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WHO guidelines on transfer of technology in pharmaceutical manufacturing Annex 7_

WHO guidelines on transfer of technology in pharmaceutical manufacturing Annex 7_
WHO guidelines on transfer of technology in pharmaceutical manufacturing Annex 7_

?World Health Organization

WHO Technical Report Series, No. 961, 2011

Annex 7

WHO guidelines on transfer of technology

in pharmaceutical manufacturing

1. Intr o duct i on

2. Sc o pe

3. Gl o ssary

4. Organ i zat i on and management

5. Pr o duct i on: transfer (process i ng, packag i ng and clean i ng)

6. Qual i ty control: analyt i cal method transfer

7. Prem i ses and equ i pment

8. D o cumentat i on

9. Qual i? cat i on and val i dat i on

References

285

1. Introduction

These gu i d i ng pr i nc i ples on transfer of technology are i ntended to serve as

a framework wh i ch can be appl i ed i n a ? ex i ble manner rather than as str i ct

r i g i d gu i dance. Focus has been placed on the qual i ty aspects, i n l i ne w i th WHO’s mandate.

1.1 Transfer of processes to an alternat i ve s i te occurs at some stage i n the

l i fe-cycle of most products, from development, scale-up, manufactur i ng, product i on and launch, to the post-approval phase.

1.2 Transfer of technology i s de? ned as “a log i cal procedure that controls

the transfer of any process together w i th i ts documentat i on and profess i onal expert i se between development and manufacture or between manufacture s i tes”. It i s a systemat i c procedure that i s followed i n order to pass the documented knowledge and exper i ence ga i ned dur i ng development and or commerc i al i zat i on to an appropr i ate, respons i ble and author i zed party.

Technology transfer embod i es both the transfer of documentat i on and the demonstrated ab i l i ty of the rece i v i ng un i t (RU) to effect i vely perform the cr i t i cal elements of the transferred technology, to the sat i sfact i on of all part i es and any appl i cable regulatory bod i es.

1.3 L i terature searches revealed l i ttle i nformat i on on the sub j ect or i g i nat i ng

from nat i onal or reg i onal regulatory b od i es. Gu i dance on i ntracompany transfers was prepared b y the Internat i onal Soc i ety for Pharmaceut i cal Eng i neer i ng (ISPE) (1).

1.4 The ever chang i ng bus i ness strateg i es of pharmaceut i cal compan i es

i ncreas i ngly i nvolve i ntra- and i ntercompany transfers of technology for

reasons such as the need for add i t i onal capac i ty, relocat i on of operat i ons or consol i dat i ons and mergers. The WHO Expert Comm i ttee on Spec i? cat i ons for Pharmaceut i cal Preparat i ons, therefore, recommended i n i ts forty-second report that WHO address th i s i ssue through preparat i on of WHO gu i del i nes on th i s matter (2).

1.5Transfer of technology requ i res a documented, planned approach us i ng

tra i ned and knowledgeable personnel work i ng w i th i n a qual i ty system, w i th documentat i on of data cover i ng all aspects of development, product i on and qual i ty control. Usually there i s a send i ng un i t (SU), a rece i v i ng un i t and the un i t manag i ng the process, wh i ch may or may not be a separate ent i ty. For “contract manufactur i ng” please see good manufactur i ng pract i ces (GMP) (3).

1.6 For the transfer to be successful, the follow i ng general pr i nc i ples and

requ i rements should be met:

?the pro j ect plan should encompass the qual i ty aspects of the pro j ect and be based upon the pr i nc i ples of qual i ty r i sk management;

286

?the capab i l i t i es of the SU and at the RU should b e s i m i lar, b ut not necessar i ly i dent i cal, and fac i l i t i es and equ i pment should operate accord i ng to s i m i lar operat i ng pr i nc i ples;

? a comprehens i ve techn i cal gap analys i s between the SU and RU i nclud i ng

techn i cal r i sk assessment and potent i al regulatory gaps, should b e performed as needed;

?adequately tra i ned staff should be ava i lable or should be tra i ned at the RU:—regulatory requ i rements i n the countr i es of the SU and the RU, and

i n any countr i es where the product i s i ntended to be suppl i ed, should

b e taken i nto account and i nterpreted cons i stently throughout any

transfer programme pro j ect; and

—there should be effect i ve process and product knowledge transfer.

1.7Technology transfer can be cons i dered successful i f there i s documented

ev i dence that the RU can rout i nely reproduce the transferred product, process or method aga i nst a prede? ned set of spec i? cat i ons as agreed w i th the SU.

1.8 In the event that the RU i dent i? es part i cular problems w i th the process

dur i ng the transfer, the RU should commun i cate them back to the SU to ensure cont i nu i ng knowledge management.

1.9 Technology transfer pro j ects, part i cularly those b etween d i fferent

compan i es, have legal and econom i c i mpl i cat i ons. If such i ssues, wh i ch may i nclude i ntellectual property r i ghts, royalt i es, pr i c i ng, con?i ct of

i nterest and con? dent i al i ty, are expected to i mpact on open commun i cat i on

of techn i cal matters i n any way, they should be addressed before and dur i ng plann i ng and execut i on of the transfer.

1.10 Any lack of transparency may lead to i neffect i ve transfer of

technology.

1.11 Some of the pr i nc i ples outl i ned i n th i s document may also b e

appl i cab le to manufactur i ng i nvest i gat i onal pharmaceut i cal products for cl i n i cal tr i als as part of research and development, but th i s i s not the ma i n focus of th i s gu i dance and has been excluded due to the complex i ty of the processes.

1.12 Some of the respons i b i l i t i es outl i ned i n th i s document for the SU

may also be cons i dered to be part of the management un i t respons i b i l i t i es.

2. Scope

Note: Th i s sect i on spec i? cally prov i des for transfer of qual i ty control (QC) methods where a techn i cal agreement ex i sts (SU manufacturer to RU manufacturer or SU manufacturer to RU QC laboratory). Where no such techn i cal agreements ex i st (e.g. test i ng by nat i onal laborator i es or test i ng

287

for procurement agenc i es) a number of the po i nts l i sted i n sect i on 2.4 may not be workable, and alternat i ve approaches may be requ i red.

2.1 Th i s document g i ves gu i dance i n pr i nc i ple and prov i des general

recommendat i ons on the act i v i t i es necessary to conduct a successful i ntra- or i nters i te transfer of technology as descr i bed i n the Introduct i on to these gu i del i nes. The i ntent i on i s to address the bas i c cons i derat i ons needed for

a successful transfer i n order to sat i sfy the regulatory author i ty de? ned for

the transfer process.

