临床药师参与2例结核病合并心脏疾病患者用药实践  

Clinical Pharmacists′Participation in the Drug Treatment of Tuberculosis Complicated with Heart Disease:Two Case Reports

作　　者：曾俊芬[1] 鲁建武[1] 宋杨一嫣 谭娟 ZENG Junfen;LU Jianwu;SONG Yangyiyan;TAN Juan(Renmin Hospital of Wuhan University,Wuhan,Hubei,China 430060)

机构地区：[1]武汉大学人民医院,湖北武汉430060

出　　处：《中国药业》2023年第7期107-110,共4页China Pharmaceuticals

基　　金：湖北省中央引导地方科技发展专项[2019ZYYD065]。

摘　　要：目的 为结核病合并心脏疾病患者提供个体化用药指导。方法 临床药师参与1例肠结核合并急性非ST段抬高型心肌梗死患者(患者1)及1例肺结核合并房颤患者(患者2)的药物治疗过程,分析患者用药存在的问题,给予用药指导及药学监护,并进行用药教育。结果 临床药师建议,患者1选择对肝功能影响更小的中等强度的瑞舒伐他汀钙调脂治疗,在使用利福平期间将替格瑞洛替换为氯吡格雷,首剂量150 mg,维持剂量75 mg(每日1次);患者2使用利福平期间胺碘酮维持200 mg(每日3次),利伐沙班20 mg(每日1次)。医师采纳建议,2例患者的各项指标均好转,且无不良事件发生。结论 利福平是细胞色素P450 3A4酶强诱导剂,可与多种药物发生相互作用,临床药师应根据药物的作用特点,为患者提供个体化用药方案。Objective To provide the individualized medication guidance for tuberculosis patients complicated with heart disease.Methods Clinical pharmacists participated in the drug treatment of an intestinal tuberculosis patient complicated with acute non-ST-elevation myocardial infarction(patient 1)and a pulmonary tuberculosis patient complicated with atrial fibrillation(patient 2),analyzed the problems existing in the medication,gave medication guidance and pharmaceutical care,and provided medication education for patients.Results The clinical pharmacists suggested that patient 1 choose the medium intensity rosuvastatin calcium for lipid-regulating treatment with less influence on the liver function,and replace ticagrelor with clopidogrel(at the initial dose of 150 mg,maintenance dose of 75 mg,once a day)during the use of rifampicin.The clinical pharmacists suggested that patient 2 maintain 200 mg of amiodarone(three times a day)during the use of rifampicin,and use 20 mg of rivaroxaban(once a day).Physicians adopted the above suggestions,then all indicators of the two patients improved,and no adverse events occurred.Conclusion Rifampicin is a strong inducer of cytochrome P4503A4 enzyme,and can interacts with many drugs.Clinical pharmacists should provide individualized medication scheme for patients according to the characteristics of drugs.

关 键 词：结核病 心肌梗死 房颤 药物相互作用 药学监护 

分 类 号：R95[医药卫生—药学] R978.3