临床药师对妊娠期用药案例的风险评估与沟通

目的 介绍临床药师对妊娠期用药致畸性的分析和建议。方法 通过对几个案例分析的展示来介绍临床药师对妊娠期用药的风险评估。结果 评估的结果可为临床医师做出妊娠期正确用药处理提供依据,沟通的内容可提高孕妇对药物的认识。结论 临床药师开展的妊娠期用药风险评估与沟通专科门诊,不仅为医师和患者解决妊娠期用药难题,同时也促进了临床药学的发展。     

妊娠期用药风险评估与沟通专科门诊的建立与实践

目的 探讨临床药师新型服务模式的开展,为临床药学工作者提供参考。方法 孕妇通过挂“妊娠期用药风险评估与沟通门诊”门诊号或者由其他科室转至该门诊,临床药师采集孕妇用药等相关信息,对孕妇进行综合量化评估,得出主要风险点,并与孕妇进行沟通,做出倾向化的建议。结果 自2012年8月在全省率先开展“妊娠期用药风险评估与沟通专科门诊”以来,截止2014年5月,门诊评估和沟通的孕妇1 078人次,咨询药物类别主要是紧急避孕药、抗感冒药、中药或中成药3大类,占总门诊量的73.01%(787人次)。明确怀孕情况下用药前来咨询的情况较少。结论 开设“妊娠期用药风险评估与沟通专科门诊”符合目前临床及社会需要,不仅为医师及患者解决妊娠期用药风险评估问题,同时也促进临床药学专业的发展。     

1例类风湿关节炎患者暴露甲氨蝶呤与来氟米特意外妊娠的胎儿风险评估

目的 通过分享1例类风湿关节炎患者妊娠16周内意外暴露甲氨蝶呤与来氟米特联合治疗的胎儿风险评估,为妊娠期用药风险咨询与沟通提供参考。方法 药师充分查阅国内外文献资料,借助妊娠期用药风险评估工具,从甲氨蝶呤、来氟米特药物代谢特点、动物生殖毒性及人类妊娠期用药安全证据等方面分析药物可能对胎儿造成的影响,与患者充分沟通,并实施暴露登记及持续追踪随访。结果 药物致胎儿畸形及发育异常多来源于动物研究及个案报道,部分较大型队列研究结果较乐观。基于现有证据尚不能作出甲氨蝶呤、来氟米特妊娠期用药风险定论。药物风险不能排除,但患者服药剂量低于文献报道常见致畸剂量,需综合考虑,谨慎权衡利弊。患者要求继续妊娠,最终足月顺利分娩一小于胎龄儿女婴,外观、骨骼、内脏无明显畸形。结论 该个案中低剂量甲氨蝶呤联合来氟米特治疗未增加出生缺陷风险。胎儿宫内生长受限可能与孕妇自身疾病及用药相关,婴儿远期结局需进一步随访。     

临床药师参与妊娠期抗癫痫会诊1例分析

目的 为临床药师参与妊娠期抗癫痫会诊提供参考。方法 临床药师参与1例妊娠期抗癫痫的会诊,分析患者既往用药史和抗癫痫药在妊娠期的用药风险,将抗癫痫药由卡马西平调整为拉莫三嗪,并根据患者的血常规检查结果调整药物。结果 临床药师参与会诊,帮助临床医师解决了妊娠期患者用药难题,降低了用药风险。结论 临床药师通过参与会诊体现了临床药师的职业价值。     

妊娠期用药对孕产妇妊娠结局影响及随访研究

目的 探讨孕产妇妊娠期用药现状及用药安全性，探索妊娠期药物咨询门诊的工作模式和数据积累。方法 将2021年10月—2022年12月在浙江大学医学院附属第一医院妊娠哺乳期用药咨询门诊所有接诊的孕产妇作为研究对象，记录其姓名、年龄、联系方式、末次月经以及妊娠期的药物使用情况，评估研究人群的用药概况及用药安全性，并对使用药物风险进行分析，整理临床药师的干预措施并对其妊娠结局进行随访研究。结果 经过筛选共纳入179名咨询孕产妇，研究人群中80%的患者是在未知妊娠状态下使用了药物，人均用药3种，最常见的用药原因为上呼吸道感染，使用率最高的3类药物为中成药、抗菌药及解热镇痛药。研究人群B级药物的使用率最高，占51.3%；有8.4%的患者使用了X级药物。完成随访151例，失访率15.6%，药师给予的药物风险评估建议患者接受率为95.4%，98.7%的患者认为妊娠咨询门诊对其有帮助且能有效缓解焦虑。结论 妊娠期药物咨询门诊能向患者提供科学的、个性化的用药指导和科普宣教，在缓解孕产妇焦虑、抑郁的方面也有显著效果。     