2.2 The gu i del i nes w i ll be appl i ed to manufactur i ng act i ve pharmaceut i cal

i ngred i ents (APIs), manufactur i ng and packag i ng of b ulk mater i als,

manufactur i ng and packag i ng of ? n i shed pharmaceut i cal products (FPPs) and/or perform i ng analyt i cal test i ng.

2.3 The recommendat i ons prov i ded i n these gu i del i nes apply to all dosage

forms but need to be ad j usted on a case-by-case bas i s (e.g. by us i ng r i sk management pr i nc i ples). Part i cularly close control of certa i n aspects w i ll be requ i red for certa i n formulat i ons such as ster i le products, and metered-dose aerosols. WHO gu i dance on manufacture of spec i? c pharmaceut i cal products(4,5) w i ll be useful i n th i s regard.

2.4 The gu i del i nes address the follow i ng areas at the SU and the RU:

—transfer of development and product i on (process i ng, packag i ng and clean i ng);

—transfer of analyt i cal methods for qual i ty assurance and qual i ty control;

—sk i lls assessment and tra i n i ng;

—organ i zat i on and management of the transfer;

—assessment of prem i ses and equ i pment;

—documentat i on; and

—qual i? cat i on and val i dat i on.

2.5Because each transfer pro j ect i s un i que, the prov i s i on of a comprehens i ve

set of gu i del i nes i s beyond the scope of th i s document.

2.6 These gu i del i nes do not prov i de gu i dance on any legal, ? nanc i al or

commerc i al cons i derat i ons assoc i ated w i th technology transfer pro j ects. 3. Glossary

The de? n i t i ons g i ven below apply to the terms used i n these gu i del i nes.

They may have d i fferent mean i ngs i n other contexts.

acceptance criteria

Measurable terms under wh i ch a test result w i ll be cons i dered acceptable. 288

active pharmaceutical ingredient (API)

Any sub stance or m i xture of sub stances i ntended to b e used i n the manufacture of a pharmaceut i cal dosage form and that, when so used, b ecomes an act i ve i ngred i ent of that pharmaceut i cal dosage form. Such substances are i ntended to furn i sh pharmacolog i cal act i v i ty or other d i rect effect i n the d i agnos i s, cure, m i t i gat i on, treatment, or prevent i on of d i sease or to affect the structure and funct i on of the body.

bracketing

An exper i mental des i gn to test only the extremes of, for example, dosage strength. The des i gn assumes that the extremes w i ll be representat i ve of all the samples between the extremes.

change control (C/C)

A formal system b y wh i ch qual i? ed representat i ves of appropr i ate d i sc i pl i nes rev i ew proposed or actual changes that m i ght affect a val i dated status. The i ntent i s to determ i ne the need for act i on that would ensure that the system i s ma i nta i ned i n a val i dated state.

commissioning

The sett i ng up, ad j ustment and test i ng of equ i pment or a system to ensure that i t meets all the requ i rements, as spec i? ed i n the user requ i rement spec i? cat i on, and capac i t i es as spec i?ed b y the des i gner or developer. Comm i ss i on i ng i s carr i ed out before qual i? cat i on and val i dat i on.

control strategy

A planned set of controls, der i ved from current product and process understand i ng, that assures process performance and product qual i ty. The controls can i nclude parameters and attr i b utes related tomater i als and components related to drug sub stances and drug product mater i als and components, fac i l i ty and equ i pment operat i ng cond i t i ons, i n-process controls, ? n i shed product spec i? cat i ons, and the assoc i ated methods and frequency of mon i tor i ng and control (6).

corrective action (C/A)

Any act i on to be taken when the results of mon i tor i ng at a cr i t i cal control po i nt i nd i cate a loss of control.

critical

Hav i ng the potent i al to i mpact on product qual i ty or performance i n a s i gn i? cant way.

critical control point (CCP)

A step at wh i ch control can be appl i ed and i s essent i al to prevent or el i m i nate a pharmaceut i cal qual i ty hazard or to reduce i t to an acceptable level.

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design quali? cation (DQ)

Documented ev i dence that the prem i ses, support i ng systems, ut i l i t i es, equ i pment and processes have b een des i gned i n accordance w i th the requ i rements of good manufactur i ng pract i ces (GMP).

design space

The mult i d i mens i onal comb i nat i on and i nteract i on of i nput var i ables (e.g.

mater i al attr i butes) and process parameters that have been demonstrated to prov i de assurance of qual i ty (7).

drug master ? le (DMF)

Deta i led i nformat i on concern i ng a spec i? c fac i l i ty, process or product subm i tted to the med i c i nes regulatory author i ty, i ntended for i ncorporat i on

i nto the appl i cat i on for market i ng author i zat i on.

? nished pharmaceutical product (FPP)

A product that has undergone all stages of product i on, i nclud i ng packag i ng

i n i ts ? nal conta i ner and labell i ng. An FPP may conta i n one or more APIs.

gap analysis

Ident i? cat i on of cr i t i cal elements of a process wh i ch are ava i lable at the SU but are m i ss i ng from the RU.

good manufacturing practices (GMP)

That part of qual i ty assurance wh i ch ensures that pharmaceut i cal products are cons i stently produced and controlled to the qual i ty standards appropr i ate to the i r i ntended use and as requ i red by the market i ng author i zat i on (3).

in-process control (IPC)

Checks performed dur i ng product i on i n order to mon i tor and, i f necessary, to ad j ust the process to ensure that the product conforms to i ts spec i? cat i ons.

The control of the env i ronment or equ i pment may also be regarded as a part of i n-process control.

installation quali? cation (IQ)

The performance of tests to ensure that the i nstallat i ons (such as mach i nes, measur i ng dev i ces, ut i l i t i es and manufactur i ng areas) used i n

a manufactur i ng process are appropr i ately selected and correctly i nstalled

and operate i n accordance w i th establ i shed spec i? cat i ons.

intercompany transfer

A transfer of technology between s i tes of d i fferent compan i es.

intracompany transfer

A transfer of technology between s i tes of the same group of compan i es.

