天疱疮患者的药学监护

Pharmaceutical care for patients with pemphigus

本文对天疱疮患者使用糖皮质激素、免疫抑制剂、静脉注射免疫球蛋白、抗感染药物治疗及合并有糖尿病、高血压等基础疾病时用药等情况下的药学监护内容进行逐一讨论,以优化临床治疗方案,保障患者的用药安全。并结合实例,协助医师对1例使用激素及环磷酰胺后出现肝功能异常的天疱疮患者进行了停用环磷酰胺,换用免疫球蛋白的用药方案调整及保肝治疗,结果患者病情好转出院;对1例合并糖尿病、冠心病的老年天疱疮患者在天疱疮治疗的方案选择、激素的用药剂量调整及其重点不良反应监护、降糖药物的选择及出现低血糖的对症处理、加强血钾及感染的监测、出现真菌感染的药物治疗方案制定等方面实行了药学监护,结果患者天疱疮病情好转,血糖、血钾等指标正常,感染得到控制。

To optimize the clinical therapeutic programs and ensure the safety use of drugs, the contents of pharmaceutical care for patients with pemphigus were discussed from the following aspects： glucocorticoid therapy, immunosuppressant therapy, intravenous immunoglobulin therapy, anti-infective therapy and simultaneous therapy for diabetes, hypertension and other underlying diseases. The cases of pharmaceutical care were reviewed. In one case, a patient with pemphigus had abnormal liver function after glucocorticoid and cyclophosphamide therapy. After pharmaceutical care of clinical pharmacist for adjustment treatment with immunoglobulin and hepatoprotective treatment regimen, the patient was relieved and discharged. The pharmaceutical cares on an elderly patient with pemphigus, diabetes and coronary heart disease were focused on treatment options, the hormone dose adjustment, adverse reaction monitoring, choice of antidiabetic drugs and hypoglycemia, potassium and infection monitoring, drug treatment program of fungal infection. Then the condition of the patient improved, and blood glucose, serum potassium and other indicators returned to normal, and the infection was controlled.