摘要
目的:通过对1例急性冠脉综合征老年患者的药学监护,探讨开展药学服务的方法和思路。方法:临床药师对1例急性冠脉综合征老年患者在药物相互作用、药物剂量和给药时间以及药物对电解质的影响等方面实行药学监护。结果:临床药师结合患者特点及合并用药情况,建议将降压药物由非洛地平改为福辛普利、停用尼麦角林、降低地高辛剂量、调整硝酸酯类药物给药时间、密切监测血钾等,医师采纳临床药师建议,有效避免了不利的药物相互作用、降低了药物蓄积中毒、耐药和电解质紊乱等风险,患者病情明显好转出院。结论:老年患者常患有多种慢性疾病,须同时应用多种药物,且老年人各种生理功能减退,从而使药品不良反应的几率和药物相互作用发生的风险显著增加。因此在老年患者的治疗过程中,临床药师应与临床医师密切合作,积极开展药学监护,协同临床优化给药方案,保障患者安全合理用药。
OBJECTIVE： To explore the methods and ideas of developing pharmaceutical care according to the pharmaceutical care for an elderly patient with acute coronary syndrome. METHODS： Clinical pharmacist provided pharmaceutical care for an elderly patient with acute coronary syndrome in respect of drug interactions, drug dose and medication time, effect of drugs on electrolyte and so on. RESULTS： According to the characteristic of the patients and drug combination, clinical pharmacist suggested to change felodipine to fosinopril, withdraw nicergoline, reduce dose of digoxin, adjust administration time of nitrates, and monitor potassium concentration, etc. The doctors adopted the suggestions of clinical pharmacist to avoid the adverse drug interactions, reduce the risk of cumulative intoxication, resistance and electrolyte imbalance. The condition of the patient was improved significantly. CONCLUSION： Elderly patients often suffer from multiple chronic diseases and physiological dysfunction, and should apply a variety of drugs, so that the probability of adverse drug reactions and drug interactions increase significantly. Therefore, in the course of treatment in elderly patients, clinical pharmacist should cooperate with clinical physicians, provide active pharmaceutical care and optimize drug scheme to guarantee the safety of drug use.
出处
《中国药房》
CAS
CSCD
北大核心
2011年第42期4024-4025,共2页
China Pharmacy
关键词
临床药师
药学监护
急性冠脉综合征
老年患者
Clinical pharmacist
Pharmaceutical care
Acute coronary syndrome
Elderly patient