290

operational quali? cation (OQ)

Documented ver i? cat i on that the system or subsystem performs as i ntended over all ant i c i pated operat i ng ranges.

performance quali? cation (PQ)

Documented ver i? cat i on that the equ i pment or system operates cons i stently and g i ves reproduc i b i l i ty w i th i n de? ned spec i? cat i ons and parameters for prolonged per i ods. (In the context of systems, the term “process val i dat i on”may also be used.)

process validation

Documented ev i dence wh i ch prov i des a h i gh degree of assurance that a spec i?c process w i ll cons i stently result i n a product that meets i ts predeterm i ned spec i? cat i ons and qual i ty character i st i cs.

quali? cation

Act i on of prov i ng and document i ng that any prem i ses, systems and equ i pment are properly i nstalled, and/or work correctly and lead to the expected results. Qual i? cat i on i s often a part (the i n i t i al stage) of val i dat i on, but the i nd i v i dual qual i? cat i on steps alone do not const i tute process val i dat i on.

quali? cation batches

Those batches produced by the RU to demonstrate i ts ab i l i ty to reproduce the product (1).

quality assurance (QA)

Qual i ty assurance i s a w i de-rang i ng concept cover i ng all matters that i nd i v i dually or collect i vely i n?uence the qual i ty of a product.It i s the total i ty of the arrangements made w i th the ob j ect i ve of ensur i ng that pharmaceut i cal products are of the qual i ty requ i red for the i r i ntended use. quality control (QC)

Qual i ty control covers all measures taken, i nclud i ng the sett i ng of spec i? cat i ons, sampl i ng, test i ng and analyt i cal clearance, to ensure that start i ng mater i als, i ntermed i ates, packag i ng mater i als and ? n i shed pharmaceut i cal products conform w i th establ i shed spec i? cat i ons for i dent i ty, strength, pur i ty and other character i st i cs.

quality planning

Part of qual i ty management focused on sett i ng qual i ty ob j ect i ves and spec i fy i ng necessary operat i onal processes and related resources to ful? l the qual i ty ob j ect i ves (6).

quality policy

Overall i ntent i ons and d i rect i on of an organ i zat i on related to qual i ty as formally expressed by sen i or management (6).

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quality risk management (QRM)

Qual i ty r i sk management i s a systemat i c process for the assessment, control, commun i cat i on and rev i ew of r i sks to the qual i ty of the pharmaceut i cal product throughout the product l i fe-cycle.

receiving unit (RU)

The i nvolved d i sc i pl i nes at an organ i zat i on where a des i gnated product, process or method i s expected to be transferred.

sending unit (SU)

The i nvolved d i sc i pl i nes at an organ i zat i on from where a des i gnated product, process or method i s expected to be transferred.

spiking

The add i t i on of a known amount of a compound to a standard, sample or placeb o, typ i cally for the purpose of con? rm i ng the performance of an analyt i cal procedure.

standard operating procedure (SOP)

An author i zed wr i tten procedure g i v i ng i nstruct i ons for perform i ng operat i ons not necessar i ly spec i? c to a g i ven product or mater i al (e.g.

equ i pment operat i on, ma i ntenance and clean i ng, val i dat i on, clean i ng of prem i ses and env i ronmental control, sampl i ng and i nspect i on). Certa i n SOPs may b e used to supplement product-spec i?c master and b atch product i on documentat i on.

technology transfer report

A documented summary of a spec i? c technology transfer pro j ect l i st i ng

procedures, acceptance cr i ter i a, results ach i eved and conclus i ons. Any dev i at i on should be d i scussed and j ust i? ed.

validation

Act i on of prov i ng and document i ng that any process, procedure or method actually and cons i stently leads to the expected results.

validation master plan (VMP)

A h i gh-level document that establ i shes an umbrella val i dat i on plan for the

ent i re pro j ect and summar i zes the manufacturer’s overall ph i losophy and approach, to be used for establ i sh i ng performance adequacy. It prov i des

i nformat i on on the manufacturer’s val i dat i on work programme and

de? nes deta i ls of and t i mescales for the val i dat i on work to be performed,

i nclud i ng a statement of the respons i b i l i t i es of those i mplement i ng the

plan.

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validation protocol (or plan) (VP)

A document descr i b i ng the act i v i t i es to b e performed i n a val i dat i on,

i nclud i ng the acceptance cr i ter i a for the approval of a manufactur i ng

process — or a part thereof — for rout i ne use.

validation report (VR)

A document i n wh i ch the records, results and evaluat i on of a completed

val i dat i on programme are assembled and summar i zed. It may also conta i n proposals for the i mprovement of processes and or equ i pment.

n and management

4. Organizatio

4.1 Transfer compr i ses an SU and an RU. In some c i rcumstances there

may be an add i t i onal un i t wh i ch w i ll be respons i ble for d i rect i ng, manag i ng and approv i ng the transfer.

4.2 There i s a formal agreement between the part i es, wh i ch spec i? es the

respons i b i l i t i es before, dur i ng and after transfer.

4.3 Organ i zat i on and management of a successful technology transfer

need to ensure that the ma i n steps have been executed and documented as descr i bed i n sect i on 1.6.

4.4There should b e a pro j ect management plan wh i ch i dent i? es

and controls all the necessary act i v i t i es i dent i?ed at the start of the undertak i ng.

4.5 The transfer protocol should l i st the i ntended sequent i al stages of the

transfer. The protocol should i nclude:

—ob j ect i ve;

—scope;

—key personnel and the i r respons i b i l i t i es;

—a parallel compar i son of mater i als, methods and equ i pment;

—the transfer stages w i th documented ev i dence that each cr i t i cal stage has been sat i sfactor i ly accompl i shed before the next commences;

—i dent i? cat i on of cr i t i cal control po i nts;

—exper i mental des i gn and acceptance cr i ter i a for analyt i cal methods;

—i nformat i on on tr i al product i on b atches, qual i? cat i on b atches and process val i dat i on;

—change control for any process dev i at i ons encountered;

—assessment of end-product;

—arrangements for keep i ng retent i on samples of act i ve i ngred i ents,

i ntermed i ates and ? n i shed products, and i nformat i on on reference

substances where appl i cable; and

—conclus i on, i nclud i ng s i gned-off approval by pro j ect manager.

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4.6 The SU should prov i de the necessary val i dat i on documentat i on for

the process and i ts support funct i ons. Usually, an estab l i shed process i s transferred, and such documentat i on i s already ava i lable.

