临床药师参与老年房颤患者难治性痛风药物治疗病例分析与干预

Case analysis and intervention of clinical pharmacists for an elderly atrial fibrillation patient with refractory gout

目的探讨临床药师在老年房颤患者合并痛风的临床治疗中的作用。方法参与1例老年房颤患者难治性痛风的药物治疗和实施药学监护,并对该病例进行分析和干预。结果痛风急性发作时,秋水仙碱传统大剂量疗法不太适用于70岁以上患者,可采用小剂量疗法或FDA推荐的冲击疗法。对反复发作的痛风患者,除了要避免诱发因素,还应使用小剂量秋水仙碱或非甾体抗炎药维持治疗以预防再次急性发作。结论对于痛风反复发作的患者,临床药师应详尽了解患者的饮食、生活及用药史,重视特殊人群的药物使用注意事项,和医生一起为患者制定个体化治疗方案,并有针对性的进行用药教育。

Objective To explore the role of the clinical pharmacists in the clinical treatment of elderly atrial fibrillation patients with gout.Methods We participated in drug treatment of an elderly atrial fibrillation patient with refractory gout and implemented pharmaceutical care,and then analyzed and intervened the case.Results When acute gout attacks happened,traditional high-dose colchicine therapy was not suitable for patients over 70 years old.A small dose therapy or the dose recommended by the FDA can be used.In addition to avoiding predisposing factors,clinical pharmacists should also use small doses of colchicine or NSAID maintenance therapy to prevent acute attack again in recurrent gout patients.Conclusions For recurrent gout patients,clinical pharmacists should learn more about the patient’s diet,lifestyle and medication history,pay attention to drug use precautions of special populations,and work with doctors to develop individualized treatment plan and make targeted medication education for patients.