临床药师参与1例肺移植患者个体化治疗的药学实践
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摘要
目的以1例百草枯中毒后肺移植患者为例,探讨临床药师在肺移植术后患者个体化治疗中的作用。方法临床药师全程参与肺移植术后患者的治疗并进行全方位的药学监护,根据患者病情变化和治疗药物监测结果调整优化给药方案、注意药物相互作用、关注药物疗效及不良反应、提供患者用药教育等。结果通过对患者治疗方案的优化,感染得到有效控制;他克莫司血药浓度维持在有效治疗窗范围内,避免了严重不良反应的发生。对患者用药教育的实施,提高了患者用药依从性。结论临床药师深入临床,对肺移植术后患者实施药学监护,有利于促进合理用药,并提高患者用药安全性和有效性。
OBJECTIVE To explore the role of clinical pharmacist in the individualized treatment for lung transplantation patients,using a case of lung transplantation patient after paraquat poisoning. METHODS Clinical pharmacist was involved in the treatment of lung transplant recipient and provided the full range of clinical pharmacy services,by adjusting and optimizing the medication regimen according to the patient' s condition and the monitoring results of therapeutic drug,paying attention to drug interaction,drug efficacy,adverse reactions and providing education of patient medication. RESULTS The infection was effectively controlled and the blood concentration of tacrolimus was maintained within the effective treatment window which avoided the serious adverse reactions,by optimizing the treatment plan. The medication adherence was improved by providing medication education for patient. CONCLUSION It is beneficial to promote rational drug use and improve the safety and effectiveness of the drug treatment for clinical pharmacist to go into clinical practice,and carry out pharmaceutical care for lung transplant recipient.
OBJECTIVE To explore the role of clinical pharmacist in the individualized treatment for lung transplantation patients,using a case of lung transplantation patient after paraquat poisoning. METHODS Clinical pharmacist was involved in the treatment of lung transplant recipient and provided the full range of clinical pharmacy services,by adjusting and optimizing the medication regimen according to the patient' s condition and the monitoring results of therapeutic drug,paying attention to drug interaction,drug efficacy,adverse reactions and providing education of patient medication. RESULTS The infection was effectively controlled and the blood concentration of tacrolimus was maintained within the effective treatment window which avoided the serious adverse reactions,by optimizing the treatment plan. The medication adherence was improved by providing medication education for patient. CONCLUSION It is beneficial to promote rational drug use and improve the safety and effectiveness of the drug treatment for clinical pharmacist to go into clinical practice,and carry out pharmaceutical care for lung transplant recipient.
引文
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[11]HUMAR A,SNYDMAN D.AST INFECTIONS DISEASESCOMMUNITY OF PRACTICE.Cytomegalovirus in solid organ transplant recipients[J].Am J Transplant,2009,9(suppl 4):78-86.
[12]CHINESE MEDICAL ASSOCIATION BRANCH OF ORGAN TRANS-PLANTATION,CHINESE MEDICAL DOCTOR ASSOCIATIONBRANCH OF ORGAN TRANSPLANT PHYSICIAN.Guidelines for the diagnosis and treatment of cytomegalovirus infection for solid organ transplant recipients in China(2016)[J].Chin J Organ Transplant(中华器官移植杂志),2016,37(9):561-565.
[13]SCHEFFERT J L,RAZA K.Immunosuppression in lung transplantation[J].J Thorac Dis,2014,6(8):1039-1053.
[14]DING Q,FENG D H.CYP3A5 gene polymorphisms and clinical rational use of drug[J].Pharm J Chin PLA(解放军药学学报),2015,31(5):435-438.
[15]CHEN Y M,LI Y,HAN Z Y,et al.Effect of CYP3A5 genetic polymorphisms on the blood concentration of tacrolimus[J].JClin Rehabil Tissue Eng Res(中国组织工程研究与临床康复),2008,12(31):6055-6059.
[16]CHEN C,ZHANG Y J,HE X L,et al.Interpretation of tacrolimus guidelines for individualized medication[J].J Med Postgra(医学研究生学报),2017,30(4):342-347.
[17]ZHANG R L,LI Z D,LIU M,et al.Influential factors of blood steady state trough concentration of FK506 in patients undergoing renal transplant[J].Eval Anal Drug-Use Hosp China(中国医院用药评价与分析),2012,12(3):233-235.
[18]TENG L C,WANG C X,CHEN L Z,et al.Effect of diarrhea on tacrolimus blood trough levels in kidney transplantation recipients[J].J Nephrol Dialy Transplant(肾脏病与透析肾移植杂志),2009,18(5):406-409.
