[药学专业知识二] 重要

[药学专业知识二] 重要 《药学专业知识(二)》第1章(精神与中枢神经系统疾病用药)中2013年和2014年执业药师考试出过哪些试～经查找发现该章节在2013年执业药师考试中所占分值为8.5分，其中最佳选择题4分，配伍选择题4.5分。如下: 最佳选择题 9. 苯二氮?类药物对离子通道的作用是: A.增加Cl-通道开放频率 B.延长Cl-通道开放时间 C.延长K+通道开放时间 D.延长Na+通道开放时间 E.增加K+通道开放频率 【答案】A (P001)(2015年版教材未要求作用机制) 【解析】苯二氮卓类作用机制:GABA(γ-氨基丁酸)是中枢神经系统抑制性递质，作用于 GABAA受体，使 Cl-通道开放，Cl-流向细胞内，引起神经细胞膜发生超极化而产生抑制效应。 当 BDZ 药物与 BDZ 受体结合时，可促进 GABA 与 GABA 受体结合，使 Cl-通道开放的频率增加，使更多的 Cl-内流，而产生超极化。从而增强了GABA 的抑制效应。 10.丙米嗪的药理作用是: A.抗精神病 B.抗抑郁作用 C.镇吐作用 D.收缩外周血管作用 E.抗癫痫作用 【答案】B (P012) 【解析】丙米嗪药理作用:具有较强抗抑郁症作用，但兴奋作用不明显，镇静作用弱。属于三环类抗抑郁药。 11. 左旋多巴抗帕金森病的作用特点是: A.奏效较快 B.作用维持时间短 C.对轻度及年轻患者疗效较好 D.对肌震颤的疗效较好 E.对肌肉僵直及运动困难疗效较差。 【答案】C (2015版教材对本药未作要求) 【解析】左旋多巴抗帕金森病作用:左旋多巴进入中枢后转变为多巴胺，补充纹状体中 DA 的不足，使DA 和 ACh 两种递质重新取得平衡，而产生抗帕金森病的作用。其作用特点是: ? 起效较慢，2,3 周后开始生效，1,6 个月后才获得最大疗效。 ? 对轻症及年轻患者疗效较好，对重症及年老衰弱者疗效较差。 ? 对肌肉僵直及运动困难的疗效较好，而对肌震颤的疗效较差。 12.纳洛酮用于治疗的疾病或症状是: A.剧烈疼痛 B.失眠 C.惊厥 D.抑郁症 E.阿片类中度 【答案】E (P24) 【解析】纳洛酮临床应用:用于阿片类药物中毒，迅速缓解呼吸抑制及其他中枢抑制症状，使昏迷患者复苏。还用于乙醇中毒、中、重度 CO 中毒、缺血性脑血管疾病、心力衰竭等治疗。 配伍选择题 【40-43】 A.乙琥胺 B.苯妥英钠 C.丙戊酸钠 D苯巴比妥 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions E.卡马西平 40.癫痫精神运动发作选用 41.癫痫大发作选用 42.癫痫大发作合并小发作选用 43.癫痫小发作选用 40【答案】E 【解析】卡马西平:是精神运动性发作的首选药。对大发作和混合型癫痫也有效。 本药对儿童的认知功能和行为影响较小，尤其适用于儿童患者。对小发作的效果差。 41【答案】B 【解析】苯妥英钠:癫痫大发作的首选药，对局限性发作和精神运动性发作亦有效，但对小发作无效，有时甚至使病情恶化。 42【答案】C 【解析】丙戊酸钠:是广谱抗癫痫药。对各种癫痫均有一定疗效。对小发作效果好，疗效优于乙琥胺，但因有肝毒性，小发作仍选用乙琥胺。在小发作合并大发作时作为首选药使用。 43【答案】A 【解析】乙琥胺:对小发作(失神性发作)有效，其疗效虽不及氯硝西泮，但是不良反应及耐受性的产生较少，故为防治小发作的首选药。对其他类型癫痫无效。 【44-47】 A.激动中枢阿片受体 B.抑制中枢神经系统胆碱酯酶 C.抑制纹状体单胺氧化酶 D.阻断中枢神经系统胆碱受体 E.激动黑质纹状体通路多巴胺受体 44. 多奈哌齐的药理作用 45. 司来吉兰的药理作用 46. 苯海索的药理作用 47. 溴隐亭的药理作用 44【答案】B 【解析】多奈哌齐:可逆性胆碱酯酶抑制剂。对 CNS 胆碱酯酶选择性高，使脑内 ACh增加，改善脑细胞功能。用于轻、中度 AD 的治疗。不良反应为腹泻、肌肉痉挛、恶心呕吐、失眠和头晕。 45【答案】C 【解析】司来吉兰作用机制: (1)抑制纹状体中的 MA0-B(B 型单胺氧化酶)，减少 DA 降解，增加DA 在脑内的浓度。 (2)抑制突触处 DA 的再摄取而延长多巴胺作用时间。 (3)抑制 DA 氧化应激过程中羟自由基和超氧阴离子的形成，从而保护黑质 DA 神经元，延缓神经元变性和帕金森病症状的发展。 46【答案】D 【解析】苯海索(安坦)作用机制:阻断中枢胆碱受体，减弱黑质-纹状体通路中ACh 的作用。抗震颤效果较好，改善僵直及运动障碍疗效不如左旋多巴。对继发症状如过度流涎有改善作用。 47【答案】E 【解析】溴隐亭:大剂量时激动黑质-纹状体通路的 D2 受体，用于治疗帕金森病。对震颤的作用较明显，常用于左旋多巴疗效不好或不能耐受者，特点是显效快，作用时间长。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 在2014年执业药师考试中所占分值为10分，其中最佳选择题3分，配伍选择题4分，多项选择题3分。如下: 最佳选择题 7(静脉注射地西泮速度过快时引起的不良反应是 A(惊厥 B(心跳加快 C(血钙下降 D(血糖升高 E(呼吸暂停 【答案】E 【解析】地西泮最常见的不良反应是困倦、头晕、乏力。其次是记忆下降、头痛、共济失调等。静脉注射过快可致呼吸暂停或心脏骤停，故静脉注射速度宜慢。 8(用硫酸镁缓解子痫惊厥时，给药途径应当是 A(口服 B 静脉注射 C(外用热敷 D 皮下注射 E(直肠给药 【答案】B 【解析】由于硫酸镁的中枢抑制作用及骨骼肌松弛作用、降压作用，临床主要用于缓解子痫、破伤风等惊厥，也常用于高血压危象的救治。临床常以肌内注射或静脉注射给药。 9(我国将吗啡列为严格管制药品，原因是其长期 使用可能产生 A(免疫抑制 B(嗜睡 C(呼吸抑制 D(中枢抑制 E(药物依赖性 【答案】E 【解析】治疗量的吗啡连续反复应用后，出来缩瞳和便秘外，其他大部分效应都会逐渐减弱，形成耐受性，表现为吗啡使用剂量逐渐增大和用药间隔时间缩短。患者会发生病态性嗜好而产生依赖性，包括精神依赖性和身体依赖性。此类患者都有强烈渴求用药的欲望，可不择一切手段去获取药品，不仅严重损害用药者的健康，还可造成严重的社会问题。故阿片类镇痛药应按国家颁布的“麻醉药品和精神药品管理条例”严格管理，限制使用。 配伍选择题 【 44-46】 A( 剧烈疼痛 B(帕金森病 C(癫痫小发作 D(精神分裂症 E(风湿性关节炎 44(丙戊酸钠的临床应用是 45(芬太尼的临床应用是 46(吲哚美辛的临床应用是 44【答案】C 【解析】丙戊酸钠对各种类型的癫痫发作均有一定疗效，特别是对小发作效果好，疗效优于乙琥胺，但是因为有肝毒性，临床仍常选用乙琥胺。 45【答案】A 【解析】芬太尼属短效、强效镇痛药，临床主要用于各种原因引起的剧痛。 46【答案】E risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 【解析】吲哚美辛为强效非选择性COX抑制剂，因此有强大的抗炎、镇痛和解热作用，临床可用于急、慢性风湿性关节炎、强直性脊柱炎、痛风性关节炎及癌性疼痛、癌性发热等。 【 47-48】 A(氟西汀 B(多奈哌齐 C(卡比多巴 D(舒必利 E(碳酸锂 47(与左旋多巴合用治疗帕金森病的药物是 48(治疗阿尔海默茨病的药物是 47【答案】C 【解析】卡比多巴单独使用无明显药理作用，主要与左旋多巴合用治疗各种原因引起的帕金森病。 48【答案】B 【解析】多奈哌齐是第二代可逆性胆碱酯酶抑制剂，对中枢神经系统胆碱酯酶选择性高，使脑内Ach增加，改善脑细胞功能。用于轻、中度阿尔兹海默病(AD)的治疗。 【 49-51】 A(吲哚美辛 B(塞来昔布 C(哌替啶 D(纳洛酮 E(喷他佐辛 49(阿片受体拮抗药是 50(阿片受体的部分激动药是 51(阿片受体的激动药是 49【答案】D 【解析】纳洛酮化学结构与吗啡相似，对μ、δ、κ受体有竞争性拮抗作用。 50【答案】E 【解析】喷他佐辛为阿片受体部分激动药，对μ受体弱的阻断作用。 51【答案】C 【解析】哌替啶为阿片受体激动药 多项选择题 76( 地西泮的药理作用有 A( 抗焦虑 B( 镇静 C( 催眠 D( 抗抑郁 E( 抗癫痫 【答案】ABCE 【解析】地西泮为苯二氮卓类的典型代表药物，也是目前临床最常用的镇静、催眠、抗焦虑药。地西泮是治疗癫痫持续状态的首选药。 77( 左旋多巴的不良反应有 A( 嗜睡 B( 齿龈增生 C( 精神障碍 D( 运动障碍 E( 开-关现象 【答案】CDE 【解析】左旋多巴的不良反应:消化道反应;心血管反应;精神障碍，表现为失眠、焦虑、恶梦、狂躁等兴奋症状，尤其是高龄者出现幻觉、妄想等;运动障碍;“开-关”现象;排尿困难;消化道溃疡、高血压、精神病、糖尿病、心律失常、闭角型青光眼患者及孕妇禁用。 78( 吗啡的临床应用有 A( 风湿热 B( 癌性剧痛 C( 骨关节炎 D( 心源性哮喘 【答案】BDE 【解析】吗啡的临床应用:镇痛，吗啡出癌性剧痛可长期应用外，一般指限于短期用于其他镇痛药无效的急性锐痛，如严重创伤、烧伤等剧痛。对急性心肌梗死risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 引起的剧烈疼痛，不仅可以止痛，而且可以减轻患者焦虑情绪和心脏负担。对胆绞痛和肾绞痛等内脏绞痛需加用M胆碱受体阻断药如阿托品等;心源性哮喘;止泻;复合麻醉。 通过上面二年的这章真题分析，本章所占比重较大，推测2015年执业药师考试中应该会有17,20分的试题(2015年每科满分为120分)～ 附:2015年大纲，第一章 小单元 要点 大单元 一 地西泮、佐匹克隆、唑吡坦的适应证、注意事项、用法用量和常用的剂型、(一)镇静与催眠药 规格 精 神 卡马西平、丙戊酸钠、苯妥英钠、苯巴比妥的适应证、注意事项、用法用(二)抗癫痫药 量和常用的剂型、规格 与 中 氟西汀、帕罗西汀、舍曲林、西酞普兰、氯米帕明、文拉法辛、米氮平、 (三)抗抑郁药 度洛西汀的适应证、注意事项、用法用量和常用的剂型、规格 枢 神 (四)脑功能改善及吡拉西坦、多奈哌齐、石杉碱甲、银杏叶提取物的适应证、注意事项、用经 系 抗记忆障碍药 法用量和常用的剂型、规格 统 疾 吗啡、哌替啶、可待因、曲马多、芬太尼、羟考酮、布桂嗪的适应证、注(五)镇痛药 病 用 意事项、用法用量和常用的剂型、规格 药 [专业知识二] [药学专业知识二] 【药圈】历年真题学习整理之第2章解热镇痛抗炎药及抗痛风药 今天楼主将会给大家继续整理分析执业药师《药学专业知识(二)》历年真题，现在我们看看《药学专业知识(二)》第2章(解热镇痛抗炎药及抗痛风药)中2013年和2014年执业药师考试出过哪些试题～ 经查找发现该章节在2013年执业药师考试中所占分值为2分，其中最佳选择题1分，配伍选择题1分。如下: 13、宜选用塞来昔布治疗的疾病是 A.骨关节炎 B.痛风 C.胃溃疡 D.支气管哮喘E.肾绞痛 【答案】A 【解析】塞来昔布:临床主要用于骨关节炎、类风湿性关节炎和牙痛的治疗。 【48-49】 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions A.对乙酰氨基酚 B.吡罗昔康 C.美洛昔康 D.双氯芬酸 E.阿司匹林 48、选择性抑制环氧酶-2(COX-2)的药物是 49、小剂量抑制血小板中的COX-1，防止血栓形成的药物是 48【答案】C 【解析】美洛昔康:是一种长效的选择性的 COX-2 抑制药，对各靶组织和器官的COX-2 抑制作用比 COX-1 强 10 倍以上。 49【答案】E 【解析】阿司匹林:抑制前列腺素合成所必需的环氧酶(COX)，干扰致热、致痛、致炎物质前列腺素的合成。 药理作用及临床应用: (1)解热镇痛:具有较强的解热镇痛作用，常与其他解热镇痛药配成复方，用于缓解头痛、牙痛、肌肉痛、神经痛和感冒发热等。 (2)抗炎、抗风湿:较大剂量阿司匹林具有较强的抗炎、抗风湿作用。用于控制急性风湿热、类风湿性关节炎疗效迅速而确实，也可用于鉴别诊断。 (3)抑制血栓形成:小剂量阿司匹林(40,80mg/日)能抑制血小板中的 COX-1，减少 TXA2(血栓素 A2)的生成，可降低心肌梗死病死率和再梗死率，防止脑血栓形成，小剂量预防心脑血管疾病。 该章节在2013年执业药师考试中所占分值为2分，其中最佳选择题1分，配伍选择题1分。如下: 10(属于阿司匹林的不良反应是 A(嗜睡 B(心动过速 C(呼吸抑制 D(凝血障碍 E(戒断症状 【答案】D 【解析】阿司匹林的不良反应:消化道反应(最常见);凝血障碍;变态反应;水杨酸反应;瑞夷(Reye)综合征;对肾脏的影响。 【52-53】 A(感冒发热 B(痛风 C(心律失常 D(高血压 E(风湿性关节炎 52(对乙酰氨基酚的临床应用 53(别嘌醇的临床应用 52、【答案】A 【解析】对乙酰氨基酚临床用于感冒发热、关节痛、头痛、神经痛和肌肉痛等。 、【答案】B 53 【解析】别嘌醇用于原发或继发性痛风。 [药学专业知识二] 【药圈】执业药师历年真题学习整理之第3章呼吸系统疾病用 通过上面二年的这章真题分析，本章所占比重较小，推测2015年执业药师考试中约有4分的试题(2015年每科满分为120分)～ 今天楼主将会给大家继续整理分析执业药师《药学专业知识(二)》历年真题，现在我们看《药学专业知识(二)》第3章(呼吸系统疾病用药)中2013年和2014年执业药师考试出过哪些试题～ 经查找发现该章节在2013年执业药师考试中所占分值为2分，其中最佳选择题0分，配伍选择题1分，多项选择题1分。如下: [67-68] risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions A氨茶碱 B沙丁胺醇 C倍氯米松 D异丙肾上腺素 E色甘酸钠 67.哮喘伴有心功能不全宜选用 68.可预防哮喘发作，对正在发作无效的是 67、【答案】A 【解析】氨茶碱:各种哮喘及急性心功能不全。与β受体激动药合用可增强疗效。与糖皮质激素合用治疗哮喘持续状态 68、【答案】E 【解析】色甘酸钠:抗过敏平喘药。预防哮喘发作，对正在发作的哮喘无效。可以减少严重哮喘患者糖皮质激素的用量。也用于过敏性鼻炎、过敏性湿疹、皮肤瘙痒症和胃肠道过敏性疾病。起效慢，口服无效，只能喷雾吸入。 80.临床用于祛痰的药物有 A.氨溴索 B.氨茶碱 C.氯化铵 D.右美沙芬 E.克伦特罗 【答案】AC 【解析】祛痰药:氯化铵(恶心性祛痰药)、氨溴索(黏液溶解剂)、溴己胺(必嗽平) 在2014年执业药师考试中所占分值为2分，其中最佳选择题1分，配伍选择题1分，多项选择题0分。如下: 18(通过激动β2 受体发挥平喘作用的药物是 A(氨茶碱 B(沙丁胺醇 C(异丙阿托品 D(色甘酸钠 E(二丙酸倍氯米松 【答案】B 【解析】沙丁醇胺选择性地兴奋β2受体，扩张支气管，解除支气管痉挛;氨茶碱为茶碱类;异丙阿托品为抗胆碱药;色甘酸钠为抗过敏平喘药;二丙酸倍氯米松为糖皮质激素类。 [65-66] A( 克伦特罗 B( 色甘酸钠 C( 可待因 D( 氨茶碱 E( 二丙酸倍氯米松 65( 治疗无痰干咳宜选用的药物是 66( 仅用于预防支气管哮喘发作宜选用的药物是 65、【答案】C 【解析】可待因为中枢性镇咳药，用于无痰干咳及剧烈频繁的咳嗽。 66、【答案】B 【解析】克伦特罗、氨茶碱、二丙酸倍氯米松为平喘药。色甘酸钠临床用于预防哮喘发作，可以检测验证哮喘患者糖皮质激素的用量。 通过上面二年的这章真题分析，本章所占比重较小，推测2015年执业药师考试中约有4分的试题(2015年每科满分为120分)～ 本章节主要药物 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (一)镇咳药 喷托维林、右美沙芬 三 (二)祛痰药 溴己新、氨溴索、乙酰半胱氨酸、羧甲司坦 呼吸系统疾 沙丁胺醇、特布他林、沙美特罗、孟鲁司特、茶碱、氨茶碱、异丙托溴(三)平喘药 病用药 铵、噻托溴铵、倍氯米松、氟替卡松、布地奈德 [药学专业知识二] 【药圈】执业药师历年真题学习整理之第4章消化系统疾病用 今天楼主将会给大家继续整理分析执业药师《药学专业知识(二)》历年真题，现在我们看《药学专业知识(二)》第4章(消化系统疾病用药)中2013年和2014年执业药师考试出过哪些试题～ 经查找发现该章节在2013年执业药师考试中所占分值为2分，其中最佳选择题1分，配伍选择题0分，多项选择题1分。如下: 21、通过阻断延脑催吐化学感受区(CTZ)D2受体而止吐的药物是 A.多潘立酮 B.昂丹司琼 C.甲氧氯普胺 D.西沙比利 E.奥美拉唑 游客，如果您要查看本帖隐藏请回复 81、具有促进排便作用药物是 A.地芬诺酯 B.硫酸镁 C.酚酞 D.乳酶生 E.乳果糖 游客，如果您要查看本帖隐藏内容请回复 在2014年执业药师考试中所占分值为2分，其中最佳选择题1分，配伍选择题0分，多项选择题1分。如下: 19(通过阻断5-HT3受体而发挥止吐作用的药物是 A(氯丙嗪 B(昂丹司琼 C(多潘立酮 D(西沙必利 E(乳果糖 游客，如果您要查看本帖隐藏内容请回复 81( 促肠胃运动药有 A(米索前列醇 B(溴己胺 C(甲氧氯普胺 D(多潘立酮 E(奥美拉唑 游客，如果您要查看本帖隐藏内容请回复 通过上面二年的这章真题分析，本章所占比重较小，推测2015年执业药师考试中约有4分的试题(2015年每科满分为120分)～ 本章主要药物 复方碳酸钙、氢氧化铝、西咪替丁、雷尼替丁、法莫替丁、奥美拉唑、 (一)抗酸剂与抑酸剂 兰索拉唑、泮托拉唑 第4章 (二)胃黏膜保护剂 枸橼酸铋钾、胶体果胶铋 消化系统 (三)助消化药 乳酶生、乳酸菌素、胰酶、胃蛋白酶、干酵母 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (四)解痉药与促胃肠颠茄、阿托品、山莨菪碱、东莨菪碱、甲氧氯普胺、多潘立酮、莫沙必 疾病用药 动力药 利 硫酸镁、酚酞、甘油、乳果糖、聚乙二醇4000、双八面体蒙脱石、洛哌(五)泻药与止泻药 丁胺、地芬诺酯、地衣芽孢杆菌制剂、双歧三联活菌制剂 (六)肝胆疾病辅助用多烯磷脂酰胆碱、还原型谷胱甘肽、甘草酸二胺、复方甘草酸苷、葡醛内酯、熊 药 去氧胆酸 [药学专业知识二] 【药圈】执业药师历年真题学习整理之第5章循环系统疾病用 今天楼主将会给大家继续整理分析执业药师《药学专业知识(二)》历年真题，现在我们看《药学专业知识(二)》第5章(循环系统疾病用药)中2013年和2014年执业药师考试出过哪些试题～ 经查找发现该章节在2013年执业药师考试中所占分值为11.5分，其中最佳选择题5分，配伍选择题5.5分，多项选择题1分。如下: 8.既可治疗高血压，又能治疗充血性心力衰竭的药 A.可乐定 B.多巴酚丁胺 C.