplanin A 3group ≤0.70;—teicoplaninA 2group >0.70and ≤1.25and within this group:—teicoplanin A 2-2=1;—teicoplanin A 2-1group <1;—teicoplanin A 2-3group >1and <1.12;—teicoplanin A 2-4=about 1.12;—teicoplanin A 2-5group >1.12and ≤1.25;—impurities >1.25.Relative retention of principal peaks of the groups withreference to teicoplanin A 2-2(retentiontime =about 18min):teicoplanin A 3-1=about 0.43;teicoplanin A 2-1=about 0.93;teicoplanin A 2-3=about 1.04;teicoplanin A 2-4=about 1.12;teicoplanin A 2-5=about1.14.System suitability :reference solution (a):—the chromatogram obtained is similarto the chromatogramsupplied with teicoplanin for identification CRS ;—resolution :minimum 1.0between the peaks due to teicoplanin A2-4and teicoplanin A 2-5.Calculate the percentage content of the different components using the following equations:teicoplanin A 2group =teicoplanin A 2-2=teicoplanin A 2-1group =teicoplanin A 2-3group =teicoplanin A 2-4=teicoplanin A 2-5group =teicoplanin A 3group =impurities =S a =sum of the areas of the peaks due to teicoplanin A 2group in the chromatogram obtained with the test solution;S b =sum of the areas of the peaks due to teicoplanin A 3group in the chromatogram obtained with the test solution;disregard any peak due to mesityl oxide;S c =sumof the areas of the peaks with a relativeretention more than 1.25;S 1=sum of the areas of the peaks due to teicoplanin A 2-1group in the chromatogram obtained with the test solution;S 2=area of the peak due to teicoplanin A 2-2in thechromatogram obtained with the test solution;General Notices (1)apply to all monographs and other texts 3039Telmisartan EUROPEAN PHARMACOPOEIA7.0S 3=sum of the areas of the peaks due to teicoplanin A2-3 group in the chromatogram obtained with the testsolution;S 4=area of the peak due to teicoplanin A2-4in the chromatogram obtained with the test solution;S 5=sum of the areas of the peaks due to teicoplanin A2-5 group in the chromatogram obtained with the testsolution.Limits:—teicoplanin A2group:minimum80.0per cent;—teicoplanin A2-2:35.0per cent to55.0per cent;—teicoplanin A2-1group:maximum20.0per cent;—teicoplanin A2-3group:maximum20.0per cent;—teicoplanin A2-4:maximum20.0per cent;—teicoplanin A2-5group:maximum20.0per cent;—teicoplanin A3group:maximum15.0per cent;—total of impurities other than mesityl oxide with a relative retention more than1.25:maximum5.0per cent;—disregard limit:the area of the peak due to teicoplanin A2-2 in the chromatogram obtained with reference solution(b)(0.25per cent).Chlorides:maximum5.0per cent,expressed as sodium chloride (anhydrous substance).Dissolve1.000g in300mL of water R,stir and acidify with2mL of nitric acid R.Titrate with0.1M silver nitrate,determining the end-point potentiometrically(2.2.20).1mL of0.1M silver nitrate is equivalent to5.844mg of NaCl. Heavy metals(2.4.8):maximum20ppm.0.50g complies with test G.Prepare the reference solution using100μL of lead standard solution(100ppm Pb)R.Filter the solutions through a membrane filter(nominal pore size 0.45μm).Impurity A.Liquid chromatography(2.2.29)as described in the test for composition and related substances with the following modifications.Injection:20μL of the test solution and reference solution(c).Relative retention with reference to teicoplanin A2-2(retentiontime=about18min):impurity A=about0.6.Limits:—impurity A:maximum twice the area of the principal peak in the chromatogram obtained with reference solution(c)(0.2per cent).Water(2.5.12):maximum15.0per cent,determined on0.300g. Bacterial endotoxins(2.6.14):less than0.31IU/mg.ASSAYCarry out the microbiological assay of antibiotics(2.7.2),using the diffusion e teicoplanin CRS as the reference substance.STORAGEProtected from light,at a temperature of2°C to8°C.IMPURITIESSpecified impurities:A.A.4-methylpent-3-en-2-one(mesityl oxide).07/2008:2154corrected6.3TELMISARTANTelmisartanumC33H30N4O2Mr514.6 [144701-48-4]DEFINITION4′-[[4-Methyl-6-(1-methyl-1H-benzimidazol-2-yl)-2-propyl-1H-benzimidazol-1-yl]methyl]biphenyl-2-carboxylic acid. Content:99.0per cent to101.0per cent(dried substance). CHARACTERSAppearance:white or slightly yellowish,crystalline powder. Solubility:practically insoluble in water,slightly soluble in methanol,sparingly soluble in methylene chloride.It dissolves in1M sodium hydroxide.It shows polymorphism(5.9).IDENTIFICATIONInfrared absorption spectrophotometry(2.2.24). Comparison:telmisartan CRS.If the spectra obtained in the solid state show differences, dissolve the substance to be examined and the reference substance separately in hot anhydrous ethanol R,evaporate to dryness and record new spectra using the residues.TESTSAppearance of solution.The solution is not more intensely coloured than reference solution Y4(2.2.2,Method II). Dissolve0.5g in1M sodium hydroxide and dilute to10mL with the same solvent.Related substances.Liquid chromatography(2.2.29).Test solution.To25mg of the substance to be examined add about5mL of methanol R and100μL of a40g/L solution of sodium hydroxide R.Dissolve with the aid of ultrasound and dilute to50mL with methanol R.Reference solution(a).Dilute1.0mL of the test solution to 10.0mL with methanol R.Dilute1.0mL of this solution to 100.0mL with methanol R.Reference solution(b).Dissolve the contents of a vial of telmisartan for system suitability CRS(containing impurities A,B,C,E and F)in2mL of methanol R.Reference solution(c).To5mg of telmisartan for peak identification CRS(containing impurity D)add about5mLof methanol R and100μL of a40g/L solution of sodium hydroxide R.Dissolve with the aid of ultrasound and dilute to 10mL with methanol R.Column:—size:l=0.125m,Ø=4.0mm;—stationary phase:octadecylsilyl silica gel forchromatography R(5μm)with a pore size of10nm;—temperature:40°C.3040See the information section on general monographs(cover pages)。

基督山伯爵法语版介绍

基督山伯爵法语版介绍

le résumé
Marseille
Captivité Préparation de la vengeance Le vengeur
Marseille
Edmond Dantès revient d‘un voyage à bord du Pharaon, navire appartenant à l’armateur Pierre Morrel. Il a dû remplacer le capitaine Leclère. À son arrivée, il est accueilli par Morrel qui lui promet de le nommer capitaine. Dantès est au comble du bonheur : il peut épouser sa belle fiancée, la Catalane Mercédès. Mais ce bonheur suscite la jalousie. Il y a tout d'abord Danglars, le comptable du bateau qui brigue le poste de capitaine du Pharaon, et aussi Fernand Mondego, un pêcheur d'origine catalane assé par elle.
L’introduction
Le Comte de Monte-Cristo est un roman d’Alexandre Dumas, écrit avec la collaboration d’Auguste Maquet et achevé en 1844. Il est partiellement inspiré de faits réels.

