关于JPKD软件的使用

上了临床药师的培训课（http://www.clinphar.cn/thread-252153-1-1.html）,老师介绍了个软件可以做TDM计算,是台湾同胞发明的,不要钱,就是是英文版的,很多地方还看不懂,也用不来,比如说 simple time 我就不明白这指啥意思,有没有用过这软件的牛人给指导一下.下载网址是:pkpd.kmu.edu.tw/jpkd

怎么安装和应用都不知道

没看到simple time啊，只看到了sampling time

没用过，先下下来看看

直接download吗

我也在学习，他涉及的药动学参数太多，它里面只有他研究所列的几种药物，如果是新的，你想推倒的，好像得自己设计那个公式

我也正在学习中，有兴趣一起讨论，QQ：37851490 邹

我回复了您的帖子，不知道为什么看不到。

给个链接

http://mp.weixin.qq.com/s?__biz= ... 3029f01b21ed0498#rd

jpkd 2013年08月19日我在我的微信公众平台hz0752120写过，瞎搞的。

http://mp.weixin.qq.com/mp/appms ... 0b3#wechat_redirect



还有这个氨基糖苷类的

http://mp.weixin.qq.com/mp/appms ... 65f#wechat_redirect

很久没来，现在又在这里看到，再瞎搞一次吧，嗯嗯。


tdm for R只是R的一个package
R 即The R Project for Statistical Computing
http://www.r-project.org/
统计学有R，stata，SAS，SPSS等软件，我都不会。

JPKD源于boomer
http://boomer.org/
我也推荐一个，rxkinetics也不错的。

使用JPKD这个软件只能作个群体药动的参考，不能作为医疗决策的依据。
前提是需要数学，尤其是概率论：什么贝叶斯、马尔科夫我都不会，呵呵；还有就是PPK这些咯。

我粗略的解释哈这个软件使用：

举例患者 F ，80yr，36kg，Scr 165 μEq/L，
dosage regimen为：万古 1000mg iv.gtt q12hr
输液1小时好了。

Ts这里可以说一哈：是取样有关的参数

峰谷Peak Trough的意义我在这里转载些参考：
Part I
Because the goal is to administer the vancomycin such that a minimumally effective concentration is always maintained in the blood, measurement of blood levels is usually timed to reflect the trough and, sometimes peak, to evaluate the adequacy of dosing and clearance of the drug from the body. Trough levels are collected just prior to a person's next vancomycin dose. Peak levels are collected 1 to 2 hours after the completion of the intravenous vancomycin dose.
The trough and sometimes peak values are used by clinical pharmacists and health practitioners to calculate rates of absorption and clearance of the drug. These results are then used to determine the appropriate amount of drug and the appropriate timing between doses to assure that the blood concentration remains in the therapeutic range.
For additional information on how the test is used, see Therapeutic Drug Monitoring.

来源：http://labtestsonline.org/unders ... ancomycin/tab/test/

Part II
Precautions
        1. Proper timing of serum sampling is critical.
The trough sample should be obtained just prior to the dose. The timing of peak levels continues to be an area of controversy. Most experts now agree that peak samples are most appropriately obtained 15 to 30 minutes after infusion rather than 1-2 hours after, because peaks drawn later substantially underestimate the true peak levels achieved immediately after infusion.
Drawing at exactly the right time is not as important as having the lab note the exact times that the samples were drawn. Also, have the nurse note the exact times that the sample infusion was started and when it ended. Please be aware of the common policy of nursing personnel to record a dose as having been given exactly as ordered if it is given within 30 minutes of the recorded time. This could lead to significant errors in analysis, therefore it is important to record the exact times.
This issue cannot be stressed enough. Inaccurate recording of drug administration times and lab draw times are the greatest source of calculation error, having a greater effect than pharmacy preparation error or lab assay error.

来源：rxkinetics

特别是这一段：
The trough sample should be obtained just prior to the dose. The timing of peak levels continues to be an area of controversy. Most experts now agree that peak samples are most appropriately obtained 15 to 30 minutes after infusion rather than 1-2 hours after, because peaks drawn later substantially underestimate the true peak levels achieved immediately after infusion.

再补充一个：
When given by IV infusion over 60 minutes, vancomycin follows a 2-compartment pharmacokinetic model; alpha (distribution) and ß (elimination). The alpha (distribution) phase is relatively long, averaging two hours. This has important implications for peak serum level sampling. If the peak level is drawn during the distribution phase, it cannot be used for analysis of the one compartment model.

到底是一室模型还是二室模型？
The following table summarizes several vancomycin 1-compartment models, collected from the published literature and from colleagues. The table illustrates the large differences in published vancomycin model parameters. This comparison emphasizes that vancomycin pharmacokinetic parameters vary widely between studies. One can logically conclude that a single vancomycin model cannot be applied to all patient populations.


根据Ts的定义我觉得（太草率了）最好取值0.25hr，0.50hr，1.00hr算一哈。

如下图：（假设上一次测得Cs为10ng/ml）

当然如果是首次使用，Loading Dose 1g，
Cs又不能为0，可不可以输入0.0000001呢？不知道。

       

椭圆里的数字我们可以选个Cp 23.3ng/ml，Ct 15.5ng/ml
输入到软件界面第三列上方两框中，点击C-->D 按钮：

   

最后可以反过来调整下面的方案看行不行，比如剂量减减，



好了，小医院也搞不了tdm的了，要是有不正确的希望各位老师给我指出来。



最后留个问题，万古霉素（我上班那用的叫稳可信）的说明书上的图是什么图呢？
你有用过么？

A．Matzke 图    B. Moellering 图    C.都不是

   

我是颜志瀛（微信rxlist），多多交流哈。

**************

之前回复帖子居然没了，后面又查了下，结尾又补充Ts的疑惑


http://mp.weixin.qq.com/s?__biz= ... 3029f01b21ed0498#rd

这个东西一定药学  搞临床药学的帮助很大的  谢谢分享