一 : 执业西药师辅导:药剂学考试重点总结(五)

第5章    栓剂
重点内容 
    1．栓剂的概念、特点和质量要求 
    2．影响栓剂中药物吸收的因素 
    次重点内容 
    栓剂的常用基质、制备方法、置换价、质量评价与包装储存 
    考点摘要 
5.1 概述 
5.1.1栓剂的概念【掌】 药物与适宜基质制成一定形状的供人体腔道给药的固体制剂。 
5.1.2栓剂的分类【掌】 
1．肛门栓（直肠栓） 为圆锥形、圆柱形、鱼雷型等。可发挥局部和全身作用。 
2．阴道栓 为球形、卵形、鸭嘴形等。主要发挥局部作用。 
5.1.3栓剂的特点 
1．常温下为固体，体温下迅速软化熔融或溶解于分泌液中。 
2．发挥局部作用，如通便、止痛、止痒、抗菌消炎等。 
3．发挥全身作用。 
5.1.4与口服制剂比较，发挥全身作用栓剂的特点【掌】 
1．部分避免首过效应，降低副作用、发挥疗效； 
2．不受胃肠ph或酶的影响； 
3．避免药物对胃肠道的刺激。 
4．对不能吞服药物的病人可使用此类栓剂； 
5．不能口服的药物可制成此类栓剂。 
6．生产率较低，成本比较高。 
5.1.5栓剂的质量要求【掌】 
1．药物与基质混合均匀，外形圆整光滑，无刺激性。 
2．硬度适宜。塞入腔道后应能融化、软化或溶化，释药。 
5.1.6栓剂的治疗作用【掌】 
1．局部作用的栓剂  通常不吸收。如痔疮栓、局麻栓、消毒栓等故应选择熔化或溶解、释药速度慢的栓剂基质。水溶性基质制成的栓剂因腔道中的液体量有限，使其溶解速度受限，释放药物缓慢，较脂肪性基质更有利于发挥局部药效．如甘油明胶基质常用于起局部杀虫、抗菌的阴道栓基质。 
  2．全身作用的栓剂  用于全身作用的栓剂主要是肛门栓。 
  (1)药物吸收途径 
  栓剂直肠给药后的吸收途径： 
①药物通过直肠上静脉→门静脉→肝脏→大循环。
　　②药物通过直肠下静脉和肛门静脉→髂内静脉→下腔大静脉→大循环。
　　③药物通过直肠淋巴系统吸收。 
阴道用栓剂给药后，阴道血管与大循环相连，不经肝脏，且吸收速度较快 
    (2)影响直肠吸收的因素 
①生理因素 
1）用药时不宜塞得太深，距肛门2cm为宜。距肛门口6cm处，易受肝脏首过作用的影响。 
2）在直肠内保留的时间长，吸收完全。 
3）无粪便的存在，有利于药物的扩散及与肠粘膜的接触。 
4）腹泻、肠梗塞以及组织脱水等均能影响药物从直肠部位吸收的速率和程度。 
    4）直肠液的ph值为7.4，中性而无缓冲能力，溶解的药物能决定直肠的ph。 
  ②药物的理化性质 
  a脂溶性与解离度：直肠粘膜属类质屏障，对分子型药物有选择通过性。pka＞4.3， pka＜8.5，药物主要以分子状存在，易吸收。脂溶性大（油-水分配系数大）的药物易于透过。 
b粒度：影响释放、溶解及吸收。混悬型栓剂中，药物粒径小，吸收快。 
c溶解度：吸收的限速过程。药物的溶解度小直肠中溶解的少，吸收少。 
  ③基质对药物作用的影响  基质的溶解性与药物相反时，利于释放与吸收。 
  ④吸收促进剂及表面活性剂的作用 加入适宜的表面活性剂可促进药物的释放与吸收。 
    吸收促进剂可直接与肠粘膜起作用，改变膜通透性，加快药物的转运过程。

二 : 精算师考试综合辅导:职业发展（PD）FAQ一

if i have 15 or more professional development (pd) units acquired through conversion, can these credits be applied to meet the requirement to complete a project?

yes, but candidates with an interest in completing a project are encouraged to do so. they would then earn an additional 15 units for the project.

if i take 15 units before submitting my plan, are they at risk if my plan is disapproved?

candidates may want to discuss their approach to pd, including the educational objectives they wish to fulfil, with their advisors before starting to attend formal programs for pd credit. there is a time limit on such programs, in that a program is valid for a period of 25 months and could expire before the plan is completed if there is a delay in obtaining approval.

the credits taken must relate directly to the candidate’s legitimate educational objectives for the plan. if the program(s) used provides concrete support to the plan, there should be little risk of credits not being accepted.

what might cause a plan to be disapproved?

there are various reasons - a lack of integration or cohesion among the plan elements (e.g. covering multiple practice areas), a superficial approach to extending the candidate’s expertise, or lack of relevance of the programs cited to the objectives for the plan. in general, there should be little risk if the candidate and advisor approach the process by first establishing educational objectives and then determining appropriate programs to support those objectives. 