4.7 The SU should prov i de cr i ter i a and i nformat i on on hazards and

cr i t i cal steps assoc i ated w i th the product, process or method to b e transferred, to serve as a b as i s for a qual i ty r i sk management (QRM) exerc i se at the RU (7–10).

4.8 The SU or th i rd party should assess the su i tab i l i ty and degree of

preparedness of the RU before transfer, w i th regard to prem i ses, equ i pment and support serv i ces (e.g. purchas i ng and i nventory control mechan i sms, qual i ty control (QC) procedures, documentat i on, computer val i dat i on, s i te val i dat i on, equ i pment qual i? cat i on, water for pharmaceut i cal product i on and waste management).

4.9The SU and the RU should j o i ntly ver i fy that the follow i ng,

sat i sfactor i ly completed, val i dat i on protocols are ava i lable:

?i nstallat i on qual i? cat i on (IQ) and operat i onal qual i? cat i on (OQ) data for

manufactur i ng and packag i ng equ i pment at the RU s i te and analyt i cal

equ i pment; and

?qual i? cat i on of the rooms for both manufacture and packag i ng at the RU

s i te.

4.10The SU and the RU should j o i ntly i mplement any tra i n i ng

programmes that may b e requ i red spec i?c to the product, process or method to be transferred, e.g. on analyt i cal methods or equ i pment usage, and assess tra i n i ng outcomes.

4.11 The SU and the RU should j o i ntly execute the transfer protocol

accord i ng to a checkl i st and or ? ow d i agram show i ng the sequence of steps to be carr i ed out to effect an ef? c i ent transfer.

4.12 Any changes and adaptat i ons made dur i ng the course of the

technology transfer should be fully documented.

4.13 The SU and the RU should j o i ntly document the execut i on of the

transfer protocol i n a transfer of technology summary i n a report.

team

Project

4.14 Any transfer pro j ect w i ll be managed by a team compr i s i ng members

w i th clearly de? ned key respons i b i l i t i es. The team should be drawn from members of relevant d i sc i pl i nes from both the SU and RU s i tes.

4.15 The team memb ers should have the necessary qual i? cat i ons and

exper i ence to manage the i r part i cular aspect of the transfer.

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5.Production: transfer (processing, packaging

and cleaning)

5.1 The RU should b e ab le to accommodate the i ntended product i on

capac i ty. If poss i ble, i t should b e estab l i shed at the outset whether the

i ntent i on i s to perform s i ngle-batch manufacture, cont i nuous product i on or

campa i gns.

5.2 Cons i derat i on should be g i ven to the level and depth of deta i l to be

transferred to support product i on and any further process development and opt i m i zat i on at the RU as i ntended under the transfer pro j ect plan.

5.3 Cons i derat i on should b e g i ven to the techn i cal expert i se, s i te

technology and s i te capab i l i t i es for the RU. It should be i dent i? ed upfront by the SU of any process robustness i ssues so that plans may be put i n place at the RU.

5.4 The SU and the RU should j o i ntly develop a protocol for the transfer

of relevant i nformat i on related to the process under cons i derat i on from the SU to the RU, as well as the development of a comparable process at the RU.

materials

Starting

5.5 The spec i? cat i ons and relevant funct i onal character i st i cs of the

start i ng mater i als (APIs and exc i p i ents) (11,12) to be used at the RU should be cons i stent w i th mater i als used at the SU. Any propert i es wh i ch are l i kely to i n? uence the process or product should be i dent i? ed and character i zed.

Active pharmaceutical ingredients (API)

5.6 The SU should prov i de the RU w i th the open (appl i cant’s) part

of the API master ?le (APIMF or drug master ?le (DMF) or act i ve substance master ? le (ASMF)), or equ i valent i nformat i on and any relevant add i t i onal i nformat i on on the API of i mportance for the manufacture of the pharmaceut i cal product. The follow i ng are examples of the i nformat i on wh i ch may typ i cally be prov i ded; however the i nformat i on needed i n each spec i? c case should be assessed us i ng the pr i nc i ples of QRM:

?manufacturer and assoc i ated supply cha i n;

?step of the API to be transferred;

?? ow chart of synthes i s pathway, outl i n i ng the process, i nclud i ng entry po i nts for raw mater i als, cr i t i cal steps, process controls and i ntermed i ates;

?where relevant, de? n i t i ve phys i cal form of the API (i nclud i ng

photom i crographs and other relevant data) and any polymorph i c and solvate forms;

?solub i l i ty pro? le;

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?i f relevant, pH i n solut i on;

?part i t i on coef? c i ent, i nclud i ng the method of determ i nat i on;

?i ntr i ns i c d i ssolut i on rate, i nclud i ng the method of determ i nat i on;

?part i cle s i ze and d i str i but i on, i nclud i ng the method of determ i nat i on;

?bulk phys i cal propert i es, i nclud i ng data on bulk and tap dens i ty, surface

area and poros i ty as appropr i ate;

?water content and determ i nat i on of hygroscop i c i ty, i nclud i ng water act i v i ty data and spec i al handl i ng requ i rements;

?m i crob i olog i cal cons i derat i ons (i nclud i ng ster i l i ty, bacter i al endotox i ns

and b i ob urden levels where the API supports m i crob i olog i cal growth)

i n accordance w i th nat i onal, reg i onal or i nternat i onal pharmacopoe i al

requ i rements;

?spec i? cat i ons and j ust i? cat i on for release and end-of-l i fe l i m i ts;

?summary of stab i l i ty stud i es conducted i n conform i ty w i th current gu i del i nes, i nclud i ng conclus i ons and recommendat i ons on retest date;

?l i st of potent i al and observed synthet i c i mpur i t i es, w i th data to support

proposed spec i? cat i ons and typ i cally observed levels;

?i nformat i on on degradants, w i th a l i st of potent i al and ob served degradat i on products and data to support proposed spec i? cat i ons and

typ i cally observed levels;

?potency factor, i nd i cat i ng ob served pur i ty and j ust i? cat i on for any recommended ad j ustment to the i nput quant i ty of API for product manufactur i ng, prov i d i ng example calculat i ons; and

?spec i al cons i derat i ons w i th i mpl i cat i ons for storage and or handl i ng,

i nclud i ng b ut not l i m i ted to safety and env i ronmental factors (e.g. as

spec i? ed i n mater i al safety data sheets) and sens i t i v i ty to heat, l i ght or

mo i sture.

