含肝肾毒性成分中成药风险防范的药学服务实践

Application of Pharmaceutical Care in Prevention of Drug Risk in Liver and Kidney Toxicity

目的探讨药学服务在含肝肾毒性成分中成药风险防范中的运用。方法检索中药肝肾毒性风险物质、不良反应报道等文献数据,结合药品说明书和《中国药典临床用药须知》2015年版中药成方制剂卷,确定北京中医医院顺义医院君药、臣药含肝肾毒性成分的中成药品种;根据药师在实际工作中发现的问题确定该类药品的药学监护要点。结果该院君药、臣药为肝肾毒性成分的中成药106种,占该院中成药总品种数的23.2%,广泛涉及理气剂、蠲痹通络剂、清热剂等22类,增加了中成药合理应用的监测难度;4种含大毒成分,大部分中成药药品说明书未详细描述药品不良反应、禁忌证、注意事项,增加联合用药导致肝肾损伤风险,亦导致临床医师忽略向患者提示用药风险;多种不同功能主治的中成药含同种肝肾毒性中药成分,同时,部分中成药含有多种肝肾毒性中药成分,且多用于治疗慢性疾病,临床长期用药增加肝损伤的潜在风险。结论对含肝肾毒性成分中成药进行归类,并找出药学服务要点,可为处方前置审核系统数据库提供数据支持,并为药学查房、门诊药物咨询、患者用药教育等药学服务提供参考,对于提升药学服务质量具有重要意义。

Objective To explore the application of pharmaceutical care in risk prevention of proprietary drugs containing hepatorenal toxicity.Methods Literature data such as risk substances for liver and kidney toxicity and reports of adverse reactions of traditional Chinese medicines were searched;the drug instructions with the Chinese Pharmacopoeia Notes for Clinical Use 2015 edition of traditional Chinese medicine prescription preparations were combined to determine whether the hospital used Jun and Chen medicines as liver and kidney toxicity components,the type of proprietary Chinese medicines;according to the problems found by the pharmacist in actual work,the pharmaceutical monitoring point of this type of medicine were determined.Results There were 106 types of Chinese patent medicines that used Jun and Chen medicines as liver and kidney toxicity components,accounting for 23.2%of the total varieties of Chinese patent medicine in the hospital.They widely involved 22 categories such as Qi agent,Juanbi Tongluo agent,heat-clearing agent,etc.,which increased the difficulty of monitoring the reasonable application of Chinese patent medicines;4 types contained large toxic ingredients,and most of the instructions of Chinese patent medicines on adverse drug reactions,contraindications,precautions were not described in detail,increasing the risk of liver and kidney damage caused by combined use of drugs and also causingclinicians to ignore the risk of prompting patients to use drugs.A variety of traditional Chinese medicines with different functions included the same liver and kidney toxicity.Liver and kidney toxic traditional Chinese medicine were mostly used for the treatment of chronic diseases,and clinical long-term medication potentially increased the risk of liver injury.Conclusion Sorting out traditional Chinese medicine varieties with liver and kidney toxicity components and their pharmaceutical service monitoring points can provide data support for the database of pre-prescription review system and references for pharmaceutical care such as pharmacy rounds,outpatient drug consultation,and patient medication education.It is of great significance for improving the quality of pharmaceutical care.