are there forms to submit with my initial plan and/or executed plan report?

initially, the letter of commitment and the pd plan, both signed by the advisor and the candidate, must be submitted along with the pd filing fee and payment form. the letter of commitment and payment form may be obtained from the soa web site or the soa's basic education catalog.

model plans have been developed and are available on the web site. candidates filing model plans will still be required to file a copy of the signed model plan and letter of commitment; and will also need to submit the filing fee and payment form. candidates may use the model plans exactly as written or as a framework for their plans, and adapt the plans to meet their individual pd needs.

upon completion of a pd plan, the candidate and advisor will submit to the soa a final executed plan, a final report attesting to the successful completion of the plan and fulfillment of the educational objectives, and the executed plan review checklist signed by the candidate and advisor. the advisor and candidate must sign-off on the executed plan and report. because the plan is unique to each candidate, we believe the attestation of a completed plan should also be unique and therefore we do not envision drafting a standardized form. the attestation should also include a written report on the project and written summaries on each program attended explaining how each program helped to attain the educational objectives of the plan and how the candidate may put to use the knowledge gained. program content information and handouts are required for any non-approved programs. see also tips for submitting your pd plan documents.

三 : 精算师考试综合辅导:职业发展（PD）FAQ二

what constitutes an acceptable topic for the project?

project topics should be subjects where actuarial analysis may be used to solve problems. the project may offer candidates an opportunity to apply actuarial reasoning and knowledge to either traditional or nontraditional areas of practice. project topics should be selected in light of the anticipated time commitment and opportunity to complete and demonstrate the appropriate project elements (that is, identification of the problem or issue, research, data collection, data analysis, and communication of results). the project is expected to involve between 60 and 100 hours of active work time and should be consistent with the educational objectives delineated in the pd plan. candidates might consider whether other actuaries of various experience levels in their organization and area of practice would find value in the results of their project. if a project would not offer other actuaries an opportunity for learning, the topic for that project may not be appropriate. see also: sample pd project.

how do ea exams fit in with the pd requirement?

if a candidate has not already received soa credit for the ea examinations (e.g. ea exam credits used in the conversion process), an ea designation satisfies 25 pd units, and meets the requirement for soa-approved units. see also: pd values for examination validated options

can an employer-sponsored program be part of my pd plan?

yes. a an employer-sponsored program may be included as a non- approved element in a candidate’s pd program, if the candidate’s advisor finds the program to be appropriate to the candidate’s development and sufficiently rigorous. as with all non-approved plan elements, the candidate is required to provide a written summary of the benefits obtained through the program content, as well as a statement of now the program helped the candidate attain one or more of the educational objectives of the plan.

employer-sponsored programs may also be included in a candidate’s pd program as soa-approved elements, if the employer sponsoring the program has applied to and received approval from the soa. employers should refer to information on applying for soa-approved pd credit on this web site.

can i do three smaller projects of 5 credits each instead of one larger project?

no. a project may consist of smaller sub-components, but each sub-component must be related to the overall project. credits for the project will be assigned on an all-or-nothing basis.

can work i do as part of a larger team be used for the project?

project work done as part of a larger team can qualify as appropriate for a professional development project, but the candidate’s involvement must be significant and each candidate must have a substantial, distinguishable component of the project for which he/she is primarily responsible. the advisor will require the candidate to report independently his/her portion of the project process as well as the entire project process and outcome in the project report. see also: use of team projects and client work.

四 : 执业医师考试辅导：医学免疫学学习方法

　　在世界历史上，我国采用人痘接种最先创立了预防天花的方法。1796年英国医生edward jenner则进一步创造了用接种牛痘预防天花的方法。免疫学就是从那时起诞生的。经过150年的发展，渐渐形成了一门新的学科，到本世纪50、60年代时，开始进入飞跃发展时期，取得了一系列意义深远的重大成果，有力地推动了整个生物医学的发展。所以说免疫学是一门既古老又年轻的学科。而免疫学现在仍处在飞跃发展的时期，已被公认为21世纪生物医学领域中起支撑和领头作用的前沿学科之一。

　　无论是从医学基础理论、还是从医学临床实践来看，免疫学都是一门十分重要的基础课程。无论是对临床医学专业，还是对护理学专业，免疫学都是一门必修课。对于参加高等教育自学考试的学生来讲，必须通过自学学好免疫学。怎样通过自学学好免疫学？本文拟就此提一点建议和看法。

　　一、掌握免疫学结构体系的特点

　　对自学者说，正确认识免疫学结构体系对学好免疫学有很大的益处。

　　免疫学发展到今天，早已跳出抗感染免疫的范畴，形成了非常丰厚的知识结构体系。它包括免疫生物学、免疫生理学、免疫病理学、免疫药理学、分子免疫学、免疫化学、免疫遗传学、肿瘤免疫学、移植免疫学、生殖免疫学等。对医学生（包括护理和临床医学专业）来说，核心是“基础免疫学”和“临床免疫学”。