Excipients

5.7 The exc i p i ents (11) to be used have a potent i al i mpact on the ? nal

product. The i r spec i? cat i ons and relevant funct i onal character i st i cs should, therefore, b e made ava i lab le b y the SU for transfer to the RU s i te. The follow i ng are examples of the i nformat i on wh i ch may typ i cally be prov i ded;

however, the i nformat i on needed i n each spec i? c case should be assessed us i ng the pr i nc i ples of QRM:

?manufacturer and assoc i ated supply cha i n;

?descr i pt i on of funct i onal i ty, w i th j ust i? cat i on for i nclus i on of any ant i ox i dant, preservat i ve or any exc i p i ent;

?de? n i t i ve form (part i cularly for sol i d and i nhaled dosage forms);

?solub i l i ty pro? le (part i cularly for i nhaled and transdermal dosage forms);

?part i t i on coef? c i ent, i nclud i ng the method of determ i nat i on (for transdermal dosage forms);

296

?i ntr i ns i c d i ssolut i on rate, i nclud i ng the method of determ i nat i on (for transdermal dosage forms);

?part i cle s i ze and d i str i but i on, i nclud i ng the method of determ i nat i on (for sol i d, i nhaled and transdermal dosage forms);

?bulk phys i cal propert i es, i nclud i ng data on bulk and tap dens i ty, surface area and poros i ty as appropr i ate (for sol i d and i nhaled dosage forms);?compact i on propert i es (for sol i d dosage forms);

?melt i ng po i nt range (for sem i-sol i d or top i cal dosage forms);

?pH range (for parenteral, sem i-sol i d or top i cal, l i qu i d and transdermal dosage forms);

?i on i c strength (for parenteral dosage forms);

?spec i? c dens i ty or grav i ty (for parenteral, sem i-sol i d or top i cal, l i qu i d and transdermal dosage forms);

?v i scos i ty and or v i scoelast i c i ty (for parenteral, sem i-sol i d or top i cal, l i qu i d and transdermal dosage forms);

?osmolar i ty (for parenteral dosage forms);

?water content and determ i nat i on of hygroscop i c i ty, i nclud i ng water act i v i ty data and spec i al handl i ng requ i rements (for sol i d and i nhaled dosage forms);

?mo i sture content range (for parenteral, sem i sol i d or top i cal, l i qu i d and transdermal dosage forms);

?m i crob i olog i cal cons i derat i ons (i nclud i ng ster i l i ty, bacter i al endotox i ns and b i ob urden levels where the exc i p i ent supports m i crob i olog i cal growth) i n accordance w i th nat i onal, reg i onal or i nternat i onal pharmacopoe i al requ i rements, as appl i cable (for general and spec i? c monographs);?spec i? cat i ons and j ust i? cat i on for release and end-of-l i fe l i m i ts;

?i nformat i on on adhes i ves support i ng compl i ance w i th peel, sheer and adhes i on des i gn cr i ter i a (for transdermal dosage forms);

?spec i al cons i derat i ons w i th i mpl i cat i ons for storage and or handl i ng, i nclud i ng b ut not l i m i ted to safety and env i ronmental factors (e.g. as spec i? ed i n mater i al safety data sheets (MSDS)) and sens i t i v i ty to heat, l i ght or mo i sture; and

?regulatory cons i derat i ons, e.g. documentat i on to support compl i ance w i th transm i ss i le an i mal spong i form encephalopathy cert i? cat i on requ i rements (where appl i cable).

Information on process and ? nished pharmaceutical

products information

5.8 The SU should prov i de a deta i led character i zat i on of the product,

i nclud i ng i ts qual i tat i ve and quant i tat i ve compos i t i on, phys i cal descr i pt i on, method of manufacture, i n-process controls, control method and spec i? cat i ons, packag i ng components and con? gurat i ons, and any safety and handl i ng cons i derat i ons.

297

5.9 The SU should prov i de any i nformat i on on the h i story of process

development wh i ch may b e requ i red to enab le the RU to perform any further development and or process opt i m i zat i on after successful transfer.

Such i nformat i on may i nclude the follow i ng:

?i nformat i on on cl i n i cal development, e.g.i nformat i on on the rat i onale for

the synthes i s, route and form select i on, technology select i on, equ i pment,

cl i n i cal tests, and product compos i t i on;

?i nformat i on on scale-up act i v i t i es: process opt i m i zat i on, stat i st i cal

opt i m i zat i on of cr i t i cal process parameters, cr i t i cal qual i ty attr i butes,

p i lot report and or i nformat i on on p i lot-scale development act i v i t i es

i nd i cat i ng the number and d i spos i t i on of batches manufactured;

?i nformat i on or report on full-scale development act i v i t i es, i nd i cat i ng

the number and d i spos i t i on of batches manufactured, and dev i at i on and

change control (somet i mes referred to as change management) reports

wh i ch led to the current manufactur i ng process;

?the change h i story and reasons, e.g. a change control log, i nd i cat i ng any

changes to the process or pr i mary packag i ng or analyt i cal methods as a

part of process opt i m i zat i on or i mprovement; and

?i nformat i on on i nvest i gat i ons of prob lems and the outcomes of the

i nvest i gat i ons.

5.10 The SU should prov i de to the RU i nformat i on on any health, safety

and env i ronmental i ssues assoc i ated w i th the manufactur i ng processes to

b e transferred, and the i mpl i cat i ons, e.g. need for gown i ng or protect i ve

cloth i ng.

5.11 The SU should prov i de to the RU i nformat i on on current process i ng

and test i ng, i nclud i ng but not l i m i ted to:

? a deta i led descr i pt i on of fac i l i ty requ i rements and equ i pment;

?i nformat i on on start i ng mater i als, appl i cab le MSDS and storage requ i rements for raw mater i als and ? n i shed products;

?descr i pt i on of manufactur i ng steps (narrat i ve and process maps or ? ow charts, and or master batch records), i nclud i ng qual i? cat i on of i n-

process i ng hold t i mes and cond i t i ons, order and method of raw mater i al

add i t i on and bulk transfers between process i ng steps;

?descr i pt i on of analyt i cal methods;

?i dent i? cat i on and j ust i? cat i on of control strategy (e.g.i dent i? cat i on of cr i t i cal performance aspects for spec i?c dosage forms, i dent i? cat i on of

process control po i nts, product qual i ty attr i butes and qual i? cat i on of cr i t i cal

process i ng parameter ranges, stat i st i cal process control (SPC) charts);

?des i gn space, i n cases where th i s has been de? ned;

?val i dat i on i nformat i on, e.g. val i dat i on plans and reports;

?annual product qual i ty rev i ews;

298

?stab i l i ty i nformat i on;

?an author i zed set of protocols and work i nstruct i ons for manufactur i ng; and ?env i ronmental cond i t i ons or any spec i al requ i rement needed for the fac i l i ty or equ i pment depend i ng on the nature of the product to b e transferred.

