临床药师参与肺移植患者药品不良反应处置的案例分析

Case analysis of clinical pharmacists participating in the treatment of adverse drug reactions in lung transplant patients

目的 通过分析临床药师参与的肺移植患者药品不良反应处置的2个典型案例,探讨临床药师在药品不良反应处置过程中的作用。方法 临床药师分别参与肺移植患者使用他克莫司血药浓度升高致高钾血症和伏立康唑致肝损伤2个典型ADR的判别和救治,结合治疗药物监测,提出用药建议,帮助医生制定对症处理方案。结果 针对ADR的干预和救治,临床药师的用药建议均被采纳。案例1建议及时停用伏立康唑和他克莫司,同时采取降钾对症治疗措施,患者血钾水平逐渐恢复正常,伏立康唑和他克莫司重新减量使用后,血药浓度和血钾水平均未再升高。案例2建议停用引起药物性肝损伤可能性较大的伏立康唑,更换为泊沙康唑口服混悬液后,肝功能相关指标降至正常。结论 临床药师可以将ADR的处置作为临床工作的切入点,分析ADR的诱发因素,判别ADR的发生,并及时干预、帮助医生制定救治方案;同时也要注重专业技术的提高,能够提前预防不良反应的发生,从而促进临床安全、合理用药。

Objective To explore the role of clinical pharmacists in the management of adverse drug reactions through the analysis of two typical cases of the treatment for adverse drug reactions in lung transplant patients.Methods Clinical pharmacist was involved in the diagnosis and treatment of 2 typical ADRs in lung transplant patients,including 1 case of hyperkalemia caused by increased blood concentration of tacrolimus,and 1 case of liver injury caused by voriconazole.Clinical pharmacist provides medicinal recommendations based on therapeutic drug monitoring to help doctors formulate symptomatic treatment plans.Results For the intervention and treatment of ADR,the suggestions of clinical pharmacist were adopted.In case 1,it was suggested to stop the use of voriconazole and tacrolimus in time,and take symptomatic treatment measures to reduce potassium,and the serum potassium level of the patient gradually returned to normal.After the re-use of voriconazole and tacrolimus in a decreased dose,the serum concentration and potassium level did not increase again.In case 2,it was suggested to stop using voriconazole,which was more likely to cause drug-induced liver injury;it was replaced with posaconazole oral suspension,and the liver function-related indicators fell to normal.Conclusion Clinical pharmacist can use the treatment for ADR as the entry point for clinical work,analyze the inducing factors of ADR,distinguish the occurrence of ADR,and intervene in time to help doctors formulate treatment plans.At the same time,we should also pay attention to the improvement of professional skills to prevent the occurrence of adverse reactions,and promote clinical safety and rational drug use.