欧洲术后镇痛指南

欧洲术后镇痛指南

PostoperativePain Management –Good Clinical PracticeGeneral recommendationsand principles forsuccessful pain managementProduced in consultation with theEuropean Society of Regional Anaesthesiaand Pain TherapyPostoperativePain Management –Good Clinical PracticeGeneral recommendationsand principles forsuccessful pain managementProduced in consultation with theEuropean Society of Regional Anaesthesiaand Pain TherapyContents ContentsContents11. Introduction and objectives1 Although the choice of drugs shown here is indicative, adjustments will be required to take account ofindividual patient variation and are the responsibility of the prescribing physician.Effective postoperative pain management has a humanitarian role, but there are additional medical and economic benefits for rapid recovery and discharge from hospital. A number of factors contribute to effective postoperative pain management including a structured acute pain management team, patient education, regular staff training, use of balanced analgesia, regular pain assessment using specificassessment tools and adjustment of strategies to meet the needs of special patient groups, such as children and the elderly.Recent advances in pain control provide greater potential for effective postoperative management. This document reflects the opinions of a panel of European anaesthesiologists. Its aims are to raise awareness of recent advances in pain control and to provide advice on how toachieve effective postoperative analgesia. The recommendations and advice are general principles of pain management and do not provide detailed advice for specific surgical procedures.1Effective pain management is now an integral part of modern surgical practice. Postoperative pain management not only minimises patient suffering but also can reduce morbidity and facilitate rapid recovery and early discharge from hospital (see section 8, page 33), which can reduce hospital costs.23Pain is a personal, subjective experience that involves sensory,emotional and behavioural factors associated with actual or potentialtissue injury. What patients tell us about their pain can be very revealing,and an understanding of how the nervous system responds and adaptsto pain in the short and long term is essential if we are to make sense ofpatients’ experiences. The wide area of discomfort surrounding awound, or even a wound that has healed long ago, such as anamputation stump, is a natural consequence of the plasticity of thenervous system. An understanding of the physiological basis of pain ishelpful to the sufferer, and the professionals who have to provideappropriate treatment.According to the International Association for the Study of Pain (IASP),pain is defined as"An unpleasant sensory and emotional experience associated withactual or potential tissue damage, or described in terms of suchdamage."(IASP 1979)There is individual variation in response to pain, which is influenced bygenetic makeup, cultural background, age and gender. Certain patientpopulations are at risk of inadequate pain control and require specialattention. These include:G Paediatric patientsG Geriatric patientsG Patients with difficulty in communicating (due to critical illness,cognitive impairment or language barriers)Postoperative pain can be divided into acute pain and chronic pain:G Acute pain is experienced immediately after surgery (up to 7 days)G Pain which lasts more than 3 months after the injury is considered tobe chronic pain3. Physiology of pain 2. Goals of pain treatmentAcute and chronic pain can arise from cutaneous, deep somatic orvisceral structures. Surgery is typically followed by acute pain and correct identification of the type of pain enables selection of appropriate effective treatment. The type of pain may be somatic (arising from skin, muscle, bone), visceral (arising from organs within the chest and abdomen), or neuropathic (caused by damage or dysfunction in the nervous system). Patients often experience more than one type of pain.3.a. Positive role of painAcute pain plays a useful "positive" physiological role by:G Providing a warning of tissue damageG Inducing immobilisation to allow appropriate healing3.b. Negative effects of painShort term negative effects of acute pain include:G Emotional and physical suffering for the patientG Sleep disturbance(with negative impact on mood and mobilisation)G Cardiovascular side effects(such as hypertension and tachycardia)G Increased oxygen consumption(with negative impact in the case of coronary artery disease)G Impaired bowel movement(while opioids induce constipation or nausea, untreated pain mayalso be an important cause of impaired bowel movement or PONV*)G Negative effects on respiratory function(leading to atelectasis, retention of secretions and pneumonia)G Delays mobilisation and promotes thromboembolism(postoperative pain on mobilisation is one of the major causes fordelayed mobilisation)Long term negative effects of acute pain:G Severe acute pain is a risk factor for the development of chronicpain1G There is a risk of behavioural changes in children for a prolongedperiod (up to 1 year) after surgical painThere are two major mechanisms in the physiology of pain:G Nociceptive (sensory):Inflammatory pain due to chemical,mechanical and thermal stimuli at the nociceptors (nerves thatrespond to painful stimuli).G Neuropathic:Pain due to neural damage in peripheral nervesor within the central nervous system.During normal physiology, pain sensations are elicited by activity in unmyelinated (C-) and thinly myelinated (Ad-) primary afferent neurons that synapse with neurons is the dorsal horn of the spinal cord. Sensory information is then relayed to the thalamus and brainstem.Repetitive activation of C- nociceptive receptors produces alterations in central as well as peripheral nervous systems.3.c. The mechanism of peripheral pain sensitisationNormally, C- fibres (slow-conducting fibres that transmit dull aching pain) are silent in the absence of stimulation, but following acute tissue injury in the presence of ongoing pathophysiology, these nociceptors become sensitised and release a complex mix of pain and inflammatory mediators leading to pain sensations (Figure 1, page 6).1Several investigations into chronic pain have concluded that 20% to 50% of all patients with chronic pain syndromes started with acute pain following trauma or surgery, but the role of effective pain treatment in preventing this risk is not clear.