卡维地洛 D.米诺地尔 E.米力农 游客，如果您要查看本帖隐藏内容请回复 14.宜选用利多卡因治疗的疾病是 A.心房扑动 B.房室早搏 C.心房颤动 D.急性心肌梗死引起的室性心律失常 E.阵发性室上性心动过速 游客，如果您要查看本帖隐藏内容请回复 15. 卡托普利抑制酶 A. Na-K-ATP酶 B. 碳酸酐酶 C. 血管紧张素酶 D. 胆碱酯酶 E. 磷酸二酯酶 游客，如果您要查看本帖隐藏内容请回复 16.治疗高血压危象选用 A.心得安 B.硝普钠 C.依那普利 D.可乐定 E.氢氯噻嗪 游客，如果您要查看本帖隐藏内容请回复 17.易产生耐受性的是 A.普萘洛尔 B.维拉帕米 C.地尔硫卓 D.双嘧达莫 E.硝酸甘油 游客，如果您要查看本帖隐藏内容请回复 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 【50-52】 A.奎尼丁 B.胺碘酮 C.普萘洛尔 D.利多卡因 E.维拉帕米 50.能引起致死性肺毒性和肝毒性的抗心律失常药是 51.阻滞钙通道，治疗阵发性室上性心动过速急性发作的抗心律失常药是 52.可产生金鸡纳反应的抗心律失常药是 游客，如果您要查看本帖隐藏内容请回复 【53-56】 A.普罗帕酮 B.噻氯匹定 C.洛伐他汀 D.多巴酚丁胺 E.米诺地尔 53.预防或治疗室性或室上性早搏和心动过速可选用的药物是 54.治疗动脉粥样硬化可选用的药物是 55.治疗其他降压药效果不佳的严重高血压可选用的药是 56.治疗心力衰竭可选用的药物是 游客，如果您要查看本帖隐藏内容请回复 【57-58】 A.卡托普利 B.硝苯地平 C.可乐定 D.哌唑嗪 E.普萘洛尔 57.通过阻断α1受体而降低血压的药物是 58.通过激动中枢α2和咪唑林受体(I2)而降低血压的药物是 游客，如果您要查看本帖隐藏内容请回复 【59-60】 A.双嘧达莫 B.硝苯地平 C.硝酸甘油 D.普萘洛尔 E.曲美他嗪 59.通过产生一氧化氮(NO)松驰血管平滑肌的药物是 60.降低细胞内Ca2+浓度，舒张血管，治疗变异型心绞痛的药物是 游客，如果您要查看本帖隐藏内容请回复 在2014年执业药师考试中所占分值为9分，其中最佳选择题5分，配伍选择题2分，多项选择题2 分。如下: 11(治疗窦性心动过速宜选用的药物是 A(普萘洛尔 B(溴苄铵 C(恩卡尼 D(利多卡因 E(苯妥英钠 游客，如果您要查看本帖隐藏内容请回复 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 12(主要通过增强心肌收缩力而改善心功能的药物是 A(卡维地洛 B(硝酸甘油 C(地高辛 D(氢氯噻嗪 E(依那普利 游客，如果您要查看本帖隐藏内容请回复 13( 通过阻断 AT 受体而用于治疗各型高血压的药物是 A(氟沙坦 B(呋塞米 C(可乐定 D(肼屈嗪 E(硝普钠 游客，如果您要查看本帖隐藏内容请回复 14( 治疗变异型心绞痛宜选用的药物 A(硝苯地平 B(卡维地洛 C(普萘洛尔 D(双嘧达莫 E(曲美他嗪 游客，如果您要查看本帖隐藏内容请回复 15(通过与胆汁酸结合而产生调血脂作用的药物是 A(辛伐他汀 B(考来烯胺 C(吉非贝齐 D(烟酸 E(普罗布考 游客，如果您要查看本帖隐藏内容请回复 【54-57】 A( 塞来昔布 B(地高辛 C( 依那普利 D(洛伐他丁 E(米力农 54(抑制 Na+，K+-ATP酶的药物是 55(抑制血管紧张素转换酶的药物是 56(抑制磷酸二酯酶 III 的药物是 57(抑制 HMG-CoA 还原酶的药物是 游客，如果您要查看本帖隐藏内容请回复 79( 硝酸甘油的临床应用 A( 劳累性心绞痛 B( 自发性心绞痛 C( 低血压 D( 充血性心力衰竭 E( 急性心肌梗死 游客，如果您要查看本帖隐藏内容请回复 80( 他汀类药物的临床应用 A( 动脉粥样硬化 B( 肾病综合症 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions C( 血管成形术后再狭窄 D( 预防心脑血管疾病事件 E( 心律失常 游客，如果您要查看本帖隐藏内容请回复 通过上面二年的这章真题分析，本章所占比重较大，推测2015年执业药师考试中约有18,23分的试题(2015年每科满分为120分)～ 主要药物 (一)抗心功能不全药 地高辛、去乙酰毛花苷、多巴胺、多巴酚丁胺、米力农 五 普鲁卡因胺、美西律、普罗帕酮、胺碘酮、维拉帕米、普萘洛尔、美托洛(二)抗心律失常药 尔、比索洛尔、拉贝洛尔、地尔硫?(艹卓) 循环 硝酸甘油、硝酸异山梨酯、单硝酸异山梨酯、硝苯地平、氨氯地平、左旋 (三)抗心绞痛药 氨氯地平、拉西地平 系统 卡托普利、依那普利、雷米普利、福辛普利、缬沙坦、厄贝沙坦、坎地沙(四)抗高血压药 疾病 坦、替米沙坦、阿利克仑、利血平、甲基多巴、硝普钠 辛伐他汀、阿托伐他汀、氟伐他汀、瑞舒伐他汀、非诺贝特、苯扎贝特、用药 (五)调节血脂药 烟酸、阿昔莫司、依折麦布 [药学专业知识二] 【药圈】执业药师历年真题学习整理之第6章血液系统疾病用 今天楼主将会给大家继续整理分析执业药师《药学专业知识(二)》历年真题，现在我们看《药学专业知识(二)》第6章(血液系统疾病用药)中2013年和2014年执业药师考试出过哪些试题～ 经查找发现本章在2013年执业药师考试中所占分值为3分，其中最佳选择题1分，配伍选择题2分，多项选择题0分。如下: 20、题干缺少， 考察知识点为:肝素药理作用:体内、体外均有抗凝作用，抗凝作用强大、迅速而短暂。可防止血栓形成和扩大，但对已形成的血栓无溶栓作用。口服无效，常静脉给药。 【64-66】 A.硫酸亚铁 B.叶酸 C.维生素B12 D.重组人促红素 64.恶性贫血和巨幼红细胞性贫血选用 65.慢性失血性贫血宜选用 66.肾性贫血宜选用 游客，如果您要查看本帖隐藏内容请回复 【71】 A.嗜睡乏力 B.低血糖 C.视觉异常 D.出血 E.骨质疏松 71.华法林引起的不良反应 游客，如果您要查看本帖隐藏内容请回复 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 本章在2014年执业药师考试中所占分值为2分，其中最佳选择题1分，配伍选择题1分，多项 选择题0分。如下: 17(阻止肝脏氢醌型维生素 K 生成的抗凝药是 A(肝素 B(链激酶 C(双嘧达莫 D(华法林 E(噻氯匹定 游客，如果您要查看本帖隐藏内容请回复 【63-64】 A( 肝素 B( 维生素 K C( 阿司匹林 D( 链激酶 E( 华法林 63( 通过激活抗凝酶?而发挥抗凝作用的药物是: 64( 通过抑制环氧酶抑制血小板聚集的药物: 游客，如果您要查看本帖隐藏内容请回复 通过上面二年的这章真题分析，本章所占比重较小，推测2015年执业药师考试中约有4,6分的试 题(2015年每科满分为120分)～ 主要药物: (一)促凝血药 酚磺乙胺、氨基己酸、氨甲环酸、维生素K1、蛇毒血凝酶、鱼精蛋白 六 (二)抗凝血药 华法林、肝素、依诺肝素、达比加群酯、利伐沙班、阿哌沙班 (三)溶栓药 尿激酶、链激酶、阿替普酶 血液 (四)抗血小板药 阿司匹林、氯吡格雷、替格雷洛、双嘧达莫、替罗非班 系统 (五)抗贫血药 硫酸亚铁、琥珀酸亚铁、蔗糖铁、叶酸、维生素B12、重组人促红素 疾病 (六)升白细胞药 腺嘌呤、非格司亭 用药 [药学专业知识二] 【药圈】执业药师历年真题学习整理之第7章利尿药及泌尿系统疾 病用药 今天楼主将会给大家继续整理分析执业药师《药学专业知识(二)》历年真题，现在我们看《药学专 业知识(二)》第7章(利尿药及泌尿系统疾病用药)中2013年和2014年执业药师考试出过哪些 试题～ 经查找发现本章在2013年执业药师考试中所占分值为4分，其中最佳选择题2分，配伍选择 题2分，多项选择题0分。如下: 18、甘露醇的作用 A.抑制碳酸甘酶 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions B.与醛固酮受体结合 C.提高血浆渗透压产生组织脱水作用 D.Na[+],Cl[_]抑制剂 E.4Na[+],K[+],2Cl[_]抑制剂 游客，如果您要查看本帖隐藏内容请回复 19、题干缺少。考察知识点为: 呋塞米临床应用 (1)严重水肿:主要用于其他利尿药无效的顽固性和严重水肿。 (2)急性肺水肿和脑水肿。 (3)急、慢性肾衰竭:大剂量呋塞米治疗慢性肾衰;也可用于急性肾衰早期的防治，禁用于无尿的 肾衰患者。 (4)加速某些毒物的排泄:用于长效巴比妥类、水杨酸类、溴化物、氟化物和碘化物等中毒。 (5)高钙血症:抑制 Ca2+的重吸收，降低血钙。 【61-63】 A.呋塞米 B.氢氯噻嗪 C.甘露醇 D.螺内酯 E.氨苯蝶啶 61、可引起血脂紊乱的降压药是: 62、可引起耳毒性的药物是: 63、用于青光眼急性发作及手术前降低眼压的药物是: 游客，如果您要查看本帖隐藏内容请回复 [70] A.嗜睡乏力 B.低血糖 C.视觉异常 D.出血 E.骨质疏松 70.西地那非引起的不良反应: 游客，如果您要查看本帖隐藏内容请回复 本章在2014年执业药师考试中所占分值为4.5分，其中最佳选择题2分，配伍选择题2.5分， 多项选择题0分。如下: 最佳选择题 16(具有降压作用的中效利尿药是 A(阿米洛利 B(氢氯噻嗪 C(呋塞米 D(氨苯喋啶 E(螺内酯 游客，如果您要查看本帖隐藏内容请回复 23(治疗男性阴劲勃起障碍宜选用的药物是: A(氯米芬 B(苯丙酸诺龙 C(他莫昔芬 D(乙 酚 E(西地那非 游客，如果您要查看本帖隐藏内容请回复 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 配伍选择题 【 58-59】 A(呋塞米 B(氢氯噻嗪 C(螺内酯 D(乙酰唑胺 E(甘露醇 58(可引起耳毒性的药物是 59(可引起血清胆固醇和低密度脂蛋白增高的药物是 游客，如果您要查看本帖隐藏内容请回复 【60-62】 A( 氢氯噻嗪 B( 呋塞米 C( 螺内酯 D( 乙酰唑胺 E( 甘露醇 60( 抑制髓袢升支粗段的 Na+-K+-2Cl-同向转运系统的药物是 61( 具有抗利尿作用的药物是 62( 具有渗透性利尿作用的药物是 游客，如果您要查看本帖隐藏内容请回复 通过上面二年的这章真题分析，本章所占比重较小，推测2015年执业药师考试中约有7分的试题(2015年每科满分为120分)～ 本章主要药物: (一)利尿药 呋塞米、布美他尼、氢氯噻嗪、螺内酯、氨苯蝶啶、阿米洛利、乙酰唑胺 七 (二)抗前列腺增生特拉唑嗪、坦洛新、非那雄胺、度他雄胺 症药 利尿药及 泌尿系统(三)治疗男性勃起西地那非、伐地那非、他达那非、十一酸睾酮、丙酸睾酮 疾病用药 功能障碍药物 [药学专业知识二] 【药圈】执业药师历年真题学习整理之第8章内分泌系统疾病 今天楼主将会给大家继续整理分析执业药师《药学专业知识(二)》历年真题，现在我们看《药学专业知识(二)》第8章(内分泌系统疾病用药)中2013年和2014年执业药师考试出过哪些试题～ 经查找发现本章在2013年执业药师考试中所占分值为6分，其中最佳选择题3分，配伍选择题0分，多项选择题3分。如下: 22.糖皮质激素对血液成分的影响() A.血红蛋白含量降低 B.血小板减小 C.嗜酸粒细胞增加 D.中性粒细胞减少 E.淋巴细胞减少 游客，如果您要查看本帖隐藏内容请回复 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 23 米非司酮作用机制 A.抗受精卵着床 D.促子宫内膜壁充血增厚 (注:选项不完整) 游客，如果您要查看本帖隐藏内容请回复 24.雌二醇的适应症 A.子宫颈癌 B.绝经期前乳腺癌 C.前列腺癌 D.子宫内膜癌 E.子宫某癌 游客，如果您要查看本帖隐藏内容请回复 82.糖皮质激素的不良反应: A.高血压 B.高钾 C.高血糖 D.向心性肥胖 E.动脉粥样硬化 游客，如果您要查看本帖隐藏内容请回复 83.甲状腺素的应用 A.单纯性甲状腺肿 B.甲状腺术前准备 C.粘液性水肿 D.呆小症 E.甲状腺危象 游客，如果您要查看本帖隐藏内容请回复 84.胰岛素不良反应 A.变态反应 B.胰岛素抵抗 C.低血糖 D.酮症酸中毒 E.脂肪萎缩与肥厚 游客，如果您要查看本帖隐藏内容请回复 本章在2014年执业药师考试中所占分值为8分，其中最佳选择题3分，配伍选择题3分，多项选择 题2分。如下: 20(泼尼松可治疗的疾病是 A(高血压 B(心律失常 C(风湿性及类风湿性关节炎 D(骨质疏松 E(粒细胞增多症 游客，如果您要查看本帖隐藏内容请回复 21(地塞米松的禁忌证是 A(抑郁症 B(支气管哮喘 C(荨麻疹 D(心绞痛 E(活动性消化性溃疡 游客，如果您要查看本帖隐藏内容请回复 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 22(米非司酮的药理作用是 A(阻断孕激素受体 B(激动雌激素受体 C(促进受精卵 D(抑制黄体生成素释放 E(促进垂体后叶素释放 游客，如果您要查看本帖隐藏内容请回复 【67-69】 A( 阿卡波糖 B( 二甲双胍 C( 甲硫咪唑 D( 巯唑嘌呤 E( 格列本脲 67( 促进组织对葡萄糖摄取和利用的药物是 68( 刺激胰岛素β细胞分泌胰岛素的药物是 69( 抑制甲状腺内酪氨酸的典化和偶联的药物是 游客，如果您要查看本帖隐藏内容请回复 【70-72】 A( 甲睾酮 B( 甲羟孕酮 C( 他莫昔芬 D( 麦角生物碱 E( 缩宫素 70( 预防先兆流产的是 71( 可用于催产和引产的是 72( 用于产后子宫复原的是 游客，如果您要查看本帖隐藏内容请回复 82( 治疗甲状腺功能亢进症的药物有 A( 瑞格列奈 B( 丙硫氧嘧啶 C( 放射性碘 D( 酚妥拉明 E( 普萘洛尔 游客，如果您要查看本帖隐藏内容请回复 83( 治疗糖尿病的药物有 A( 阿卡波糖 B( 甲硫咪唑 C( 氨鲁米特 D( 瑞格列奈 E( 吡格列酮 游客，如果您要查看本帖隐藏内容请回复 通过上面二年的这章真题分析，推测本章在2015年执业药师考试中约有14,16分的试题(2015 年每科满分为120分)～ 本章主要药物: (一)肾上腺糖皮质激氢化可的松、地塞米松、泼尼松、泼尼松龙、甲泼尼松龙、曲安奈德 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 八 素 (二)雌激素 雌二醇、戊酸雌二醇、炔雌醇、雌三醇、尼尔雌醇 内分 (三)孕激素 黄体酮、甲羟孕酮 泌系 (四)避孕药 炔诺酮、 (五)蛋白同化激素 司坦唑醇 统疾 (六)甲状腺激素及抗左甲状腺素、甲状腺片、丙硫氧嘧啶、甲巯咪唑、碘和碘化物 甲状腺药 病用 (七)胰岛素及胰岛素胰岛素、低精蛋白锌胰岛素、精蛋白锌胰岛素、门冬胰岛素、赖脯胰岛素、甘精胰 药 类似物 岛素 格列本脲、格列喹酮、格列吡嗪、格列齐特、格列美脲、瑞格列奈、那格列奈、二 (八)口服降糖药 甲双胍、阿卡波糖、伏格列波糖、罗格列酮、吡格列酮、艾塞那肽、利拉鲁肽、西 格列汀、阿格列汀 (九)调节骨代谢与形碳酸钙、葡萄糖酸钙、骨化三醇、阿法骨化醇、阿仑膦酸钠、依替膦酸钠、帕米膦 成药 酸二钠、降钙素、依降钙素、雷洛昔芬、依普黄酮 [药学专业知识二] 【药圈】执业药师学习整理之第9章调节水电解质酸碱平衡药与营 养药 2015年版药学专业知识二第9章调节水电解质酸碱平衡药与营养药为新增加内容。 主要药物: (一)调节水、电解氯化钠、氯化钾、枸橼酸钾、门冬氨酸钾镁、氯化钙 质平衡药 (二)调节酸碱平衡碳酸氢钠、乳酸钠、氯化铵 九 药 (三)葡萄糖与 调节水、 葡萄糖、二磷酸果糖钠 电解质、酸果糖 碱平衡 药 维生素B1、维生素B2、维生素B6、复合维生素B、维生素C、维生素A、与营养药 (四)维生素 维生素D3、维生素E、维生素AD 精氨酸、复方氨基酸(18AA)、复方氨基酸注射剂(3AA)、复方氨基酸(五)氨基酸 注射剂(9AA) 本章主要内容如下: 第九单元 调节水、电解质、酸碱平衡药与营养药 正常人体通过神经、代谢和内分泌等系统的调节作用，维持着血容量、渗透压、电解质、酸碱度的正 常范围(动态平衡)，但当疾病、创伤、感染、物理化学因素或不合理的药物治疗后，可以出现上述 平衡失调，当超过人体的代偿能力或人体缺乏代偿时，可致水、电解质、酸碱平衡紊乱，严重时可危 及生命，应给予及时纠正或调整。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 第一节调节水、电解质平衡药 一、药理作用与临床评价 (一)作用特点 1、钠 钠不足时，能量的生成和利用较差，以至于神经肌肉传导迟钝。表现为肌无力、神志模糊昏迷，出现心血管功能受抑制的症状。 高钠血症指血钠> 145mmol/L，低钠血症指血钠< 135mmol/L 氯化钠可补充血容量和钠离子，用于各种缺盐性失水症(大面积烧伤、创伤、严重腹泻或呕吐、大出血、大量发汗)和低钠血症;同时在大量出血而无法紧急输注血液(血浆)时，可以滴注氯化钠注射液以维持血容量。对低钠血症可直接补充。 2、钾正常人体血钾浓度范围在3.5—5.5mmol/L。 血钾> 5.5mmol/L称为高钾血症，高于7.0mmol/L则为严重高钾血症。见于应用留钾利尿剂、强心苷、糖皮质激素、抗肿瘤药可致高钾血症; 低钾血症系指血钾<3.5mmol/L，见于排钾利尿剂(氢氯噻嗪、吲达帕胺)、强心苷、糖皮质激素、α受体阻断剂(哌唑嗪、多沙唑嗪、乌拉地尔)、双膦酸盐(帕米膦酸钠、唑来膦酸钠)、抗酸剂的长期连续使用或用量过多，促进钾由尿液中排出; 3、镁 低血镁症系指血镁浓度<0.75mmol/L。 硫酸镁用于低镁血症，并在妊娠期妇女控制子痫抽搐及防止再抽搐、预防重度子痫发展，为子痫、子痫前期治疗的首选药。 4、钙 血钙浓度>2.75mmol/L即为高钙血症 血钙<2.2mmol/L(8.8mg/L)时称为低钙血症 氯化钙、葡萄糖酸钙可改善细胞膜的通透性，增加毛细血管壁的致密性，减少液体渗出，促进骨骼和牙齿的钙化形成，高浓度钙与镁离子存在竞争性拮抗作用，也可与氟化物形成不溶性氟化钙，用于镁、氟中毒的解救和低钙血症的防治。 (二)典型不良反应 1(钠盐 体内钠离子浓度过高，可引起高血压、心动过速、水钠潴留，静脉滴注过量可引起组织水肿。氯化钠摄人过多可致体内的电解质平衡失调(高钠、低钾、碳酸氢盐丢失)。 2(钾盐常见高钾血症。 静脉滴注速度过快或原有肾功能不全者可致高钾血症，表现为软弱无力、手足口唇麻木、意识模糊、焦虑、心率减慢、心律失常、呼吸困难、心脏停搏，逐渐出现心电图P-R间期延长、P波消失、QRS波变宽等。注射液直接静脉注射可有刺激性，导致疼痛、组织坏死、猝死，必须充分以溶剂稀释后应用。静脉滴注速度过快可引起呕吐、血管疼痛、面部潮红、血压下降、偶见心率减慢。 