对1例肺隐球菌感染患者的药学监护

Pharmaceutical care on a patient with pulmonary cryptococcal infection

1例42岁女性患者,因咳嗽、咳痰伴胸闷1月余,咯血3d入院。结合肺隐球菌的病理结果,先后给予抗真菌药物氟康唑和伊曲康唑治疗。住院期间药师及时评估治疗方案,并对患者的肝肾功能监测、抗真菌药物潜在药物相互作用以及药物配制注意事项等提供药学监护。患者首次静脉滴注伊曲康唑结束后,出现一过性视物模糊,11d后再次静脉滴注自觉症状加重,第13天停药后未再出现视物模糊,考虑为伊曲康唑的不良反应。接受抗真菌药物治疗32d后,因症状较前改善,患者出院继续接受抗真菌治疗。鉴于肺隐球菌病长期正规治疗的重要性,提示患者关注氟康唑的药物相互作用,谨慎合用其他药物。

A 42-year-old female patient with cough, sputum and chest distress for more than a month and hemoptysis for 3 days was hospitalized. According to the pathological result of pulmonary cryptococcosis, the patient was treated with fluconazole and itraconazole for antifungal treatment. Clinical pharmacist timely assessed the drug therapy, and the pharmaceutical care on the monitoring of liver and kidney function, potential drug interactions and the notes of drug preparation were implemented.The patient developed a transient blurred vision after receiving itraconazole by intravenous infusion in the first time. The symptom of blurred vision, which can be considered as the adverse reaction caused by itraconazole, became more serious 11 days later and disappeared after stopping itraconazole. The patient discharged from hospital after 32 days treatment when the symptom improved and continued the anti-fungal treatment outside the hospital.In view of the importance of long-term and regular treatment of pulmonary cryptococcosis, pharmacist offered medication education and suggested that the patient should pay attention to drug interactions between fluconazole and other drugs.