Treatment optimization for dermatitis medicamentosa in a patient with abnormal liver function associated with infection
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摘要: 目的 探讨1例肝功能异常伴感染患者出现药疹时，如何判断药疹、优化抗组胺药物及糖皮质激素的使用。 方法 结合患者肝肾功能及血常规、治疗药物、过敏史等情况，通过查阅药疹诊疗文献、抗组胺药物使用说明书及糖皮质激素指导原则，从药物联用、药物组成及制剂特点、抗组胺药的分类及各自代谢、排泄特点、患者感染控制和皮疹进展情况，明确引起药疹的药物并优化治疗方案。 结果 临床药师建议加用氯苯那敏（肌注）+西替利嗪（口服），在皮疹仍控制不佳的情况下，建议加用地塞米松（静脉滴注），医师接受建议。 结论 临床药师面对脏器功能异常伴感染患者发生药疹并进行药物治疗时，应综合分析疾病及药物特点，及时准确地提供药学建议。Abstract: Objective To optimize the treatment plan for dermatitis medicamentosa in a patient with abnormal liver function associated with infection. Methods The culprit medication for drug eruption was identified by reviewing the patient's liver and kidney function, routine blood count, therapeutic drugs, allergic history, by analyzing the characteristics of the compounding medication, combined with literature search on drug eruption diagnosis and treatments. Following the antihistamines and glucocorticoid use guidelines, the treatment plan was optimized by selecting appropriate antihistamines and glucocorticoids based on their metabolism and excretion pathway. Results The rash was poorly controlled after clinical pharmacist's initial recommendation to use chlorpheniramine (intramuscular injection) and cetirizine (oral). The clinical pharmacist further suggested dexamethasone intravenous drip. The patient recovered well with the combination therapy of antihistamines and glucocorticoid. Conclusion When drug eruption occurred, clinical pharmacists should evaluate patient's disease and medications comprehensively, provide timely and accurate pharmaceutical care to patients.
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Key words:
- drug eruption /
- antihistamine drugs /
- glucocorticoids /
- clinical pharmacist
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[1] 中华医学会.糖皮质激素类药物临床应用指导原则[J].中华内分泌代谢杂志,2012,28(2):增录2a-28-29. [2] 漆 军,李恒进.药物性皮炎的治疗[J].中国全科医学,2004,7(12):893-894. [3] 葛蒙梁.药疹的临床类型和诊治[J].中国药物警戒,2006,3(1):43-46. [4] 赵 广.药疹的识别与治疗[J].中华全科医师杂志,2010,9(5):362-363. [5] 中华医学会外科学分会胆道外科学组.急性胆道系统感染的诊断和治疗指南(2011版)[J].中华消化外科杂志,2011,10(1):9-13. [6] 葛均波,徐永健.内科学[M]. 8版.北京:人民卫生出版社,2013:439-445. [7] 崔福德. 药剂学[M].6版.北京:人民卫生出版社,2007:26-27. [8] 沈丽芳,马淑媚.几种抗组胺药物的作用特点及应用[J].中外医疗,2009,28(7):176. [9] 刘保国,李志英,李宗珊,等.抗组胺药临床应用[J].临床合理用药杂志,2015,8(8):85-86. [10] 程淑锋,林 滔,程丽雪.几种第二代抗组胺药的对比和临床应用[J].海峡药学,2005,17(5):108-110. [11] 任 耘,崔 琳.西替利嗪的临床应用进展及安全性[J].中国医院用药评价与分析,2003,3(6):369-371. [12] 孙平华,姚志红,孙铁民.抗组胺药的药物相互作用[J].中国新药杂志,2006,15(10):769-772. [13] 曾丽宁.奥美拉唑致不良反应研究进展[J].医学理论与实践,2015,28(10):1305-1306. [14] 彭彦孟.氯雷他定致肝功能异常1例[J].人民军医,2007,50(12):720. [15] 毕真真,杭小锋,徐文胜.氯雷他定诱发严重淤胆型肝炎1例[J].肝脏,2009,14(4):353. [16] Tillement JP. The advantages for an H1 antihistamine of a low volume of distribution[J].Allergy,2000,55(Suppl 60):17-21. [17] 马满玲,刘 璐.第2代抗组胺药物心脏毒性研究进展[J].中国药业,2005,14(4):75-76. [18] 孙会仙,刘丽萍.第二代抗组胺药的研究进展[J].国外医学(药学分册),2001,28(5):263-266. -
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