OBJECTIVE: To investigate the experience of clinical pharmacists in pharmaceutical care for immunosuppressive agent-induced renal insufficiency patients with secondary Pneumocystis carinii pneumonia. METHODS: A patient with edema of both lower limbs fever and cough was admitted to Guang’anmen Hospital of Chinese Academy of TCM in May 2017. The patient was given large dose of glucocorticoids, cyclophosphamide, mycophenolate mofetil and other immunosuppressive agent during the past 8 years. After admission, the patient was diagnosed as anti-neutrophil cytoplasmic antibody-associated vasculitis, type Ⅲ crescent glomerulonephritis, membranous nephropathy, and P. carinii gene test was positive. Clinical pharmacists provided pharmaceutical care and medication education from the aspects of antibacterial, anti-P. carinii, antihypertension, and glucocorticoid use. RESULTS: According to the patient’s medication befor admission and medication plan prescribed by the physician after admission, clinical pharmacists recommend replacing anti-infective drugs as Imipenem and cliastatin sodium for injeetion and clindamycin phosphate tablet with moxifloxacin and captopril which were not required to reduce dose in renal insufficiency patient, adding fosinopril to the treatment of hypertension, protecting the residual nephron, providing medication education for the patient about the use of glucocorticoids, and informing the patient of potential adverse reactions and countermeasures. Doctors and patients agreed and accepted the opinions of clinical pharmacists; the patient was discharged from the hospital after the patient’s infection symptoms were controlled, blood pressure dropped to normal range, lower limb edema improved, and renal function gradually recovered. CONCLUSIONS: Through pharmaceutical care, clinical pharmacists can optimize the medication program of patients, help to improve the curative effect, improve the prognosis, and promote clinical rational drug use.
关键词
免疫抑制剂肾功能不全卡氏肺孢子菌肺炎药学监护
Keywords
Immunosuppressive agentRenal insufficiencyPneumocystis carinii pneumoniaPharmaceutical care
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Related Author
WU Yanyan
WANG Can
YANG Xinwei
KONG Wenqiang
HU Xuelian
LI Chenlu
PAN Hongming
SHEN Lirong
Related Institution
Dept. of Pharmacy, Second Affiliated Hospital, Army Medical University
Dept. of Pharmacy, Chongqing Health Center for Women and Children/Women and Children’s Hospital of Chongqing Medical University