1例胰岛素过敏老年2型糖尿病患者降糖药物的选择与药学监护

目的通过参与胰岛素过敏伴心功能不全老年2型糖尿病患者降糖的药物治疗实践,探讨临床药师参与临床药物治疗和开展药学监护的方法。方法临床药师参与临床治疗团队,根据患者具体病情变化,提供合理性意见,与临床医师共同制定个体化治疗方案,并开展有效药学监护。结果患者对多种胰岛素存在过敏现象,且无法耐受胰岛素脱敏治疗,综合考虑患者年龄、生理状况以及药物作用特点等因素,药师建议给予联合口服作用温和或半衰期短的胰岛素促分泌剂格列吡嗪控释片和α-糖苷酶抑制剂类阿卡波糖片进行降糖治疗,并在治疗过程中对药物剂量适时进行有效调整,治疗方案维持7 d后,患者血糖控制较平稳,出院回家。结论临床药师深入临床直接面向患者提供药学服务,参与制定患者个体化治疗方案,开展药学监护,可避免延误患者的有效药物治疗,切实提高药物治疗水平和医疗质量。

Pharmaceutical care for an insulin allergy elderly patient with type 2 diabetes

Objective To seek the methods of providing individualized medications and pharmaceutical care for an insulin allergy elderly patient with type 2 diabetes when clinical pharmacists worked in clinical departments.Methods Clinical pharmacists participated in the drug therapy for an insulin allergy elderly patient with type 2 diabetes,provided reasonable opinions for individualized medications and offered special pharmaceutical cares for the main drugs.Results Because the insulin allergy elderly patient with type 2 diabetes couldn＇t tolerate insulin desensitization therapy,clinical pharmacist suggested combination use of glipizide controlled-release tablets and acarbose tablets after comprehensive consideration of the patient age,physical condition as well as the characteristics of drugs and other factors,and adjusted drug dose timely during the course of treatment.The patient recovered and was discharged from hospital after blood sugar control treatment for 7 days.Conclusion Clinical pharmacists provide pharmaceutical care for patients directly in clinic,such as participating in setting individualized treatment for insulin allergy elderly patient with type 2 diabetes,which can provide effective drug therapy for inpatients and improve the quality of medication.