临床药师参与1例多发性骨髓瘤患者治疗方案选择和药学监护

Clinical pharmacists participate in the selection of therapy regimen and pharmaceutical care for a patient with multiple myeloma

目的 :通过案例实践探讨临床药师在抗肿瘤治疗多学科团队的作用。方法 :临床药师运用药剂学、药理学、药物分析等药学专业知识参与对1例合并基础疾病的多发性骨髓瘤患者抗肿瘤治疗方案的调整、静脉血栓栓塞预防方案的选择并提出建议及对患者治疗全程进行药学监护。结果 :医师接受来那度胺拆分剂量以混悬液形式给药和选择达肝素钠抗凝的建议,通过临床药师的药学监护,患者疗效稳定,无血栓形成或出血以及其他药物不良反应的临床表现。结论:临床药师参与抗肿瘤治疗多学科团队,对抗肿瘤治疗和辅助治疗的临床决策具有积极作用,尤其凭借对药学知识的熟练掌握,能进一步确保患者药物治疗的安全、有效、经济,将抗肿瘤综合治疗体系构建得更全面、更完善。

Objective:To explore the role of clinical pharmacists in multidisciplinary team of antineoplastic therapy by case practice.Methods:Clinical pharmacists participated in the adjustment of antineoplastic therapy regimen and the selection of venous thromboembolism prevention,provided suggestions and implemented pharmaceutical care for a patient with multiple myeloma complicated with underlying diseases using specialized pharmaceutical knowledge such as pharmaceutics,pharmacology,and pharmaceutical analysis.Results:The physician accepted our suggestions to administer lenalidomide by suspension and to choose dalteparin as an anticoagulant.The patient had a stable outcome and no clinical manifestations of thrombosis or bleeding and other adverse drug reactions by our pharmaceutical care.Conclusion:The participation of clinical pharmacists in the multidisciplinary team of antineoplastic therapy can play an active role in the clinical decision-making of antineoplastic treatment and adjuvant therapy,especially with their proficiency in pharmaceutical knowledge,which can further ensure the safety,effectiveness and economy of medication and build a more comprehensive and better antineoplastic treatment system.