Kelner M J
University of California, San Diego School of Medicine, La Jolla.
Clin Lab Med. 1987 Sep;7(3):567-85.
This article has briefly summarized the physiologic effects, pharmacokinetics, adverse effects, drug interactions, and methods of analysis for the newer cardiac agents. Methods of analysis for these newer agents are primarily chromatographic types, such as gas-liquid or high-pressure liquid chromatography. Conspicuously absent from methods of analysis for these agents are the newer immunologic methods such as RIA or enzyme-linked assays. This deficiency in methodology is due to several factors. Cross-reactivity between metabolites and parent compounds is often a problem with antibody-based assays, and several of these agents have metabolites that reach concentrations equivalent to that of the parent drug. Several of the newer antiarrhythmics are structurally related not only to each other but also to older agents such as lidocaine. Overcoming this cross-reactivity would be necessary before these assays could be used in patients being converted from intravenous lidocaine to the newer oral preparations. With the development of monoclonal antibody techniques, the need for close therapeutic monitoring of several of the drugs, and the increased emphasis on restraining costs in the clinical laboratory, the newer immunologic methods may soon be introduced in the United States.
本文简要总结了新型心脏药物的生理效应、药代动力学、不良反应、药物相互作用及分析方法。这些新型药物的分析方法主要是色谱类型，如气液色谱或高压液相色谱。这些药物的分析方法中明显缺乏新型免疫方法，如放射免疫分析（RIA）或酶联测定法。方法学上的这一缺陷是由几个因素造成的。代谢物与母体化合物之间的交叉反应通常是基于抗体的检测方法所面临的问题，而且这些药物中有几种的代谢物浓度可达到与母体药物相当的水平。几种新型抗心律失常药物不仅在结构上彼此相关，而且与利多卡因等老药也有关联。在这些检测方法可用于从静脉注射利多卡因转换为新型口服制剂的患者之前，克服这种交叉反应是必要的。随着单克隆抗体技术的发展、对几种药物进行密切治疗监测的需求以及临床实验室对控制成本的日益重视，新型免疫方法可能很快会在美国被引入。