3(钙盐 钙盐可兴奋心脏，静脉注射时常见全身发热感、皮肤发热、血管扩张;静注速度过快可使血钙浓度迅速升高，引起心律失常、血压下降，甚至心脏停搏。 4(镁盐少见高镁血症、肺水肿，减慢注射速度可以消失。罕见低钙血症、低磷血症。 (三)禁忌证 1(氯化钠禁用于妊娠期高血压疾病者。 2(氯化钾禁用于高钾血症者、急慢性肾功能不全者。枸橼酸钾禁用于伴少尿或氮质血症的严重肾 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 功能损害者、未经治疗的原发性肾上腺皮质功能减退症、急性脱水、中暑性痉挛、无尿、严重心肌损害、家族性周期性麻痹和各种原因引起的高钾血症患者。 3(氯化钙在应用强心苷或停用后7日内禁用。 4(下列情况禁用氯化钙:高钙血及高尿钙症者、含有钙结石或肾结石患者、结节性患者(可加重高钙血症);肾功能不全的低钙血症患者及呼吸性酸中毒衰竭者禁用。 二、用药监护 (一)注意电解质监测调节水、电解质平衡药用药失当也可引起再发的水、电解质平衡失衡。 1(氯化钠注射液静脉滴注过多或滴速过快，可致水、钠潴留，引起水肿、血压升高、心率加快、胸闷、呼吸困难、甚至急性左心衰竭;高渗透压氯化钠注射液应用过量或不恰当可导致高钠血症和低钾血症，氯过高可导致碳酸氢根丢失;过快、过多给予低渗透压氯化钠注射液可致溶血、脑水肿等。 2(氯化钾注射液应用过量可致高钾血症，出现神经和心血管系统症状;同时滴注氯化钠或高浓度葡萄糖注射液可降低钾的作用。 3(氯化钙注射液静脉滴注过多可致高钙血症，同时监测血镁和血钾水平、心电图。 (二)监测给药途径和用药速度 氯化钾注射液严禁肌内注射和直接静脉注射，仅可静脉滴注，于临用前应用葡萄糖或氯化钠注射液稀释，否则不仅引起剧痛，且致心脏停搏。静脉滴注时氯化钾的浓度不宜过高，一般不宜超过0.2%-0.4%，心律失常可用0.6% -0.7%。 高渗透压氯化钠注射液、氯化钾的滴速宜慢。而治疗脑出血、颅内压增高的疾病时，滴速应快，一般要求在15 - 30min滴毕，否则起不到降低颅压的作用。 (三)警惕由低血钾症所引发的尖端扭转型室性心动过速 尖端扭转型室性心动过速是室性心律失常的一个特殊类型，常见于心电图Q-T间期延长者，通常由用药所引发，其他致病因素包括低钾血症、严重心动过缓和遗传因素。其为一种严重的室性多形性心动过速，也是致命性心室颤动和猝死的预兆。主要表现为心电图Q-T间期延长、晕厥、恶性心律失常甚至猝死。在心律失常发作期，心脏输出严重受损，常导致晕厥或癫痫样发作。 三、主要药品 氯化钠 【适应证】用于各种原因所致的低渗性、等渗性和高渗性失水，高渗性非酮症糖尿病昏迷，低氯性代谢性碱中毒。用作部分注射液的溶剂。外用可冲洗眼部、伤口等。浓氯化钠主要用于各种原因所致的水中毒及严重的低钠血症。 氯化钾 【适应证】用于防治低钾血症，治疗洋地黄中毒引起的频发性、多源性早搏或快速心律失常。 氯化钙 【适应证】用于:(1)低钙血症、高钾血症、高镁血症以及钙通道阻滞剂中毒(心功能异常)。 (2)血钙过低所引起手足抽搐、肠绞痛、输尿管绞痛。 (3)解救镁盐中毒。 (4)甲状旁腺功能亢进症术后的 “骨饥饿综合征”。 (5)过敏性疾病。 (6)作为强心剂，用于心脏复苏。 第二节 调节酸碱平衡药 一、药理作用与临床评价 (一)作用特点 1(调节酸平衡药 调节酸平衡药有碳酸氢钠、乳酸钠、复方乳酸钠山梨醇等。其中碳酸氢钠是临床上最常用碱性药。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 2(调节碱平衡药 调节碱平衡药有氯化铵、氯化钠、盐酸精氨酸等，其中氯化铵为酸性盐，口服或静脉滴注后可酸化体液和尿液，纠正碱中毒 (二)典型不良反应 1(碳酸氢钠 大量应用可引起碱中毒、心律失常、肌肉痉挛性疼痛、低血钾、疲乏、头痛;肾功能不全者或用药过量可引起水肿、精神症状、肌肉疼痛、口腔异味、抽搐、呼吸缓慢等，主要由代谢性碱中毒所致。 2(乳酸钠 偶见有心率加快、胸闷、气促、肺水肿、心力衰竭、血压升高、水肿、体重增加、低钾血症。低血钙者于酸中毒后，常因血清钙离子浓度降低而出现手足麻木、疼痛、抽搐、呼吸困难。静脉滴注时可出现焦虑、惊恐、出汗、感觉异常、震颤、心动过速、眩晕、呼吸困难。长期或大量应用可引起碱中毒。 3(氯化铵 偶见心动过速、面色苍白、精神紊乱、定向力障碍、酸中毒。给药速度过快可出现惊厥、呼吸停止。 (三)禁忌证 1(碳酸氯钠有溃疡出血者及碱中毒者、限制钠盐摄人者禁用。 2(乳酸钠 对肝功能不全者或在缺氧时忌用。严重肺水肿、脑水肿者、严重肝功能受损、休克、右心衰竭或乳酸性酸血症者禁用。 3(氯化铵 氯化铵可增加血氨浓度，于肝功能不全者可诱发肝昏迷，对肝肾功能不全者禁用。 (四)药物相互作用 1(糖皮质激素有保钠作用，与乳酸钠合用可提高血钠浓度。 2(乳酸钠与双胍类降糖药(二甲双胍、尤其是苯乙双胍)合用，会阻碍肝脏对乳酸的利用，引起尿乳酸中毒。 3(碳酸氢钠可升高尿液pH而增强氨基糖苷类抗菌药物的疗效。 4(碳酸氢钠与糖皮质激素尤其是具有较强盐皮质激素作用者、促糖皮质激素、雄激素合用时，易致高钠血症和水肿。 5(碳酸氢钠能显著提高磺胺类药及乙酰化代谢产物的溶解度，避免或减少磺胺结晶的形成。 6(碳酸氢钠碱化尿液后能抑制乌洛托品转化成甲醛，从而降低其疗效，故不宜与乌洛托品合用。 7(碳酸氢钠与排钾利尿剂合用，使导致低氯性碱中毒的危险性增加。 8(碳酸氢钠可增加肾脏对弱酸性药(苯巴比妥、水杨酸等)的排泄，从而可降低后者的血浆药物浓度。本品可减少抗凝血药(华法林)、H2受体阻断剂(西咪替丁、雷尼替丁等)、抗毒蕈碱药、四环素、口服铁剂的吸收。本品可碱化尿液，使碳酸锂、甲氨蝶呤、水杨酸盐、四环素、氯磺丙脲的肾脏清除率增加;使氟卡胺、奎尼丁、拟肾上腺素能药的肾脏消除减缓。 二、用药监护 (一)监控患者用药中的代谢状况 尽管碳酸氢钠在治疗代谢性酸中毒症的作用已经得到肯定，但其在治疗伴随组织缺氧的代谢性酸中毒症尤其是乳酸性酸中毒时，给予碳酸氢钠后可产生大量的二氧化碳，如出现组织灌注不良、换气量受损或两者并存的情况下，不能被正常排出体外的二氧化碳可迅速扩散进入细胞，加剧细胞内酸中毒。此外，在治疗伴随有机酸一乳酸代谢性酸中毒时，除纠正动脉血pH后，人体会重新对酸类进行新陈代谢，存在着过碱化的风险。碱性药物必须在起效前被risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 代谢为碳酸氢盐，以乳酸钠为例，不能将其普遍应用于代谢活性受损的急性酸中毒患者，尤其是乳酸代谢受损的患者。 (二)纠正酸、碱中毒症须同步给予支持治疗 在应用调节酸、碱平衡药同时，必须纠正低血容量，纠正电解质失衡(钾、钠、钙、镁)，密切观察患者的肾功能。 三、主要药品 碳酸氢钠 【适应证】用于代谢性酸中毒，碱化尿液以预防尿酸性肾结石，减少磺胺药的肾毒性，以及急性溶血时防止血红蛋白沉积在肾小管，治疗胃酸过多引起的症状;静脉滴注对巴比妥类、水杨酸类药物及甲醇等药物中毒有非特异性的治疗作用。 乳酸钠 【适应证】用于代谢性酸中毒，碱化体液或尿液;用于高钾血症或普鲁卡因胺引起的心律失常伴有酸血症者。 氯化铵 【适应证】用于代谢性碱中毒，酸化体液或尿液，促进碱性药物(哌替啶、苯丙胺、普鲁卡因)的排泄;增加在酸性环境中发挥药效药物，如乌洛托品、四环素、青霉素。 第三节 葡萄糖与果糖 一、药理作用与临床评价 (一)作用特点 1(葡萄糖 静脉滴注高渗透压的25%—50%葡萄糖注射液可迅速提高血浆渗透压，快速注射具有利尿、脱水作用，引起组织脱水。仍广泛用于治疗脑水肿(脑出血、脑外伤)、颅内压增高、眼压升高和青光眼。另外葡萄糖是维持和调节腹膜透析液渗透压的主要物质，大量注射液药品的溶剂或稀释剂。 2、药理剂量的二磷酸果糖可作用于细胞膜，产生下列作用: (1)促进细胞对循环中钾的摄取及刺激细胞内高能磷酸和2，3一二磷酸甘油的产生，促进钾内流。 (2)可减少机械创伤引起的红细胞溶血和抑制化学刺激引起的氧自由基的产生，有利于休克、缺氧、缺血、损伤、体外循环、输血等状态下的细胞能量代谢和对葡萄糖的利用，利于心肌细胞的修复，改善功能状态。 (3)加强细胞内高能基团的重建作用，保持红细胞的韧性。 (4)改善心肌缺血。 (5)对人体代谢调节具有显著的多种功能。 (6)加强呼吸肌强度。 可广泛用于急性心肌梗死、慢性阻塞性肺病、严重心肌缺血、心功能不全、外周血管疾病、多种类型的休克等缺血缺氧性疾病的急救，还可作为各类外科手术和胃肠外营养患者的重要辅助药物等。 (二)典型不良反应 1(葡萄糖 长期单纯补给葡萄糖时易出现低钾、低钠及低磷血症;1型糖尿病患者应用高浓度葡萄糖时偶见发生高钾血症高钾血症者应用高浓度注射液时偶见出现低钾血症、低钠血症。原有。心功能不全者补液过快可致心悸、心律失常，甚至急性左心衰竭。高浓度注射液外渗可致局部肿痛、静脉炎。 2(二磷酸果糖 偶见尿潜血、血色素尿、血尿、高钠血症、低钾血症，大剂量和快速静脉滴注时可出现乳酸中毒。 (三)禁忌证 1(葡萄糖对糖尿病酮症酸中毒未控制者、葡萄糖一半乳糖吸收不良者(避免口服)、高血糖非酮症性高渗状态者禁用。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 2(二磷酸果糖对过敏者、高磷血症者、肾衰竭者禁用。 (四)药物相互作用 葡萄糖可诱发或加重洋地黄类强心苷(地高辛、洋地黄、洋地黄毒苷及毛花丙苷等)中毒。机制是由于大量的葡萄糖进入体内后，暂时不能被利用的葡萄糖合成糖原储存，合成糖原时需要消耗钾，大量钾进入细胞内可致血钾降低，从而诱发或增强地高辛的毒性。故在应用地高辛或其他强心苷期间，输入葡萄糖(特别是大剂量葡萄糖)时应注意同时补钾。二磷酸果糖禁忌与碱性药物、钙剂配伍。 二、用药监护 (一)注意监测低血糖和电解质紊乱 1(葡萄糖联合应用胰岛素过量，可发生反应性低血糖，尤其有低血糖倾向及全静脉营养疗法突然停用时极易发生。 2(高血糖非酮症昏迷，多见于糖尿病、应激状态、使用大量糖皮质激素、尿毒症腹膜透析者、腹腔内给予高渗透葡萄糖注射液及全静脉营养疗法时容易发生。 3(长期大量应用葡萄糖应注意监测电解质紊乱，长期单纯补充葡萄糖易出现低钾、低钠和低磷血症。 (二)监护二磷酸果糖的滴速， 二磷酸果糖多用于急救，为维持疗效，在部分药品说明书中要求滴速较快，一般l0ml/min(lg/min)，但应注意注射液(除外特殊要求者)的滴速与不良反应发生率密切相关，滴注速度越快，不良反应发生率和反应严重程度越大，尤其是对慢性疾病者和过敏眭休克者，没有必要滴速过快。每日最大用量为200ml，滴速约为l0ml/min (lg/min)，但以4 - 7ml/min为适宜，输注速度过快可致水钠潴留、脑水肿、过敏(面部潮红、心悸、手足蚁走感、头晕、胸闷、皮疹)和输液反应。为减少典型不良反应，对体质虚弱者、心功不全者、过敏体质者、老年人尽可能放慢滴速。同时对伴有心力衰竭者可将剂量减半。 三、主要药品 葡萄糖 【适应证】用于补充能量和体液、低血糖症、高钾血症、饥饿性酮症，高渗透压注射液作为组织脱水剂，配制腹膜透析液、注射药品的溶剂。 二磷酸果糖钠 【适应证】用于心肌缺血引起的各种症状，如心绞痛、心肌梗死和心力衰竭，慢性疾病(酒精中毒、长期营养不良、慢性呼吸衰竭)中出现的低磷血症。 第四节 维生素 一、药理作用与临床评价 (一)作用特点 1(水溶性维生素 (1)维生素B1:参与维持正常的糖代谢及神经、心脏系统功能。缺乏可致神经系统和心血管系统的生理紊乱。可出现下列反应:神经系统反应(干性脚气病)、心血管系统反应(湿性脚气病)、韦尼克脑病及多发神经炎性精神病。 (2)维生素B2:维生素B2促进脂肪、糖、蛋白质的代谢。此外，对皮肤、黏膜和视觉正常功能有一定作用，缺乏维生素B2时，出现典型的维生素B2缺乏症状。首先出现咽喉炎和口角炎，然后为舌炎、唇炎(红色剥脱唇)、面部脂溢性皮炎、躯干和四肢出现皮炎，随后有贫血和神经系统症状。 (3)维生素B6:维生素B6在红细胞内转化为磷酸吡哆醛，维生素B6缺乏的症状主要表现在皮肤和中枢神经系统。神经系统方面表现为周围神经炎、伴有关节肿胀和触痛，特别是腕关节肿胀(腕管病)是由于吡哆醇缺乏所致，应用大剂量吡哆醇治疗可以奏效。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (4)维生素C:在人体内，维生素C是高效抗氧化剂，维生素C尚可减少毛细血管的通透性，减低毛细血管脆性，增加血管弹性，刺激骨髓造血功能，加速红细胞的生长。可用于防治坏血病、牙龈出血、也可用于各种急、慢性传染疾病及紫癜等的辅助治疗。维生素C可促进去铁胺对铁的螯合，使铁的排出加速，故可用于慢性铁中毒的治疗 (5)烟酸 在体内转化为烟酰胺后，发挥药理作用，通过抑制密度蛋白的合成而影响胆固醇的合成，大剂量尚可降低血清胆固醇及三酰甘油的浓度，且有周围血管扩张作用。 (6)叶酸:临床用于治疗巨幼红细胞贫血、血小板减少症。 2(脂溶性维生素 (1)维生素A:维生素A是人体视网膜的杆状细胞感光物质——视紫质的生物合成前体，如体内缺乏，会因视网膜内视紫质的不足而患夜盲症。 (2)维生素D:维生素D能促进小肠对钙的吸收，在婴儿和儿童，维生素D缺乏，从而引起骨生长障碍，即所谓佝偻病。在成人，维生素D缺乏引起骨软化病或成人佝偻病， (3)维生素E:维生素E能促进生殖力，在临床上常用维生素E治疗先兆流产和习惯性流产。 (4)维生素K:是肝脏合成凝血酶原(因子?)的必需物质，并参与凝血因子?、?、X的合成。缺乏维生素K可致上述凝血因子合成障碍，影响凝血过程而引起出血。此时给予维生素K可达到止血作用。 维生素K用于防治维生素K缺乏所致的出血，如阻塞性黄疸、胆瘘、慢性腹泻、广泛肠切除所致肠吸收不良患者，早产儿、新生儿低凝血酶原血症，香豆素类(华法林)或水杨酸类过量及其他原因所致凝血酶原过低等引起的出血的救治。华法林过量易致出血，紧急纠正应缓慢静脉注射维生素K15-10mg(>30min，静注后恢复凝血功能需4h)。当有严重出血或国际化指标(INR)>20时，可应用维生素K110mg、新鲜血浆和凝血酶原复合物缓慢静注。 (二)典型不良反应 1(水溶性维生素(维生素B、C) (1)维生素B1大剂量肌内或静脉注射时，可能发生过敏性反应或休克。 (2)维生素B2大量服用后尿呈黄色;偶见有过敏反应;罕见引起类甲状腺功能亢进症。 (3)长期大量维生素B6可引起严重神经感觉异常，进行性步态不稳至足麻木、手不灵活。妊娠期妇女接受大量的维生素B6后，可致新生儿产生维生素B6依赖综合征。 (4)维生素C偶见腹泻、皮肤红亮、头痛、尿频、恶心、呕吐、胃部不适、胃痉挛、尿频等反应。 大量可能引起尿酸盐、半胱氨酸或草酸盐结石。 2(脂溶性维生素(维生素A. D. E.K) (1)长期、大量服用维生素A可引起慢性中毒，可出现疲乏、软弱、全身不适、发热、颅内压增高、夜尿增多、毛发干枯或脱落、皮肤干燥或瘙痒、体重减轻、四肢疼痛、贫血、眼球突出、剧烈头痛等现象。急性中毒可见异常激动、嗜睡、复视、颅内压增高等症状。 (2)长期、大量服用维生素D可会引起低热、烦躁哭闹、惊厥、厌食、体重下降、肝脏肿大、肾脏损害，骨硬化等症。 (3)大量服用维生素E (400-800mg/d)可引起视物模糊、乳腺肿大、类流感样综合征、胃痉挛、疲乏、软弱。长期超量服用(>800mg/d)，对维生素缺乏者可引起出血倾向。 (4)维生素K1常见呕吐，对红细胞6-磷酸脱氢酶缺乏症者可诱发急性溶血性贫血。 二、用药监护 (一)区分维生素的预防性与治疗性应用 (二)合理掌握维生素剂量 (三)注意联合用药时对维生素吸收和代 谢的影响三、主要药品维生素B1 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 【适应证】用于维生素B1缺乏所致的脚气病或威克尔脑病的治疗，亦可用于维生素B1缺乏引起的周围神经炎、消化不良等的辅助治疗;用于遗传性酶缺陷病，如亚急性坏死性脑脊髓病、支链氨基酸病，也用于全胃肠道外营养及营养不良的补充。 维生素B2 【适应证】用于防治维生素B2缺乏症，如口角炎、唇干裂、舌炎、阴囊炎、角膜血管化、结膜炎、脂溢性皮炎等。 维生素B6 【适应证】用于维生素B6缺乏的预防和治疗，防治药物(青霉胺、异烟肼、环丝氨酸)中毒或引起的维生素B6缺乏、脂溢性皮炎、口唇干裂，也可用于妊娠呕吐及放疗和化疗抗肿瘤所致的呕吐，新生儿遗传性维生素B6依赖综合征、遗传性铁粒幼细胞贫血。 维生素C 【适应证】用于防治坏血病，以及创伤愈合期、急慢性传染病、紫癜及过敏性疾病的辅助治疗;特发性高铁血红蛋白血症的治疗;慢性铁中毒的治疗;克山病患者发生心源性休克时，可用大剂量本品治疗;某些病对维生素C需要量增加，如接受慢性血液透析的患者、发热、创伤、感染、手术后的患者及严格控制饮食、营养不良者。 维生素A 【适应证】用于防治维生素A缺乏症，如角膜软化、干眼病、夜盲症、皮肤角质粗糙等。 维生素D 【适应证】用于预防和治疗维生素D缺乏及维生素D缺乏性佝偻病症，因吸收不良或慢性肝脏疾病所致的维生素D缺乏，甲状旁腺功能不全引起的低钙血症。 维生素E 【适应证】用于吸收不良新生儿、早产儿、低出生体重儿;用于进行性肌营养不良，以及心、脑血管疾病，习惯性流产及不孕症的辅助治疗。 第五节 氨基酸 一、药理作用与临床评价 (一)作用特点氨基酸的主要作用可归纳为: (1)合成蛋白质: (2)氮平衡作用: (3)转变为糖或脂肪 (4)参与酶、激素及部分维生素的组成 各种氨基酸制剂可用于大面积烧伤、创伤、严重感染等应激状态下肌肉分解代谢亢进、消化系统功能障碍、营养恶化及免疫功能低下患者的营养支持，或用于蛋白质摄人不足、吸收障碍等氨基酸不能满足人体代谢需要者;亦用于术后患者改善其营养状态。 (二)典型不良反应 静脉滴注速度过快可致发热、头痛、心悸、寒战，也可致血栓性静脉炎，应及时减慢滴注速度(15 滴,分为宜)，对老年人和危重患者尤应注意。长期大量静脉滴注可致胆汁淤积性黄疸;偶见肝功能损害等。 (三)禁忌证 1(严重氮质血症、严重肝功能不全、肝性脑病昏迷或有向肝性脑病昏迷发展趋势、严重肾衰竭或尿毒症者。 2(对氨基酸有代谢障碍等者。 3(过敏者。 4(心力衰竭者及酸中毒状态等未纠正者。 5(对高氯性酸中毒、肾功能不全及无尿患者禁用。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (四)药物相互作用 1(精氨酸与谷氨酸钠或谷氨酸钾联合应用，可增加治疗肝性脑病的疗效。 2(精氨酸可使细胞内钾转移至细胞外，而螺内酯可减少肾脏钾排泄，两者联用时可引起高钾血症。 有报道合并严重肝脏疾病的代谢性碱中毒患者，在应用螺内酯后应用精氨酸出现严重并可致命的高钾血症。 二、用药监护 (一)注意氨基酸的合理应用 静脉滴注氨基酸的转归有二: (1)合成蛋白质。 (2)分解提供热能。