社区药师门诊对老年慢病患者药物治疗管理（MTM）的服务实践

摘 要 目的：探讨在社区开设药学门诊,为老年慢病患者提供药物治疗管理（MTM）服务的工作模式的作用和实践。方法: 临床药师对2017年3～12月372例患者实施MTM服务,分析该类人群患者不合理用药的特点,通过实例介绍临床药师进行MTM服务的作用与实践。结果: 372例患者中合并2种及以上疾病的患者占58.9%,同时服用5种药物以上的患者占78%,其中不合理用药突出问题中重复用药比例高达43.7%。结论: 社区药师门诊开展MTM服务,临床药师为老年患者多重用药管理提供了保障,提高了患者用药安全性和合理性,也为临床药师工作模式转型、建立药物治疗管理体系提供参考。     

临床药师在普外科开展药学服务的实例分享及体会

摘 要 目的：总结临床药师在普外科开展药学服务的经验, 探索药师参与临床药物治疗实践模式。方法: 从药物重整、药物不良反应的发现及处置、药物治疗方案的参与制定三方面分享临床药师在普外科参与药物治疗的典型实例并进行分析。结果: 临床药师通过药物重整提高了患者用药的准确性和有效性,通过及时发现肝素引起的血小板减少症并停药避免了患者发生出血不良事件的风险,参与制定抗感染方案使得患者切口感染得到迅速而有效的控制。结论:临床药师深入病区开展“以患者为中心”的药学服务,提高了患者用药安全性及合理性,对提高临床医疗质量具有重要的作用。     

哺乳期用药咨询策略与实践案例分析

摘 要 目的：总结对哺乳期母亲开展用药咨询的工作经验,为促进哺乳期合理用药提供参考。 方法：对临床药师参与哺乳期乳腺炎、避免葡萄糖 6 磷酸脱氢酶（G6PD）缺乏乳儿用药风险、产后抑郁用药选择、哺乳期抗幽门螺杆菌三联方案替换治疗等典型案例进行分析,探讨临床对哺乳期用药咨询的需求方向、临床药师应关注的切入点、临床药师提供哺乳期用药咨询的策略与技巧。 结果：临床在哺乳期常见疾病的用药选择、特殊乳儿的用药风险评估、哺乳期可替代药物治疗方案的选择等方面对药学服务存在迫切需求。临床药师应兼顾临床、药动学知识,基于循证证据、注重与患者沟通技巧、尊重患者价值观,可以对哺乳期药物治疗效果和用药安全起到很好的促进和保障作用。 结论：特殊人群用药是临床药师服务临床的切入点之一,哺乳期用药咨询可以使哺乳期母亲得到有效治疗的同时,保障乳儿的安全性,加强医患沟通,值得推广。     

1例妊娠期氯氮平暴露对母婴影响的药学监护

目的 探讨妊娠期氯氮平暴露对母婴影响的药学监护策略，为妊娠合并精神疾病患者药学监护提供参考。方法 临床药师参与1例妊娠期氯氮平暴露的精神分裂症患者分娩前、分娩后及新生儿治疗的全过程，对妊娠期氯氮平暴露产生的妊娠并发症、分娩时药物治疗、母源性不良反应对新生儿治疗影响及分娩后药物治疗等方面协助临床进行特殊人群个体化用药监护。结果 临床药师通过辅助决策协助医师进行预估监护治疗，患者分娩顺利，未出现病情复发，新生儿病情好转，未发生氯氮平暴露不良事件。结论 临床药师参与妊娠期氯氮平暴露诊疗过程，评估药物治疗获益风险，保障了患者用药安全及医疗安全。     