　　基础免疫学是学习免疫学必备的基本知识，是起步阶段必需的知识基础。基础免疫学涉及免疫生物学、免疫化学、免疫生理学、免疫遗传学、免疫病理学等方面的基本概念、基本知识、基本理论。基础免疫学又可分为两部分。第一部分介绍了有关的基本概念、基本知识：什么是免疫？免疫有何功能作用，在生理、病理状态下有何表现？免疫功能是靠什么组织系统完成的，免疫系统的构成如何？免疫器官有哪些，各有何结构与功能特点？免疫细胞有哪些、各有何功能、各有何重要结构及其与功能的关系？免疫分子有哪些、各有何结构、分布及功能特点？第二部分介绍了免疫应答的发生及其调节机制：什么是免疫应答、有哪些类型？免疫应答发生在哪里，有何基本特点？免疫应答的基本过程是怎样的？b细胞介导的体液免疫应答是怎样发生的，抗体产生的一般规律如何，抗体怎样发生免疫效应？t细胞介导的细胞免疫应答是怎样发生的，其免疫效应机制的生理、病理作用是什么？何谓免疫耐受、发生机理如何，有何实际意义？免疫调节机制有哪些，是怎样发挥作用的？

　　临床免疫学是把基础免疫学中所学习的基础知识应用于临床实际问题。它介绍根据免疫学基本原理所设计的免疫学检测或诊断技术的原理、方法和临床应用；介绍根据免疫学基本原理所发展的免疫学防治方法的原理与应用；介绍了超敏反应性疾病、自身免疫性疾病、肿瘤及移植排斥反应发生的免疫学原理、免疫诊断及防治的基本原则、方法及其原理。

　　因此，根据免疫学自身的结构体系特点，自学者应把自学重点放在基础免疫学部分，着重掌握免疫的功能、免疫器官、免疫细胞、抗原、抗体、补体、细胞因子和粘附分子、主要组织相容性抗原、免疫应答等方面的基本概念、基本知识；再在此基础上深刻理解、融汇贯通，去认识和解决相关的临床问题（免疫病理机制、免疫学诊断及免疫学防治）。

　　二、记忆是基础，理解是关键，注意与临床实际相结合

　　从学科特点看，免疫学具有形态学和机能学相结合的特点，常以形态学为基础，但落脚在机能学上。因此，它的知识中既有形象、直观的内容，又有抽象、理念性的内容。而形态结构是为功能服务的。所以学习中必须抓住功能这个“重中之重”。

　　免疫学中有许多基本概念，如中枢免疫系统、外周免疫系统、淋巴细胞再循环、抗原、抗体、免疫球蛋白、补体、细胞因子、粘附分子、过敏毒素、超化因子、调理作用、白细胞介素、主要组织相容性抗原、异嗜性抗原、肿瘤相关抗原、免疫粘附、超敏反应、免疫耐受等等，必须在充分理解的基础上进行记忆。只有理解了、记住了，才谈得上学习免疫学的系统性知识。免疫学中还有许多常用的英文缩写名词，如siga、smig、adcc、tcr、ifn、tnf、apc、 ctl、mhc、elisa等，必须了解其英文原文，从而掌握其中文名称及其含义。对于许多重要的免疫因素即免疫系统的组成成分，如t细胞、b细胞、nk 细胞、ctl、th、tdth、巨噬细胞、抗体、cd分子、mhc－ⅱ分子、细胞因子等，要通过理解基础上的记忆，熟悉其形态或结构特点及其主要的生物学功能。在此基础上，要进一步通过横向比较，加深理解，在深层上掌握各自的特点，如异嗜性抗原与类属抗原的区别、抗体与免疫球蛋白的区别、补体活化经典途径与旁路途径的区别、中枢免疫器官与外周免疫器官的区别、tcr与bcr的区别、ctl与nk细胞的区别、mhc－ⅰ和mhc－ⅱ类分子的区别、主动免疫与被动免疫的区别、活病苗与死疫苗的区别、免疫耐受与免疫抑制/免疫缺陷的区别、青霉素皮试与o.t/ppd试验的区别等。另外还要注意掌握免疫细胞、免疫分子的结构与对应功能的关系。对免疫学中的许多机制问题，如抗原识别机制、淋巴细胞活化机制、抗体产生机制、抗体的免疫效应机制、ctl/nk细胞杀伤靶细胞的机制、tdth细胞完成免疫效应的机制、免疫调节机制、各型超敏反应的发生机制、自身免疫病的发生机制、抗感染机制、抗肿瘤免疫机制、移植排斥反应发生机制、人工免疫机制、各种临床常用免疫学检测技术的原理等必须在充分理解的基础上掌握，要把前面部分所学习的免疫学基本概念、基本知识有机地运用于对各种免疫机制的学习和领会。这里存在一个前后结合、汇融贯通、触类旁通的问题。

本文标题：执业药师考试辅导精华-执业西药师辅导:药剂学考试重点总结(五)
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