临床药师对1例罕见卡瑞利珠单抗致中毒性表皮坏死松解症患者的用药分析
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篇名: 临床药师对1例罕见卡瑞利珠单抗致中毒性表皮坏死松解症患者的用药分析
TITLE:
摘要:
目的介绍临床药师在卡瑞利珠单抗致中毒性表皮坏死松解症TEN患者治疗过程中的作用为类似不良反应的治疗提
供参考方法临床药师参与1例卡瑞利珠单抗致中毒性表皮坏死松解症患者的治疗过程该患者使用注射用卡瑞利珠单抗联合甲磺酸阿帕替尼片抗肿瘤治疗因全身大面积皮疹入院临床药师查阅相关文献并结合患者入院诊断[重症大疱性表皮松解重症药疹多形红斑型)、肝功能异常等]和检查结果低钾血症等建议停用上述抗肿瘤药物予以注射用甲泼尼龙琥珀酸钠 160 mg80 mg60 mgqd静脉滴注抗炎+注射用亚胺培南西司他丁1 gq8 h静脉滴注抗感染+氯化钾注射液1 gqd静脉滴注调节电解质+复方氨基酸注射液3AA)(10.65 gqd静脉滴注营养支持+注射用泮托拉唑钠40 mgqd静脉滴注抑酸护 +注射用还原性谷胱甘肽2.4 gqd静脉滴注保肝等并在用药前对患者进行认知行为教育和用药宣讲在患者用药期间密切 监护其相关指标变化在患者出院时进行带药指导结果医师采纳临床药师的建议患者治疗16 d后躯干四肢皮疹好转双眼睑仍糜烂渗出有较多分泌物患者要求转院治疗结论临床药师协助医师完善了卡瑞利珠单抗致TEN患者的治疗方案对患者进行认知行为教育和用药宣讲保障了其用药的有效性和安全性
ABSTRACT:
OBJECTIVETo introduce the role of clinical pharmacists in the treatment of camrelizumab-induced toxic epidermal necrolysis TEN),and to provide reference for the therapy of similar ADR. METHODSThe clinical pharmacist participated in therapy duration of a patient with TEN caused by camrelizumab. The patient was treated with Camrelizumab for injection combined with Apatinib mesylate tablet as anti-tumor therapyand was admitted to hospital due to extensive skin lesions. After consulting relevant literatures and analyzing the patients admission diagnosis [severe epidermolysis bullosasevere drug eruptionerythema multiforme),abnormal liver functionetc.] and examination resultshypokalemiaetc.),clinical pharmacists suggested to stop above anti-tumor drugs and given Methylprednisolone sodium succinate for injection160 mg80 mg60 mgqdivgttfor anti-inflammatory treatmentImiperan cilastatin for injection 1 gq8 hivgttfor an ti-infection treatment
Potassium chloride injection1 gqdivgttfor electrolyte regulationCompound amino acid injection
3AA)(10.65 gqdivgttfor nutritional support treatmentPantoprazole sodium for injection40 mgqdivgttfor acid inhibition and stomach protectionReduced glutathione for injection2.4 gqdivgttfor liver protection. Before medicationthe patient was given cognitive and behavioral education and medication publicity. The changes of relevant indicators were closely monitored during medicationand the patient was given medication guidance when he was discharged. RESULTSThe doctors adopted the suggestions of clinical pharmacistsand 16 days after treatmentthe skin lesions of the trunk and limbs were improvedand the double eyelids were still erosive and exuded a lot of secretions. The patient requested transfer for treatment. CONCLUSIONSClinical pharmacists assisted physicians to improve the treatment plan of patients with TEN caused by camrelizumaband carried out cognitive and behavioral education and medication publicity for patients to ensure the effectiveness and safety of their medication.
期刊: 2021年第32卷第21期
作者: 胡功利,李家伟,肖 溢,黄 玉
AUTHORS: HU Gongli,LI Jiawei,XIAO Yi,HUANG Yu
关键字: 卡瑞利珠单抗;中毒性表皮坏死松解症;不良反应;药学实践
KEYWORDS: Camrelizumab;Toxic epidermal necrolysis;ADR;Pharmaceutical practice
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