Practice of clinical pharmacists participating in treatment of visual impairment caused by voriconazole in a patient of multiple myeloma
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摘要: 目的 通过临床药师参与一例血液系统肿瘤并粒细胞缺乏患者长期服用伏立康唑片剂后出现视觉障碍不良反应的临床实践过程,探讨临床药师的服务模式、药学监护内容及临床药师应具备的基础知识和技能。 方法 对病例的病史、用药史、当前用药进行全面系统回顾,利用药品不良反应因果关系判别方法分析患者反应与用药间相互关系,考察药物浓度影响因素,提出改进用药的建议。 结果 医师接受药学建议,减少合并用药奥美拉唑的剂量以减轻肝药酶抑制,降低对伏立康唑浓度干扰。10 d后患者视觉障碍症状缓解。 结论 临床药师应具备灵活运用所学药学知识的能力,能通过独立思考判断与评估用药后可能产生的效益及风险,制定药学监护计划,减少或避免药源性损伤。Abstract: Objective To discuss the service mode, contents of pharmaceutical care and the basic knowledge and skills that a clinical pharmacist should master by participating in treatment of visual impairment caused by voriconazole in a patient of multiple myeloma. Methods The case history, past medication and ongoing administration of the patient of multiple myeloma were systematically analyzed to find out the relationship between the adverse reaction and the combined medication. Then rational advice was given according to the pharmacological characteristics and drug concentration of voriconazole. Results The physician accepted the advice and reduced the dose of omeprazole for less suppression of hepatic drug metabolizing enzyme and fewer disturbances on dose of voriconazole. Ten days later visual impairment of the patient was improved. Conclusion Clinical pharmacists should be good at flexibly using pharmacological knowledge, evaluating the effects and risks of medication and planning for pharmaceutical care to reduce or avoid subsequent drug impairment.
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Key words:
- voriconazole /
- adverse reaction /
- clinical pharmacist
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