临床药师参与解决肿瘤患者个体化用药问题的实践

本文从关注肿瘤患者的基础疾病和并发症的预防，以及抗肿瘤药物不良反应三个方面，分析高血压肿瘤患者保肝药物的调整；乙肝病毒表面抗原阳性的化疗患者抗HBV药物的使用；肿瘤患者静脉血栓栓塞症（VTE）的预防；以及阿帕替尼引起高血压患者的降压药物调整4个典型案例，对临床药师参与肿瘤内科患者个体化用药进行分析，表明临床药师能充分运用专业知识，为患者提供更合适的治疗建议，提高其用药的合理安全性，在实现肿瘤患者的个体化用药方面发挥重要作用。

Practice of Clinical Pharmacists in the Department of Oncology in Solving Problems of Clinical Individualized Medication

With the development of health care in China, clinical pharmacists are facing more and more challenges. Focusing on the basic diseases of tumor patients, the prevention of complications and the adverse reactions of anti-tumor drugs, this article analyzed four typical cases, which were about the adjustment of liver protecting drugs for hypertensive tumor patients, the use of anti HBV drugs for chemotherapy patients with positive HBsAg, the prevention of venous thromboembolism (VTE) in hospitalized tumor patients, and the adjustment of antihypertensive drugs in patients with hypertension caused by apatinib. The analysis shows that clinical pharmacists in the department of oncology can make full use of professional knowledge in daily work, cooperate with clinicians, put forward more appropriate treatment suggestions for patients and improve the rational safety of patients'' medication, which is very important in the realization of individualized medication for tumor patients.