1例高血脂症患者应用PCSK9抑制剂无应答的用药分析与药学监护

Medication analysis and pharmaceutical care of a patient with hyperlipidemia with no response to PCSK9 inhibitor

1例高血脂症患者口服辛伐他汀1个月后出现肌肉酸痛,临床药师详细评估患者治疗方案和用药前后血液指标变化、血脂控制情况,并查阅相关文献,认为患者肌肉损伤与辛伐他汀相关,建议停用辛伐他汀,1个月后改用PCSK9抑制剂,医生接受建议。患者停药1个月后,肌酸激酶指标恢复正常,后应用PCSK9抑制剂出现无反应。临床药师持续监护患者病情变化,在其连续注射第2个月后,建议停用PCSK9抑制剂,改用瑞舒伐他汀和依折麦布降脂治疗,医生接受建议,患者经治疗后血脂达标。本案例中临床药师对患者他汀类药物不耐受和PCSK9抑制剂无应答的情况进行用药分析,提供药学监护,促进了患者临床安全合理用药。

A patient with hyperlipidemia was treated with oral simvastatin lipid-lowering drugs.After one month,muscle soreness occurred.The clinical pharmacist carefully evaluated the patient′s treatment plan,changes in blood indicators before and after medication,and blood lipid control.After consulting relevant literature,clinical pharmacist concluded that the patient′s muscle damage was related to simvastatin.It was recommended to stop simvastatin and switch to PCSK9 inhibitor after one month.The doctor accepted the recommendation.The patient′s creatine kinase index returned to normal one month after discontinuation of medication,and there was no response after using PCSK9 inhibitor.The clinical pharmacist continuously monitored the changes of the patient′s condition and recommended discontinuing the PCSK9 inhibitor after the second month of continuous injection and switching to rosuvastatin and ezetimibe for lipid lowering treatment.The doctor accepted the recommendation and the patient′s blood lipids meet the standard after treatment.In this case,the clinical pharmacist conducted medication analysis on patients with statin intolerance and no response to PCSK9 inhibitors,provided pharmaceutical monitoring,and promoted safe and reasonable clinical medication for patients.