临床药师对一例原发性甲减合并心衰老年患者的药学监护

Pharmaceutical care for an elderly patient with primary hypothyroidism complicated with heart failure by clinical pharmacists

目的通过对1例原发性甲减合并心衰老年患者的药学监护,探讨实施药学监护的过程、方法及作用。方法临床药师对原发性甲减伴心衰老年患者在住院期间进行药学监护,主要包括:甲状腺功能、BNP、心肌酶、心室率、血压、液体出入量、电解质等指标的监测,并根据监测结果提出药物剂量调整及药物选择使用建议;同时对患者进行用药教育,保障患者用药安全有效。结果患者病情得到缓解,用药依从性提高。结论临床药师从药物药效学及药动学、药物相互作用、药品不良反应和患者教育方面,积极配合医师,为患者提供合理的用药方案,使患者的临床症状得到改善。

Objective To explore the processe,method and role of pharmaceutical care for an elderly patient with primary hypothyroidism complicated with heart failure by clinical pharmacists. Methods Pharmaceutical care was given to the elderly patient with primary hypothyroidism complicated with heart failure by clinical pharmacists during the hospitalization period. Monitoring points of pharmaceutical care included the thyroid function,BNP,cardiac enzyme,ventricular rate,blood pressure,liquid intake and output,electrolyte,etc. Clinical pharmacists gave recommendations about drugs selection and dose according to the results of drug monitoring and provided medication education for the patient to guarantee the safety and effectiveness of drug use. Results The patient＇ s condition was improved,and the compliance in drug use was raised. Conclusion Clinical pharmacists help physician to provide reasonable medication to improve clinical symptoms significantly from the aspects of drug pharmacodynamics,pharmacokinetics,interaction monitoring,adverse drugs action and patient education.