氨基酸能否充分利用于蛋白质合成，取决于合理的热卡,氮比值。在补充氨基酸时，不仅可以减少体内蛋白质的分解，且能促进蛋白质的合成。为达到正常的氮平衡，应使热卡,氮比值达到120—200cal/g，或按每克氨基酸加入5-6g非蛋白质热源的比例输入(葡萄糖、脂肪)，借以提高氨基酸的利用率。 (二)注意监测电解质紊乱 氨基酸的缓冲容量较大，尤其氨基酸复方制剂的可滴定酸度比一般输液剂高，引发酸中毒发生的可能性较大，在氨基酸代谢的过程中可产生大量氯离子，而肾小管对氯离子和碳酸氢盐的重吸收呈倒数关系，致使血浆氯离子量增加，碳酸氢盐的含量降低，从而导致酸中毒。在临床应用尤其是大量应用时，应密切监测患者的酸碱平衡状态，适量加入5%碳酸氢钠注射液，使pH调整至7.4。 (三)注意监测血压 精氨酸是一氧化氮的生物前体，服后可显著降低血压、血液透析者和肾移植受体的平均收缩压。对原发性高血压者，可以改善动脉内皮依赖性介质介导的血管扩张，使血压降低。对妊娠期高血压疾病患者以及有先兆子痫妇女滴注精氨酸，可显著降低收缩压和舒张压。 (四)注意给药的适宜性 三、主要药品 精氨酸 【适应证】用于肝性脑病，适用于忌钠的患者，也适用于其他原因引起血氨增高所致的精神症状治疗，代谢性酸中毒;肠外营养中可能增强免疫功能。 复方氨基酸(18A) 【适应证】用于:(1)不能进食、进食不足或不愿进食者; (2)营养不良(指营养不足)者;(3)肝肾功能基本正常的低蛋白血症者;(4)大面积烧伤、创伤、高分解代谢、蛋白丢失负氮平衡者;(5) 改善外科手术前、后患者的营养状态。 复方氨基酸(9AA) 【适应证】用于急性和慢性肾功能不全患者的肠道外支持;大手术、外伤或脓毒血症引起的严重肾功能衰竭以及急性和慢性紧与衰竭。 [药学专业知识二] 【药圈】执业药师历年真题学习整理之第10章抗菌药物 今天楼主将会给大家继续整理分析执业药师《药学专业知识(二)》历年真题，现在我们看《药学专业知识(二)》第10章(抗菌药物)中2013年和2014年执业药师考试出过哪些试题～ 经查找发现本章在2013年执业药师考试中所占分值为8.5分，其中最佳选择题3分，配伍选择题4.5分，多项选择题1分。如下: 最佳选择题 2.对革兰阴性菌和革兰阳性菌有强烈的杀菌作用，对耐药肠杆菌某些菌株敏感的第四代头孢菌素类是 A.头孢拉定 B.头孢克洛 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions C.头孢匹罗 D.头孢噻肟 E.头孢唑林 游客，如果您要查看本帖隐藏内容请回复 3.属于快速杀菌药，对静止期细菌也有较强杀菌作用的药是 A.β-内酰胺类 B.大环内酯类 C.磺酰胺类 D.林可霉素类 E.氨基糖苷类 游客，如果您要查看本帖隐藏内容请回复 4.哇诺酮类药物的抗菌机制是 A.抑制细胞壁合成 B.抑制细菌蛋白质合成起始阶段 C.改变细菌胞浆膜的通透性 D.抑制细菌mRNA的合成 E.抑制细菌DNA回旋酶和拓扑异构酶IV 游客，如果您要查看本帖隐藏内容请回复 配伍选择题 [25-26] A.青霉素 B.四环素 C.庆大霉素 D.氯霉素 E.头孢唑林 25.治疗钩端螺旋体病、梅毒及回归热宜选用的药物是 26.常发生耳毒性和肾毒性的药物是 游客，如果您要查看本帖隐藏内容请回复 [27-28] A.氨苄西林 B.头孢唑林 C.亚胺培南 D.青霉素 E.氨曲南 27.对大多数革兰阳性菌、革兰阴性菌和厌氧菌均有强大抗菌活性的药物是 28.仅革兰阴性杆菌有强效，对革兰阳性菌、厌氧菌稍差的药物是 游客，如果您要查看本帖隐藏内容请回复 [29-31] A.阿米卡星 B.万古霉素 C.利福平 D.盐酸克林霉素 E.红霉素 29.治疗各种革兰阴性杆菌有效的宜选用的药物是 30.治疗耐甲氧西林金黄色葡萄球菌有效的宜选用的药物是 31.治疗结核病宜选用 游客，如果您要查看本帖隐藏内容请回复 [32-33] A.异烟肼 B.利福平 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions C.乙胺丁醇 D.吡嗪酰胺 E.卡那霉素 32.可引起周围神经炎的是 33.可引起球后视神经炎的是 游客，如果您要查看本帖隐藏内容请回复 多项选择题 74.奎诺酮类药可治疗的疾病 A.伤寒 B.复杂性尿路感染 C.敏感细菌引起的呼吸道感染 D.格兰阳性菌引起的骨髓和关节炎 E.梅毒 游客，如果您要查看本帖隐藏内容请回复 本章在2014年执业药师考试中所占分值为10.5分，其中最佳选择题4分， 配伍选择题4.5分，多项选择题2分。如下: 最佳选择题 2(反应抗菌药物抗菌活性的主要指标是 A(抗菌谱 B(化疗指数 C(最低抑菌或杀菌浓度 D(安全系数 E(效价强度 游客，如果您要查看本帖隐藏内容请回复 3(治疗产青霉素酶的金黄色葡萄球菌感染宜选用的药物是 A(青霉素 V B(双氯西林 C(氨苄西林 D(阿莫西林 E(替卡西林 游客，如果您要查看本帖隐藏内容请回复 4(治疗鼠疫宜选用的药物是 A(庆大霉素 B(青霉素 C(链霉素 D(阿米卡星 E(奈替米星 游客，如果您要查看本帖隐藏内容请回复 5(仅用于治疗浅部真菌感染的药物 A(伊曲康唑 B(甲硝唑 C(特比萘芬 D(氟胞嘧啶 E(两性霉素B 游客，如果您要查看本帖隐藏内容请回复 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 配伍选择题 【29-31】 A(抑制 RNA 聚合酶 B(抑制二氢叶酸还原酶 C(抑制二氢蝶酸合酶 D(抑制拓扑异构酶 IV E(抑制肽酰基转移酶 29(磺胺类抗菌作用机制是 30(利福平抗菌作用机制是 31(甲氧苄啶抗菌作用机制是 游客，如果您要查看本帖隐藏内容请回复 【32-35】 A(伪膜性肠炎 B(耳毒性 C(牙釉质发育障碍 D(肌腱炎 E(再生障碍性贫血 32(喹诺酮类引起的不良反应是 33(氯霉素引起的不良反应是 34(氨基糖甘类引起的不良反应是 35(四环素类引起的不良反应是 游客，如果您要查看本帖隐藏内容请回复 【38-39】 A(异烟肼 B(对氨基水杨酸 C(利福平 D(乙胺丁醇 E(环丙沙星 38(可引起周围神经炎的药物是 39(可引起球后视神经炎的药物是 游客，如果您要查看本帖隐藏内容请回复 多项选择题 74( 红霉素的药理作用和临床应用有 A( 抑制细菌蛋白质合成 B( 治疗大肠杆菌引起的肠炎 C( 治疗支原体引起的肺炎 D( 治疗衣原体引起的尿道炎 E( 干扰细菌核酸代谢 游客，如果您要查看本帖隐藏内容请回复 75(甲氨苄啶和磺胺甲噁唑联合应用的目的有 A(减少代谢 B(减少排泄 C(协同抗菌 D(防止发生叶酸缺乏症 E(防止产生耐药菌株 游客，如果您要查看本帖隐藏内容请回复 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 通过上面二年的这章真题分析，本章内容较重要，推测本章在2015年执 业药师考试中约有17,21分的试题(2015年每科满分为120分)～ 本章主要药物: 青霉素、氨苄西林、阿莫西林、哌拉西林、苄星青霉素、阿莫西林克(一)青霉素类抗菌药物 拉维酸钾 头孢唑林、头孢氨苄、头孢拉定、头孢呋辛、头孢克洛、头孢地尼、 (二)头孢菌素类抗菌药物 头孢克肟、头孢噻肟、头孢曲松、头孢哌酮、头孢哌酮舒巴坦、头孢 他啶、头孢吡肟 (三)其他β-内酰胺类抗菌药头孢美唑、头孢西丁、头孢米诺、拉氧头孢、氨曲南、亚胺培南西司 物 他丁、美罗培南、厄他培南 (四)氨基糖苷类抗菌药物 链霉素、庆大霉素、阿米卡星、依替米星、大观霉素 十 (五)大环内酯类抗菌药物 红霉素、琥乙红霉素、罗红霉素、克拉霉素、阿奇霉素 (六)四环素类抗菌药物 四环素、米诺环素、多西环素 (七)林可霉素类抗菌药物 林可霉素、克林霉素 抗 万古霉素、去甲万古霉素、替考拉宁、多黏菌素E(黏菌素)、多黏(八)多肽类抗菌药物 菌 菌素 (九)酰胺醇类抗菌药物 氯霉素、甲砜霉素 药 (十)氟喹诺酮类抗菌药物 诺氟沙星、环丙沙星、左氧氟沙星、莫西沙星 物 (十一)硝基呋喃类抗菌药物 呋喃妥因 (十二)硝基咪唑类抗菌药物 甲硝唑、替硝唑 (十三)磺胺类抗菌药物及甲氧磺胺嘧啶、磺胺甲噁唑、甲氧苄啶 苄啶 (十四)其他抗菌药物 磷霉素、利奈唑胺、夫西地酸、小檗碱 (十五)抗结核分枝杆菌药 异烟肼、利福平、吡嗪酰胺、乙胺丁醇、对氨基水杨酸钠 两性霉素B、氟康唑、伊曲康唑、伏立康唑、特比萘芬、卡泊芬净、(十六)抗真菌药 米卡芬净、氟胞嘧啶 【真题】西药专二第10章抗菌药物，预计20分 2015-08-07 药圈 今天给大家分享的是药圈三碗不过冈整理的药学专业知识二第10章抗菌药物预计能考 下角阅读原文更有他分享的重20分。他给我们找到了这一章近两年考过的真题。～左 点内容，希望大家支支持下分享者～ risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 本章在2014年执业药师考试中所占分值为10.5分，其中最佳选择题4分，配伍选择题4.5分，多项选择题2分。如下: 最佳选择题 2(反应抗菌药物抗菌活性的主要指标是 A(抗菌谱 B(化疗指数 C(最低抑菌或杀菌浓度 D(安全系数 E(效价强度 答案及解析请点击这里 【答案】C 【解析】抗菌活性指抗菌药物抑制或杀灭病原菌的能力。能抑制培养基内细菌生长的最低浓度称最低抑菌浓度(MIC)，能够杀灭培养基内细菌(即杀死99.9%供试微生物)的最低浓度称为最低杀菌浓度(MBC)。 3(治疗产青霉素酶的金黄色葡萄球菌感染宜选用的药物是 A(青霉素 V B(双氯西林 C(氨苄西林 D(阿莫西林 E(替卡西林 答案及解析请点击这里【答案】B 【解析】耐酶青霉素类主要有:甲氧西林、苯唑西林、氯唑西林、氟氯西林、双氯西林。临床主要用于耐青霉素酶的金黄色葡萄球菌感染，如败血症、心内膜炎、肝脓肿。 4(治疗鼠疫宜选用的药物是 A(庆大霉素 B(青霉素 C(链霉素 D(阿米卡星 E(奈替米星 答案及解析请点击这里【答案】C 【解析】链霉素临床首选用于治疗土拉菌病和鼠疫，特别是与四环素联合用药已成为目前治疗鼠疫的最有效手段。 5(仅用于治疗浅部真菌感染的药物 A(伊曲康唑 B(甲硝唑 C(特比萘芬 D(氟胞嘧啶 E(两性霉素B 答案及解析请点击这里【答案】C 【解析】特比萘芬对浅部真菌有杀菌作用;伊曲康唑为三唑类广谱抗真菌 药，可抗大部分浅部真菌和深部真菌;两性霉素B是目前治疗深部真菌感染的首选药;氟胞嘧啶主要用于念珠菌、隐球菌和其他敏感真菌所引起的肺部感染、尿路感 染、败血症、心内膜炎等的治疗，疗效不如两性霉素B，临床上常将两药合用治疗深部真菌感染;甲硝唑为治疗阴道滴虫病的首选药，临床上主要用于治疗厌氧菌感 染包括由厌氧菌引起的产后盆腔感染、肺脓肿、胸膜感染、败血症、骨髓炎、脓毒性关节炎、气性坏疽等，还可用于防治阑尾、结肠、妇产科手术感染。 配伍选择题 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 【29-31】 A(抑制 RNA 聚合酶 B(抑制二氢叶酸还原酶 C(抑制二氢蝶酸合酶 D(抑制拓扑异构酶 IV E(抑制肽酰基转移酶 29(磺胺类抗菌作用机制是 30(利福平抗菌作用机制是 31(甲氧苄啶抗菌作用机制是 答案及解析请点击这里29、【答案】C 【解析】磺胺类药物与PABA的结构相似，可与PABA竞争二氢蝶酸合成酶，阻止细菌二氢蝶酸的合成，从而抑制细菌的生长繁殖。 30、【答案】A 【解析】利福平与依赖DNA的RNA的多聚酶的β亚单位牢固结合，阻止该酶与DNA链接，阻断RNA的转录工程，从而抑制细菌RNA的合成。 31、【答案】B 【解析】甲氧苄啶是强大的细菌二氢叶酸还原酶抑制剂。 【32-35】 A(伪膜性肠炎 B(耳毒性 C(牙釉质发育障碍 D(肌腱炎 E(再生障碍性贫血 32(喹诺酮类引起的不良反应是 33(氯霉素引起的不良反应是 34(氨基糖甘类引起的不良反应是 35(四环素类引起的不良反应是 答案及解析请点击这里 32、【答案】D 【解析】喹诺酮类抗菌药的不良反应:消化道反应;神经系统反应;变态反应;光过敏反应和光毒性反应;肌肉、骨骼系统反应:可致患者关节病变、肌腱炎或肌腱断裂等;肝损害。 33、【答案】E 【解析】氯霉素最严重的不良反应有(1)与剂量有关的可逆性骨髓抑制;(2)与剂量无关的骨髓毒性反应:常表现为严重的、不可逆性再生障碍性贫血。 34、【答案】B 【解析】氨基糖苷类的不良反应:耳毒性;肾毒性;神经肌肉毒性;变态反应 35、【答案】A 【解 析】四环素类的典型不良反应:(1)四环素牙——与钙离子形成的螯合物在体内呈黄色，沉积于牙齿和骨中，造成牙齿黄染，并影响胎儿、新生儿和婴幼儿骨骼的 正常发育。(2)肝毒性。(3)肠道菌群失调——轻者引起维生素缺乏，严重二重感染，亦可发生难辨梭菌性抗生素相关性腹泻(伪膜性肠炎)。 注:伪膜性肠炎在2015版教材未提到，出现在2014版及之前教材中。 【38-39】 A(异烟肼 B(对氨基水杨酸 C(利福平 D(乙胺丁醇 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions E(环丙沙星 38(可引起周围神经炎的药物是 39(可引起球后视神经炎的药物是 答案及解析请点击这里38、【答案】A 【解析】异烟肼可引起周围神经炎。 39、【答案】D 【解析】乙胺丁醇较严重的毒性反应为球后神经炎。 多项选择题 74( 红霉素的药理作用和临床应用有 A( 抑制细菌蛋白质合成 B( 治疗大肠杆菌引起的肠炎 C( 治疗支原体引起的肺炎 D( 治疗衣原体引起的尿道炎 E( 干扰细菌核酸代谢 答案及解析请点击这里 【答案】ACD 【解析】大环内酯类抗生素通过抑制细菌蛋白质合成发挥抗菌 作用。红霉素是治疗军团菌病、百日咳、空肠弯曲菌肠炎和支原体肺炎的首选药。也常用于治疗厌氧菌引起的口腔感染和肺炎支原体、溶脲脲原体等非典型病原体所 致的呼吸及泌尿生殖系统感染。红霉素可在妊娠期间作为一线药物治疗泌尿生殖系统衣原体感染，也可用于四环素类禁忌症如婴儿期衣原体肺炎和新生儿眼炎。 75(甲氨苄啶和磺胺甲噁唑联合应用的目的有 A(减少代谢 B(减少排泄 C(协同抗菌 D(防止发生叶酸缺乏症 E(防止产生耐药菌株 答案及解析请点击这里【答案】【ACE 【解析】复方新诺明是甲氧苄啶(TMP)和磺胺甲噁唑的复方制剂，其协同抗菌作用是由于二者配伍后，可使细菌的叶酸代谢受到双重阻断，从而产生显著的协同抗菌效应，并使抑菌作用专为杀菌作用，减少耐药菌株产生。 通过上面二年的这章真题分析，本章内容较重要，推测本章在2015年执业药师考试中约有17,21分的试题(2015年每科满分为120分)～ [药学专业知识二] 【药圈】执业药师历年真题学习整理之第11章抗病毒药 今天楼主将会给大家继续整理分析执业药师《药学专业知识(二)》历年真题，现在我们看《药学专业知识(二)》第11章(抗病毒药)中2013年和2014年执业药师考试出过哪些试题～ 经查找发现本章在2013年执业药师考试中所占分值为1分，其中最佳选择题1分，配伍选择题0分，多项选择题0分。如下: 最佳选择题 5.治疗带状胞疹宜选用的药物是 A.拉米夫定 B.金刚乙胺 C.齐多夫定 E.扎那米韦 E.阿昔洛韦 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 游客，如果您要查看本帖隐藏内容请回复 本章在2014年执业药师考试中所占分值为0分，其中最佳选择题0分，配伍选择题1分，多项选择题0分。如下: 【36-37】 A( 疱疹病毒感染 B(流感病毒感染 C(麻疹病毒感染 D(乙型脑炎病毒感染 E(人类免疫缺陷病毒(HIV)感染 36(齐多夫定可治疗的疾病是 37(阿昔洛韦可治疗的疾病是 游客，如果您要查看本帖隐藏内容请回复 通过上面二年的这章真题分析，推测本章在2015年执业药师考试中约有2分的试题(2015年每科满分为120分)～ 本章主要药物: 利巴韦林、奥司他韦、阿昔洛韦、更昔洛韦、泛昔洛韦、阿糖腺苷、膦甲酸钠、十 一 、抗病毒药 抗病毒药 拉米夫定 [药学专业知识二] 【药圈】执业药师历年真题学习整理之第12章抗寄生虫药 今天楼主将会给大家继续整理分析执业药师《药学专业知识(二)》历年真题，现在我们看《药学专业知识(二)》第12章(抗寄生虫药)中2013年和2014年执业药师考试出过哪些试题～ 经查找发现本章在2013年执业药师考试中所占分值为1分，其中最佳选择题1分，配伍选择题0分，多项选择题0分。如下: 最佳选择题 6.按制疟疾复发和传播宜选用的抗疟药是 A.乙胺嘧啶 B.伯氨奎 C.青蒿素 C.氯奎 E.奎宁 游客，如果您要查看本帖隐藏内容请回复 本章在2014年执业药师考试中所占分值为1分，其中最佳选择题0分，配伍选择题0分，多项选择题1分。如下: 多项选择题 84( 左旋咪唑的临床应用有 A( 器官移植后的抗排斥 B( 肿瘤放化疗的辅助治疗 C( 肺结核 D( 蛔虫病 E( 红斑狼疮 游客，如果您要查看本帖隐藏内容请回复 通过上面二年的这章真题分析，推测本章在2015年执业药师考试中约有2分的试题(2015年每科满risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 分为120分)～ 本章主要药物: (一)抗疟药 氯喹、青蒿素、奎宁、伯氨喹、乙胺嘧啶 十二 抗寄生虫药 (二)抗肠蠕虫药 哌嗪、阿苯达唑、甲苯咪唑、噻嘧啶、吡喹酮 [药学专业知识二] 【药圈】执业药师学习整理之第13章抗肿瘤药 《药学专业知识(二)》的第13章(抗肿瘤药)在2014年之前的教材中所占比例较小(10页)， 经查找发现本章在2013年和2014年执业药师考试中均未考查到。在2015年的新版教材中比例增加 (达到37页)，预计所占分数为4分。 本章主要药物: (一)直接影响DNA结构和功能的环磷酰胺、塞替派、顺铂、奥沙利铂、卡铂、丝裂霉素、博来 药 霉素、羟喜树碱、伊立替康、依托泊苷 十 三 (二)干扰核酸生物合成的药物(抗氟尿嘧啶、阿糖胞苷、甲氨蝶呤、巯嘌呤 代谢药) 抗 (三)干扰转录过程和阻止RNA合 多柔比星、柔红霉素 成的药物(作用于核酸转录药物) 肿 (四)抑制蛋白质合成与功能的药物长春新碱、长春碱、紫杉醇、多西他赛、高三尖杉酯碱、门冬瘤 (干扰有丝分裂药) 酰胺酶 (五)调节体内激素平衡的药物 他莫昔芬、托瑞米芬、氟他胺 药 (六)靶向抗肿瘤药 吉非替尼、厄洛替尼、利妥昔单抗、曲妥珠单抗、西妥昔单抗 (七)放疗与化疗止吐药 昂丹司琼、阿瑞吡坦 本章主要内容如下: 第十三章 抗肿瘤药 第一节:直接影响DNA结构和功能的药物可以分为 (1)破坏DNA的烷化剂:环磷酰胺、白消安、司莫司汀、氮芥。 (2)破坏DNA的铂类化合物:顺铂、卡铂。 (3)破坏DNA的抗生素类药物:博来霉素、丝裂霉素。 (4)拓扑异构酶抑制剂:羟喜树碱、依立替康。 第一亚类:破坏DNA的烷化剂 一、药理作用与临床评价 1、氮芥是最早应用的烷化剂，主要用于恶性淋巴瘤和慢性淋巴细胞白血病;也可用于恶性肿瘤特别 是小细胞肺癌所致的上腔静脉综合征。 2、环磷酰胺抗瘤谱较广，对恶性淋巴瘤疗效显著;塞替派局部刺激性小，可采取多种给药方式。 3、卡莫司汀脂溶性大，能透过血一脑屏障进入脑组织，可用于原发性脑瘤、脑转移瘤、脑膜白血病 等。 4、烷化剂几乎具有细胞毒类药所有典型的不良反应，骨髓功能抑制为最为常见的不良反应。 5、在药物特异性不良反应中，氮芥、环磷酰胺、卡莫司汀可出现中度恶心呕吐;环磷酰胺可出现出 血性膀胱炎。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 6、所有的烷化剂都是通过与细胞中DNA发生共价结合，使其丧失活性或使DNA分子发生断裂，导致肿瘤细胞死亡。 7、由于烷化剂对细胞有直接毒性作用，故又被称为细胞毒类药物。 (二)典型不良反应 1、骨髓功能抑制表现在白细胞计数、血小板、红细胞计数和血红蛋白下降。除长春新碱和博来霉素外几乎所有的细胞毒药，均可导致骨髓抑制。 2、口腔黏膜反应常见症状有咽炎、口腔溃疡、口腔黏膜炎。抗肿瘤药所引起的脱发几乎在l或2周后可发生。 3、化疗可诱导高尿酸血症，且与急性肾衰竭有关。 4、大多数细胞毒类药都有致畸性，对妊娠及哺乳期妇女禁用。 5、出血性膀胱炎是泌尿系统毒性的表现，使用异环磷酰胺及大剂量环磷酰胺时会出现，这是由于代谢物丙烯醛所致。 (三)禁忌证 对药物过敏者、妊娠及哺乳期妇女、严重肝肾功能损害者、骨髓功能抑制者、感染患者、肝肾功能损害者。 (四)药物相互作用 1(环磷酰胺 肝药酶诱导剂如巴比妥类、糖皮质激素、别嘌醇及氯霉素等对本品的代谢、活性和毒性均有影响，并用时应注意。 2(司奠司汀选用司莫司汀进行化疗时，应避免同时联合其他对骨髓抑制较强的药物。 3(塞替派 (1)塞替派可增加血尿酸水平，为控制高尿酸血症可给予别嘌醇。 (2)与尿激酶同时应用，可增加塞替派治疗膀胱癌的疗效，尿激酶为纤维蛋白溶酶原的活化剂，可增加药物在肿瘤组织中的浓度。 4(白消安 由于服用本品可增加血尿酸及尿尿酸水平，因此对原合并痛风或服本品后血尿酸增加的患者，可服适量的抗痛风药。若服本品的同时或曾于短期内用过其他抑制骨髓的药物或放射治疗者，可酌情减量。 二、用药监护 (一)骨髓功能抑制 骨髓功能抑制常出现在给药后的7-10日，因此，在一次治疗前必须检查外周末梢血象。如骨髓功能尚未恢复，应酌情减少用药剂量或推迟治疗时间。对中性白细胞计数减少或由此带来的发热患者，应当使用重组粒细胞集落刺激因子(G– CSF)，必要时考虑给予抗菌药物治疗。 (二)应对口腔黏膜反应 抗肿瘤药的细胞毒性首先损伤上皮细胞，导致口腔黏膜反应，如咽炎、口腔溃疡、口腔黏膜炎。黏膜反应是肿瘤化疗中常见的一种并发症，应对口腔溃疡的措施有:(1)进行有效口腔护理(常用3%碳酸氢钠、1.5%过氧化氢、0.1%氯己定溶液漱口)。(2)真菌感染应用制霉素液(l000U/l00ml)漱口。(3)局部应用硫糖铝一利多卡因一苯海拉明组成的糊剂，并应用氯己定口腔溃疡膜、口腔溃疡软膏。 (三)抗肿瘤药药液外渗时的应对 (1)当化疗药渗漏时，应即停止注射。(2)根据化疗药的特性采取相应的防治措施。一般可用1%普鲁卡因注射液局部封闭，局部进行冷敷(禁忌热敷)，以减轻皮肤坏死的机会。(3)局部使用解毒剂是化疗药外渗处理的重要环节，根据药物渗出量和范围做局部皮下封闭，即有疼痛或肿胀区域行多点注射:?地塞米松5mg加利多卡因l00mg局部封闭，一日1次，连续3天，以减轻局部疼痛和炎症反应; risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions ?给予氢化可的松琥珀酸钠50-200mg或5%碳酸氢钠5ml加地塞米松4mg，局部静脉注射或渗漏部位多处皮下注射;?透明质酸酶300U加0.9%氯化钠注射液2ml局部注射或透明质酸酶2ml加地塞米松5mg加5%利多卡因2ml局部注射。 (四)应用环磷酰胺应监护膀胱毒性，环磷酰胺的水解物丙烯醛可刺激膀胱，大剂量使用，缺乏有效预防措施时，可致出血性膀胱炎，表现为少尿、血尿、蛋白尿，由其代谢物丙烯醛刺激膀胱所致。 (1)应用本品时应鼓励患者多饮水，大剂量应用时应水化、补液利尿，以保障足量的液体和尿量。为预防白血病及淋巴瘤患者出现尿酸性肾病，可大量补液、碱化尿液和给予别嘌醇。为防止水中毒，可同时给予呋塞米。 (2)美司钠可防止膀胱毒性的发生，常规用于环磷酰胺的治疗过程。美司钠一般静脉注射，常用剂量为环磷酰胺的20%，时间为0、4h后及8h后的时段。 三、主要药品 环磷酰胺 【适应证】用于恶性淋巴瘤、急性或慢性淋巴细胞白血病、多发性骨髓瘤、乳腺癌、睾丸肿瘤、卵巢癌、肺癌、头颈部鳞癌、鼻咽癌、神经母细胞癌、横纹肌肉瘤及骨肉瘤。 噻替哌 【适应证】用于乳腺癌、卵巢癌、癌性体腔积液的腔内注射、膀胱癌的局部灌注、胃肠道肿瘤。 第二亚类:破坏DNA的铂类化合物 一、药理作用与临床评价 (一)作用特点 1、铂类化合物可与DNA结合，破坏其结构与功能，使肿瘤细胞DNA复制停止，阻碍细胞分裂，为细胞增殖周期非特异性抑制剂。 2、铂类化合物的抗瘤谱非常广泛，常用铂类化合物有顺铂、卡铂和奥沙利铂。顺铂是非小细胞肺癌、头颈部及食管癌、胃癌、卵巢癌、膀胱癌、恶性淋巴瘤、骨肉瘤及软组织肉瘤等实体瘤的首选药之一;卡铂抗瘤谱与顺铂类似，多用于非小细胞肺癌、头颈部及食管癌、卵巢癌等;而奥沙利铂是胃肠道癌的常用药，是结直肠癌的首选药之一。 (二)典型不良反应 1、常见消化道反应(恶心、呕吐、腹泻)、肾毒性、耳毒性、神经毒性、低镁血症等，也可出现骨髓功能抑制、过敏反应。 2、由于分子结构上的差异，导致三种铂类化合物的各自毒性亦有所区别，如顺铂典型不良反应为恶心、呕吐、肾毒性和耳毒性，骨髓功能抑制相对较轻;卡铂引起的恶心和呕吐的严重程度比顺铂轻，在肾毒性、神经毒性和耳毒性方面的问题比顺铂少，但骨髓抑制比顺铂严重;奥沙利铂的神经毒性(包括感觉周围神经病)是剂量依赖性的，在累积量超过800mg/m2时，在部分患者可导致永久性感觉异常和功能障碍。 (三)禁忌证 1(卡铂 对卡铂或其他铂类化合物有过敏史者;有严重骨髓抑制、出血性肿瘤、严重肾功能不全者及妊娠期妇女。 2(顺铂肾功能不全者、对顺铂或其他含铂类化合物过敏者及妊娠期妇女。 3(奥沙利铂 对奥沙利铂或其他铂类化合物过敏者、妊娠及哺乳妇女。 二、用药监护 (一)关注顺铂所致的肾毒性 肾毒性是大剂量顺铂化疗最常见、最严重的并发症之一。 应对措施有:(1)化疗时严格按医嘱用药，用药后及时给予利尿剂，一日水摄入量维持在3000—3500ml，使尿量维持在2500ml以上，水化过程中注意观察液体超负荷病症并及时处理。(2)risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 定期监测血电解质、肾功能，同时观察24h尿量及尿液颜色，鼓励患者多饮水，促进毒物排泄，以防尿酸结晶形成造成肾功能损害。(3)必要时给予碳酸氢钠碱化尿液和别嘌醇，抑制尿酸形成，监测尿液的酸碱度，pH保持在6.5,7之间，准确24h尿量，密切观察尿量变化。(4)对可能出现问题的要防患于未然，肾功能不全者慎用。 (二)应用卡铂应监护骨髓造血功能等 应对措施有:(1)有明显骨髓功能抑制和肝肾功能不全者、对顺铂或其他铂化合物过敏者、对甘露醇过敏者(本品注射剂中含有甘露醇)、妊娠及哺乳期妇女禁用。水痘、带状疱疹、感染、肾功能不全及老年患者慎用。(2)应用本品前应监测血象及肝肾功能，治疗期间至少每周检查1次白细胞计数与血小板。(3)在用药期间，应随访监测以下指标:?听力;?神经功能;?血尿素氮、肌酐清除率与血肌酐测定;?血细胞比容，血红蛋白测定，白细胞计数分类与血小板计数;?血清钙、镁、钾、钠含量的测定。 (三)仔细监测奥沙利铂的神经系统毒性特别是与其他有神经系统毒性的药物合用时。(1)每一次治疗前都要进行神经系统检查，以后定期复查。(2)如患者出现神经系统症状(感觉障碍、痉挛)，应依据症状持续的时间和严重程度推荐以下方法调整奥沙利铂的剂量。(3)应告知患者治疗停止后，周围感觉神经病变症状可能持续存在。辅助治疗停止后，局部中度感觉异常或影响日常活动的感觉异常可能持续3年以上。(4)由于遇冷可加重奥沙利铂的神经毒性，甚至可因咽喉痉挛而致严重后果，在临床使用奥沙利铂期间及其后一段时间内应避免受凉，如禁食冷饮冷水(果汁)、接触凉物及避风等。 (四)注意选择适宜的溶剂卡铂和奥沙利铂在葡萄糖溶液中稳定，使用中应采用5%葡萄糖注射液溶解输注;顺铂在0.9%氯化钠注射液中更为稳定，同时应注意避光，以保证药物的稳定性，大剂量(30mg/m2以上)应用时，需要加强水化和利尿。 三、主要药品 顺铂 【适应证】用于非精原细胞性生殖细胞癌，晚期顽固性卵巢癌，晚期顽固性膀胱癌，顽固性头颈鳞状细胞癌姑息治疗。 奥沙利铂 【适应证】用于经过氟尿嘧啶治疗失败后的结、直肠癌转移的患者，可单独或联合氟尿嘧啶使用。 卡铂 【适应证】用于晚期上皮来源的卵巢癌的第一线治疗和其他治疗失败后第二线治疗，小细胞肺癌和头颈区鳞癌。 第三亚类 破坏DNA的抗生素 一、药理作用与临床评价 (一)作用特点 1、破坏DNA的抗生素类抗肿瘤药有丝裂霉素和博来霉素。丝裂霉素的作用机制与烷化剂相同，博来霉素可使DNA单链断裂而抑制肿瘤细胞的增殖。 (二)典型不良反应 1(丝裂霉素 十分常见的是骨髓功能抑制，可致白细胞及血小板计数减少，白细胞减少常发生于用药后28-42日，一般在42—56日恢复。恶心、呕吐反应常发生于给药后l—2h，呕吐于3,4h内停止，恶心可持续2-3日。少见间质性肺炎、不可逆的肾衰竭等。 2(博来霉素 常见间质性肺炎(肺毒性)、白细胞计数减少;少见食欲减退、呕吐、厌食、口内炎、腹泻、皮疹、荨麻疹、发热伴红皮症;罕见过敏性休克。 (三)禁忌证 1(丝裂霉素有过敏史、水痘或带状疱疹、妊娠及哺乳期妇女。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 2(博来霉素 有过敏史、严重肺部疾患、严重弥漫性肺纤维化、严重肾功能不全、严重心脏疾病、胸部及其周围接受放射治疗者、妊娠及哺乳期妇女。 二、用药监护 (一)应用丝裂霉素需监护肝肾损害 (1)对肝损害或肾损害、骨髓功能抑制、合并感染症、水痘患者慎用。(2)小儿用药应慎重，尤应注意不良反应的出现，并考虑对性腺的影响。(3)本品会引起骨髓功能抑制等严重不良反应，故应频繁进行临床监测(血液检查、肝肾功能等)，注意观察患者状态。若出现异常应减量或暂停并适当处置。另外，长期用药会加重不良反应呈迁延性推移，故应慎重给药。(4)充分注意感染症状、出血倾向的出现或恶化。 (5)给药时:?静脉内给药时，有时会引起血管痛、静脉炎、血栓，故应充分注意注射部位和注射方法等，尽量减慢注射速度。若药液从血管泄漏，则会引起注射部位硬结、坏死，故应慎重给药以免药液泄漏。?动脉内给药时，有时会出现动脉支配区域的疼痛，发红，红斑、水疱、糜烂、溃疡等皮肤损害，导致皮肤及肌肉坏死，若出现此类症状应停药并适当处置。?肝动脉内给药时，会因药液流入靶位以外的动脉而引起胃及十二指肠溃疡、出血、穿孔等，故应以造影等方法充分确认导管先端位置及药物分布范围，随时注意导管的脱逸、移动、注入速度等。另外，若出现此类症状应停药并适当处置。 (二)注意博来霉素的肺毒性 (1)博来霉素所致间质性肺炎，捻发音是最初出现的体征，当发现异常时应立即停药，按特发性肺纤维化处置，给予糖皮质激素及抗生素预防继发感染。(2)肺功能基础较差者，间质性肺炎化出现频率较高，总剂量应在150mg以下。(3)用药过程中出现发热、咳嗽、活动性呼吸困难等，应立即停药。进行胸部X线检查、血气分析、动脉氧分压、一氧化碳扩散度等相关检查。随后2个月定期检查。(4)血气分析、动脉氧分压等每周检查1次，持续2周以上。出现下降时应立即停药。 三、主要药品 丝裂霉素 【适应证】用于胃癌、结肠及直肠癌、肺癌、胰腺癌、肝癌、官颈癌、官体癌、乳腺癌、头颈区肿瘤、膀胱肿瘤。 博来霉素 【适应证】用于皮肤恶性肿瘤、头颈部肿瘤(颌癌、舌癌、唇癌、咽部癌、口腔癌等)、肺癌(尤其是原发和转移性鳞癌)、食管癌、恶性淋巴瘤(网状细胞肉瘤、淋巴肉瘤、何杰金瘤)、子宫颈癌、神经胶质瘤、甲状腺癌。 第四亚类:拓扑异构酶抑制剂 一、药理作用与临床评价 (一)作用特点 1、拓扑异构酶抑制剂是直接抑制拓扑异构酶，阻止DNA复制及抑制RNA合成。 拓扑异构酶I抑制剂的代表药有依立替康、拓扑替康、羟喜树碱;拓扑异构酶?抑制剂的代表药有依托泊苷、替尼泊苷。 2、喜树碱有较强的细胞毒性，对消化道肿瘤(如胃癌、结肠直肠癌)、肝癌、膀胱癌和白血病等有较好的疗效。但是毒性比较大，主要表现为尿频、尿痛和血尿等。 (二)典型不良反应 1(羟喜树碱可见呕吐、食欲减退、骨髓功能抑制、尿急、尿痛、血尿、蛋白尿及脱发。 2(依立替康 迟发性腹泻和中性粒细胞减少为依立替康的剂量限制性毒性。迟发性腹泻多发生在给药后5天，平均持续4天，严重者致死。血液系统可见中性粒细胞减少、血小板计数减少、贫血、乙酰胆碱综合征。 3(依托泊苷可见骨髓抑制、白细胞及血小板计数减少、口腔炎、脱发、低血压及喉痉挛。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (三)禁忌证 1(依立替康对本品过敏者、慢性肠炎或肠梗阻者、胆红素超过正常值上限1.5倍者、严重骨髓功能衰竭者、WHO行为状态评分>2者、妊娠及哺乳期妇女。 2(依托泊苷 骨髓功能抑制者、白细胞计数和血小板明显低下者、心肝肾功能严重障碍者、妊娠期妇女。本品含苯甲醇，禁用于儿童肌内注射。 二、用药监护 (一)监护由依立替康所致的迟发性腹泻 (1)应告知患者在使用本品24h后及在下周期化疗前任何时间均有发生迟发性腹泻的危险。静脉滴注后发生首次稀便的中位时间是第5天，一旦发生应即开始适当治疗。(2)一旦出现第一次稀便，患者需开始饮用大量含电解质的饮料并马上开始抗腹泻治疗。(3)推荐的抗腹泻治疗措施为:高剂量的洛哌丁胺(2mg/2h)，这种治疗需持续到最后一次稀便结束后12h，中途不得更改剂量，本品有导致麻痹性肠梗阻的危险。故所有患者以此剂量用药不得少于12h，但也不得连续使用超过48h。(4)当腹泻合并严重的中性粒细胞减少症(粒细胞计数?0.05×109/L)时，应用广谱抗生素预防性治疗。(5)曾出现严重腹泻患者，在下个周期用药应酌减剂量。 (二)应用依立替康期间应监测血象 应用依立替康治疗期间，每周应查全血细胞计数，患者应了解中性粒细胞减少的危险性及发热的意义，发热性中性粒细胞减少症(体温>38?，中性粒细胞计数?0.1×109/L)，应立即住院静脉滴注广谱抗菌药物治疗。 若出现急性胆碱能综合征(早发性腹泻及其他不同症状如出汗、腹部痉挛、流泪、瞳孔缩小及流涎)，应使用硫酸阿托品治疗(0.25mg皮下注射)。对气喘的患者应小心谨慎。对有急性、严重的胆碱能综合征患者，下次使用本品时，应预防性使用硫酸阿托品。 使用本品24h内，有可能出现头晕及视物障碍，请勿驾车或操作机械。 三、主要药品 羟喜树碱 【适应证】用于胃癌、结肠及直肠癌、肺癌、胰腺癌、肝癌、宫颈癌、官体癌、乳腺癌、头颈区肿瘤、膀胱肿瘤。 伊立替康 【适应证】用于晚期大肠癌，可与氟尿嘧啶、亚叶酸钙联合用，单独用药氟尿嘧啶化疗失败者。 依托泊苷 【适应证】用于治疗小细胞及非小细胞肺癌、恶性淋巴瘤、恶性生殖细胞瘤、白血病、神经母细胞瘤、横纹肌肉瘤、卵巢瘤、胃癌及食管癌。 第二节:干扰核酸生物合成的药物(抗代谢药) 一、药理作用与临床评价 (一)作用特点 1、根据药物主要干扰的生化步骤或所抑制的靶酶的不同进行分类。 (1)二氢叶酸还原酶抑制剂:包括甲氨蝶呤、培美曲塞。 (2)胸腺核苷合成酶抑制剂:氟尿嘧啶、卡培他滨。 (3)嘌呤核苷合成酶抑制剂:巯嘌呤、硫鸟嘌呤。 (4)核苷酸还原酶抑制剂:羟基脲。 (5)DNA多聚酶抑制剂:阿糖胞苷、吉西他滨。 2、常用药物包括甲氨蝶呤、嘌呤和嘧啶衍生物等。抗代谢药主要用于治疗急性白血病和恶性淋巴瘤，也用于治疗一些实体瘤如乳腺癌、胃肠道癌、绒毛膜上皮癌、骨肉瘤等。 (二)典型不良反应 氟尿嘧啶:急性毒性-恶心呕吐腹泻，慢性—口腔溃疡、骨髓抑制、脱发、小脑失调 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 阿糖胞苷:急性毒性-恶心呕吐腹泻，慢性—口腔溃疡、骨髓抑制巯嘌呤:急性毒性-恶心呕吐，慢性—骨髓抑制、肝损害 甲氨蝶呤:急性毒性-恶心腹泻，慢性—骨髓抑制、胃肠溃疡、肝肾损害 二、用药监护 (一)应用甲氨蝶呤应监测肾毒性 (1)为预防肾毒性，于化疗期间充分补充液体，鼓励患者多饮水，大剂量应用时应水化、利尿，同时给予尿路保护剂美司钠，并碱化尿液、使尿液pH?7.0，尿量保持在每日2000-3000ml。 (2)尽量在血浆药物浓度监测下谨慎应用。 (3)大剂量应用甲氨蝶呤后，可利用正常细胞(5-7天)与肿瘤细胞(7-10天)复苏时间差，用亚叶酸钙解救，可减轻本品所致的黏膜损害和骨髓抑制，同时又尽可能多地杀灭肿瘤细胞，提高化疗效果而减少不良反应。 (4)为预防白血病和淋巴肿瘤患者出现尿酸性肾病，可给予降低尿酸药或排酸药(丙磺舒、苯溴马隆)，但别嘌醇可增加本品的骨髓毒性。 (5)当大剂量用药时，除应密切观察骨髓功能外，尤其要注意非血液学毒性如心肌炎、中毒性肝炎及肺纤维化等。 (6)同时给予口腔护理，应用含亚叶酸钙的含漱液进行口腔保护。 (二)应用氟尿嘧啶需监测血象和用药程序在应用中注意监测: (1)治疗前及疗程中定期检查周围血象。 (2)与亚叶酸钙、亚叶酸联合应用，可增强疗效和不良反应，可先给予亚叶酸钙60-300mg静脉滴注，再继用本品，可增强疗效。 三、主要药品 氟尿嘧啶 【适应证】用于消化道肿瘤、绒毛膜上皮癌、乳腺癌、卵巢癌、肺癌、宫颈颈癌、膀胱癌及皮肤癌。 阿糖胞苷 【适应证】用于治疗急性淋巴细胞及非淋巴细胞白血病的诱导缓解期及维持巩固期，慢性粒细胞白血病的急变期。本品亦适用于恶性淋巴瘤。 甲氨蝶呤 【适应证】用于乳腺癌、绒毛膜癌、恶性葡萄胎、急性白血病、恶性淋巴瘤、非霍奇金淋巴瘤、蕈样肉芽肿、多发性骨髓瘤、卵巢癌、宫颈癌、睾丸癌、头颈部癌、支气管肺癌、软组织肉瘤、骨肉瘤等。 巯嘌呤 【适应证】用于绒毛膜上皮癌、恶性葡萄胎、急性淋巴细胞白血病及急性非淋巴细胞白血病及慢性粒细胞白血病的急变期。 第三节:干扰转录过程和阻止RNA合成的药物(作用于核酸转录药物) 一、药理作用与临床评价 (一)作用特点 1、蒽环类抗肿瘤抗生素有柔红霉素(DNR)、多柔比星(ADM)、表柔比星(EPI)、吡柔比星(THP) 。