目的:探讨临床药师在肾病综合征合并肺孢子菌肺炎(PCP)药物治疗中提供药学监护的方法和作用。方法:临床药师参与1例肾病综合征合并PCP患者的药物治疗,从抗感染治疗方案的制订、糖皮质激素用药的优化、用药过程的监护、患者用药教育等方面实施药学监护。同时建议将阿奇霉素0.5 g,ivgtt,qd+复方磺胺甲噁唑片2片,po,q12 h抗感染这一疗效不佳的初始方案,调整为复方磺胺甲噁唑片3片,po,q6 h +克林霉素0.6 g,ivgtt,q8 h,后加用卡泊芬净50 mg,ivgtt,qd;并根据患者疾病进展4次调整注射用甲泼尼龙琥珀酸钠剂量。结果:医师采纳临床药师建议,治疗30 d后患者肺内病灶基本吸收,感染得到控制。结论:临床药师参与抗感染治疗及药学监护,协助医师制订用药方案,促进了临床合理用药,提高了药物临床治疗的有效性和安全性。
Abstract
OBJECTIVE: To explore the method and role of clinical pharmacists in pharmaceutical care for nephrotic syndrome complicated with Pneumocystis carinii pneumonia (PCP). METHODS: Clinical pharmacists participated in the treatment for a patient with nephrotic syndrome complicated with PCP, and implemented pharmaceutical care in terms of the development of anti-infective therapy regimens, glucocorticoid optimization, guardianship for drug use, the medication education for patients. Clinical pharmacists provided suggestion that primary anti-infective plan of azithromycin 0.5 g,ivgtt,qd+Compound sulfalene tablet 2 tablets, po, q12 h; which was not effective,was adjusted plan as Compound sulfalene tablet 3 tablets, po, q6 h+clindamycin 0.6 g, ivgtt, q8 h+caspofungin 50 mg, ivgtt, qd. The dose of Methylprednisolone for injection was adjusted 4 times according to disease progression. RESULTS: Physicians adopted the suggestions of clinical pharmacists. After 30 days of treatment, lung abnormal lesion was absorbed basically and infection control was achieved. CONCLUSIONS: Clinical pharmacists participate in anti-infective treatment and pharmaceutical care, and assist physicians to develop therapy plan to promote rational drug use in the clinic and improve the effectiveness and safety of clinical treatment.
关键词
肾病综合征肺孢子菌肺炎临床药师药学监护
Keywords
Nephrotic syndromePneumocystis carinii pneumoniaClinical pharmacistsPharmaceutical care