1例免疫检查点抑制剂相关肾上腺皮质功能减退肺鳞癌患者的用药分析
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篇名: 1例免疫检查点抑制剂相关肾上腺皮质功能减退肺鳞癌患者的用药分析
TITLE: Analysis of Drug Use in a Lung Squamous Carcinoma Patient with Immune Checkpoint Inhibitors Associated Adrenocortical Insufficiency
摘要: 目的:探讨临床药师在免疫检查点抑制剂相关肾上腺皮质功能减退诊治中的作用,为类似病例的诊治提供参考。方法:1例长期静脉滴注帕博利珠单抗注射液的肿瘤免疫治疗肺鳞癌患者,因“乏力、纳差10余天”入院。临床药师查阅文献资料并结合患者查体结果(入院第2天上午8时的血浆皮质醇16.41nmol/L,促肾上腺皮质激素8.39pg/mL,血清电解质钠126.00mmol/L、氯88.00mmol/L等)和用药史(接受免疫检查点抑制剂治疗)进行不良反应关联性评价,协助医师确诊其为肾上腺皮质功能减退症,与帕博利珠单抗的关联性为“很有可能”;在医嘱停用帕博利珠单抗的基础上,临床药师建议口服氢化可的松片(上午8时20mg,下午4时10mg)进行糖皮质激素生理剂量替代治疗,并于治疗前对患者及其家属进行用药宣教,于用药过程中实施药学监护对糖皮质激素剂量及效果进行评估,于出院时进行用药教育。结果:医师采纳临床药师的建议。患者于给药后第5天肾上腺皮质功能减退症状显著改善,带药出院。结论:临床药师在该患者的治疗过程中,发挥了其药学特长,协助医师制定了适宜的用药方案,对患者及其家属进行了用药教育,保障了患者用药的有效性和安全性。建议在进行免疫检查点抑制剂治疗前,应完善患者基线检查,包括体格检查、上午8时血浆皮质醇水平;用药期间增加监测上午8时血浆皮质醇水平和血清电解质水平的频次;撤药后至少随访1年,以尽量对免疫检查点抑制剂相关肾上腺皮质功能减退做到早发现、早治疗。
ABSTRACT: OBJECTIVE:To explore the role of clinical pharmacists in the diagnosis and tre atment of immune checkpoint inhibitor related adrenocortical insufficiency ,so as to provide reference for the diagnosis and treatment of similar cases. METHODS:A lung squamous carcinoma patient with tumor immunotherapy ,who received long-term intravenous infusion of Pembrolizumab injection ,was hospitalized for more than 10 days due to fatigue and poor appetite. The clinical pharmacists consulted the literature and evaluated the correlation of ADR on the basis of patient ’s physical examination results (plasma cortisol 16.41 nmol/L at 8:00 in the morning on the second day of admission ,adrenocorticotropic hormone 8.39 pg/mL,serum electrolyte sodium 126.00 mmol/L,chlorine 88.00 mmol/L,etc.)and medication history (receiving the treatment with immune checkpoint inhibitors). The clinical pharmacists assisted the doctor to confirm that the patient was adrenocortical insufficiency ,and the correlation with pembrolizumab was “very likely ”. On the basis of discontinuation of pembrolizumab ,it was recommended to take Hydrocortisone tablets orally (20 mg at 8:00 in the morning and 10 mg at 4:00 in the afternoon )for glucocorticoid physiological dose substitution therapy. Before treatment ,the patient and his families should be educated on the use of drugs ,pharmaceutical care should be implemented to evaluate the glucocorticoid doseand efficacy during treatment ,and medication education was carried out at discharge. RESULTS :The doctor adopted theli_xyan suggestions of the clinical pharmacist. On the 5th day after @126.com administration,the symptoms of adrenocortical insufficiency were significantly impro ved,and the patient was discharged with medicine. CONCLUSIONS :During the treatment of the patient , the clinical pharmacist gave full play to his pharmaceutical expertise ,assisted the doctor to formulate an appropriate medication plan,and carried out medication education for the patient and his family members ,so as to ensure the effectiveness and safety of the patient ’s medication. It is suggested that the baseline examination of patients should be improved before immune checkpoint inhibitor treatment ,including physical examination and plasma cortisol level at 8:00 in the morning ;the frequency of monitoring plasma cortisol level and serum electrolyte level at 8:00 in the morning. should be increased during medication ;the patients should be followed up for at least 1 year after withdrawal ,so as to early detect and treat immune checkpoint inhibitor related adrenocortical dysfunction.
期刊: 2021年第32卷第22期
作者: 吴君,李妍,王媛媛,朱熙
AUTHORS: WU Jun,LI Yan,WANG Yuanyuan ,ZHU Xi
关键字: 帕博利珠单抗;肾上腺皮质功能减退;免疫相关不良反应;药学监护;临床药师
KEYWORDS: Pembrolizumab;Adrenocortical insufficiency ;Immune-related adverse events ;Pharmaceutical care ;Clinical
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