* PONV = Postoperative Nausea and Vomiting.Figure 1.Mechanism of peripheral sensitisation3.d. The mechanism of central sensitisationThe responses in the CNS are primarily physiological. Centralsensitisation is a physiological process and, only if there is continual firing of C-nociceptors over time, will these processes leads to more chronic pain syndromes.Sustained or repetitive C-nociceptor activity produces alterations in the response of the central nervous system to inputs from the periphery.When identical noxious stimuli are repeatedly applied to the skin at a certain rate, there is a progressive build-up in the response of spinalcord dorsal horn neurons (known as ‘wind up’). This allows the size of the dorsal horn neuron’s receptive field to grow (Figure 2). This process,called central sensitisation, occurs with any tissue damage. As with sensitisation of primary afferent nociceptors, this sensitisation of central pain transmission is a normal physiological response of the undamaged nervous system.Figure 2.Pain mediatorsGUnexpected intense pain, particularly if associated with altered vital signs, (hypotension, tachycardia, or fever), is immediately evaluated. New diagnoses, such as wound dehiscence, infection, or deep venous thrombosis, should be considered.GImmediate pain relief without asking for a pain rating is given to patients in obvious pain who are not sufficiently focused to use a pain rating scale.GFamily members are involved when appropriate.4.a. Specific tools for pain assessmentSpecific pain assessment scales are used to quantify pain. The use of one scale within a hospital ensures that everyone in the team "speaks the same language"regarding the intensity of pain. The patient's own report is the most useful tool. The intensity of pain should therefore be assessed as far as possible by the patient as long as he/she is able tocommunicate and express what pain feels like. Always listen to and believe what the patient says.A number of different patient self-assessment scales are available (Figure 3, page 12):A. Facial expressions: a pictogram of six faces with differentexpressions from smiling or happy through to tearful. This scale is suitable for patients where communication is a problem, such as children, elderly patients, confused patients or patients who do not speak the local language.B. Verbal rating scale (VRS): the patient is asked to rate their pain on a five-point scale as "none, mild, moderate, severe or very severe".Assessment of pain is a vital element in effective postoperative pain management. The principles of successful pain assessment are shown in Table 1.44. Assessment of pain4G The treatment strategy to be continued is discussed by the physician responsible for the patient in conjunction with the ward nurses.GThe physician and nurses pay attention to the effects and side effects of the pain treatment.C. Numerical rating scale (NRS): This consists of a simple 0 to 5 or 0 to 10 scale which correlates to no pain at zero and worst possible pain at 5 (or 10). The patient is asked to rate his/her pain intensity as a number.D. Visual analogue scale (VAS): This consists of an ungraduated,straight 100 mm line marked at one end with the term " no pain" and at the other end "the worst possible pain". The patient makes a cross on the line at the point that best approximates to their pain intensity.The VRS and NRS are the most frequently used assessment tools in the clinical setting while the VAS scale is primarily used as a research tool.4.b. Selection of suitable assessment tool (Figure 3, page 12):When selecting a pain assessment tool ensure that:GIt is appropriate for the patient's developmental, physical, emotional, and cognitive statusGIt meets the needs of both the patient and the pain management team4.c. DocumentationDocument pain regularly, take appropriate action and monitor efficacy and side effects of treatment. Record the information in a well-defined place in the patient record, such as the vital sign sheet or a purpose-designed acute pain chart.GThe nurse responsible for the patient reports the intensity of pain and treats the pain within the defined rules of the local guidelines. GThe physician responsible for the patient may need to modify theintervention if evaluation shows that the patient still has significant pain.44Faces painassessmentscale(Fig A) Patientable to communicatewell ?VRS painassessmentscale(Fig B)NRSassessmentscale(Fig C)VASassessmentscale(Fig D) NoYesChoice of assessment tool12Fig A. Alternatecoding Fig B.Fig C. Fig D.G Select a pain assessment tool, and teach the patient to use it.Determine the level of pain above which adjustment of analgesia or other interventions will be considered.G Provide the patient with education and information about pain control.GEmphasise the importance of a factual report of pain, avoiding stoicism or exaggeration.The "Patient Information Project" is a useful source of information for patients who require information about anaesthesia and postoperative pain management. This is a joint project between the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland, together with patient representative groups. The website is:Patients are unlikely to be aware of postoperative pain treatment techniques and as the success of pain relief is influenced by theirknowledge and beliefs, it is helpful to give patients (and parents in case of children) detailed information about postoperative pain and pain treatment. Adequate information gives the patient realistic expectations of the care that can be provided (pain relief, not a "pain free status"). This information can include:G The importance of treating postoperative pain G Available methods of pain treatment G Pain assessment routinesG Goals (optimum pain scoring) (see section 2, page 2)GThe patient's participation in the treatment of painInformation for the patient can be given in different ways (in combination):G Verbal informationGWritten and/or audiovisual information -Brochures -Wall posters -Video films -Web pagesA preoperative discussion with the patient and relatives can include the following:GDiscuss the patient's previous experiences with pain and preferences for pain assessment and management.GGive the patient information about pain management therapies that are available and the rationale underlying their use.GDevelop with the patient a plan for pain assessment and management.141555. Patient education51716Effective treatment of postoperative pain includes a number of factors,including good nursing, non-pharmacological techniques, such as distraction, and balanced (multimodal) analgesia to provide adequate pain relief with optimal drug combinations used at the lowest effective doses.6.a. Pharmacological methods of pain treatment 1Postoperative pain management should be step-wise and balanced (Figure 4, page 18). The four main groups of analgesic drugs used for postoperative pain management are shown in Table 2 opposite, with examples of drugs listed in each group.6.a.i. Balanced (multimodal) analgesiaBalanced (multimodal) analgesia uses two or more analgesic agents that act by different mechanisms to achieve a superior analgesic effect without increasing adverse events compared with increased doses of single