临床药师参与1例卡培他滨致晚期乳腺癌患者手足综合征治疗实践

Clinical Pharmacists′Participation in the Treatment of Advanced Breast Cancer with Hand-Foot Syndrome Induced by Capecitabine:A Case Report

目的探讨临床药师在抗肿瘤药物所致药品不良反应(ADR)临床治疗中的作用。方法临床药师参与1例晚期乳腺癌患者手足综合征(HFS)的临床诊疗过程,通过查阅相关指南与文献,结合患者用药史,协助医师分析与判断可能导致HFS的药物,利用诺氏不良反应评估量表进行量化评估,提出合理的干预措施与个体化的抗肿瘤药物治疗方案。结果临床药师分析患者HFS与卡培他滨的使用“很可能相关”(诺氏不良反应评估量表评分为7分),ADR等级为3级,建议患者本化学药物治疗周期暂停使用卡培他滨,并口服塞来昔布胶囊(每次200 mg,每天2次)和外用尿素软膏(涂于患处,每天3次)对症治疗,HFS症状好转时可再次使用卡培他滨(减量25%)。医师采纳药师建议,患者ADR(HFS)等级降至1级,且后续治疗过程中HFS未加重。结论临床药师通过参与抗肿瘤药物所致ADR的诊疗过程,可体现自身价值,保障临床用药的安全性与有效性。

Objective To investigate the role of clinical pharmacists in the treatment of adverse drug reactions(ADRs)induced by anti-tumor drugs.Methods Clinical pharmacists participated in the diagnosis and treatment of an advanced breast cancer patient with hand-foot syndrome(HFS).By referring to relevant guidelines and literature,clinical pharmacists assisted physicians in analyzing and determining the drugs that might induce HFS based on the patient′medication history,used the Naranjo adverse drug reaction probability scale for quantitative evaluation,proposed rational intervention measures and individualized anti-tumor drug treatment plan.Results Clinical pharmacists determined that the patient′s HFS was probably induced by capecitabine(the Naranjo adverse drug reaction probability scale score was seven points),and it was considered an ADR of grade three.Clinical pharmacists suggested to suspend the use of capecitabine during this chemical drug treatment cycle,take Celecoxib Capsules orally(200 mg each time,twice a day)and use urea ointment externally(applied to the infected part,three times a day)for symptomatic treatment,and suggested that capecitabine can be used again when HFS symptoms improved,while the dose should be reduced by 25%.The physicians adopted the pharmacists′suggestions,then the patient′s HFS improved to the ADR of grade one,and her HFS was not severer during subsequent treatment.Conclusion Clinical pharmacists′participation in the diagnosis and treatment process of ADRs induced by anti-tumor drugs in multiple stages can reflect their value and ensure the safety and effectiveness of clinical medication.