这些抗生素大多是直接作用于DNA或嵌入DNA，干扰DNA的模板功能，从而干扰转录过程，阻止mRNA的形成。 2、这类药物多有一定毒性，有些是特异性毒性，例如多柔比星的心脏毒性，因此在应用时应常规检查血象、心、肺及肝肾功能。蒽醌类抗肿瘤抗生素的毒性主要是骨髓抑制和心脏毒性。 (二)典型不良反应急性毒性——恶心、呕吐、腹泻、注射部位反应、红尿迟发毒性-骨髓抑制、心脏毒性、胃炎、脱发禁忌症:骨髓抑制、心肺功能失代偿、电解质或酸碱平衡紊乱、妊娠及哺乳。 二、用药监护 (一)注意监护心脏毒性 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 柔红霉素、多柔比星、表柔比星、吡柔比星及米托蒽醌等蒽环类抗肿瘤药可致氧自由基形成，与其心脏毒性有关，表现为剂量累积性的心肌炎，引起迟发性严重心力衰竭，心电图呈室上性心动过速、室性前期收缩、ST-T段改变，(1)蒽环类抗肿瘤药慎用于有心脏病、高血压、高龄的和接受过心脏介入的患者，在用药期间监测心功能、心电图、超声心动图、血清酶学等。(2)必须应用专属性极强的解毒剂右雷佐生。右雷佐生在细胞内水解成开环形式后，具有螯合作用，能与柔红霉素、多柔比星复合物螯合，抑制自由基的产生，起到保护心肌的作用，减轻由蒽醌类抗肿瘤药所引起的心脏毒性。 (二)注意监护肝肾毒性血液毒性 (1)少数患者应用多柔比星后可引起黄疸或其他肝功能损害。有肝功能不全者，用量应酌减。 (2) 本品由尿液排出虽较少，但在用药后1-2天内可出现红色尿，一般都在2天后消失。肾功能不全者应用后要警惕高尿酸血症的出现;痛风患者如应用多柔比星，要相应增加别嘌醇的剂量，并多饮水。 (3)曾用其他抗肿瘤药或放疗已引起骨髓抑制者，心肺功能失代偿患者、严重心脏病患者、妊娠及哺乳期妇女、白细胞计数低于3.5×109/L或血小板低于50×109/L者，明显感染或发热、恶病质、失水、电解质或酸碱平衡失调患者，胃肠道梗阻、明显黄疸或肝功能损害患者、水痘或带状疱疹患者禁用。2岁以下幼儿、老年患者慎用。 (4)用药期间应监测:?测定心功能、心电图、超声心动图、血清酶学和其他心肌功能试验;?随访检查血象(每周至少1次)和肝功能;?应经常查看有无口腔溃疡、腹泻以及黄疸等情况，?血尿酸、尿尿酸，并劝患者多饮水以减少高尿酸血症的可能，必要时检查肾功能。 三、主要药品 多柔比星 【适应证】用于治疗急性白血病(淋巴细胞性和粒细胞性)、恶性淋巴瘤、乳腺癌、支气管肺癌(未分化小细胞性)、卵巢癌、软组织肉瘤、成骨肉瘤、横纹肌肉瘤、尤文肉瘤、肾母细胞瘤、神经母细胞瘤、膀胱癌、胃癌、肝癌等。 柔红霉素 【适应证】用于治疗各种类型的急性白血病、红白血病、慢性粒细胞白血病、恶性淋巴瘤，也可用于神经母细胞瘤及横纹肌肉瘤。 第4节 抑制蛋白质合成与功能的药物(干扰有丝分裂药) 一、药理作用与临床评价 (一)作用特点 主要作用于有丝分裂M期，干扰微管蛋白合成的药物包括三大类，即长春碱类、紫杉烷类和高三尖杉酯碱。 1(长春碱类 包括长春新碱、长春碱、长春地辛和长春瑞滨，用于治疗多种肿瘤，包括白血病、淋巴瘤和一些实体瘤(如乳腺癌和肺癌)。长春碱类药静脉注射后进入肝脏较多，同时浓集于神经细胞较血细胞多，故神经毒性重，但是很少通过血一脑屏障。其共同的不良反应为骨髓抑制、消化道反应、神经系统毒性、血栓性静脉炎，尤其以后两者为主要特点。神经系统毒性的主要表现是四肢麻木、腱反射迟钝或消失、外周神经炎、便秘、麻痹性肠梗阻、运动神经和感觉神经及脑神经症状。 2(紫杉烷类 紫杉烷类药是一类广谱抗肿瘤药，包括紫杉醇和多西他赛。紫杉醇是从红豆杉植物紫杉的树干和树皮中提取开发得到的天然抗肿瘤药。紫杉醇由于水溶性小，其注射液通常加入表面活性剂，如聚环氧化蓖麻油等助溶剂，常会引起血管舒张，血压降低及过敏反应等。 多西他赛的水溶性比紫杉醇好，毒性较小，抗肿瘤谱更广。在相当剂量下，抗肿瘤作用比紫杉醇高1倍。 3(高三尖杉酉昔碱 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 是从我国三尖杉属植物中分离出的抗肿瘤生物碱之一，其抗肿瘤作用机制为干扰核蛋白体功能阻止蛋白质合成的药物，为细胞周期非特异抗肿瘤药物，但对S期细胞更敏感。 4(门冬酰胺酶 为影响氨基酸供应、阻止蛋白质合成的药物。可降解血中门冬酰胺，使瘤细胞缺乏此氨基酸，不能合成蛋白质。 (二)典型不良反应骨髓抑制、消化道反应、神经系统毒性、血栓性静脉炎、脱发 二、用药监护 (一)关注长春碱类的神经毒性 长春碱类药的神经系统毒性为此类药物的剂量限制性毒性，主要表现为四肢麻木，腱反射消失，腹痛和便秘、甚至麻痹性肠梗阻等。静脉反复注药可致血栓性静脉炎，注射时漏至血管外可造成局部坏死，应立即停止注射，以氯化钠注射液稀释局部;或以1%普鲁卡因注射液局部封闭，温湿敷或冷敷;发生皮肤破溃后按溃疡处理。 (二)预防由紫杉醇所致的超敏反应 紫杉醇因其以特殊溶剂聚乙烯醇蓖麻油进行溶解而可能导致严重的超敏反应，需常规进行糖皮质激素、抗组胺药和组胺H2受体阻断剂的预处理，以防止严重的超敏反应。紫杉醇的外周神经毒性也更为常见;紫杉醇另一重要不良反应为心脏毒性，更常见的只有心动过缓和无症状的低血压。多西他赛与紫杉醇相比，神经毒性和心脏毒性都较轻，但多西他赛骨髓抑制较明显，为主要剂量限制性毒性;另外多西他赛可致持续的液体潴留，也会发生超敏反应，因此建议口服地塞米松以减少液体潴留和超敏反应。 三、主要药品 长春新碱 【适应证】用于急性白血病、急性和慢性淋巴细胞白血病、恶性淋巴瘤、生殖细胞肿瘤、小细胞肺癌、尤文肉瘤、肾母细胞瘤、神经母细胞瘤、乳腺癌、消化道癌、黑色素瘤和多发性骨髓瘤。 长春碱【适应证】用于霍奇金病、淋巴细胞瘤、组织细胞性淋巴瘤、晚期蕈样真菌病、晚期睾丸肿瘤、Kaposi肉瘤、组织细胞增生症、绒癌、乳腺癌、卵巢癌以及单核细胞白血病。 紫杉醇 【适应证】用于卵巢癌、乳腺癌、非小细胞肺癌、头颈癌、食道癌、精原细胞瘤、复发非霍奇金淋巴瘤及与艾滋病相关性卡氏肉瘤。 多西他赛 【适应证】用于局部晚期或转移性乳腺癌、局部晚期或转移性非小细胞肺癌，即使是在以顺铂为主的化疗失败后，也可使用。 高三尖杉酯碱 【适应证】用于急性非淋巴细胞白血病、骨髓增生异常综合征、慢性粒细胞性白血病和真性红细胞增多症。 门冬酰胺酶 【适应证】用于急性淋巴细胞性白血病、急性粒细胞性白血病、急性单核细胞性白血病、慢性淋 巴细胞性白血病、霍奇金病及非霍奇金病淋巴瘤和黑色素瘤。 第五节:调节体内激素平衡的药物 激素失调能诱发多种肿瘤，与许多肿瘤的发生和生长有着密切关系，改变激素平衡可以有效地抑制肿瘤的生长环境。 与激素水平有关的肿瘤包括乳腺癌、前列腺癌、甲状腺癌、宫颈癌、卵巢癌、睾丸肿瘤等，尤其是在乳腺癌、前列腺癌的治疗中，激素类药发挥着重要的作用。 常用药物包括雌激素类、雄激素类、孕激素(甲羟孕酮酯)、抗雌激素类(他莫昔芬、托瑞米芬)、糖皮质激素类、抗雄激素类(氟他胺、安鲁米特)等。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 一、药理作用与临床评价 (一)作用特点 1(雌激素类 己烯雌酚作用机制一般认为是利用雌激素对下丘脑一垂体一性腺轴的负反馈作用。由于其不良反应较多，目前已很少用于治疗前列腺癌，有时用于治疗绝经后乳腺癌。常用药物包括己烯雌酚和炔雌醇。 2(抗雌激素类 抗雌激素类药分为雌激素受体拮抗剂和芳香氨酶抑制剂。雌激素受体拮抗剂主要包括他莫昔芬和托瑞米芬。 其中，他莫昔芬是目前临床上最常用的内分泌治疗药，主要用于治疗乳腺癌(ER阳性者，绝经前、后均可使用)、化疗无效的晚期卵巢癌和晚期子宫内膜癌。 3(孕激素类孕激素类主要包括甲羟孕酮及甲地孕酮。主要适应证为乳腺癌、子宫内膜癌、前列腺癌、肾癌，也可用于改善晚期肿瘤患者的恶病质。 4(雄激素类 雄激素主要用于晚期乳腺癌的治疗，但目前已基本上被其他药物所替代。这类药用于乳腺癌的作用机制还不明确，可能是通过抑制垂体分泌促卵泡生成素，使卵巢分泌雌激素减少，并可对抗雌激素的作用。药物包括丙酸睾酮等。 5(抗雄激素类 抗雄激素类药的代表药为氟他胺。该药是一种非甾体的雄激素拮抗剂，适用于晚期前列腺癌患者。其作用机制为此药与雄激素竞争肿瘤部位的雄激素受体，组织细胞对雄激素的摄取，抑制雄激素与靶器官的结合。 该药的主要不良反应系因治疗过程中雄激素作用减少所致，包括男性乳房女性化，乳房触痛、溢乳等，减少剂量或停药后症状消失。 (二)典型不良反应 雌激素:急性—恶心呕吐，迟发毒性-高钙血症、水潴留、血栓栓塞、子宫出血 抗雌激素:急性—恶心呕吐，迟发毒性-阴道出血、月经不调 孕激素:急性—恶心呕吐，迟发毒性-高钙血症、水潴留、黄疸 雄激素:急性—无，迟发毒性-高钙血症、水潴留、男性化抗 雄激素:急性—恶心呕吐，食欲增强，失眠。迟发毒性-男性乳房发育 二、用药监护 (一)用前须监测雌激素受体表达和肝药酶的多态性 他莫昔芬结构中存在Z型和E型两种异构体，Z型具有抗雌激素作用，E型则具微弱雌激素活性。如乳腺癌细胞内有雌激素受体(estro-gen receptor，ER)，当雌激素进入肿瘤细胞内并与其结合，促使肿瘤细胞的DNA和mRNA的合成，刺激肿瘤细胞生长。Z型进入细胞内与ER竞争性结合，形成受体复合物，抑制雌激素作用和乳腺癌细胞增殖。对雌激素受体或孕激素受体阳性者易出现疗效。 他莫昔芬为前药，主要在肝脏经CYP2D6代谢，推荐乳腺癌者处方他莫昔芬以前应先监测CYP2D6的基因多态性。 (二)于用药期间规避怀孕 (1)鉴于他莫昔芬可促进排卵，有导致怀孕的可能，对患有乳腺癌的未绝经妇女不宜应用。若绝经前必须使用本品，应同时服用抗促性腺激素类药。(2)治疗期间和停药后2个月，患者应严格避孕，并不得使用雌激素类药避孕。(3)对接受他莫昔芬治疗者，如发现子宫异常出血，应立即进行检查。 三、主要药品 他莫西芬 【适应证】用于复发转移乳腺癌、乳腺癌术后转移的辅助治疗。 托瑞米芬 【适应证】用于绝经后妇女雌激素受体阳性或不详的转移性乳腺癌。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 三、主要药品 氟他胺 【适应证】用于以前未经治疗或对激素控制疗法无效或失效的晚期前列腺癌患者，它可被单独使用(睾丸切除或不切除)或与促黄体生成激素释放激素(LHRH)激动剂合用。作为治疗局限性B2- C2 (T2b- T4)型前列腺癌症的一部分，本品也可缩小肿瘤体积和加强对肿瘤的控制以及延长无病生存期。 第六节 靶向抗肿瘤药 第一亚类 酪氨酸激酶抑制剂 一、药理作用与临床评价 (一)作用特点 酪氨酸激酶抑制剂可作为ATP与酪氨酸激酶结合的竞争性抑制剂，阻断酪氨酸激酶的活性，抑制细胞增殖。目前临床上最常用的包括吉非替尼、厄洛替尼等。我国批准的吉非替尼、厄洛替尼适应证为经一个或两个化疗方案失败的局部晚期或转移性非小细胞肺癌。 (二)典型不良反应 皮肤毒性、腹泻、间质性肺炎 二、用药监护 (一)监护不良反应 (1)吉非替尼和厄洛替尼所致不良反应中以皮肤毒性和腹泻最为常见，皮肤不良反应包括皮疹、皮肤干燥和指甲异常。皮疹往往为痤疮样，皮疹的严重程度可以预示疗效。轻、中度皮疹无须特殊处理，应避免日晒，涂抹润肤露和含糖皮质激素软膏或口服抗过敏药氯苯那敏、阿司咪唑和氯雷他定等，伴发感染时可局部涂抹抗生素软膏或口服抗生素。(2)中、重度腹泻者可予口服洛哌丁胺，同时补充液体和电解质，严重者宜短暂停药以恢复。 (3)吉非替尼和厄洛替尼于治疗期间有发生间质性肺炎的可能，发生率极低但可致命，临床表现为呼吸困难、咳嗽、低热和血氧饱和度降低，影像学上往往有肺间质的毛玻璃样改变。治疗过程中应密切监测有无间质性肺病发生的可能性。当新出现难以解释的上述症状时，应进一步检查，一旦确认间质性肺炎时，应即停用，并给予相应的治疗。(4)吉非替尼和厄洛替尼均经肝脏代谢，可以引起无症状的肝脏转氨酶AST及ALT升高，治疗中应注意监测。 (二)注意肝药酶的相互作用 三、主要药品 吉非替尼 【适应证】用于既往接受过铂化合物和多西他赛治疗或不适于化疗的晚期或转移性非小细胞肺癌。 厄洛替尼 【适应证】用于两个或两个以上化疗方案失败的局部晚期或转移的非小细胞肺癌。 第二亚类:单克隆抗体 一、药理作用与临床评价 (一)作用特点 单克隆抗体的作用机制是药物在癌细胞膜外与生长因子竞争结合受体，阻断信号传递过程，从而阻止癌细胞的生长和扩散。单克隆抗体抗肿瘤药(简称单抗药)在癌症治疗方面最突出的优点是选择性―杀灭‖，就是只对癌细胞起作用而对正常体细胞几乎没有伤害，从而有效地抑制癌细胞的增长和扩散，并大幅度降低毒副作用。曲妥珠单抗、利妥昔单抗、西妥昔单抗主要通过上述机制发挥作用，贝伐单抗作用机制较为特殊，作用于血管内皮生长因子(VEGF)，阻碍VEGF与其受体在内皮细胞表面相互作用，从而阻止内皮细胞增殖和新血管生成。 (二)典型不良反应 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 单抗药为大分子蛋白质，静脉滴注蛋白可致患者发生过敏样反应或其他超敏反应。轻一中度过敏反应表现为发热、寒战、头痛、皮疹等，少数患者可发生严重过敏反应，出现血压下降、气管痉挛、呼吸困难等。淋巴瘤患者血液循环中有大量恶性肿瘤细胞(>25000个/ml)或肿瘤病灶>l0cm者，发生严重的细胞因子释放综合征或肿瘤溶解综合征的风险较高。使用利妥昔单抗时应极其慎重。 应用西妥昔单抗治疗者80%以上可能发生皮肤反应，其中约15%症状严重。主要症状为粉刺样皮疹，其次为指甲病(如甲床炎)，其他包括皮肤干燥，皲裂，以及炎症和感染性后遗症，如睑炎，唇炎，蜂窝织炎等。这些不良反应大多在治疗的第1周内出现。通常中断治疗后上述症状可以自行消退，并无后遗症。在单独使用曲妥珠单抗治疗的患者中，中、重度心力衰竭的发生率为5%。在与化疗联合的随机临床试验中，中、重度的心力衰竭的发生率为16%，而不加瞳妥珠单抗治疗的患者中发生率仅为3%。 (三)禁忌证已知有严重超敏反应(3级或4级)者，妊娠及哺乳期妇女。 (一)建议单抗药在用前尽可能先做基因筛查 (二)注意单抗药综合征 1(过敏反应。单抗类药的过敏反应大多数发生在第一次用药时，尤其是首次剂量较高时。典型的超敏反应常于开始滴注的几分钟内发生，为预防过敏反应发生，一般在开始治疗前30- 60rain给予解热镇痛药和抗组胺药，也可考虑应用皮质激素。 2(利妥昔单抗可致细胞因子释放综合征。以严重的呼吸困难(常伴支气管痉挛和低氧血症)、发热(可能出现高热惊厥)、寒战、荨麻疹和血管性水肿为特征。还可伴随出现一些肿瘤溶解综合征的特征，如高尿酸血症、高钾血症、低钙血症、乳酸脱氢酶升高、急性肾衰竭以及危及生命的呼吸衰竭。 3(肿瘤溶解综合征。肿瘤细胞短期内大量溶解，释放细胞内代谢产物，引起以高尿酸血症、高血钾、高血磷、低血钙和急性肾衰竭为主要表现的一组临床综合征。 4(应用西妥昔单抗患者如发生严重的皮肤反应必须中断治疗。只有当皮肤反应恢复到2级，才能重新进行治疗。如严重的皮肤反应属首次发生，不须调整剂量。如严重的皮肤反应为第二次或第三次出现，须再次中断使用本品。 5(在使用曲妥珠单抗治疗的患者中应密切观察有无心脏功能减退的症状和体征。与曲妥珠单抗治疗相关的充血性心衰可能相当严重，并可引起致命性心力衰竭、黏液栓子脑栓塞，甚至死亡。 (三)特殊人群用药注意事项 1(已知免疫球蛋白IgG可透过胎盘屏障，所以除非可能给患者带来的益处大于潜在的危险，否则单抗类药不应用于妊娠期妇女。 2(育龄期妇女在使用单抗的过程中及治疗后的12个月，应采取有效的避孕措施。 3(已知母体的IgG可由乳汁分泌，建议哺乳期妇女在使用单抗类药治疗期间和最后1次用药后1个月内不要哺乳。 4(老年患者无需调整剂量。 三、主要药品 利妥昔单抗 【适应证】用于复发或耐药的滤泡性中央型淋巴瘤，未经治疗的CD20阳性?-?期滤泡性非霍奇金淋巴瘤，应给予标准CVP(环磷酰胺、长春新碱和泼尼松)8个周期联合治疗。CD20阳性弥漫大ß细胞性非霍奇金淋巴瘤(DLBCL)，应给予标准CHOP(环磷酰胺、多柔比星、长春新碱、泼尼松)8个周期联合治疗。 曲妥珠单抗【适应证】用于人表皮生长因子受体-2过度表达的转移性乳腺癌、已接受过1个或多个化疗方案的转移性乳腺癌、联合紫杉类药治疗未接受过化疗的转移性乳腺癌。 西妥昔单抗 【适应证】与伊立替康联用治疗表达表皮生长因子受体，经伊立替康治疗失败的转移性结直肠癌。 第七节:放疗与化疗止吐药 化疗药致吐性按致吐频率分成四个等级水平:高度、中度、低度和微弱。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (1)高度致吐级别:呕吐发生频率大于90%，高度致吐级别的化疗药有顺铂、达卡巴肼、卡莫司汀、环磷酰胺、氮芥。 (2)中度致吐级别:呕吐发生频率为31%-90%。中度致吐致级别的化疗药有卡铂、环磷酰胺、异环磷酰胺、多柔比星、柔红霉素、表柔比星、紫杉醇、阿糖胞苷、奥沙利铂、伊立替康、拓扑替康、培美曲塞、甲氨蝶呤 (3)低度致吐级别:呕吐发生频率为10%-30%。低度致吐的化疗药有依托泊苷、甲氨蝶呤、氟达拉 滨、氟尿嘧啶、吉西他滨、多西他赛、博来霉素、长春碱、长春新碱、长春瑞滨、紫杉醇、米托蒽醌、丝裂霉素、苯丁酸氮芥等。 一、药理作用与临床评价 (一)作用特点 止吐药按作用机制可分为三类:多巴胺受体阻断剂、5-HT3受体阻断剂和神经激肽-1(neurokinin-1，NK-1)受体阻断剂。 1(多巴胺受体阻断剂 其代表药是甲氧氯普胺，为多巴胺D2受体阻断剂，与糖皮质激素联用，可增加疗效并减轻毒副作用。但长期反复或大剂量使用因阻断多巴胺受体，使胆碱能受体相对亢进而发生神经中枢抑制或锥体外系反应，表现为肌震颤、发音困难、共济失调等。因此，多巴胺受体阻断剂在临床应用上受到限制。 2.5- HT3受体阻断剂 高选择性的5- HT3受体阻断剂渐成为目前临床上化疗止吐的主要用药。5- HT3受体阻断剂与糖皮质激素(地塞米松)联合应用，可显著提高预防急性呕吐的疗效。已经上市的5- HT3受体阻断剂主要有昂丹司琼、格雷司琼、托烷司琼等。 昂丹司琼为首个上市的高选择性5- HT3受体阻断剂，可以拮抗外周和中枢神经元的5-HT3受体，阻断胃肠道嗜铬细胞释放的5-HT与5- HT3受体的结合，从而抑制迷走传人神经兴奋的产生与传导，起到止吐作用。由于该药具有高效选择性，所以没有锥体外系反应、神经抑制症状等不良反应。 3(神经激肽-1受体阻断剂 神经激肽A-(NKA)和神经激肽B-(NKB)共属于速激肽家族，该家族有3种亚型受体(NK-1受体、NK-2受体和NK-3受体)，其中P物质与NK-1受体的亲和力最强。P物质主要存在于胃肠道与中枢神经系统中。静脉注射P物质可引起呕吐，这说明P物质有致吐作用，而选择性NK-1受体阻断剂则能抑制P物质所致呕吐。随着对迟发性化疗所致恶心与呕吐的重视，P物质及NK-1成了开发止吐药的新靶点。