临床药师参与1例重症医院获得性肺炎患者的治疗实践与体会

摘 要 目的： 小结临床药师参与1例医院获得性肺炎患者临床药物治疗实践的实践与体会。方法: 临床药师在治疗过程中,从药物选择、方案调整以及降阶梯治疗等方面提出优化建议。结果: 医师采纳临床药师提出的抗感染治疗药物及剂量调整建议,经治疗患者体温恢复正常,生命体征平稳,感染得到有效控制。 结论:临床药师要以自己的专业特长参与到治疗方案的优化调整中,特别关注老年、危重患者的用药安全,为临床安全合理用药提供技术支持与保障。     

“妊娠期用药风险评估与沟通药师门诊”的咨询内容和特殊案例分析

目的通过调查"妊娠期用药风险评估与沟通药师门诊"(简称"药师门诊")患者咨询的问题,了解妊娠用药的基本情况,筛选出典型案例,探讨分析妊娠期用药安全的影响因素及原则,为女性妊娠期的安全用药提供参考。方法对2012年9月-2017年8月在药师门诊咨询的对象共3405例,采用直接对话形式进行咨询、沟通、教育,并记录。结果咨询者中女性占90.84%,男性占9.16%。妊娠用药对胎儿影响为咨询的主要问题,且大部分为确诊妊娠前用药,占咨询人数的59.15%,妊娠早期用药占37.53%,其他占3.32%。从妊娠期用药患者中筛选出典型案例,临床药师重点评估药物对胎儿的致畸风险。案例涉及女方使用的孕激素、雌激素、降糖药、抗菌药物、精神药、抗凝剂及父母双方使用的兴奋剂。结论临床药师开展的门诊妊娠期妇女用药咨询服务模式针对性强,不仅改善妊娠期妇女对药物治疗的正确认识和态度,也大大提高了临床药师的专业知识水平。     

“Subutex is safe”: Perceptions of risk in using illicit drugs during pregnancy

BackgroundThe dominant biomedical discourse stresses the physiological risks to the foetus or newborn posed by the prenatal use of illicit drugs. There is also a strong moral incentive for pregnant women to abstain from drugs. Yet few researchers have explored how pregnant, drug-using women themselves perceive the risks involved. The present paper investigates the reasoning by women about risks involved in prenatal drug use. Theoretically, a socio-cultural approach to risk is taken.MethodsThe paper is based on fourteen ethnographic interviews with women who had used illicit drugs during pregnancy (mainly buprenorphine), had recently given birth and had regularly used prenatal services during pregnancy. The interviews were informal, semi-structured and focused on the women's experiences of pregnancy and service use. Each interview lasted about an hour. The interviews were transcribed and inductively analysed using thematic coding. Risk perceptions were identified in the interviewees’ expressions and understanding of fears, dangers, threats and worries.ResultsThe women were not primarily concerned about health risks: their greatest fears in connection with the prenatal use of illicit drugs were giving birth to a child with withdrawal symptoms, child protection interventions and child removal, encountering negative attitudes in seeking professional help as well as terminating drug use. The interviewees did not see abstaining from drugs as a risk-free option. On the contrary, the prospect of a drug-free life was filled with fears linked to physical and mental pain and disruptions in significant social bonds. The women made use of biomedical and nonprofessional understandings of risks. The women's friends and acquaintances played a central role as providers of knowledge about risks.ConclusionWhen providing health education to pregnant women with drug problems, professionals should take women's perceptions of risk seriously, treat the women respectfully and engage them in dialogue about the risks involved. Further studies on pregnant women's perceptions of risk in using illicit drugs would be highly valuable.     

Arabic-speaking pregnant women with a migration background: A vulnerable target group for prenatal counseling on medicines

BackgroundThe diversity of the European population increased over the last decades due to migration influences. It is obvious that pregnant women with a migration background also need access to the healthcare system of their host country. Nevertheless, pregnancies among women with a migration background may be even more challenging due to a higher prevalence of adverse pregnancy outcomes, higher risk of vitamin deficiencies or lower intake of folic acid. These issues reinforce the need for effective counseling by healthcare professionals (HCPs).ObjectivesTo explore the experiences of Arabic-speaking pregnant women with a migration background living in Belgium regarding their communication with HCPs, as well as their perceptions towards HCPs and the use of healthcare products during pregnancy.MethodsSemi-structured interviews with Arabic-speaking pregnant women were conducted between February–July 2017 using purposive and snowball sampling. An empirically based conceptual framework, grounded in the interview data, was developed prior to content analysis and coding with Nvivo 11.ResultsIn total, 17 interviews were conducted. Most women reported that they were suffering from the language barrier, which hindered their communication with HCPs and had undesirable consequences on their treatment and medication use. Communication was largely affected by the presence of interpreters. During pregnancy, a high threshold to use medicines and a preference for natural remedies was observed.ConclusionArabic-speaking pregnant women with a migration background living in Belgium are a vulnerable target group for prenatal counseling on medicines. Besides early dectection and willingness to help these women, HCPs should refer them to appropriate and understandable online sources and provide evidence-based information about the use of healthcare products during pregnancy. To facilitate the patient-HCP communication, strategies are further needed to stimulate these women to learn a national language and to increase their social integration.     