5.12 Dur i ng the transfer process, the RU should i dent i fy any d i fferences

i n fac i l i t i es, systems and capab i l i t i es and commun i cate w i th the SU about

these d i fferences to understand the potent i al i mpact on ab i l i ty to run the process to del i ver good product qual i ty. D i fferences should be understood and sat i sfactor i ly addressed to assure equ i valent product qual i ty. Based on the i nformat i on rece i ved from the SU, the RU should cons i der i ts own capab i l i ty to manufacture and pack the product to the requ i red standards and should develop relevant plant operat i ng procedures and documentat i on

b efore the start of product i on. Process development at the RU should

address the follow i ng tasks:

?compar i son and assessment of su i tab i l i ty and qual i? cat i on of fac i l i ty and

equ i pment;

?descr i pt i on of manufactur i ng process and ?ow of personnel and of mater i als at the RU (narrat i ve and or process maps or ? ow charts);

?determ i nat i on of cr i t i cal steps i n manufacture, i nclud i ng hold t i mes, end-

po i nts, sampl i ng po i nts and sampl i ng techn i ques (13);

?wr i t i ng and approval of SOPs for all product i on operat i ons (e.g.d i spens i ng,

granulat i on or blend i ng or solut i on preparat i on, tablet compress i on, tablet

coat i ng, encapsulat i on, l i qu i d ? ll i ng, pr i mary and secondary packag i ng

and i n-process qual i ty control), packag i ng, clean i ng, test i ng and storage;

?evaluat i on of stab i l i ty i nformat i on, w i th generat i on of s i te-spec i? c

stab i l i ty data i f requ i red (14); and

?compl i ance w i th regulatory requ i rements for any changes made, e.g.i n

terms of batch s i ze.

Packaging

5.13 The transfer of packag i ng operat i ons should follow the same

procedural patterns as those of the product i on transfer.

5.14 Informat i on on packag i ng to be transferred from the SU to the RU

i ncludes spec i? cat i ons for a su i table conta i ner or closure system, as well

as any relevant add i t i onal i nformat i on on des i gn, pack i ng, process i ng or labell i ng requ i rements and tamper-ev i dent and ant i-counterfe i t i ng measures needed for qual i? cat i on of packag i ng components at the RU.

5.15 For QC test i ng of packag i ng components, spec i? cat i ons should be

prov i ded for draw i ngs, artwork and mater i al (for example, glass, card or ? bre board).

299

5.16 Based on the i nformat i on prov i ded, the RU should perform a

su i tab i l i ty study for i n i t i al qual i? cat i on of the packag i ng components.

Packag i ng i s cons i dered su i table i f i t prov i des adequate protect i on (prevent i ng degradat i on of the med i c i nedue to env i ronmental i n? uences), safety (ab sence of undes i rab le sub stances released i nto the product), compat i b i l i ty (absence of i nteract i on poss i bly affect i ng med i c i ne qual i ty) and performance (funct i onal i ty i n terms of drug del i very).

Cleaning

5.17 Dur i ng the manufactur i ng process, pharmaceut i cal products and

APIs can be contam i nated by other pharmaceut i cal products or APIs i f the plant i s process i ng d i fferent products. To m i n i m i ze the r i sk of contam i nat i on and cross-contam i nat i on, operator exposure and env i ronmental effects, adequate clean i ng procedures are essent i al.

5.18Clean i ng procedures and the i r val i dat i on are s i te-spec i? c. In order for

the RU to de? ne i ts clean i ng strategy the SU should prov i de i nformat i on on clean i ng at the SU to m i n i m i ze cross-contam i nat i on due to res i dues from prev i ous manufactur i ng steps, operator exposure and env i ronmental i mpact, i nclud i ng:

—i nformat i on on solub i l i ty of act i ve i ngred i ents, exc i p i ents and veh i cles;

—m i n i mum therapeut i c doses of act i ve i ngred i ents;

—therapeut i c category and tox i colog i cal assessment; and

—ex i st i ng clean i ng procedures.

Add i t i onal i nformat i on should be prov i ded, as appropr i ate and where ava i lable, e.g.:—clean i ng val i dat i on reports (chem i cal and m i crob i olog i cal);

—i nformat i on on clean i ng agents used (ef? cacy, ev i dence that they do not

i nterfere w i th analyt i cal test i ng for res i dues of APIs, removal of res i dual

clean i ng agents); and

—recovery stud i es to val i date the sampl i ng methodology.

5.19 Before the transfer, the SU should prov i de i nformat i on on l i m i ts for

product res i dues, and the rat i onale for l i m i t select i on.

5.20 Based on the i nformat i on prov i ded by the SU, clean i ng procedures

should be des i gned at the RU, tak i ng i nto account relevant character i st i cs of the start i ng mater i als (e.g. potency, tox i c i ty, solub i l i ty, corros i veness and temperature sens i t i v i ty), manufactur i ng equ i pment des i gn and con? gurat i on, clean i ng agent and products res i due.

Implementation of processing, packaging and cleaning systems

5.21 Tr i al batch(es) (“demonstrat i on batches”) are normally produced to

con? rm process capab i l i ty before i n i t i at i ng formal val i dat i on. Where tr i al 300

batches are produced, at a m i n i mum, all cr i t i cal process i ng parameters and ? n i shed product spec i? cat i ons should be assessed.

5.22 Once process capab i l i ty has been establ i shed at the RU, assur i ng that

the product, process or method at the RU meets prede? ned and j ust i? ed spec i? cat i ons, process val i dat i on and clean i ng val i dat i on can be carr i ed out.

o ntrol: analytical method transfer

6. Quality c

6.1 Transfer of analyt i cal methods should accommodate all the analyt i cal

test i ng requ i red to demonstrate compl i ance of the product to be transferred w i th the reg i stered spec i? cat i on (15).

6.2 Analyt i cal methods used to test pharmaceut i cal products, start i ng

mater i als, packag i ng components and clean i ng (res i due) samples, i f appl i cable, should be i mplemented at the test i ng laboratory before test i ng of samples for process val i dat i on stud i es i s performed by the RU. Process val i dat i on samples may be tested at the RU, the SU or a th i rd laboratory.

