临床药师对1例席汉综合征患者使用糖皮质激素后出现精神异常的药学监护

Pharmaceutical care by clinical pharmacists for a Sheehan′s syndrome patient with glucocorticoid-induced mental abnormalities

目的探讨临床药师在席汉综合征患者治疗中发挥的作用。方法临床药师参与1例席汉综合征患者使用糖皮质激素后出现精神异常的临床治疗,通过因果关系评估精神异常与糖皮质激素的相关性,优化激素替代治疗方案,对患者进行药学监护。结果临床药师对引起精神异常的可能病因以及可疑药物进行分析,并根据药品不良反应事件分析方法遵循的5条原则,考虑糖皮质激素是引起精神异常的主要原因;临床药师优化患者的激素替代治疗方案,建议降低糖皮质激素替代治疗剂量,加用小剂量左甲状腺素钠。结论临床药师在参与临床治疗过程中,应充分发挥自身药学特长,结合循证药学证据,辨别、诊断药物不良反应,提供药学服务。

Objective To discuss the role of clinical pharmacists in the treatment of Sheehan′s syndrome.Methods Clinical pharmacists participated in the treatment of one patient with Sheehan′s syndrome,who had mental abnormalities after using glucocorticoid,the correlation between mental abnormalities and glucocorticoid was evaluated through the causal relationship,the hormone replacement therapy program was optimized,and pharmaceutical care for the patient was conducted.Results The clinical pharmacists analyzed the possible causes and suspected drugs inducing mental abnormalities.According to the 5 principles of ADRs analysis,clinical pharmacists considered that glucocorticoid was the main cause of the patient′s mental abnormalities;they optimized the hormone replacement therapy for the patient,and suggested lowering the dose of glucocorticoid and adding a small dose of levothyroxine sodium.Conclusion Clinical pharmacists should give full play to their pharmaceutical expertise in clinical treatment,identify and diagnose adverse drug reactions and provide pharmaceutical care based on the evidence-based pharmaceutical evidence.