1例坎地沙坦致不良反应慢病患者实施药物治疗管理的实践  

Medication Therapy Management Practice of A Chronic Disease Patient with Adverse Drug Reactions Caused by Candesartan

作　　者：柳丽丽[1] 冯毅 刘文生[1] 王毅军[1] 任超逸[1] 骆昱煜 LIU Lili;FENG Yi;LIU Wensheng;WANG Yijun;REN Chaoyi;LUO Yuyu(Tianjin Third Central Hospital/Tianjin Institute of Hepatobiliary Disease/Tianjin Key Lab of Artificial Cells/Research Center of Artificial Cell Engineering Technology,Ministry of Public Health,Tianjin 300170,China;Tianjin Fifth Central Hospital/Peking University Binhai Hospital,Tianjin 300450,China)

机构地区：[1]天津市第三中心医院/天津市肝胆疾病研究所/天津市人工细胞重点实验室/卫生部人工细胞工程技术研究中心,天津300170 [2]天津市第五中心医院/北京大学滨海医院,天津300450

出　　处：《中国药房》2019年第11期1559-1564,共6页China Pharmacy

基　　金：天津市科技计划项目(No.17YFZCSY01070)

摘　　要：目的:为评价药物与药品不良反应(ADR)的关联性及实施药物治疗管理(MTM)提供参考。方法:回顾性分析天津市第三中心医院门诊收治的1 例服用坎地沙坦后出现白细胞、血小板减少及肝脏生化学检查异常等ADR的慢病(高血压合并冠心病)老年患者的临床资料,MTM药师采用Naranjo评估量表法分析坎地沙坦与ADR的关联性,并联合Roussel Uclaf因果关系评价法(简称RUCAM法)分析患者肝脏生化学检查异常的原因,根据结果对患者进行用药重整,配合医师制订个体化用药方案并跟踪随访。结果:采用Naranjo评估量表法,分析结果为坎地沙坦与ADR关联性为“很可能有关”;采用RUCAM法,分析结果为坎地沙坦与肝脏生化学检查异常之间关联性为“很可能”。MTM药师建议及时停用坎地沙坦并调整患者用药,医师及患者采纳药师建议,患者停药38 天后,ADR症状消失,白细胞、血小板计数和肝脏生化学检查结果均正常。调整用药后随访6 个月,患者血压恢复正常,情况良好。结论:Naranjo评估量表法和RUCAM法在评价药物与ADR及肝毒性关联性上简单可行,二者在评价药物与肝毒性相关性上具有一致性,在评价含肝脏生化学检查异常ADR相关性时可联用Naranjo评估量表法和RUCAM法进行分析。OBJECTIVE:To provide reference for the evaluation of the correlation between drugs and adverse drug reaction (ADR)and the implementation of medication therapy management(MTM). METHODS:Clinical information of a elderly patient with chronic disease(hypertension and coronary heart disease)whose suffered from leukocyte and platelet counts reduction and abnormal liver biochemical examination after taking candesartan were analyzed retrospectively in outpatient department of Tianjin Third Central Hospital. MTM pharmacists analyzed the correlation of candesartan with ADR using Naranjo evaluation scale method. The reasons for abnormal liver biochemical examination were analyzed by Naranjo evaluation scale method combined with Roussel Uclaf causality analysis method(called RUCAM method for short). The medication reconciliation was conducted according to the results,and pharmacists cooperated with doctors to set individualized medication regimen and follow-up. RESULTS:By Naranjo evaluation scale method,analysis results showed that candesartan was“probably related”to ADR. By RUCAM method,analysis results showed that candesartan was“probably related”to liver biochemical abnormalities. MTM pharmacists suggested that candesartan should be stopped in time and the patient’s medication should be adjusted. The physician and the patient adopted the pharmacist’s advice. After 38 days of drug withdrawal,the patient’s ADR symptoms disappeared,and leukocyte count,platelet count and liver biochemical examination were normal. After adjustment of medication,the patient was followed up for 6 months with normal blood pressure. CONCLUSIONS:Naranjo evaluation scale method and RUCAM are simple and feasible in evaluating the correlation of drugs with ADR and hepatotoxicity. The two methods are consistent in evaluating the correlation between drugs and hepatotoxicity. Naranjo scale method and RUCAM method can be combined to analyze the correlation between drugs and ADR with abnormal liver biochemical examination.

关 键 词：Naranjo评估量表法 Roussel Uclaf因果关系评价法 药物治疗管理 坎地沙坦 药品不良反应 

分 类 号：R969.3[医药卫生—药理学]