临床药师参与1例复发转移乳腺癌患者的药学监护

目的：探讨临床药师参与复发转移乳腺癌患者临床药物治疗的方法和切入点。方法：临床药师通过对化疗方案的评估，分析化疗过：程中可能出现的不良反应，将紫杉醇致骨髓抑制和神经毒性等预防、卡培他滨致手足综合征预防、紫杉醇及卡培他滨致呕吐和腹泻等不良反应预防、曲妥珠单抗过敏及心脏毒性预防、戈舍瑞林致皮肤潮红及关节痛等预防、唑来膦酸致发热等不良反应预防、糖皮质激素等辅助药物对患者血糖血压的影响、药物相互作用等作为药学监护点，协助临床医师完善治疗方案。结果：临床药师利用相关药学知识，使患者避免了可能产生的药源性损害，保障了肿瘤患者的用药安全。结论：临床药师参与复发转移乳腺癌化疗方案的制订与调整，可协助医师更好地为患者提供针对性强、可耐受的个体化用药方案。

Clinical Pharmacists Participating in Pharmaceutical Care for a Case of Recurrent Metastatic Breast Cancer

OBJECTIVE： To investigate the approaches and breakthrough point of clinical pharmacists participating in the treatment for patients with recurrent metastasis breast cancer. METHODS： By evaluating the chemotherapy scheme and analyzing the potential adverse drug reactions in chemotherapy course, the prevention of paclitaxel-induced arrest of bone marrow and neurotoxicity, the prevention of capecitabine-induced hand-foot syndrome, the prevention of paclitaxel and capecitabine-induced ADR as vomiting and diarrhea, the prevention of trastuzumab allergy and cardiac toxicity, the prevention of goserelin-induced erubescence and arthralgia, the prevention of zoledronic acid-induced ADR as fever, the effects of auxiliary drugs as glucocorticoid on blood glucose and blood pressure, drug interaction were considered as pharmaceutical care points to assist clinical physicians to promote treatment scheme. RESULTS： Clinical pharmacists wisely utilized the pharmacological knowledge, which prevented the patients from drug-induced damage and guaranteed the safety of drug use. CONCLUSIONS： Clinical pharmacists participate in the development and adjustment of recurrent metastasis breast cancer chemotherapy scheme, assist physicians to establish individualized treatment programs and make the programs targeted and tolerable.