临床药师参与预防药源性癫痫的体会

Experience of Clinical Pharmacists Participte in the Prevention of Drug-induced Epilepsy

目的:总结临床药师在预防药源性癫痫中的作用和临床常见易引发癫痫的药物。方法:通过分析临床药师在某例癫痫患者的全程药学监护中的作用,协助临床降低药源性癫痫的风险。在监护的全过程中通过查阅文献,总结能诱发癫痫的药物,并分析作用机制,探索临床药师在预防药源性疾病中的作用。结果:临床药师在癫痫患者诊疗工作中的作用,主要包括询问患者用药史分析药源性癫痫风险、指导患者逐步停用风险药物、参与临床用药方案的制订和诊疗环节的用药风险并协助临床医师调整用药方案、监护患者服药后症状的改变、对患者进行"癫痫患者特殊用药告知"等。常见诱发癫痫的药物包括抗菌药物(氟喹诺酮类、β-内酰胺类等)、中枢神经系统药(镇静催眠和抗癫痫药、治疗精神障碍药等)、中草药和中成药以及解热镇痛抗炎药、循环系统药等其他药物。药物的作用机制包括透过血-脑脊液屏障进入脑组织、抑制γ-氨基丁酸与受体部位结合、生成氨基或自由基影响大脑皮层一部分神经元等。结论:临床药师在癫痫患者的用药安全中的作用十分重要,其对诱发癫痫的药物的关注对临床用药具有极大的参考价值。

OBJECTIVE：To summarize the role of clinical pharmacists on the prevention of medicine-induced epilepsy and common epilepsy-inducing drugs in clinic. METHODS：The role of clinical pharmacists in whole process of pharmaceutical care for an epilepsy patient was introduced,and clinical pharmacists assisted physicians to reduce the risk of drug-induced epilepsy. The role of clinical pharmacists on the prevention of epilepsy-inducing medicine during pharmaceutical care was explored through reviewing literature,summarizing epilepsy-inducing drug and analyzing mechanism. RESULTS：The role of clinical pharmacists in diagnosis and treatment of epilepsy included that analyzing the risk of medicine-induced epilepsy by inquiring about the history of drug use,guiding patients to gradually stop taking risk drugs,participating in the formulation of clinical medication plan and drug risk during diagnosis and treatment,assisting physicians to adjust medication plan,monitoring the change of patient＇s symptoms after drug,＂special medication notification for epilepsy patient＂,etc. The types of common epilepsy-inducing medicine included antibiotics（fluoroquinolone,β-lactam,etc.）,drugs for central nervous system（sedative and antiepileptic drug,mental disorders drug,etc.）,Chinese herbal drug,Chinese patent drug,antipyretic-analgesic and anti-inflammatory drug,circulatory system drug and other drugs. The mechanisms of drug effect included entering the brain through the blood cerebrospinal fluid barrier,inhibiting the binding of γ-aminobutyric acid to the receptor site,producing amino or free radicals and affecting a part of the cerebral cortex.CONCLUSIONS：Clinical pharmacists play an irreplaceable role in the safety of drug use in epilepsy patient. Their focuses to epilepsy-inducing drug are of significance to clinical practice.