agents. For example, epidural opioids can be administered in combination with epidural local anaesthetics; intravenous opioids can be administered in combination with NSAIDs, which have a dose sparing effect for systemically administered opioids.Balanced analgesia is therefore the method of choice wherever possible,based on paracetamol and NSAIDs for low intensity pain with opioid analgesics and/or local analgesia techniques being used for moderate and high intensity pain as indicated (Figure 4, page 18).66. Treatment optionsTable 2Pharmacological options of pain managementNon-opioid analgesicsParacetamolNSAIDs, including COX-2 inhibitors*Gabapentin, pregabalin 2Weak opioidsCodeine TramadolParacetamol combined with codeine or tramadol Strong opioidsMorphine Diamorphine Pethidine Piritramide Oxycodone Adjuvants**Ketamine Clonidine* At the time of writing, COX-2 inhibitor drugs are subject to scrutiny by international regulatory bodies with regard to adverse outcomes when used for long-term oralprescription or for pain relief in patients with cardiovascular problems such as myocardial infarction, angina pectoris, hypertension. Rofecoxib has been withdrawn fromsales and prescription of valdecoxib has been suspended pending further research into its adverse events profile for cardiovascular morbidity and the occurrence of severemuco-cutaneous side effects. The injectable COX-2 inhibitor, parecoxib remains available for short-term use in treating postoperative pain. All NSAIDs should be used with care in patients with cardiovascular disease.** These adjuvants are not recommended for routine use in acute pain management because of their adverse side effects. Their use should be restricted to specialists in managing pain problems.62Gabapentin and pregabalin are approved for pain management but at the time of writing there is little published data to recommend the use of these drugs for acute pain management.1The example doses given are indicative and do not take account of individual patient variation.196.a.ii. Opioids 1Severeintensity painFor example:ThoracotomyUpper abdominal surgery Aortic surgery Knee replacementModerateintensity painFor example:Hip replacement Hysterectomy Jaw surgeryMildintensity painFor example:Inguinal hernia VaricesLaparoscopy(i) Paracetamol and wound infiltration with local anaesthetic (ii) NSAIDs (unless contraindicated) and(iii) Regional block analgesiaAdd weak opioid or rescue analgesia with small increments of intravenous strong opioid if necessary(i) Paracetamol and wound infiltration withlocal anaesthetic (ii) NSAIDs (unless contraindicated) and (iii) Peripheral nerve block(single shot or continuous infusion) or opioid injection (IV PCA)(i) Paracetamol and woundinfiltration with local anaesthetic (ii) NSAIDs (unlesscontraindicated) and (iii) Epidural local analgesia ormajor peripheral nerve or plexus block or opioid injection (IV PCA)1 The examples given here represent levels of pain commonly experienced and are subject to individual variation and contra-indications may apply.Figure 4Treatment options in relation to magnitude of postoperative pain expected following different types of surgery 1Table 3Morphine and weak opioidsMorphine Administration(i) Intravenous.(ii) Subcutaneous by continuous infusion or intermittent boluses via indwelling cannula.(iii) Intramuscular (not recommended due to incidence of pain. 5-10 mg 3-4 hourly).Dosage:IV PCABolus: 1-2 mg, lockout: 5-15 min (usually 7-8 min),no background infusion.Subcutaneous0.1-0.15 mg/kg 4-6 hourly, adapted in relation to pain score, sedation and respiratory rate.Monitoring Pain score, sedation, respiratory rate, side mentsSide effects such as nausea, vomiting, sedation and apnoea.No other opioid or sedative drug should be administered.18continued overleaf1 The doses and routes of administration of drugs described above are general examples and each patient should beassessed individually before prescribing.2120 6.a.iii. Non-opioids 1Table 5Combination of codeine + paracetamolAdministration Oral.DosageParacetamol 500 mg + codeine 30 mg. 4 x 1 g paracetamol/day.Monitoring Pain score, sedation, side effects.CommentsAnalgesic action is likely to be due to conversion to morphine. A small number of patients derive no benefit due to absence of the converting enzyme.NV = nausea and vomitingTramadol Administration(i) Intravenous: inject slowly (risk of high incidence of NV).(ii) Intramuscular.(iii) Oral administration as soon as possible.Dosage 50-100 mg 6 hourly.Monitoring Pain score, sedation, respiratory rate, side mentsTramadol reduces serotonin and norepinephrine reuptake and is a weak opioid agonist.In analgesic efficiency, 100 mg tramadol is equivalent to 5-15 mg morphine.Sedative drugs can have an additive effect.Table 4ParacetamolAdministration(i) Intravenous: Start 30 min before the end of surgery.(ii) Oral administration as soon as possible.Duration: as long as required.Dosage4 x 1 g paracetamol/day (2 g propacetamol/day).Dose to be reduced (e.g. 3 x 1 g/day) in case of hepatic insufficiency.Monitoring Pain scores.CommentsShould be combined with NSAID and/or opioids or loco-regional analgesia for moderate to severe pain.1 The doses and routes of administration of drugs described above are general examples and each patient should beassessed individually before prescribing.1 The doses and routes of administration of drugs described above are generally examples and each patient should be assessed individually before prescribing.Table 3 (continued)Codeine Administration OralDosage3 mg/kg/day combined with paracetamol.A minimum of 30 mg codeine/tablet is required.Monitoring Pain score, sedation, side effects.CommentsAnalgesic action is likely to be due to conversion to morphine. A small number of patients derive no benefit due to absence of the converting enzyme.6.a.iv. AdjuvantsIn addition to systemic administration of NSAIDs or paracetamol, weak opioids and non-opioid analgesic drugs may be administered "on request" for moderate or severe pain. These include ketamine and clonidine. Clonidine can be administered orally, intravenously orperineurally in combination with local anaesthetics. However, the side effects could be significant. The most important ones are hypotension and sedation. Ketamine can be administered via oral, intramuscular or intravenous routes. It has also significant side effects.6.a.v. Regional analgesiaContinuous Central Neuraxis Blockade (CCNB)CCNB is one of the most effective forms of postoperative analgesia, but it is also one of the most invasive. However, CCNB remains the first choice for a number of indications, such as abdominal, thoracic, and major orthopaedic surgery, where adequate pain relief cannot be achieved with other analgesia techniques NB can be achieved via two routes:G Continuous epidural analgesia - the recommended first choice GContinuous spinal analgesia - should be limited to selected cases only, as there is less experience with this techniquePostoperative epidural analgesia is usually accomplished with acombination of a long-acting local anaesthetic and an opioid, in dilute concentrations. Long-acting local anaesthetics are preferred because they are associated with less tachyphylaxis. Maintenance techniques in epidural analgesia include:GContinuous Infusion (CI): An easy technique that requires littleintervention. The cumulative dose of local anaesthetic is likely to be higher and side effects are more likely than with the other two techniques.2322Table 6NSAIDs 1Administration(i) Intravenous: administration should start at least 30-60 min before end of surgery.