临床药师参与1例别嘌醇致重症药疹治疗的病例分析

发布时间：2019-04-12 08:24

【摘要】：目的:探讨临床药师在识别和处理别嘌醇致重症药疹中的作用。方法:临床药师参与1例高尿酸血症患者的药物治疗,通过筛查患者住院前后所用药物、建议进行人类白细胞抗原(HLA)-B~*5801相关基因检测,并根据检测结果最终确定导致重症药疹的药物为别嘌醇。同时,根据患者临床症状、基因型、实验室检查指标、药敏试验结果等先后建议加用依巴斯汀片、复方吲哚美辛酊、曲安奈德益康唑乳膏等对症治疗;停用别嘌醇片,改用激素+免疫球蛋白冲击疗法(注射用甲泼尼龙琥珀酸钠80 mg,ivgtt,qd+静注人免疫球蛋白20 g,ivgtt,qd)控制过敏症状;加用百令胶囊、复方α-酮酸片改善肾功能;改用注射用美罗培南、伏立康唑片抗感染;并行疗效评价、电解质水平监测、用药教育、转科随访等药学监护。结果:医师采纳临床药师建议;患者药疹逐渐消退,肺部感染好转。结论:别嘌醇引起的重症药疹病情重、病程长,甚至可危及患者的生命。因此,建议在使用别嘌醇前进行HLA-B~*5801等相关基因筛查,并加强用药宣教,确保患者用药的安全、有效。
[Abstract]:Objective: to investigate the role of clinical pharmacists in the identification and management of allopurinol-induced severe drug eruption. Methods: a clinical pharmacist was involved in the treatment of a patient with hyperuricemia. After screening the drugs used by the patients before and after hospitalization, it was suggested to detect the related genes of human leukocyte antigen (HLA)-B _ (B) _ (5801). According to the results of the test, allopurinol was identified as the drug causing severe drug eruption. At the same time, according to the clinical symptoms, genotype, laboratory test indexes, drug sensitivity test results and so on, it is suggested that Ebastin tablets, compound indomethacin tincture, triamcinolone acetonide econazole cream and other symptomatic treatment should be added. Stop the use of allopurinol tablets, and use hormone immunoglobulin shock therapy (methylprednisolone succinate 80 mg,ivgtt,qd intravenous injection of human immunoglobulin 20 g, iv gtt, QD) to control allergic symptoms; In addition, Bering capsule and compound 伪-ketonic acid tablets were used to improve renal function, meropenem and Voliconazole tablets for injection were used for anti-infection, curative effect evaluation, monitoring of electrolyte level, drug education, follow-up of transfer and so on were used in pharmaceutical care. Results: doctors adopted clinical pharmacist's advice. The patients' drug rash gradually subsided and lung infection improved. Conclusion: allopurinol-induced severe drug eruption is serious, the course of disease is long, and even endangers the life of the patient. Therefore, it is suggested that HLA-B~*5801 and other related genes should be screened before allopurinol is used, and drug education should be strengthened in order to ensure the safety and effectiveness of drug use in patients.
【作者单位】：天津市胸科医院药剂科;高密市人民医院药剂科;
【分类号】：R758.25

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