6.3 A protocol de? n i ng the steps should b e prepared for transfer of

analyt i cal methods. The analyt i cal methods transfer protocol should i nclude

a descr i pt i on of the o

b j ect i ve, scope and respons i b i l i t i es of the SU and the

RU; a spec i? cat i on of mater i als and methods; the exper i mental des i gn and acceptance cr i ter i a; documentat i on (i nclud i ng i nformat i on to be suppl i ed w i th the results, and report forms to b e used, i f any); procedure for the handl i ng of dev i at i ons; references; s i gned approval; and deta i ls of reference samples (start i ng mater i als, i ntermed i ates and ? n i shed products).

6.4 The SU’s respons i b i l i t i es for the transfer of analyt i cal methods are to:

?prov i de method-spec i? c tra i n i ng for analysts and other qual i ty control staff, i f requ i red;

?ass i st i n analys i s of QC test i ng results;

?de? ne all methods to be transferred for test i ng a g i ven product, start i ng mater i al or clean i ng sample;

?de? ne exper i mental des i gn, sampl i ng methods and acceptance cr i ter i a;

?prov i de any val i dat i on reports for methods under transfer and demonstrate

the i r robustness;

?prov i de deta i ls of the equ i pment used, as necessary (part of val i dat i on report, i f ava i lable) and any standard reference samples;

?prov i de approved procedures used i n test i ng; and

?rev i ew and approve transfer reports.

6.5 The RU’s respons i b i l i t i es are to:

?rev i ew analyt i cal methods prov i ded by the SU, and formally agree on acceptance cr i ter i a before execut i on of the transfer protocol;

301

302

?ensure that the necessary equ i pment for QC i s ava i lable and qual i ? ed at the RU s i te . The equ i pment used by the RU dur i ng the analyt i cal transfer should meet appropr i ate spec i ? cat i ons to ensure the requ i rements of the method or spec i ? cat i on are met ;

?ensure that adequately tra i ned and exper i enced personnel are i n place for analyt i cal test i ng ;

?prov i de a documentat i on system capable of record i ng rece i pt and test i ng of samples to the requ i red spec i ? cat i on us i ng approved test methods, and of report i ng, record i ng and collat i ng data and des i gnat i on of status (approved, re j ected, quarant i ne);

?execute the transfer protocol ;

?perform the appropr i ate level of val i dat i on to support the i mplementat i on of the methods ; and

?generate and obta i n approval of transfer reports .

6.6 Appropr i ate tra i n i ng should be prov i ded and all tra i n i ng act i v i t i es and outcomes should be documented .

6.7 Reference to compend i al monographs (e .g . The International Pharmacopoeia (15),European Pharmacopoeia ,British Pharmacopoeia and United States Pharmacopeia ), where ava i lable, i s expected .

6.8 Poss i ble exper i mental des i gns and acceptance cr i ter i a for the ma i n analyt i cal test i ng methods are shown i n Tab le 1. Note that th i s tab le represents h i gh-level gu i dance to apply the general pr i nc i ple that method transfers should account for the var i ab i l i ty and sens i t i v i ty of the method and the spec i ? cat i ons for the qual i ty parameter . Alternat i ve procedures and acceptance cr i ter i a may be appl i ed based on sc i ence and the character i st i cs of the analyt i cal method and the analyte .

T able 1

Possible experimental designs and acceptance criteria for analytical testing Test Considerations for transfer Replication

of tests Set-up Acceptance criteria Direct Statistically

derived

Identity Transfer should focus on sample prepara t ion,instruments, data interpretation.Acceptable to

include in assay

transfer where

relevant

One determina-

tion usually

suf? cient to

demonstrate

equivalence

for transfer of tests

Direct Statistically

derived

Assay for potency – N on-speci? c

assay should

not be used for

stability testing.

–Bracketing may

be appropri-

ate for multiple

strengths

At each site:

2 analysts

× 3 lots, in

triplicate

(= 18 per site)

Different sets

of instruments

and columns

Independent

solution pre-

paration

Comparison

of mean and

variability

Two one-

sided t-tests

with intersite

differences

≤ 2% , 95%

con? dence

Content uniformity If method is

equivalent to

assay method,

separate transfer

is not usually

requird

At each site:

2 analysts,

× 1 lot

(= 2 per site)

Different sets

of instruments

and columns

Independent

solution

preparation

Mean at RU

within ± 3%

of mean at

SU; compari-

son of relative

st. dev.

Two one-

sided t-tests

with intersite

differences

≤ 3% , 95%

con? dence

Dissolution Bracketing may

be appropri-

ate for multiple

strengths 6 units

(12 if not

routine at RU,

and for ex-

tended release

products)

Mean at RU

within ± 5%

of mean

at SU

Compare

pro? le

(e.g. F2), or

Compare

data at Q

time points

as for assay

Cleaning

veri? ca t ion (re c overy of residues from surfaces)Con? rm that

same swabbing

material is used

at sending unit

(SU) and

receiving unit

(RU)

Use spiked

samples,

with levels

within 3×

validated st.

dev. or within

± 10% of

speci? cation

(whichever is

the greater)

–All samples

spiked above

speci? cation

should fail

–90% of

samples

spiked

below spe-

ci? cation

should pass

Micro-biological testing (qualitative and quanti-tative limit tests)–Execute com-

mon on-site

validation pro-

tocol: rationale;

method iden-

tity; validation

parameters;

data summary;

acceptance cri-

teria; methods

of compiling

and analysing

data; handling

of out-of-speci-

? cation results;

follow-up

requirements

–Use same ma-

terials, techni-

ques, inocu l um

preparation

Validation in

triplicate

Use different

lots for each

validation

exercise

–Qualitative:

Demon-

strate

recovery

of micro-

organisms

–Quan-

titative:

Recovery

levels within

acceptance

limits

speci? ed in

protocol

303

for transfer of tests

Direct Statistically

derived

Impurity, degrada-tion, residu-al solvents –Con? rm re-

sponse factors

for calcula t ion

relative to drug

peak;

–Con? rm limit

of quantitation

at RU;

–Compare

chroma t o-

grams

–Compare

accuracy and

precision for

spiking experi-

ments

At each site:

2 analysts × 3

lots,

in duplicate

(in triplicate if

done together

with assay)

–Different

days,

different

sets of

instru-

ments and

columns

–Use

samples of

similar age,

homogene-

ity, packag-

ing, storage

–Use spiked

samples if

necessary

(For low

levels) Values

at RU within

± 25% of

values at SU,

or Mean at

RU within ±

0.05%

of mean at

SU (5%)

(For moder-

ately high lev-

els) Two one-

sided t-tests,

differences

≤ 10%, 95%

con? dence

st. dev., standard deviation.