(ii) Oral administration should start as soon as possible.Duration: 3-5 days.Dosage examples(i) Conventional NSAIDs include:ketorolac: 3 x 30-40 mg/day (only IV form)diclofenac: 2 x 75 mg/day ketoprofen: 4 x 50 mg/day (ii) Selective NSAIDs include:meloxicam 15 mg once dailyCOX-2 inhibitors are now licensed for postoperative pain management. They are as efficient as ketorolac but reduce GI side effects. Examples include: parecoxib: 40 mg followed by 1-2 x 40 mg/day (IV form) or celecoxib: 200 mg/day. However, there is some debate due to cardiovascular risks in patients witharteriosclerosis. *See note below Table 2, page 17MonitoringPain scores.Renal function in patients with renal or cardiac disease, elderly patients, or patients with episodes of severe hypotension. Gastrointestinal side effects. Non-selective NSAIDs would be combined with proton inhibitors (i.e. omeprasol) in patients at risk of gastrointestinal side effects.CommentsCan be added to the pre-medication.Can be used in association with paracetamol and/or opioids or local regional analgesia for moderate to severe pain.1 The doses and routes of administration of drugs described above are general examples and each patient should beassessed individually before prescribing.2524Continuous Peripheral Nerve Blockade (CPNB)Continuous peripheral nerve blocks are being increasingly used since they may provide more selective but still excellent postoperative analgesia with reduced need for opioids over an extended period.Peripheral nerve blocks (PNBs) avoid the side effects associated with central neuraxial blockade, such as hypotension and wide motorblockade with reduced mobility and proprioception, and complications such as epidural haematoma, epidural abscess and paraparesis.After major orthopaedic lower limb surgery, clinical studies showperipheral nerve blocks are as effective as epidural and that both are better than IV opioids. Examples of drugs and dosages for use in continuous peripheral analgesia are shown in Table 8.Table 8Examples of local anaesthetics and doses in continuous peripheral nerve analgesiaG Intermittent Top-up: Results in benefits due to frequent patient/staff contact but can produce a high staff workload and patients may have to wait for treatment.GPatient-Controlled Epidural Analgesia (PCEA): This technique produces high patient satisfaction and reduced dose requirements compared with CI. However, sophisticated pumps are required and accurate catheter position is important for optimal efficacy.Examples of drugs and dosages for use in continuous epidural analgesia are shown in Table 7.Table 7Examples of local anaesthetics and opioids and doses in epidural analgesia 1LocalRopivacaineSufentanil 0.5-1 µg/ml anaesthetics/opioids0.2% (2 mg/ml) or orFentanyl 2-4 µg/mlLevobupivacaine or Bupivacaine0.1-0.2% (1-2 mg/ml)Dosage for continuous 6-12 ml/hinfusion (thoracic or lumbar level)Dosage for patient Background: 4-6 ml/h controlled infusion Bolus dose: 2 ml (2-4 ml)(lumbar or thoracic)2Minimum lockout interval 10 min (10-30 min)Recommended maximum hourly dose (bolus + background): 12 ml1 The tip of the catheter should be placed as close as possible to the surgical dermatomes: T6-T10 for majorintra-abdominal surgery, and L2-L4 for lower limb surgery.2 There are many possible variations in local anaesthetic/opioid concentration yielding good results, the examples givenhere should be taken as a guideline; higher concentrations than the ones mentioned here are sometimes required but cannot be recommended as a routine for postoperative pain relief.Site of catheterLocal anaesthetics and dosage*Ropivacaine 0.2%Bupivacaine 0.1-0.125%Levobupivacaine 0.1-0.2%Interscalene5-9 ml/h Infraclavicular 5-9 ml/h Axillary 5-10 ml/h Femoral 7-10 ml/h Popliteal3-7 ml/h*Sometimes, higher concentrations are required in individual patients. As a standard, starting with a low concentration/dose is recommended to avoid sensory loss or motor block.2726Patient Controlled Regional Analgesia (PCRA) can be used to maintain peripheral nerve block. A low basal infusion rate (e.g. 3-5 ml/h)associated with small PCA boluses (e.g. 2.5-5 ml - lockout: 30-60 min) is the preferred technique.Infiltration blocksPain relief may be achieved by infiltration of the wound with localanaesthetic. The technique is easy to perform by the surgeon at the time of surgery. The efficacy and duration of analgesia depend on the length of the wound and the type of local anaesthetic used (Table 9).The advantages and disadvantages of various techniques of regional analgesia are shown in Table 10.Table 9Local anaesthetic infiltrationLocal anaestheticVolumeAdditivesIntraarticular instillation Knee arthroscopy0.75% Ropivacaine 20 ml Morphine 1-2 mg 0.5% Bupivacaine20 ml Morphine 1-2 mgShoulder arthroscopy 0.75% Ropivacaine10-20 mlIntraperitoneal instillation Gynaecological 0.75% Ropivacaine 20 ml Cholecystectomy 0.25% Ropivacaine40-60 mlWound infiltration Inguinal hernia0.25-0.5% Ropivacaine 30-40 ml 0.25-0.5% Levobupi*30-40 ml0.25-0.5% Bupivacaine Up to 30 mlTable 10Advantages of different techniques of regional analgesiaAdvantagesDisadvantagesContinuous Very effective.Motor block and urinary Epiduralretention may develop Analgesia (CEA)Much experience.or persist depending on the concentrations used.Differential block withDrugs used must have motor sparing is possible.low risk of systemic toxicity and produce as little motor Excellent postoperative block as possible.pain control over an extended period.Requires regular clinical monitoring on surgical Useful for rehabilitation wards or ICU.and physiotherapy.There are no universal Reduces the quantity of guidelines for monitoring.opioid analgesics needed.May mask a haematoma or abscess resulting in damage to spinal nerves.continued overleafThyroid surgery0.25-0.5% Ropivacaine 10-20 ml 0.25-0.5% Levobupi*10-20 ml0.25-0.5% Bupivacaine Up to 20 mlPerianal surgery0.25-0.5% Ropivacaine 30-40 ml 0.25-0.5% Levobupi*30-40 ml0.25-0.5% Bupivacaine Up to 30 mlcontinued opposite* Levobupi = Levobupivacaine.* Levobupi = Levobupivacaine.Please consult the manufacturer’s full prescribing information before use.。