阿瑞吡坦是目前唯一应用于临床的NK-1受体阻断剂，通过与NK-1受体(主要存在于中枢神经系统及其外围)结合来阻滞P物质的作用。 (二)典型不良反应和禁忌症 5-HT3受体阻断剂——头痛、发热、便秘，转氨酶升高，禁忌症:胃肠梗阻、过敏。 多巴胺受体阻断剂——锥体外系统、昏睡、烦躁不安、倦怠。禁忌症:对普鲁卡因过敏者、癫痫患者、胃肠出血、嗜铬细胞瘤、乳腺癌患者。 (一)化疗药所致恶心与呕吐的分级 对轻度恶心与呕吐反应可口服多潘立酮、甲氧氯普胺进行处理，如效果不佳，可合并应用地塞米松或劳拉西泮作为补充。对严重呕吐或处理效果不佳者，可给予5- HT3受体阻断剂，包括昂丹司琼、格雷司琼、雷莫司琼和托烷司琼;对化疗后的急性或延迟性恶心与呕吐 发作者，也可给予神经激肽受体拮抗剂阿瑞吡坦，提高对恶心和呕吐的控制。为预防迟发症状，可口服地塞米松，可以单独使用，也可与甲氧氯普胺、苯海拉明联合应用。 (二)依据化疗药的致吐性选用止吐药 (1)重度致吐性化疗药所引起恶心呕吐的治疗，每天化疗前，联合应用5- HT3受体阻断剂、口服地塞米松12mg和阿瑞吡坦125mg，化疗后从第2日到第4日，口服地塞米松一次4mg，一日2次，以及第2日到第3日口服阿瑞吡坦80mg。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (2)中度致吐性化疗药所引起恶心呕吐的治疗，每天化疗前，联合应用5- HT3受体阻断剂和口服地塞米松12mg，化疗后，从第2日到第3日口服地塞米松或应用 5- HT3受体阻断剂。 (3)低度致吐性化疗药所引起恶心与呕吐的治疗，每日化疗前，应用5–HT3受体阻断剂或地塞米松口服，化疗后不需应用。 (4)微弱致吐性化疗药所引起恶心与呕吐可不需治疗，必须时每天于化疗前，应用5- HT3受体阻断剂，化疗后不需应用。 三、主要药品 昂丹司琼 【适应证】用于预防和治疗化学、放射治疗和术后引起的恶心与呕吐。 阿瑞吡坦 【适应证】用于化疗后的急性、延迟性恶心或呕吐发作，尚可用于重度抑郁症(伴焦虑)。 [药学专业知识二] 【药圈】执业药师学习整理之第14章眼科疾病用药 《药学专业知识(二)》第14章(眼科疾病用药)为新增内容，本章主要药物如下: (一)抗眼部细菌感染药 氯霉素、红霉素、氧氟沙星、左氧氟沙星、利福平、四环素可的松 十 四 (二)降低眼压药 毛果芸香碱、卡替洛尔、拉坦前列素、地匹福林 (三)抗眼部病毒感染药 阿昔洛韦、更昔洛韦、利巴韦林、碘苷 眼科疾病 (四)眼用局部麻醉药 用药 (五)散瞳药 阿托品、托吡卡胺、复方托吡卡胺 本章主要内容如下: 第14章 眼科疾病用药 第一节:抗眼部细菌感染药 一、药理作用与临床评价 (一)作用特点 1、局部给予抗菌药物(滴眼剂、眼膏剂)是眼科细菌感染疾病的首选方法。 2、大多数细菌性结膜炎是自限性的，但是应用抗菌滴眼剂或眼膏剂是恰当的治疗措施。如用药后反应很差，则表明可能是病毒性或过敏性结膜炎 3、衣原体感染会导致致盲性沙眼和包涵体性结膜炎。对于衣原体感染的治疗除了注意个人和环境卫生之外，主要是抗菌药物的治疗。急性期或严重的沙眼应采用口服阿奇霉素进行全身治疗，局部治疗可选用滴眼剂或眼膏剂，如10%磺胺醋酰钠、0.3%氧氟沙星及0.1%利福平滴眼剂等。 4、眼科手术后引起的细菌性眼内炎，可向眼内注入万古霉1mg/0.1ml或头孢他啶2.25mg/0.lml，2-3日后重复注射。 5、左氧氟沙星具有抗菌谱广、作用强的特点，是用于治疗眼部浅层感染的可供选择的药物。氯霉素具有广谱抗菌活性，也是治疗眼表浅层感染的可供选择的药物，由于氯霉素滴眼后存在不易发现的再生障碍性贫血的风险，因此在临床中应当慎用。 (二)典型不良反应 1、偶见眼部一过性刺激症状、局部灼热和异物感、眼险水肿、流泪、畏光、视力减低、皮疹、荨麻疹; 2、罕见全身过敏反应。使用利福平滴眼剂后可致齿龈出血和感染、伤口延迟愈合以及出现畏寒、发热、头痛、泪液呈橘红色或红棕色等。 3、长期使用四环素可的松眼膏剂可引起青光眼、白内障。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (三)禁忌证 1(对相应药物过敏者。 2(氟喹诺酮类药禁用于18岁以下的儿童及青少年;氯霉素类药禁用于早产儿、新生儿;氨基糖苷类药禁用于8岁以下儿童。 3(抗眼部细菌感染药不宜长期使用，以免诱发耐药菌株或真菌感染。 4(肝功能不全、哺乳期妇女禁用夫西地酸。 5(严重肝功能不全、胆道阻塞患者禁用利福平。 6(单纯疱疹性或溃疡性角膜炎患者禁用四环素可的松眼膏剂。 二、用药监护 (一)监护联合应用糖皮质激素的风险 多种抗眼部细菌感染制剂中常加入糖皮质激素，虽然这类制剂具有抗菌、抗炎、加速感染治愈过程的优点，但有诱发真菌或病毒感染、延缓创伤愈合、升高眼压和导致晶状体混浊等风险，尤其是不能给尚未确诊的―红眼‖患者开具此类药，因为这种情况有时是由于难以诊断的单纯性疱疹病毒感染所致。如使用此类制剂，不应当超过10日，并在使用期间定期测量眼压。 (二)监护给药的合理性抗菌药物用药的频次决定于眼部感染的严重程度和眼部发生不可逆损伤的可能性。 三、主要药品 氯霉素 【适应证】用于由大肠埃希菌、流感嗜血杆菌、克雷伯杆菌属、金黄色葡萄球菌、溶血性链球菌和其他敏感菌所致的结膜炎、角膜炎、眼睑缘炎、沙眼等。 红霉素 【适应证】用于沙眼、结膜炎、角膜炎、眼睑缘炎及眼外部感染。 氧氟沙星 【适应证】用于治疗细菌性结膜炎、角膜炎、角膜溃疡、泪囊炎、术后感染等外眼感染。 左氧氟沙星 【适应证】用于治疗细菌性结膜炎、角膜炎、角膜溃疡、泪囊炎等外眼感染。 利福平 【适应证】主要用于治疗细菌性外眼感染，如沙眼、结核性眼病及某些病毒性眼病。 四环素可的松 【适应证】用于沙眼、结膜炎等眼病。 第二节 降低眼内压 正常人眼压为1.73-3.19kPa(13-24mmHg)，高于此范围则称为青光眼。 青光眼患者因房水生成过多或流出受阻，眼压升高，视网膜、脉络膜和视神经乳头的血管受到压迫，血流减少，氧和营养的供应也减少，最终导致失明。降低眼压的药物，主要是抑制房水生成和促进房水外流。常用治疗药有:拟M胆碱药、作用于肾上腺素受体类(ß受体阻断剂、受体激动剂)、前列腺素类似物及碳酸酐酶抑制剂等。在一些高眼压症或需要手术的患者中，需要紧急降低眼压，可以应用20%甘露醇静脉滴注，用量可至一次500ml。 一、药理作用与临床评价 (一)作用特点 1(拟M胆碱药 毛果芸香碱具有缩小瞳孔和降低眼压作用，可用于闭角型青光眼和开角型青光眼 2(β受体阻断剂 眼部滴用β受体阻断剂可通过阻断ß受体，减少房水的生成，口服β受体阻断剂也可以降低眼压，但此种给药途径有明显的不良反应，因此不宜选用。用于青光眼的β受体阻断剂有卡替洛尔、美替洛尔、噻吗洛尔和倍他洛尔。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 3(前列腺素类似物 前列腺素类似物通过松弛睫状肌，增宽肌间隙，增加房水的葡萄巩膜通路外流和引流而降低眼压，降低夜间的眼压作用强，尤其是对其他降低眼压药不能耐受或效果不佳的患者。拉坦前列素、曲伏前列素、比马前列素。 4(肾上腺素受体激动剂 肾上腺素受体激动剂通过减少房水生成和增加房水经小梁网的外流来发挥药效。肾上腺素的不良反应包括眼部剧烈刺痛、眼红。肾上腺素用于高血压和心脏病患者时应格外谨慎。 代表药:地匹福林，溴莫尼定 (二)典型不良反应 1(拟M胆碱药 常见头痛、偏头痛、结膜充血、近视、眼痒、刺痛。 2(β受体阻断剂 包括眼部针刺感、烧灼感、疼痛、眼痒、红斑、眼干及过敏反应(包括过敏性结膜炎和睑结膜炎)。 偶见引起角膜病变。 3(前列腺类似物 常见虹膜颜色加深、睑缘炎、眼部刺激症状和疼痛、眼睫毛变黑增粗增长、结膜充血、暂时点状角膜上皮糜烂、眼睑水肿和红斑。偶见皮疹、眼睑皮肤变黑。罕见虹膜炎、葡萄膜炎。 4(肾上腺素受体激动剂地匹福林滴眼后可出现轻微眼部灼烧、刺痛感，结膜滤泡增生、结膜充血、视物模糊、结膜角膜色素沉着等。有引起散大瞳孔和无晶状体黄斑病变的可能。 (三)禁忌证 1(拟M胆碱药虹膜睫状体炎和继发性青光眼患者。 2(β受体阻断剂 (1)对过敏者禁用。 (2)心动过缓、房室传导阻滞、未控制的心力衰竭、哮喘或有气道阻塞性病史的患者禁用。 3(前列腺素类似物 (1)对过敏者，急性眼部感染者禁用。 (2)对儿童、妊娠及哺乳期妇女、严重哮喘者、眼感染充血期、角膜接触镜佩带者禁用。也不适用于闭角型或先天性青光眼，色素沉着性青光眼。 4(肾上腺素受体激动剂 未经手术的闭角型青光眼、甲状腺功能亢进、高血压、冠状动脉供血不全、心律失常、糖尿病及对本品过敏者禁用地匹福林。 二、用药监护 (一)监护β受体阻断剂所掩盖的急性低血糖症状 β受体阻断剂可能掩盖急性低血糖症状，因此糖尿病患者使用时要特别注意，尤其是原发性低血糖患者、正在接受胰岛素治疗或口服降糖药者。β受体阻断剂会掩盖甲状腺功能亢进的临床体征，如心动过速。 (二)监护卡替洛尔的缩瞳副作用 卡替洛尔的缺点是在滴眼后0.5-3h内，伴随缩瞳同时可产生暗黑感、远视障碍、调节痉挛，长期用药可引起近视化倾向。若长期应用于无玻璃体或眼底有病变的患者时，偶见眼底黄斑部出现水肿、混浊，须定期测定视力。 三、主要药品 毛果芸香碱 【适应证】(1)用于急性闭角型青光眼，慢性闭角型青光眼，开角型青光眼，继发性青光眼等。本品可与其他缩瞳剂、β受体阻断剂、碳酸酐酶抑制剂、拟交感神经药或高渗脱水剂联合用于治疗青光眼。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (2)用于检眼镜检查后，用本品滴眼缩瞳以抵消睫状肌麻痹剂或扩瞳药的作用。 卡替洛尔 【适应证】用于青光眼、高眼压症 拉坦前列素 【适应证】用于治疗青光眼和高眼压症，以及各种眼压增高的情况。 地匹福林 【适应证】(1)用于降低开角型青光眼和高眼压症患者的眼压。 (2)用于对闭角型青光眼虹膜切除后的残余性青光眼。 第三节 抗眼部病毒感染药 可应用利巴韦林、阿昔洛韦、更昔洛韦治疗单纯疱疹病毒性眼部感染;应用羟苄唑治疗病毒性结膜炎;应用阿昔洛韦、更昔洛韦进行全身治疗或玻璃体腔内注射治疗急性视网膜坏死综合征。 一、药理作用与临床评价 (一)作用特点 1、阿昔洛韦对I、?型单纯疱疹病毒有效，本品具有良好的眼内通透性。 2、更昔洛韦对病毒DNA多聚酶的抑制作用比对宿主细胞DNA多聚酶强。本品可进入眼内组织。 3、利巴韦林可能是抑制病毒合成酶，减少病毒核糖核酸和蛋白合成，破坏病毒的复制与传播。 4、羟苄唑能选择性抑制被感染细胞的微小RNA病毒聚合酶。在组织培养中用本品(10μg/ml)能抑制急性流行性出血性结膜炎、角膜炎。 (二)典型不良反应偶见眼部轻微疼痛和烧灼感等刺激症状。更昔洛韦偶见白细胞下降。 (三)禁忌证 (1)对相应药物过敏者禁用。 (2)严重中性粒细胞减少(少于0.5×109/L)或严重血小板减少(少于25×109/L)者禁用更昔洛韦。 (3)妊娠期妇女禁用利巴韦林。 三、主要药品阿昔洛韦 【适应证】用于单纯疱疹性角膜炎。 更昔洛韦 【适应证】用于单纯疱疹病毒性角膜炎。 利巴韦林 【适应证】用于单纯疱疹病毒性角膜炎。 碘苷 【适应证】用于单纯疱疹性角膜炎及其他疱疹性眼病，疱疹性皮肤病，亦可用于疱疹性脑膜炎。 第四节 眼用局部麻醉药 局部麻醉是眼科最常用的麻醉方法，包括表面麻醉、浸润麻醉和传导阻滞麻醉等。 丁卡因和奥布卡因是广泛使用的局部麻醉药(简称局麻药)。 丙美卡因刺激小，多用于儿童。奥布卡因或利多卡因和荧光素的混合制剂可用于眼压测量。丁卡因可产生深度麻醉作用，适用于眼科小手术前麻醉，如角膜缝线的拆除。利多卡因单独或与肾上腺素合用，可注入眼睑后施行小手术，进行球后或球周注射后施行眼球手术。 局麻药不能单纯作为镇痛药来解除眼部症状。也不能交与患者自行滴用。 一、药理作用与临床评价 (一)作用特点 局麻药是一类以适当浓度应用于局部神经末梢或神经千周围的药物，能暂时、完全和可逆性地阻断神经冲动的产生和传导，在意识清醒的条件下可使局部痛觉等感觉暂时消失，局麻作用消失后，神经功能可完全恢复，同时对各类组织无损伤性影响。 (二)典型不良反应 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (1)滴眼后有短暂烧灼感。 (2)对角膜上皮有轻度损伤，影响创伤角膜上皮再生。 (3)可发生休克、过敏样症状。 (4)大剂量使用可致心脏传导系统和中枢神经系统抑制。 (三)禁忌证 对过敏者禁用。眼球有穿通性伤口患者禁用丁卡因。对本品成分或对安息香酸酯(除可卡因外)类局麻药有过敏史者禁用奥布卡因。 二、用药监护 局麻药过敏反应较为少见，在少量用药后立即发生类似过量中毒的症状，出现荨麻疹、支气管痉挛及喉头水肿等症状。一般认为酯类局麻药比酰胺类发生过敏反应为多。麻醉前须询问患者及家属过敏反应史，用药时可先给予小剂量，若患者无特殊主诉和异常再给予适当剂量。另外局麻前给以适当巴比妥类药物，使局麻药分解加快。一旦发生过敏反应，应立即停药并抢救。 第五节 散瞳药 1、散瞳药是眼科常用药物。抗M胆碱类药能散大瞳孔，麻痹睫状肌。 2、作用时间短、作用相对弱的散瞳剂，如0.5%托吡卡胺滴眼剂可用于眼底检查。1%阿托品滴眼剂可引起睫状肌麻痹，适用于青少年的屈光检查。 1%阿托品眼膏剂更适合于5岁以下儿童。具有较长作用时间的阿托品也可用于治疗前葡萄膜炎，主要是防止瞳孔缘虹膜后粘连。 3、1%后马托品作用时间较短，可作为治疗眼前节炎症的首选药。 4、肾上腺素受体激动剂去氧肾上腺素具有散大瞳孔的作用，但没有睫状肌麻痹作用。10%去氧肾上腺素滴眼剂经常与1%阿托品滴眼剂合用，以便增强散瞳作用。但10%去氧肾上腺素滴眼剂禁用于新生儿、儿童及患有心脏病的老年人，只能用2.5%的浓度。 (二)典型不良反应 (1)眼部不良反应包括一过性针刺感和眼压升高。 (2)长时间用药会引起眼局部刺激、充血、水肿和结膜炎。 (3)应用抗M胆碱类散瞳剂，特别是阿托品，可以导致接触性睑皮肤炎。长期应用阿托品会发生一些全身的不良反应，如皮肤和黏膜干燥、发热、激动和谵妄、心动过速、脸部潮红等。 (三)禁忌证 (1)对相应药物过敏者、青光眼患者禁用。 (2)前列腺肥大者及儿童脑外伤者禁用阿托品。 (3)婴幼儿有脑损伤、痉挛性麻痹及先天愚型综合征患者禁用托吡卡胺。 (4)妊娠期妇女、婴幼儿、服用单胺氧化酶抑制剂和三环抗抑郁药，如丙米嗪、阿米替林、普罗替林、多虑平等时禁用去氧肾上腺素。 主要药品 硫酸阿托品 【适应证】 (1)用于眼底检查及验光前的睫状肌麻痹，眼科手术前散瞳，术后防止粘连。 (2)用于治疗角膜炎、虹膜睫状体炎。 托吡卡胺 【适应证】用于散瞳和调节麻痹。 去氧肾上腺素 【适应证】 散瞳，用于检查眼底及晶状体，鉴别闭角型或开角型青光眼(后者用此药后眼压不增高)。 [药学专业知识二] 【药圈】执业药师学习整理之第15章耳鼻喉科疾病用药 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 《药学专业知识(二)》第15章(耳鼻喉科疾病用药)为新增内容，本章主要药物如下: (一)消毒防腐药 硼酸、酚甘油、过氧化氢 十五 耳鼻喉科 (二)减鼻充血药 麻黄碱、羟甲唑啉、赛洛唑啉 疾病用药 本章内容如下: 第十五章:耳鼻喉科疾病用药 第一节:消毒防腐剂 一、药理作用与临床评价 (一)作用特点 1、消毒防腐药包括硼酸滴耳剂、酚甘油滴耳剂及3%过氧化氢溶液，主要用于外耳道炎及中耳炎的治疗。 2、苯酚的水溶液有强大的杀菌作用，其甘油剂和油溶液作用显著降低。苯甲酸在微酸性环境下比在碱性环境中有效。苯酚的杀菌作用强，但对病毒无效。病毒对碱类敏感，对酚类耐药。 3、真菌对羟苯乙酯敏感，对氧化剂不敏感。有些药物如阳离子表面活性剂和阴离子表面活性剂共用，可使其作用减弱。 (二)典型不良反应 1(硼酸滴耳剂滴耳时可有短时间刺痛感。2(高浓度过氧化氢溶液对皮肤和黏膜产生刺激性灼伤，形成一疼痛―白痂‖。 (三)禁忌证 1(对相应药物及所含成分过敏者禁用。 2(鼓膜穿孔且流脓患者及6个月以下婴儿禁用酚甘油滴耳剂。 二、用药监护 使用滴耳剂治疗耳部炎症时应先清洗耳部脓液，保持耳道局部清洁、干燥。 三、主要药品 硼酸 【适应证】用于急、慢陛中耳炎、外耳道炎。 酚甘油 【适应证】用于鼓膜未穿孔的急性中耳炎，外耳道炎。 过氧化氢 【适应证】用于急性、慢性化脓性中耳炎及外耳道炎。 第二节 减鼻充血药 减鼻充血药通常用于缓解鼻塞症状，但不宜长期使用。糖皮质激素具有显著的抗炎作用而被广泛用于鼻炎的治疗。减鼻充血药是α受体激动剂，可对鼻甲中的容量血管产生收缩作用，通过减少鼻黏膜中的血流而缓解鼻塞症状。减鼻充血药起效迅速，喷雾剂的药物分布效果强于滴鼻剂。常用者包括:0.5%麻黄碱、0.05%羟甲唑啉和0.1%赛洛唑啉等。如果使用频率过高(间隔不足3h)或疗程过长(3周以上)，可使鼻黏膜损伤导致药物性鼻炎，因此，对于以长期鼻塞为主要症状的患者，减鼻充血药并非适宜选择。 一、药理作用与临床评价 (一)作用特点 盐酸麻黄碱通过激动ɑ肾上腺素受体引起血管收缩，从而减少鼻腔黏膜容积。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 盐酸羟甲唑啉和赛洛唑啉为咪唑啉类衍生物，是α肾上腺素受体激动剂，具有良好的外周血管收缩作用，直接激动血管α1肾上腺素受体引起鼻腔黏膜血管收缩，减轻炎症所致的充血和水肿，几分钟内发生作用，并可维持数小时。 (二)典型不良反应 偶见一过性轻微烧灼感，鼻黏膜干燥感，头痛，头晕，心率加快，长期使用可致心悸，焦虑不安，失眠等。滴药过频易致反跳性鼻充血，久用可致药物性鼻炎。偶有患者使用后出现血压升高。罕见过敏反应。 (三)禁忌证 1(对相应药物过敏者、2岁以下婴幼儿。 2(萎缩性鼻炎、鼻腔干燥患者。 3(接受单胺氧化酶抑制剂治疗的患者。 4(妊娠期妇女禁用盐酸羟甲唑琳。 二、用药监护 (一)警惕由减鼻充血药所致的高血压 减鼻充血药中的盐酸麻黄碱、伪麻黄碱、萘甲唑啉、羟甲唑啉、抗感冒药的复方制剂(氨酚伪麻、苯酚伪麻、氨酚伪麻、双扑伪麻、特酚伪麻、氨酚伪敏、美扑伪麻、美息伪麻、双芬伪麻片剂或颗粒剂等含伪麻黄碱)，可促使鼻黏膜血管收缩，缓解鼻塞，但在滴鼻时过量，易发生心动过速、血压升高。 应注意:(1)对高血压患者慎用。 (2)控制用量。 (3)滴鼻后宜适当休息60min。 (二)注意滴鼻剂的用法 (1)如滴鼻液过多流人口腔，可将其吐出。 (2)使用本类药物时不能同时使用其他滴鼻剂。如正在服用其他药品，使用本类药物前请咨询医师或药师。 (3)儿童必须在成人监护下使用。 (4)如使用过量或发生严重不良反应应立即就医。 三、主要药品 麻黄碱 【适应证】(1)缓解鼻黏膜充血肿胀引起的鼻塞。(2)用于鼻出血。 羟甲唑啉 【适应证】用于急、慢性鼻炎，鼻窦炎，过敏性鼻炎。 [药学专业知识二] 【药圈】执业药师学习整理之第16章皮肤科科疾病用药 《药学专业知识(二)》第16章(皮肤科疾病用药)为新增内容，本章主要药物如下: (一)皮肤寄生虫感染治升华硫、林旦、克罗米通 疗药 (二)痤疮治疗药 过氧苯甲酰、维A酸、阿达帕林、异维A酸 十六 (三)皮肤真菌感染治疗制霉菌素、克霉唑、益康唑、咪康唑、酮康唑、联苯苄唑、特比萘芬、 皮肤科 药 环吡酮胺 疾病用药 醋酸氢化可的松、丁酸氢化可的松、地塞米松、醋酸曲安奈德、 (四)外用糖皮质激素 糠酸莫米松、卤米松 本章内容如下: risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 第十六章:皮肤科疾病用药 (1)正确掌握使用方法。如湿敷的方法;软膏、乳膏外用后应多加揉擦;对苔藓化肥厚皮损可采用封包疗法，以促进药物吸收，提高疗效。 (2)药物浓度要适当。有刺激性的药物应从低浓度开始逐渐递增，如维A酸类制剂 (3)用药要考虑患者年龄、性别、皮损部位。如儿童不宜使用强作用的糖皮质激素制剂;皮肤皱褶及黏膜部位不应使用高浓度、有刺激作用的药物。 (4)注意用药部位用药方法和个体差异，皮肤吸收药物的能力因部位不同而有所不同。 (5)应嘱咐患者，用药部位一旦出现刺激症状或红肿、皮肤瘙痒等过敏反应，应立即停药，清洗患处，并到医院就诊。 (6)适当的用量。 第一节:皮肤寄生虫感染治疗药物 疥疮和虱病是皮肤科常见的寄生虫感染性疾病。疥疮是由疥螨引起，主要通过直接接触传染， 治疗主要用外用药，如5%,10%硫黄软膏、林旦乳膏、10%克罗米通乳膏等。 虱病包括头虱、体虱、阴虱。患者大多为卫生条件差、群居生活的人。通过直接接触患者或其衣服、被褥等传染。 一、药理作用与临床评价 (一)作用特点 1、局部应用杀灭疥虫药，其中以林旦霜(疥灵霜，r-666霜)疗效最佳，其次是克罗米通(优力肤)、苯甲酸苄酯、硫黄软膏，被公认为特效药。 2、升华硫具有杀细菌和真菌及杀虫作用，能去除油脂，并有角质促成和角质溶解作用。 3、林旦是杀灭疥虫的有效药物，亦有杀灭虱和虱卵的作用，其与疥虫和虱体体表直接接触后，透过体壁，引起神经系统麻痹而死。 4、克罗米通具有局部麻醉作用，可治疗各型瘙痒症，并有特异性杀灭疥螨的作用，可作用于疥螨的神经系统，使疥螨麻痹死亡。另外，对链球菌和葡萄球菌的生长也有抑制作用。易于透入皮肤，作用迅速，可持续作用6h。 5、苯甲酸苄酯高浓度时可杀灭疥虫，作用优于硫黄。 (二)典型不良反应使用本类药后有轻度刺激症状如灼热感、瘙痒、皮疹等。克罗米通偶见过敏反应。长期大量使用林旦后，可能由于药物经皮肤吸收后，对中枢神经系统产生毒性作用，诱发癫痫等。 (三)禁忌证对相应药物过敏者禁用。 有癫痫病史,中枢神经系统器质性病变者、妊娠及哺乳期妇女、12岁以下儿童禁用林旦、苯甲酸苄酯。 急性渗出性皮肤病禁用克罗米通。 二、用药监护 (一)注意药品的正确应用 (二)监护药品的毒性 三、主要药品 硫磺 【适应证】用于疥疮、头癣、痤疮、脂溢性皮炎、酒渣鼻、单纯糠疹等。 林旦 【适应证】用于疥疮和阴虱病。 克罗米通 【适应证】用于疥疮、皮肤瘙痒。 第二节 痤疮治疗药 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 痤疮是青春发育期由于雄激素增多，致皮脂腺毛囊管壁角化并堵塞毛孔造成皮脂排出不畅，引起毛囊皮脂腺的炎症反应，同时与痤疮丙酸杆菌感染有关。 一、药理作用与临床评价 (一)作用特点 1(非抗生素类抗菌药 本类药物包括过氧苯甲酰和壬二酸。过氧苯甲酰为强氧化剂，可杀灭痤疮丙酸杆菌，并有使皮肤干燥和脱屑作用。 壬二酸可直接抑制和杀灭皮肤表面和毛囊内的细菌，消除病原体，并竞争性抑制产生二氢睾酮的酶过程。 2、抗角化药物 维A酸是维生素A的代谢中间体，调节表皮细胞有丝分裂，促进更新，抑制角化。 异维A酸具有缩小皮脂腺，抑制皮脂腺活性，减少皮脂分泌，以及减轻上皮细胞分化和减少毛囊中痤疮丙酸杆菌的作用。服后皮肤尤其是头面部的油脂分泌会明显减少。对严重的结节状痤疮有高效。 阿达帕林是维A酸类化合物，与维A酸细胞核受体有较高的亲和力，具有强大抗炎作用，抑制角质形成细胞过度增生，溶解痤疮和粉刺，调节毛囊、皮脂腺上皮肤细胞的分化，减少粉刺的产生，减少小囊数量。 (二)典型不良反应 1(非抗生素类抗菌药 过氧苯甲酰可能出现过敏性接触性皮炎和干燥现象。壬二酸有局部刺激反应，偶见皮肤脱色，罕见光敏感。 2(抗角化药 局部反应包括烧灼感、红斑、刺痛、瘙痒、皮肤干燥或脱屑，对紫外光敏感性增强。可出现一过性皮肤色素沉着。用于眼周可出现局部刺激和水肿、脱屑。如不良反应严重，应减少用药次数或停药。 口服异维A酸后，皮肤或黏膜(口唇、眼、鼻黏膜)可出现干燥、脱皮、鼻出血、头痛、肌肉与关节痛、血脂升高、肝脏转氨酶AST及ALT升高;有报道服药后出现精神变化，如抑郁、自杀倾向、焦虑、脱发;偶见过敏反应及光敏反应。妊娠期妇女服后可致自发性流产及胎儿发育畸形。 (三)禁忌证 1(非抗生素类抗菌药对相应药物过敏者及皮肤急性炎症或破溃者禁用。 2(抗角化药 对相应药物过敏者、妊娠及哺乳期妇女禁用。眼部、急性或亚急性皮炎、湿疹类皮肤病患者禁用维A酸。肝肾功能不全、维生素A过量及高脂血症患者禁用异维A酸。 二、用药监护 (一)针对痤疮的不同类型选择用药 1(对皮脂腺分泌过多所致的寻常型痤疮，首选2.5%,10%过氧苯甲酰凝胶涂敷患部，一日1-2次。 2(对轻、中度寻常型痤疮可选0.025%,0.03%维A酸乳膏剂或0.05%维A酸凝胶剂外搽，一日1-2次。于睡前洗净患部，连续8-12周为1个疗程，可显著减轻炎症对皮肤的损害。 3(对炎症突出的痤疮，轻、中度者可选维A酸和克林霉素磷酸酯凝胶外用治疗。 4(对痤疮伴细菌感染显著者，可应用红霉素一过氧苯甲酰凝胶、克林霉素磷酸酯凝胶或溶液涂敷，一日l一2次。 5(对中、重度痤疮伴感染显著者推荐涂敷0.1%阿达帕林凝胶，一日1次，或15%壬二酸乳膏，一日2次。 6(对囊肿型痤疮推荐口服维胺酯胶囊，一次50mg，一日3次，其可促进上皮细胞分化，有较好的疗效。或异维A酸，推荐剂量为一日0.lmg/kg，连续4—6月后，改为外用涂敷维持以控制复发。 (二)注意规避细菌耐药性 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 为减少痤疮丙酸杆菌等的耐药性，应做到 (1)尽可能使用非抗生素类抗菌药，如过氧苯甲酰或壬二酸。 (2)如果某种抗生素有效，可重复使用该药物数疗程，疗程的间歇期配合使用过氧苯甲酰或壬二酸。 (3)外用抗生素的疗程为4-8周，在此基础上一旦没有用药指征，应即停药。 (三)注意用药部位的保护 1(过氧苯甲酰、红霉素一过氧苯甲酰凝胶对皮肤有急性炎症及破损者禁用。 2(维A酸应避免用于皮肤较薄的皱褶部位，注意浓度不宜过高(0.3%以下较为适宜)， 3(维A酸与过氧苯甲酰联合应用时，在同一时间、同一部位应用有物理性配伍禁忌，应早、晚交替使用，即夜间睡前使用维A酸凝胶或乳膏，晨起洗漱后使用过氧苯甲酰凝胶。 三、主要药品过氧苯甲酰 【适应证】用于寻常痤疮。 维A酸 【适应证】用于寻常痤疮，特别是粉刺类损害，扁平疣、皮肤及毛囊角化异常性病变、寻常型银屑病。 阿达帕林 【适应证】用于以粉刺、丘疹和脓疱为主要表现的寻常型痤疮;面部、胸和背部的痤疮。 异维A酸 【适应证】用于重度痤疮(尤其是结节囊肿型痤疮)，毛发红糠疹。 第三节 皮肤真菌感染治疗药物 皮肤真菌感染可分为浅部及深部两大类。浅部真菌病主要包括皮肤癣菌病如手癣、足癣、体癣、股癣、甲癣及头癣等。常用的有咪唑类药物如咪康唑、联苯苄唑、益康唑、酮康唑和克霉唑等，丙烯胺类药物如特比萘芬、萘替芬等，还有吗啉类阿莫罗芬和吡啶酮类环吡酮胺等一、药理作用与临床评价。 (一)作用特点 1(抗生素类抗真菌药 抗生素类抗真菌药分为多烯类抗生素(如两性霉素B和制霉菌素等)与非多烯类抗生素(如灰黄霉素)，其中两性霉素B抗真菌活性最强，是唯一可用于治疗深部和皮下真菌感染的多烯类药物，因毒性大，不宜用作注射给药。局部应用不良反应少见。 2(唑类抗真菌药 本类药分为咪唑类(包括酮康唑、咪康唑、益康唑、克霉唑和联苯苄唑等)和三唑类(包括伊曲康唑、氟康唑和伏立康唑等)。 3(丙烯胺类抗真菌药本类药包括萘替芬和特比萘芬，为鲨烯环氧酶的非竞争性、可逆性抑制剂。 4(吗啉类抗真菌药 本类药有阿莫罗芬，为局部抗真菌药，通过干扰真菌细胞膜麦角固醇的合成导致真菌死亡。对皮肤癣菌、念珠菌、皮炎芽生菌、荚膜组织胞浆菌、申克孢子丝菌有抗菌活性。 5(吡啶酮类抗真菌药本类药有环吡酮胺，作用于真菌细胞膜。 (二)典型不良反应 (1)抗生素类抗真菌药:外用制霉菌素偶见接触性皮炎、局部发红、刺痛等刺激症状。阴道片或阴道栓可引起白带增多。 (2)唑类抗真菌药:本类药用后偶见局部刺激、瘙痒、烧灼感、接触性皮炎，皮肤可出现红斑、丘疹、水疱、脱屑等。 (3)丙烯胺类抗真菌药:本类药用后少数患者有局部刺激症状，如红斑、烧灼、干燥、瘙痒等，偶可引起接触皮炎。 (4)吗啉类抗真菌药:阿莫罗芬偶见局部刺激症状。 (5)吡啶酮类抗真菌药:偶见局部发红、刺痛、瘙痒、烧灼感等刺激症状，接触性皮炎。 (三)禁忌证 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions (1)抗生素类抗真菌药:对制霉菌素过敏者禁用。 (2)唑类抗真菌药:对本类药过敏者禁用。 (3)丙烯胺类抗真菌药:对本类药过敏者禁用。 (4)吗啉类抗真菌药:对阿莫罗芬过敏者、儿童(尤其是婴幼儿)禁用。 二、用药监护 (一)注意与糖皮质激素的适宜联合应用 (1)在体、股、足癣尚未根治之前，原则上禁止应用糖皮质激素制剂，如曲安奈德(去炎松)乳膏、氟西奈德(肤轻松)乳膏，以免加重病情。(2)为防止复发，治疗在感染症状消失后需再持续1-2周。 (3)为减轻炎症和过敏反应，可使用抗真菌药与糖皮质激素的复合制剂，如益康唑曲安奈德软膏，复方酮康唑软膏等，由于合用的是中、强效激素，因此此类复方制剂不能用于皮肤薄嫩处，更不能长期使用，以免产生皮肤萎缩等不良反应。(4)对于顽固、泛发或有免疫功能缺陷的患者，可选用系统抗真菌药治疗，如伊曲康唑一日lOOmg，连续15日，或一次200mg，一日2次，连续7日。也可用特比萘芬一日250mg，连续1-2周。 二、用药监护 (二)注意对手、足癣的预防与合理用药 (1)在使用外用药期间，对患部皮肤尽量不洗烫，少用或不用肥皂和碱性药物，少洗澡，以使抗真菌药在体表停留的时间延长，巩固和提高疗效。 (2)若患者同时患有手、足癣，必须同时治疗，以免由瘙抓而发再次感染。体股癣合并有糖尿病者，在应用抗真菌药的同时，宜控制血糖。 (3)保持足、体、股、大腿部的皮肤干燥，注意个人卫生，糜烂型足癣忌用热水洗烫，鞋袜应定期洗烫，在夏季潮湿的季节，宜在适宜场合经常解开鞋带而释放湿气。 三、主要药品制霉菌素 【适应证】用于白色念珠菌、隐球菌和球孢子菌等引起的皮肤、口腔、阴道、消化道的感染。 克霉唑 【适应证】用于体癣、股癣、手癣、足癣、花斑癣、头癣及念珠菌性甲沟炎和念珠菌性外阴阴道炎。 益康唑 【适应证】用于浅部真菌病、花斑糠疹、念珠菌性口角炎。 特比奈芬 【适应证】用于手癣、足癣、体癣、股癣、花斑糠疹及皮肤念珠菌病等。 第四节 外用糖皮质激素 一、药理作用与临床评价 (一)作用特点 外用糖皮质激素具有消炎、止痒和抑制皮损发作的作用 (二)典型不良反应 1、常见播散或加重用药局部的皮肤感染、皮肤萎缩、毛细血管扩张、接触性皮炎、口周皮炎、痤疮、色素沉着或减退及多毛等。 2、长期外用，尤其外用强效药者，可引起激素依赖性皮炎，多见于面部，可见红斑、毛细血管扩张和痤疮样丘疹似酒渣鼻样，伴有瘙痒或灼热感。 3、长期大面积外用或加封包使用强效、超强效糖皮质激素，由于经皮吸收累积量增加，可发生系统性不良反应，如库欣综合征等。 (三)禁忌证 对糖皮质激素或其赋形剂过敏者禁用。 外用糖皮质激素不能用于皮肤溃疡或有皮肤萎缩的部位。 也不能用于局部有明显细菌、真菌及病毒感染的疾病。强效及超强效激素不宜大面积使用。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions 任何外用激素制剂均不应长期、大面积使用。 二、用药监护 (一)严格控制糖皮质激素的应用指征 糖皮质激素并不对抗细菌、真菌等病原微生物，患有活动性肺结核者及肺部真菌、病毒感染者慎用。如皮肤合并感染时，应联合应用抗菌药物;并发全身过敏时，应同服抗过敏药。糖皮质激素与感染的关系体现在两个方面: (1)非生理性糖皮质激素对抗感染不利。在激素作用下，原来已被控制的感染可活动起来，最常见者为结核分枝杆菌、真菌感染复发。 (2)在某些感染时应用激素可减轻组织的破坏、减少渗出、减轻感染中毒症状，但必须同时用有效的抗菌药物治疗、密切观察病情变化，在短期用药后，即应迅速减量、停药。 (二)用量尽量节俭 (1)患部用药量应尽量节俭，初始时可涂一层薄膜，一日用药1-2次，一旦病情控制，用药次数即应减至最小量，以防再发。 (2)局部应用糖皮质激素，常发生可预期的不良反应，如表皮和真皮萎缩致使皮肤变薄，出现皮纹、毛细血管扩张和紫癜等，最常见于高吸收区(如面、颈、腋窝、会阴、生殖器)，老年人尤甚，应予注意。 (3)初始剂量宜小而停药应缓慢。 (三)注意用药部位面部和阴部等皮肤柔嫩及皱褶部位应避免长期外用糖皮质激素制剂。儿童使用强效激素制剂，连续使用不应超过2周。婴儿尿布皮炎尤应慎用，外用激素制剂应限于5-7日内。用于皮肤薄嫩、擦伤、有糜烂的皮损或大面积使用时会增加激素的局部吸收，严重时可出现系统性不良反应。超强效激素制剂通常只用于严重、顽固的皮炎、湿疹及银屑病皮损，而且只能短期使用，皮损消退后即可停药，再发再用;或以弱效糖皮质激素制剂或非糖皮质激素类抗炎药维持治疗。 主要药品 醋酸氢化可的松 【适应证】 (1)用于过敏性、非感染性皮肤病和一些炎症性皮肤疾病，如皮炎、湿疹、神经性皮炎、脂溢性皮炎及瘙痒症等。 丁酸氢化可的松 【适应证】用于对糖皮质激素有效的皮肤病，如接触性皮炎、特应性皮炎、脂溢性皮炎、湿疹、神经性皮炎、银屑病等瘙痒性及非感染性炎症性皮肤病。 地塞米松 【适应证】用于对糖皮质激素有效的非感染性、炎症性及瘙痒性皮肤病，如接触性皮炎、特应性皮炎、脂溢性皮炎、湿疹、神经性皮炎及局限性瘙痒症等。 risk managers with two account manager to deal with the above key. Section I of chapter III risk management requirements pre-loan investigation pre-loan investigation should double handle. Pre-loan investigation dominated by field investigations on the ground, while utilizing credit enquiries, telephone enquiries, bank information system query-related personnel, and so on. Interview system of Bank's strict application of the system of personal credit business interview. Investigators should work with borrowers, to the repayment or the guarantor credit business, such as parties and the spouse of confirmed acts such as loans, guarantees, verification of its authenticity and its rights and obligations in the credit business, retain these signed transcript of the interview, from the first step to prevent false loans and other business risks. Investigator should retain the borrower sign a personal loan application, loan applications should be clearly the amount, purpose, duration and other information. Investigators should follow the practice for information collection and verification of data authenticity it carefully, and keep copies, photocopies must be checked against the original agreement, effectively preventing borrowers using false information to apply for credit. Income and occupation, and other key information to verify authenticity investigators should carefully verifying the borrower's income. To income as the main source of repayment, subject to proof of income is required, but should also audit payroll flowing water, and staff than the peer confirmed the authenticity of the same type; operating income as the main source of repayment, and should refer to the working capital loans required to verify real incomes, accuracy; guard no ability to repay or guarantee of the ability of the borrower, guarantor to obtain credit. Given that some products for an object to have a specific professional restrictions