病毒性脑膜炎引发癫痫持续状态患者的用药监护

一名病毒性脑炎继发癫痫的患者,在控制病毒感染的同时,联合运用苯妥英钠、苯巴比妥、丙戊酸钠和卡马西平以控制癫痫症状,但由于治疗期间停用丙戊酸钠和卡马西平致使癫痫症状加重。随后调整用药,在密切监测苯妥英钠和苯巴比妥血药浓度的情况下,加大这两种药物的用量,最终患者癫痫得到了控制,而且意识得到恢复。在整个治疗期间,临床药师与医师共同商讨治疗药物方案,医师听取并采纳了药师的合理用药建议。

Pharmaceutical care for status epilepticus induced by viral encephalitis

A patient with repeated epileptic seizures secondary to viral encephalitis was treated with phenytoin sodium,phenobarbital,sodium valproate and carbamazepine for controlling seizures besides anti-virus infection therapy.Initial multianticonvulsant therapy failed to control seizures,which were exacerbated by sudden withdrawal of anticonvulsants,further leading to status epilepticus.It is well known that status epilepticus is a very serious condition that causes neural necrosis and permanent cerebral injury.Notably,in this case,when serum concentration of phenobarbital went up well,nearly double the therapeutic top limit,the spikes on her EEG were still high and were finally low only when the serum concentration of phenytoin reached the therapeutic range.Finally,severe seizures were controlled by increasing dosage of phenytoin and phenobarbital under carefully monitoring their serum concentrations.During the treatment,the pharmacist and the physician worked together and the physician adopted rational medication suggestions from the pharmacist.In the efforts of both the pharmacist and the physician,the patient gained consciousness and no further attacks.