USP泼尼松校正片说明书(中英文对照)

USP泼尼松校正片说明书(中英文对照)

Certificate(证书)PREDNISONE TABLETS(泼尼松片)USP Catalog No.: 1559505USP Lot No。

: R031Y1(10 mg nominal prednisone content per tablet)(每片含泼尼松10mg)FOR DISSOLUTION PERFORMANCE VERIFICATION TEST (PVT)用于溶出性能确认实验Period of validity: This certificate of USP Prednisone Tablets Lot R031Y1 is valid through June 30th, 2017。

有效期:USP泼尼松片批号R031Y1的证书有效期到2017年6月30日The USP Prednisone Tablets RS is provided for use in the Performance Verification Test for USP Apparatus 1 and 2 with 1 liter vessels in the USP General Test Chapter on DISSOLUTION <711〉and DRUG RELEASE <724〉,APPARATUS SUITABILITY。

Store in a dry place. Store the tablets at controlled room temperature not exceeding 25°.USP泼尼松标准片用于采取USP中方法1和方法2对1升溶出杯,进行USP通用测试部分溶出(711)和释放(724)项目的性能能确认实验,药品贮藏在干燥,温度低于25℃环境中。

Dissolution Medium: We recommend preparing the medium as follows:Heat a suitable amount of water, while stirring gently, to about 41-45°. Filter under vacuum through a 0.45—μm-porosity filter into a suitable filtering flask equipped with a stirring device。

USP 干燥失重法中英文对照

USP 干燥失重法中英文对照

<731>LOSS ON DRYINGThe procedure set forth in this chapter determines the amount of volatile matter of any kind that is driven off under the conditions specified.For substances appearing to contain water as the only volatile constituent, the procedure given in the chapter,Water Determination921,is appropriate,and is specified in the individual monograph.Mix and accurately weigh the substance to be tested,and,unless otherwise directed in the individual monograph,conduct the determination on1to 2g.If the test specimen is in the form of large crystals,reduce the particle size to about2mm by quickly crushing.Tare a glass-stoppered, shallow weighing bottle that has been dried for30minutes under the same conditions to be employed in the determination.Put the test specimen in the bottle,replace the cover,and accurately weigh the bottle and the contents.By gentle,sidewise shaking,distribute the test specimen as evenly as practicable to a depth of about5mm generally,and not more than10mm in the case of bulky materials.Place the loaded bottle in the drying chamber,removing the stopper and leaving it also in the chamber. Dry the test specimen at the temperature and for the time specified in the monograph.[NOTE—The temperature specified in the monograph is to be regarded as being within the range of±2of the stated figure.]Upon opening the chamber,close the bottle promptly,and allow it to come to room temperature in a desiccator before weighing.If the substance melts at a lower temperature than that specified for the determination of Loss on drying,maintain the bottle with its contents for1to2hours at a temperature5to10below the melting temperature, then dry at the specified temperature.Where the specimen under test is Capsules,use a portion of the mixed contents of not fewer than4capsules.Where the specimen under test is Tablets,use powder from not fewer than 4tablets ground to a fine powder.Where the individual monograph directs that loss on drying be determined by thermogravimetric analysis,a sensitive electrobalance is to be used.Where drying in vacuum over a desiccant is directed in the individual monograph,a vacuum desiccator or a vacuum drying pistol,or other suitable vacuum drying apparatus,is to be used.Where drying in a desiccator is specified,exercise particular care to ensure that the desiccant is kept fully effective by frequent replacement.Where drying in a capillary-stoppered bottle*in vacuum is directed in the individual monograph,use a bottle or tube fitted with a stopper having a225±25&micro;m diameter capillary,and maintain the heating chamber at a pressure of5mm or less of mercury.At the end of the heating period, admit dry air to the heating chamber,remove the bottle,and with the capillary stopper still in place allow it to cool in a desiccator before weighing.本章中给出的方法阐述了在特定的条件下物质中的挥发性成分的测定。

爱维莫潘及胶囊项目简介

爱维莫潘及胶囊项目简介

爱维莫潘及胶囊项目简介品名:爱维莫潘alvimopan项目代号:C032注册类别:化药3.1类剂型及规格:胶囊12mg适应症:用于手术以及使用阿片类药物导致的胃肠功能紊乱,特发性便秘以及肠易激综合症等。

知识产权状况:开发本品无知识产权问题。

研发进度:临床前研究中原研单位及国外上市时间:2008年5月由FDA批准,Adolor公司与史克公司联合开发。

作用机制:爱维莫潘是一种高选择性的外周μ型阿片受体拮抗剂。

阿片及阿片受体在调节胃肠道机能中有着重要的作用,目前研究得较多的阿片受体有μ、κ和δ三种。

在手术中,由于使用阿片类镇痛药物,使得胃肠道机能失常,表现为厌食、恶心、胀气、腹胀、排便减少以及肠梗阻等。

使用选择性的阿片受体拮抗剂可以有效的缓解上述症状。

爱维莫潘正是这样一种有效的药物。

药理研究显示,爱维莫潘对阿片受体具有良好的亲和力,尤其是对μ型受体具有高度的选择性。

爱维莫潘对μ、κ和δ三种受体的亲和常数(Ki)分别为0.77、40和4.4nmol/L。

在动物模型中,爱维莫潘表现出长效、高强度的μ受体拮抗作用,可有效抵抗由吗啡诱导的小鼠胃肠道转运抑制和抵抗吗啡或洛哌丁胺对蓖麻油小鼠腹泻模型的抑制作用。

无论是口服还是静脉注射,爱维莫潘都选择性地拮抗吗啡的外周作用,而对吗啡通过中枢介导的镇痛作用没有影响。

爱维莫潘酰胺水解产物可能对爱维莫潘的持久胃肠道效应有贡献。

国外临床情况:1)在一项评价爱维莫潘治疗手术后胃肠道功能障碍的研究中,78名18~78岁的结肠部分切除和腹式子宫全切除的患者随机分为三个组,分别口服爱维莫潘1、6mg 和安慰剂,在手术前2小时服用,每天服用两次,直到出现肠道首次运动,最常给药时间持续到术后7天。

结果显示:该项研究显示:爱维莫潘6mg(b.i.d)能加速手术后胃肠道的功能恢复,而对阿片药物的全身作用没有有效。

2)在一项代号为14CL302的研究中,爱维莫潘能够显著加快重大腹部手术后患者的胃肠道功能恢复。

L-亮氨酸的生产方法及有关DNA和微生物[发明专利]

L-亮氨酸的生产方法及有关DNA和微生物[发明专利]

专利名称:L-亮氨酸的生产方法及有关DNA和微生物
专利类型:发明专利
发明人:M·M·古斯雅廷纳,M·G·伦特斯,Y·I·科兹洛夫,L·V·伊万诺维斯卡雅,E·B·沃罗希洛瓦
申请号:CN00120462.9
申请日:20000710
公开号:CN1280135A
公开日:
20010117
专利内容由知识产权出版社提供
摘要:生产L-亮氨酸的方法,包括以下步骤:在培养基中培养用编码L-亮氨酸的反馈抑制被脱敏的α-异丙基苹果酸合酶的DNA转化的细菌,以在培养基中产生和积累L-亮氨酸,并且由培养基中回收L -亮氨酸。