Note: numbers in the table are given as examples only and should not be considered as recommendations.

The SU and the RU should execute the transfer protocol and j o i ntly prepare

a transfer report. The po i nts to

b e addressed i n the analyt i cal methods

transfer report are l i sted i n these gu i del i nes.

7.Premises and equipment

Premises

7.1 The SU s hould prov i de i nformat i on to the RU on the layout, construct i on

and ? n i sh of bu i ld i ngs and serv i ces (16,17) (heat i ng, vent i lat i on and a i r-cond i t i on i ng (HV AC), temperature, relat i ve hum i d i ty, water, power, and compressed a i r), wh i ch have an i mpact on the product, process or method to be transferred.

7.2 The SU should prov i de i nformat i on on relevant health, safety and

env i ronmental i ssues, i nclud i ng:

?i nherent r i sks of the manufactur i ng processes (e.g. react i ve chem i cal hazards, exposure l i m i ts, ? re and explos i on r i sks);

?health and safety requ i rements to m i n i m i ze operator exposure (e.g.

atmospher i c conta i nment of pharmaceut i cal dust);

?emergency plann i ng cons i derat i ons (e.g.i n case of gas or dust release, sp i llage, ? re and ? rewater run-off); and

?i dent i? cat i on of waste streams and prov i s i ons for re-use, recycl i ng and/

or d i sposal.

304

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在“设备和打印机”窗口中,右键点击“HP LaserJet 1020”图标,选择“删除设备”菜单项。如图 1 删除设备所示: 图1: 删除设备 在“删除设备”窗口中,点击“是”按钮。如图 2 确认删除设备所示: 图2: 确认删除设备

必须断开USB 连接线,重新启动电脑。 重新启动电脑后不要进行任何打印操作。 在“设备和打印机”窗口中,点击“Microsoft XPS DocumentWriter”打印机图标,选择“打印服务器属性”菜单。如图 3 打印服务器属性所示: 图3: 打印服务器属性 在“打印服务器属性”窗口中,点击“驱动程序”选项卡,选择“HP LaserJet 1020”打印机型号,然后点击“删除”按钮。如图 4 属性所示:

抗疟药

原发性红细胞外期: 在蚊子叮咬人体时, 疟原虫孢子进入人体并侵入肝 细胞进行发育繁殖,然后 从肝细胞释放,进入红细胞, 此时无症状,为疟疾的潜伏期。疟原虫感染红细胞时期称 红细胞内期,此时疟原虫产生的代谢产物和红细胞碎片刺激 机体,引起寒战、高热、 出汗等疟疾的临床症状。 继发性红细胞外期: 肝细胞中部分处于休眠状态 疟原虫是疟疾复发的根源。 抗疟药分为3类: (1)控制疟疾症状: 氯喹、奎宁、甲氟喹、 青蒿素、咯萘啶、本芴醇 (2)控制疟疾复发和传播:伯氨喹 (3)疟疾预防: 乙胺嘧啶、磺胺类。 一、控制疟疾症状 主要杀灭红细胞内期疟原虫 氯喹 药理作用: 杀灭红细胞内期的间日疟、 三日疟以及敏感的 恶性疟原虫,迅速控制 疟原虫症状的发作, 对恶性疟有根治作用, 是控制疟疾症状的 首选药物。 特点:起效快、疗效高、 作用持久。 对红细胞外期无效, 不能用作病因性预防和 良性疟的根治。

作用机制: 干扰疟原虫体内代谢产物 的处理,导致虫体溶解; 使疟原虫分解和利用 血红蛋白的能力降低, 引起氨基酸缺乏而 抑制疟原虫的生长繁殖。 氯喹临床应用 (1)控制疟疾的急性发作和根治恶性疟,是治疗 疟疾的首选药物; (2)治疗肠外阿米巴病 可用于甲硝唑治疗无效 或禁忌的阿米巴肝炎 或肝脓肿。 (3)免疫抑制 治疗类风湿性关节炎、 系统性红斑狼疮等。 氯喹不良反应 头晕、头痛、胃肠不适、 皮疹,眼耳毒性、 心血管反应、 白细胞减少、 肝脏、肾脏损害。 心肌损害, 有致畸作用,孕妇禁用。 青蒿素及其衍生物 药理作用 产生自由基,破坏疟原虫 的生物膜、蛋白质等, 使之死亡。 对红细胞内期原虫有效, 对间日疟和恶性疟, 包括耐氯喹虫株有强大而快速 的杀灭作用, 但对红外期疟原虫无效。 主要用于控制症状。 青蒿素临床应用 控制间日疟和恶性疟的症状 治疗耐氯喹虫株,

如何手动安装驱动

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我们就要自己指定驱动程序文件,手动安装了。 我们可以从设备管理器中来自己指定驱动程序的位置,然后进行安装。当然这个方法要事先准备好所要安装的驱动程序,该方法还适用于更新新版本的驱动程序。 首先从控制面板进入“系统属性”,然后依次点击“硬件”——“设备管理器”。 如图,网卡是没有安装驱动程序的设备,其前面会有感叹号“!”标示。 右键点击该设备,然后选择“更新驱动程序”。

接着就会弹出一个“硬件更新向导”,我们既然知道了它是属于什么型号的设备,而且还有它的驱动程序,选择“从列表或指定位置安装”。

如果驱动程序在光盘或软盘里,在接着在弹出的窗口里把“搜索可移动媒体”勾上就行,如果在硬盘里,则把“在搜索中包括这个位置”前面的复选框勾上,然后点“浏览”。接着找到咱们准备好的驱动程序文件夹,要注意的是很多硬件厂商会把其生产的很多类型的硬件设备驱动都压制在一张盘中,而且还会有不同的操作系统版本,如For Win2K(Win2000)和For WinXP的,要注意选择正确的设备和操作系统版本。点“确定”之后,点击“下一步”就行了。

中药药理试题

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电脑驱动程序安装顺序

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北京中医药大学远程教育《中药化学B》作业5答案

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