[19]SANSONE-PARSONS A,KRISHNA G,MARTINHO M,et al.Effect of oral posaconazoleon the pharmacokinetics of cyclosporine and tacrolimus[J].Pharmacotherapy,2007,27(6):825-834.
[2]WU B,CHEN J Y.Progress in prevention and treatment of infection after lung transplantation[J].Chin J Organ Transplant(中华器官移植杂志),2015,36(5):298-301.
[3]CAI X J,SONG H Z,JIAO Z,et al.Distribution and drug resistance characteristics of pathogens for infection after lung transplantation from 2010 to 2016[J].Chin J Organ Transplant(中华器官移植杂志),2017,38(9):513-519.
[4]HUAN G,DENG Z D,NI Y X,et al.Chinese experts'consensus on prevention and control of multidrug resistance organism healthcare-associated infection[J].Chin J Infect Control(中国感染控制杂志),2015,14(1):1-9.
[5]SOLE A,SALAVERT M.Fungal infections after lung transplantation[J].Curr Opin Pulm Med,2009,15(3):243-253.
[6]NEOH C F,SNELL G I,KOTSIMBOS T,et al.Antifungal prophylaxis in lung transplantation-a world-wide survey[J].Am JTransplant,2011,11(2):361-366.
[7]CHINESE MEDICAL ASSOCIATION BRANCH OF ORGANTRANSPLANTATION,CHINESE MEDICAL DOCTOR AS-SOCIATION BRANCH OF ORGAN TRANSPLANT PHYSI-CIAN.Guidelines for the diagnosis and treatment of invasive fungal disease for solid organ transplant recipients in China(2016)[J].Chin J Organ Transplant(中华器官移植杂志),2016,37(5):300-305.
[8]MA X,ZHAO L,WANG X X,et al.Advances in research on pharmacokinetic characteristics and therapeutic drug monitoring for the antifungal extended-spectrum posaconazole[J].Chin Pharm J(中国药学杂志),2016,51(6):433-436.
[9]CONTE J E,DEVOE C,LITTLE E,et al.Steady-state intrapulmonary pharmacokinetics and pharmacodynamics of posaconazole in lung transplant recipients[J].Antimicrob Agents Chemother,2010,54(9):3609-3613.
[10]FISHMAN J A.Prevention of infection caused by Pneumocystis carinii in transplant recipients[J].Clin Infect Dis,2001,33(8):1397-1405.
[11]HUMAR A,SNYDMAN D.AST INFECTIONS DISEASESCOMMUNITY OF PRACTICE.Cytomegalovirus in solid organ transplant recipients[J].Am J Transplant,2009,9(suppl 4):78-86.
[12]CHINESE MEDICAL ASSOCIATION BRANCH OF ORGAN TRANS-PLANTATION,CHINESE MEDICAL DOCTOR ASSOCIATIONBRANCH OF ORGAN TRANSPLANT PHYSICIAN.Guidelines for the diagnosis and treatment of cytomegalovirus infection for solid organ transplant recipients in China(2016)[J].Chin J Organ Transplant(中华器官移植杂志),2016,37(9):561-565.
[13]SCHEFFERT J L,RAZA K.Immunosuppression in lung transplantation[J].J Thorac Dis,2014,6(8):1039-1053.
[14]DING Q,FENG D H.CYP3A5 gene polymorphisms and clinical rational use of drug[J].Pharm J Chin PLA(解放军药学学报),2015,31(5):435-438.
[15]CHEN Y M,LI Y,HAN Z Y,et al.Effect of CYP3A5 genetic polymorphisms on the blood concentration of tacrolimus[J].JClin Rehabil Tissue Eng Res(中国组织工程研究与临床康复),2008,12(31):6055-6059.
[16]CHEN C,ZHANG Y J,HE X L,et al.Interpretation of tacrolimus guidelines for individualized medication[J].J Med Postgra(医学研究生学报),2017,30(4):342-347.
[17]ZHANG R L,LI Z D,LIU M,et al.Influential factors of blood steady state trough concentration of FK506 in patients undergoing renal transplant[J].Eval Anal Drug-Use Hosp China(中国医院用药评价与分析),2012,12(3):233-235.
[18]TENG L C,WANG C X,CHEN L Z,et al.Effect of diarrhea on tacrolimus blood trough levels in kidney transplantation recipients[J].J Nephrol Dialy Transplant(肾脏病与透析肾移植杂志),2009,18(5):406-409.
[19]SANSONE-PARSONS A,KRISHNA G,MARTINHO M,et al.Effect of oral posaconazoleon the pharmacokinetics of cyclosporine and tacrolimus[J].Pharmacotherapy,2007,27(6):825-834.