1例高龄晚期肺癌合并心血管基础疾病患者的药学监护.pdfVIP

中国药物应用与监测2011年8月第8卷第4期 Chinese Journal of Drug Application and Monitoring, Vol.8, No.4, August 2011 1例高龄晚期肺癌合并心血管基础疾病患者的药学监护 1 2 （1. 青海省肿瘤医院药剂科，青海 西宁 810006；2. 青海省人民医院药剂科，青海 西宁 810006 ） 宋和勇 ，卢海儒 [摘要] 1例高龄晚期肺癌合并心血管基础疾病患者，肺癌 γ- 刀放疗后，3 周期TP （顺铂+ 紫杉醇脂质体）方案化疗3 个月的 过程中，临床药师积极开展药学监护，协助临床医师优化用药方案。结合高龄晚期肺癌合并心血管基础疾病患者的疾病特 点、用药选择、药物不良反应等情况，对患者使用抗高血压药、抗心律失常药提出用药建议。为避免肺癌患者的咳嗽症状加 重，停用了对患者呼吸系统影响较大的肾素血管紧张素转换酶抑制剂；对患者化疗后出现低血压、心律失常的情况，及时停 β 用钙离子拮抗剂并换用血管紧张素Ⅱ受体拮抗剂，减量使用抗心绞痛药并加用 - 受体阻滞剂；在抗菌药物使用方面选用了 对肠道感染效果较好且适用于老年人的左氧氟沙星，合用蒙脱石散治疗腹泻并减轻抗肿瘤药的消化道毒性；对患者使用顺 铂、紫杉醇所致消化道不良反应、骨髓抑制进行积极的预防和治疗；并对患者进行出院用药指导。 [关键词] 高龄；肺癌；临床药师；药学监护 [ 中图分类号] R972 [文献标识码] A [文章编号] 1672 – 8157(2011)04 – 0219 – 03 Pharmaceutical care on one elderly patient with lung cancer and cardiovascular disease 1 2 SONG He-yong , LU Hai-ru ( 1.Department of Pharmacy, Qinghai Cancer Hospital, Xining 810006, China; 2. Department of Pharmacy, Qinghai Provincial People’s Hospital, Xining 810006, China ) [ABSTRACT] The pharmaceutical care was provided by clinical pharmacists in collaboration with physicians during the three cycles of TP chemotherapy treatment (cisplatin and paclitaxel liposome) to one elderly patient with lung cancer and cardiovascular disease who had been treated with Gamma knife radiosurgery. Clinical pharmacists made recommendations on the rational use of anti-hypertensive and anti-arrhythmia drugs, based on the disease characteristics of elderly lung cancer complication with cardiovascular disease, selection of medication and adverse drug reaction. Angiotensin converting enzyme inhibitor (ACEI) was discontinued to avoid cough in lung cancer patient. To deal with the hypotension and arrhythmia caused by chemotherapy, calcium channel blocker (CCB) was switched to angiotensin Ⅱr