申请人:味之素株式会社
地址:日本东京都
国籍:JP
代理机构:中国专利代理(香港)有限公司
更多信息请下载全文后查看。

美国药典USP3NF26色谱621(DOC74页).doc

美国药典USP3NF26色谱621(DOC74页).doc

美国药典USP3NF26色谱621(DOC74页)621CHROMATOGRAPHY色谱法INTRODUCTION介绍This chapter defines the terms and procedures used in chromatography and provides general information. Specific requirements for chromatographic procedures for drug substances and dosage forms, including adsorbent and developing solvents, are given in the individual monographs.此章节定义了色谱法中用到的术语和步骤,并提供了通用信息。

对于原料药和成药的色谱步骤的具体要求,包括吸附剂和展开溶剂,在具体各论中给出。

Chromatography is defined as a procedure by which solutes are separated by a dynamic differential migration process in a system consisting of two or more phases, one of which moves continuously in a given direction and in which the individual substances exhibit different mobilities by reason of differences in adsorption, partition, solubility, vapor pressure, molecular size, or ionic charge density. The individual substances thus separated can be identified or determined by analytical procedures.色谱法是应用溶质在两相或多相系统中的差速迁移来进行分离的技术,其中一相持续地向特定方向移动,而由于物质在吸附性、分配、溶解性、气体压力、分子大小、或离子电荷密度上的差异,会显示出不同的移动性。

  1. 1、下载文档前请自行甄别文档内容的完整性,平台不提供额外的编辑、内容补充、找答案等附加服务。
  2. 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
  3. 3、如文档侵犯您的权益,请联系客服反馈,我们会尽快为您处理(人工客服工作时间:9:00-18:30)。

