临床药师参与重症肌无力合并支气管哮喘病例的药学实践
|
摘要
1例重症肌无力合并支气管哮喘的中年男性患者,既往肾肿瘤切除病史,临床药师参与患者的药物治疗并对其进行药学监护。因患者哮喘控制欠佳,为重症肌无力一线治疗方案即溴吡斯的明的用药禁忌,且糖皮质激素用药初期可能引发重症肌无力危象,治疗方案需要多重考虑后制定。临床药师通过文献调研,利用药学相关专业知识,协助医师制定治疗方案,筛查用药合理性,对患者进行药学监护及用药依从性宣教。临床药师为医师及患者提供个体化药学服务,促进临床合理用药。
A middle-aged male patient with myasthenia gravis and history of renal tumor resection was admitted into our hospital,and the clinical pharmacist participated in the treatment of the patient and provided pharmaceutical care.There was contraindication of the first-line treatment for myasthenia gravis due to poor asthma control,and glucocorticoid might cause myasthenia gravis crisis.The treatment plan needed to be carefully considered.Through literature research with pharmaceutical knowledge,the clinical pharmacist assisted the physicians in formulating treatment plans and selecting rational drug.In addition,the clinical pharmacist conducted pharmaceutical care and medication compliance counseling for the patient.Clinical pharmacists can provide individualized pharmaceutical service to physicians and patients,and promote rational drug use.
A middle-aged male patient with myasthenia gravis and history of renal tumor resection was admitted into our hospital,and the clinical pharmacist participated in the treatment of the patient and provided pharmaceutical care.There was contraindication of the first-line treatment for myasthenia gravis due to poor asthma control,and glucocorticoid might cause myasthenia gravis crisis.The treatment plan needed to be carefully considered.Through literature research with pharmaceutical knowledge,the clinical pharmacist assisted the physicians in formulating treatment plans and selecting rational drug.In addition,the clinical pharmacist conducted pharmaceutical care and medication compliance counseling for the patient.Clinical pharmacists can provide individualized pharmaceutical service to physicians and patients,and promote rational drug use.
引文
[1]饶明俐.神经病学[M].3版.北京:人民卫生出版社,2017:423-425.
[2]Satkunam N,Siddiqi Z A,Vethanayagam D.Severe asthma associated with myasthenia gravis[J].Can Respir J,2014,21(1):el-e3.
[3]刘欣,王连云,宇峥,等.胸腺瘤、重症肌无力合并支气管哮喘1例[J].河北医药,2014,36(14):2234-2236.
[4]Melzer N,Ruck T,Fuhr P,et al.Clinical features,pathogenesis,and treatment of myasthenia gravis:a supplement to the Guidelines of the German Neurological Society[J].J Neurol,2016,263(8):1473-1494.
[5]Guptill J T,Soni M,Meriggioli M N.Current treatment,emerging translational therapies,and new therapeutic targets for autoimmune myasthenia gravis[J].Neurotherapeutics,2016,13(1):118-131.
[6]中华医学会神经病学分会神经免疫学组,中国免疫学会神经免疫学分会.中国重症肌无力诊断和治疗指(2015年版)[J].中华神经科杂志,2015,48(11):934-940.
[7]宋文明.糖皮质激素冲击治疗后重症肌无力早期一过性加重的机制研究[J].国际神经病学神经外科学杂志,2015,41(1):22-25.
[8]刘一民,陈红兵.糖皮质激素冲击治疗诱发重症肌无力危象临床特点和危险因素分析[J].中国医院药学,2016,36(2):11-12.
[9]周德智,沈月平.他克莫司治疗重症肌无力的系统性回顾及meta分析[J].中国医药科学,2017,7(3):41-44.
[10]Zhao C B,Zhang X,Zhang H,et al.Clinical efficacy and immunological impact of tacrolimus in Chinese patients with generalized myasthenia gravis[J].Int Immunopharmacol,2011,11(4):519-524.
[11]中华医学会呼吸病学分会《雾化吸入疗法在呼吸疾病中的应用专家共识》制定专家组.雾化吸入疗法在呼吸疾病中的应用专家共识[J].中华医学杂志,2016,96(34):2696-2708.
[12]李坚,谢汝萍,肖卫忠.丙种球蛋白与糖皮质激素联用致肝功能异常6例[J].药物不良反应杂志,2005,7(2):138-139.
[2]Satkunam N,Siddiqi Z A,Vethanayagam D.Severe asthma associated with myasthenia gravis[J].Can Respir J,2014,21(1):el-e3.
[3]刘欣,王连云,宇峥,等.胸腺瘤、重症肌无力合并支气管哮喘1例[J].河北医药,2014,36(14):2234-2236.
[4]Melzer N,Ruck T,Fuhr P,et al.Clinical features,pathogenesis,and treatment of myasthenia gravis:a supplement to the Guidelines of the German Neurological Society[J].J Neurol,2016,263(8):1473-1494.
[5]Guptill J T,Soni M,Meriggioli M N.Current treatment,emerging translational therapies,and new therapeutic targets for autoimmune myasthenia gravis[J].Neurotherapeutics,2016,13(1):118-131.
[6]中华医学会神经病学分会神经免疫学组,中国免疫学会神经免疫学分会.中国重症肌无力诊断和治疗指(2015年版)[J].中华神经科杂志,2015,48(11):934-940.
[7]宋文明.糖皮质激素冲击治疗后重症肌无力早期一过性加重的机制研究[J].国际神经病学神经外科学杂志,2015,41(1):22-25.
[8]刘一民,陈红兵.糖皮质激素冲击治疗诱发重症肌无力危象临床特点和危险因素分析[J].中国医院药学,2016,36(2):11-12.
[9]周德智,沈月平.他克莫司治疗重症肌无力的系统性回顾及meta分析[J].中国医药科学,2017,7(3):41-44.
[10]Zhao C B,Zhang X,Zhang H,et al.Clinical efficacy and immunological impact of tacrolimus in Chinese patients with generalized myasthenia gravis[J].Int Immunopharmacol,2011,11(4):519-524.
[11]中华医学会呼吸病学分会《雾化吸入疗法在呼吸疾病中的应用专家共识》制定专家组.雾化吸入疗法在呼吸疾病中的应用专家共识[J].中华医学杂志,2016,96(34):2696-2708.
[12]李坚,谢汝萍,肖卫忠.丙种球蛋白与糖皮质激素联用致肝功能异常6例[J].药物不良反应杂志,2005,7(2):138-139.