临床药师对3例安罗替尼治疗晚期肺癌致不良反应的药学监护

目的:探讨临床药师在使用安罗替尼治疗晚期肺癌患者致不良反应中的作用,为临床安全用药提供参考。方法:针对3例安罗替尼治疗晚期肺癌致不良反应的典型病例,临床药师从安罗替尼的使用、患者用药教育、不良反应防治措施等方面对患者进行药学监护,协助临床医师处理安罗替尼相关咯血、肝损伤、血压升高、蛋白尿等不良反应。结果:对1例安罗替尼致咯血患者,临床药师分析咯血程度较轻,建议停用安罗替尼,并给予止咳、止血对症处理,必要时加用垂体后叶素,控制咯血后可继续服用安罗替尼,临床医师采纳,患者用药期间未再出现咯血。对1例安罗替尼致肝功能损伤患者,临床药师分析为轻度的胆汁淤积型,建议无需停用安罗替尼,给予腺苷蛋氨酸治疗,临床医师采纳,治疗5 d后患者肝功能恢复正常,后期未见明显肝功能损伤。对1例安罗替尼致血压升高伴蛋白尿患者,由于患者有高血压病史,针对高血压临床药师加强了对患者的用药教育,指导患者调节饮食、适当活动、减轻精神压力以及监测血压等,通过心理干预等非药物降压效果不佳后,临床药师建议为患者修改降压治疗方案,临床医师采纳,将既往的降压药尼群地平更改为血管紧张素受体阻滞剂缬沙坦,治疗2周后血压恢复正常;针对尿蛋白临床药师建议停用安罗替尼,2周后尿蛋白恢复正常,临床药师建议下调安罗替尼剂量继续治疗,临床医师采纳,后期复查尿蛋白未发现异常。结论:临床药师应积极对安罗替尼治疗的肺癌患者开展药学监护,加强对患者的用药教育,促进临床合理用药。

Pharmaceutical Care of Clinical Pharmacists for Anlotinib-induced ADR in 3 Patients with Advanced Lung Cancer

OBJECTIVE:To explore the role of clinical pharmacists on anlotinib-induced ADR in patients with advanced lung cancer,and to provide reference for safe drug use in clinic. METHODS:For 3 typical cases of ADR caused by the treatment of advanced lung cancer with anlotinib,clinical pharmacists provided pharmaceutical care to patients from the aspects of the use of anlotinib,medication education,the prevention and treatment of ADR,and assisted clinicians to solve ADR related to anlotinib such as hemoptysis, liver injury, elevated blood pressure, proteinuria, etc. RESULTS: For one case of anlotinib-induced hemoptysis, clinical pharmacists analyzed that the degree of hemoptysis was mild. They suggested that anlotinib should be discontinued and treated symptomatically with cough relief and hemostasis. If necessary,pituitrin should be added. Anlotinib could be continued after hemoptysis control,which doctors adopted. No hemoptysis occurred during the treatment period. For the case of anlotinib caused liver function damage, clinical pharmacists analyzed it as mild cholestasis type. They suggested that no discontinuation of anlotinib should be given and adenosylmethionine treatment should be given,which doctors adopted. After 5 days of treatment,the patients’ liver function returned to normal,and no obvious liver function damage was found in the later period. For the case of anlotinib induced hypertension with proteinuria,the patient had a history of hypertension. For hypertension,clinical pharmacists strengthened medication education for patients,instructed patients to adjust diet,appropriately activities,reduce mental stress and monitor blood pressure. The psychological intervention and other non-drug antihypertensive effects were poor,and then clinical pharmacists suggested to modify the antihypertensive treatment for patients. Doctors adopted it and changed the former antihypertensive drug nitrendipine to angiotensin receptor blocker valsartan. After 2 weeks of treatment,blood pressure returned to normal. For urinary protein,clinical pharmacists recommend to discontinue the use of anlotinib,and the urinary protein returned to normal after 2 weeks. Clinical pharmacists recommend to reduce the dose of anlotinib to continue treatment,which the doctors adopted. No abnormal urinary protein was found in the later review. CONCLUSIONS:Clinical pharmacists should actively provide pharmaceutical care for lung cancer patients treated with anlotinib,and strengthen medication education so as to promote rational drug use in clinic.