2566Aurothioglucose / Official Monographs USP 36USP Reference standards 〈11〉—USP Avobenzone RS Aurothioglucose Injectable SuspensionIdentification—A: Infrared Absorption 〈197K 〉.» Aurothioglucose Injectable Suspension is a ster-B: Ultraviolet Absorption 〈197U 〉—ile suspension of Aurothioglucose in a suitable Solution: 5µg per mL.vegetable oil. It contains not less than 90.0per-Medium: alcohol.cent and not more than 110.0percent of the la-Absorptivities at 360 nm do not differ by more than beled amount of C 6H 11AuO 5S. It may contain 3.0%.suitable thickening agents.Melting range, Class I 〈741〉: between 81° and 86°.Loss on drying 〈731〉—Dry it in vacuum at 70° for 4hours:Packaging and storage—Preserve in single-dose or in it loses not more than 0.5% of its weight.multiple-dose containers, preferably of Type I glass. Protect Chromatographic purity—from light.Test solution—Proceed as directed for Assay preparation in USP Reference standards 〈11〉—the Assay .USP Aurothioglucose RSChromatographic system (see Chromatography 〈621〉)—Identification—Transfer a volume of Injectable Suspension,Proceed as directed in the Assay .equivalent to about 200mg of aurothioglucose, to a centri-fuge separator containing 20mL of ethyl acetate and 50mL Procedure—Inject a volume (about 1µL) of Test solution of water. Shake the mixture thoroughly, and centrifuge until into the chromatograph, record the chromatogram, and the liquid phases have been clearly separated. Withdraw the measure the peak responses. Calculate the percentage of lower, aqueous phase, and filter, discarding the first 10mL each impurity in the portion of Avobenzone taken by the of the filtrate. Collect the filtrate in a glass-stoppered vessel,formula:and proceed as directed in Identification test A under100(r I /r S )Aurothioglucose , beginning with “apply 10µL of this solu-tion.”in which r I is the response of each individual peak, other Bacterial endotoxins 〈85〉—It contains not more than than the avobenzone peak, in the chromatogram of the Test 7.14 USP Endotoxin Units per mg of aurothioglucose.solution; and r S is the sum of the responses of all of the Sterility 〈71〉—It meets the requirements.peaks in the chromatogram of the Test solution: not more Other requirements—It meets the requirements under In-than 3.0% of any individual impurity is found, and the sum jections 〈1〉.of all of the impurities is not more than 4.5%.Assay—Transfer with a pipet, calibrated to contain rather Assay—than to deliver, an accurately measured volume of Injectable Standard preparation—Dilute an accurately measured Suspension, equivalent to about 200mg of aurothioglucose,quantity of USP Avobenzone RS in acetone, and dilute to a beaker containing 400mL of acetone. Wash the pipet quantitatively, and stepwise if necessary, with acetone to into the beaker with a small quantity of acetone, mix, allow obtain a solution having a known concentration of about the solids to settle, and decant the supernatant through a 50mg per mL.filter. Wash the solids with another 400-mL portion of ace-Assay preparation—Transfer about 500mg oftone, and repeat the decantation. Transfer the solids to the Avobenzone, accurately weighed, to a 10-mL volumetric filter with the aid of acetone, then transfer the filter and its flask, dilute with acetone to volume, and mix.contents to a short-necked, 300-mL Kjeldahl flask, add 5mL Chromatographic system (see Chromatography 〈621〉)—The of water, and proceed as directed in the Assay under Gold gas chromatograph is equipped with a flame-ionization de-Sodium Thiomalate , beginning with “add 20mL of nitric tector and a 0.32-mm × 25-m fused silica capillary column acid.” The weight of gold so obtained, multiplied by 1.991,coated with phase G1. The column temperature is main-represents the weight of C 6H 11AuO 5S in the portion of In-tained at about 200° until the time of injection, then in-jectable Suspension taken.creased at a rate of 4° per minute to 280°. The injection port temperature is maintained at 200°, and the detector temperature is maintained at about 280°. Helium is used as the carrier gas. The split ratio is 50:1. Chromatograph the Standard preparation, and record the peak responses as di-Avobenzonerected for Procedure: the resolution, R, between avobenzone and any adjacent peak is not less than 1.0; and the relative standard deviation for replicate injections is not more than 2.0%.Procedure—Separately inject equal volumes (about 1µL)of the Standard preparation and the Assay preparation into the chromatograph, record the chromatograms, and meas-C 20H 22O 3310.39ure the responses for the major peaks. Calculate the quan-1,3-Propanedione, 1-[4-(1,1-dimethylethyl)phenyl]-tity, in mg, of C 20H 22O 3 in the portion of Avobenzone taken 3-(4-methoxyphenyl)-.by the formula:1-(p -tert -Butylphenyl)-3-(p -methoxyphenyl)-1,3-propane-dione [70356-09-1].10C (r U /r S )» Avobenzone contains not less than 95.0per-in which C is the concentration, in mg per mL, of USP Avobenzone RS in the Standard preparation; and r U and r S cent and not more than 105.0percent of are the peak responses obtained from the Assay preparation C 20H 22O 3, calculated on the dried basis.and the Standard preparation, respectively.Packaging and storage—Preserve in tight, light-resistant containers.USP 36Official Monographs / Azaperone2567Azaperone Azaperone Injection» Azaperone Injection is a sterile solution ofAzaperone in Water for Injection, prepared withthe aid of Tartaric Acid. It may contain a suitableC19H22FN3O327.40preservative and a stabilizing agent. It contains1-Butanone, 1-(4-fluorophenyl)-4-[4-(2-pyridinyl)-not less than 90.0percent and not more than1-piperazinyl]-.110.0percent of the labeled amount of4′-Fluoro-4-[4-(2-pyridyl)-1-piperazinyl]butyrophenoneC19H22FN3O.[1649-18-9].Packaging and storage—Preserve in single-dose or in» Azaperone contains not less than 98.0percentmultiple-dose containers, preferably of Type I glass, pro-and not more than 102.0percent of C19H22FN3O,tected from light.calculated on the dried basis.Labeling—Label it to indicate that it is for veterinary useonly.Packaging and storage—Preserve in well-closed contain-ers, protected from light. Store at room P Reference standards 〈11〉—USP Azaperone RSLabeling—Label it to indicate that it is for veterinary useonly.Identification—The chromatogram of the Assay prepara-tion obtained as directed in the Assay exhibits a major peak USP Reference standards 〈11〉—for azaperone, the retention time of which corresponds to USP Azaperone RSthat exhibited in the chromatogram of the Standard prepa-Identification, Infrared Absorption 〈197K〉: previously dried.ration, obtained as directed in the Assay.Melting range 〈741〉: between 92° and 95°.pH 〈791〉: between 4.0 and 5.6.Loss on drying 〈731〉—Dry it in vacuum at 60° for 4hours:Other requirements—It meets the requirements under In-it loses not more than 0.5% of its weight.jections 〈1〉.Residue on ignition 〈281〉: not more than 0.1%.Assay—Chromatographic purity—Dissolve an accurately Mobile phase—Prepare a filtered and degassed mixture weighed quantity of USP Azaperone RS in a mixture of ace-containing 6 volumes of acetonitrile and 4 volumes of 0.01 tone and methylene chloride (5:1) to obtain a solution hav-M dibasic potassium phosphate, and adjust by the addition ing a concentration of 0.50mg per mL (Standard solution of dilute phosphoric acid (1 in 10) to a pH of 7.8 ± 0.1. A). Quantitatively dilute a volume of Standard solution A Make adjustments if necessary (see System Suitability under with the same solvent mixture to obtain a solution having a Chromatography 〈621〉).concentration of 0.25mg per mL (Standard solution B). Pre-Internal standard solution—Prepare a solution of benzo-pare a test solution by dissolving an accurately weighedphenone in methanol containing about 0.5mg per mL. quantity of Azaperone in a mixture of acetone and methyl-ene chloride (5:1) to obtain a solution containing 50mg per Standard preparation—Dissolve an accurately weighed mL. Separately apply 1µL each of Standard solution A, Stan-quantity of USP Azaperone RS in methanol, and dilute quan-dard solution B, and the test solution to a thin-layer chro-titatively with methanol to obtain a solution having a known matographic plate (see Chromatography 〈621〉) coated with concentration of about 0.5mg per mL. Combine 2.5mL of a 0.2-mm layer of chromatographic silica gel mixture with this solution with 2.5mL of Internal standard solution, dilute chemically bonded amino groups, and allow the spots to quantitatively with methanol to 10.0mL, and mix.dry. Develop the chromatograms in a solvent system con-Assay preparation—Dilute an accurately measured volume sisting of a mixture of cyclohexane, acetone, and methanol of Injection quantitatively with methanol to obtain a solu-(65:30:5) until the solvent front has moved about three-tion containing about 0.5mg of azaperone per mL. Com-fourths of the length of the plate. Remove the plate from bine 2.5mL of this solution with 2.5mL of Internal standard the chromatographic chamber, and allow the plate to air-solution, dilute quantitatively with methanol to 10.0mL, and dry. Examine the plate under short-wavelength UV light,mix.and compare the intensities of any secondary spots, other Chromatographic system (see Chromatography 〈621〉)—The than any spot at the origin, observed in the chromatogram liquid chromatograph is equipped with 243-nm detectorof the test solution with those of the principal spots in the and a 4.6-mm × 25-cm column that contains packing L1. chromatograms of Standard solution A and Standard solution The flow rate is about 2mL per minute. Chromatograph the B: the sum of the intensities of the secondary spots obtained Standard preparation, and record the peak responses as di-from the test solution corresponds to not more than the rected for Procedure: the resolution, R, between the azaper-intensity of the principal spot in the chromatogram of Stan-one and internal standard peaks is not less than 2.7; and dard solution A (1.0%).the relative standard deviation for replicate injections is not Assay—Dissolve about 120mg of Azaperone, accurately more than 2.0%.weighed, in 50mL of a mixture of methyl ethyl ketone and Procedure—Separately inject equal volumes (about 10µL) glacial acetic acid (7:1). Add 3drops of p-naphtholbenzein of the Standard preparation and the Assay preparation into TS, and titrate with 0.1 N perchloric acid VS. Perform a the chromatograph, record the chromatograms, and meas-blank determination, and make any necessary correction.ure the responses for the major peaks. Calculate the quan-Each mL of 0.1 N perchloric acid is equivalent to 16.37mg tity, in mg, of azaperone (C19H22FN3O) in each mL of theof C19H22FN3O.Injection taken by the formula:(C)(L/D)(R U/R S)in which C is the concentration, in mg per mL, of USPAzaperone RS in the Standard preparation; L is the labeledquantity, in mg, of azaperone in each mL of the Injection; Dis the concentration, in mg per mL, of azaperone in theAssay preparation, based on the volume of Injection taken。

相关文档
最新文档