临床药师参与1例重症天疱疮患者的药学监护

目的:探讨临床药师在重症天疱疮患者药物治疗过程中的作用。方法:临床药师参与1例重症天疱疮患者的药物治疗过程。根据患者出现的症状、不良反应及时调整医师的用药方案:针对可能因糖皮质激素减量所致的双手、后背出现数粒新发水疱,临床药师建议将醋酸泼尼松片用量调整为入院前剂量70 mg,每日1次;针对患者感染控制不佳,建议将米诺环素胶囊剂量调整为100 mg,每日2次;针对低钾血症,临床药师嘱患者口服补钾,并将其加入果汁、牛奶或者蜂蜜中服用;为预防糖皮质激素引起的骨质疏松,临床药师建议患者服用碳酸钙D3咀嚼片的同时加服阿仑膦酸钠维D3片70 mg,每周1次;针对患者口腔黏膜出现的白色念珠菌,根据药敏试验结果,临床药师建议将伊曲康唑胶囊调整为氟康唑胶囊50 mg,每日1次;同时密切关注利妥昔单抗注射液输注后可能出现的输液反应,并行不良反应监测、出院用药教育等药学监护。结果:医师均采纳临床药师建议。患者病情好转,于治疗47 d后出院。结论:临床药师参与了重症天疱疮患者的药物治疗过程,协助医师完善了其治疗方案,保证了患者用药的有效性和安全性。

Pharmaceutical Care for a Patient with Severe Pemphigus by Clinical Pharmacist

OBJECTIVE:To investigate the role of clinical pharmacists in drug therapy for patients with severe pemphigus.METHODS:Clinical pharmacists participated in drug therapy for a patient with severe pemphigus.Clinical pharmacist adjusted the doctor’s medication plan in time according to the symptoms and adverse reactions of the patients.In view of several new blisters on the hand palms and back that may be caused by hormone reduction,the clinical pharmacist suggested that the dosage of Prednisone acetate tablets should be adjusted to 70 mg before administration,once a day.For poor infection control,it was recommended to adjust the dose of minocycline to 100 mg,bid;for hypokalemia,the clinical pharmacist advised the patients to take potassium orally,and added it into juice,milk or honey for taking;in order to prevent osteoporosis caused by glucocorticoid,the clinical pharmacist suggested that patients supplement Calcium carbonate and vitamin D3 chewable tablets and Alendronate sodium and vitamin D3 tablets 70 mg at the same time,once a week.For Candida albicans in patient’s oral mucosa,according to the results of drug sensitivity test,the clinical pharmacists suggested that Itraconazole capsules should be adjusted to Fluconazole capsules 50 mg,once a day.At the same time,pharmacist paid close attention to the adverse reactions after the infusion of Rituximab injection and pharmaceutical care was provided,such as ADR monitoring,discharge medication education.RESULTS:The doctors took all the advice of clinical pharmacists.The patient recovered and was discharged 47 days later.CONCLUSIONS:During drug therapy for the patient with severe pemphigus.Clinical pharmacists can help doctors improve the treatment plan so as to ensure the effectiveness and safety of patients’medication.