临床药师对1例肺癌伴脑膜转移患者的药学监护

Pharmaceutical Care for a Patient with Lung Cancer Complicating with Meningeal Metastasis by Clinical Pharmacist

目的:通过临床药师对1例肺癌伴脑膜转移患者的药学监护,探讨临床药师如何在临床治疗中发挥作用。方法:临床药师在1例肺癌伴脑膜转移患者的治疗过程中,监护患者用药全过程:分析患者肝功能异常和培美曲塞使用的关系;关注抗肿瘤药物与其他药物之间的相互作用,发现卡马西平与厄洛替尼合用对厄洛替尼血药浓度的影响;对鞘内注射抗肿瘤药尼妥珠单抗进行安全评估及监护有无中枢神经系统症状改变。结果:在临床药师参与下,临床医师调整治疗方案,使用叶酸和地塞米松后未再出现肝功能异常,未出现癫痫再次发作;该患者鞘内注射尼妥珠单抗耐受性良好,且脑转移症状缓解,患者顺利出院。结论:临床药师通过开展药学监护,可以协助医师保障患者用药安全、有效。

OBJECTIVE： To explore the role of clinical pharmacists in the clinical treatment by providing pharmaceutical care for a patient with lung cancer complicating with meningeal metastasis. METHODS： Clinical pharmacist monitored the entire treat- ment process of a patient with lung cancer complicating with meningeal metastasis; analyzed the relationship of liver function abnor- mality with the use of pemetrexed; paid attention to the interaction of antitumor drugs with other drugs; discovered relation of car- bamazepine with the blood concentration of edotinib the safety of intrathecal injection of antitumor drugs nimotuzumab was evaluat- ed, and the changes of central nervous system symptom were monitored. RESULTS： Clinical pharmacist cooperated with physi- cians to adjust treatment protocols. The abnormality of hepatic function as well as epilepsia didn＇ t appear again after treatment of fo- lic acid and dexamethasone. The intrathecal injection of nimotuzumab is well tolerated, and meningeal metastasis was relieved. And then the patient discharged from hospital successfully. CONCLUSIONS： Clinical pharmacists provide pharmaceutical care, which assist physicians to ensure the safety and effectiveness of drug use.