Prophylaxis of vertical HBV infection

ABSTRACT

Introduction: An appropriate management of HBV infection is the best strategy to finally reduce the total burden of HBV infection. Mother-to-child transmission (MTCT) is responsible for more than one third of chronic HBV infections worldwide. Because HBV infection in infancy or early childhood often leads to chronic infection, appropriate prophylaxis and management of HBV in pregnancy is crucial to prevent MTCT.

Areas covered: The prevention of HBV vertical transmission is a complex task and includes: universal HBV screening of pregnant women, administration of antivirals in the third trimester of pregnancy in women with high viral load and passive-active HBV immunoprophylaxis with hepatitis B vaccine and hepatitis B immune globulin in newborns of all HBV infected women.

Expert opinion: Universal screening of pregnant women for HBV infection, early identification of HBV DNA level in HBV-infected mothers, maternal treatment with class B according to FDA antivirals and passive/active anti-HBV immunoprophylaxis to newborns of HBV-positive mothers are crucial strategies for reducing vertical HBV transmission rates. Consideration of caesarean section in order to reduce the risk of vertical HBV transmission should be recommend in HBV infected pregnant women with high viral load despite antiviral therapy or when the therapy in the third trimester of pregnancy is not available.     

妊娠期妇女用药咨询解析及安全用药法则的建立

目的建立妊娠期妇女相关安全用药法则,以便药师为育龄期及妊娠期妇女用药提供指导。方法收集2018年7月至2019年1月来医院药物咨询室进行用药咨询的妊娠期妇女的相关信息,统计分析用药时间、药物类别及问题类型,根据咨询情况及咨询心得建立安全用药法则。结果孕早期(0~2周)中用药问题最多(53.01%),孕前期用药问题最少(5.29%);咨询问题数排名前三的药品类别分别为营养类(24.15%)、中成药类(19.31%)、降糖、降压药(15.09%);孕前期咨询问题主要集中在"不知道能否用药",孕早期(0~2周)主要集中在"已服药对胎儿是否有影响",孕早期(3~12周)、孕中期(13~28周)及孕晚期(29~42周)均集中在"能否服用准备服用的某种药物";提前(advance)、避免(avoid)、获得(acquire)、保障(assure)为妊娠期妇女安全用药的4A法则。结论妊娠期各阶段咨询的问题有所差异,临床药师依据分析结果建立的4A法则可保障妊娠期妇女安全用药。     

Adverse drug reactions associated with antiretroviral therapy during pregnancy

Introduction: Antiretroviral (ARV) drug use during pregnancy significantly reduces mother-to-child HIV transmission, delays disease progression in the women and reduces the risk of HIV transmission to HIV-serodiscordant partners. Pregnant women are susceptible to the same adverse reactions to ARVs as nonpregnant adults as well as to specific pregnancy-related reactions. In addition, we should consider adverse pregnancy outcomes and adverse reactions in children exposed to ARVs during intrauterine life. However, studies designed to assess the safety of ARV in pregnant women are rare, usually with few participants and short follow-up periods.

Areas covered: In this review, we discuss studies reporting adverse reactions to ARV drugs, including maternal toxicity, adverse pregnancy outcomes and the consequences of exposure to ARV in infants. We included results of observational studies, both prospective and retrospective, as well as randomized clinical trials, systematic reviews and meta-analyses.

Expert opinion: The benefits of ARV use during pregnancy outweigh the risks of adverse reactions identified to date. More studies are needed to assess the adverse effects in the medium- and long term in children exposed to ARVs during pregnancy, as well as pregnant women using lifelong antiretroviral therapy and more recently available drugs.