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1例EGFR-TKI致间质性肺病合并艾滋病机会性感染肿瘤患者的药学服务
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| 篇名： | 1例EGFR-TKI致间质性肺病合并艾滋病机会性感染肿瘤患者的药学服务 |
| TITLE： | Pharmaceutical care for a case of tumor patient with interstitial lung disease due to EGFR-TKI and AIDS opportunistic infection |
| 摘要： | 目的 为艾滋病合并肿瘤患者的药物治疗及药学监护提供参考。方法针对1例艾滋病合并肺腺癌患者靶向治疗过程中多次出现间质性肺病，且无法排除细菌、真菌感染的复杂病情，临床药师对该患者开展了用药监护、药物重整、不良反应监测等药学服务。结果该患者使用阿美替尼与间质性肺病等不良反应的相关性为“很可能相关”，临床药师建议暂停肿瘤靶向治疗药物，制定激素用药监护计划；针对有艾滋病机会性感染可能的病原菌，建议停用厄他培南、膦甲酸钠，监测伏立康唑血药浓度，随访伏立康唑安全性及抗真菌疗程；结合药物相互作用及患者自身状况，调整抗艾滋病药物为比克恩丙诺片；针对患者有肺孢子菌肺炎、血栓、胃黏膜损伤可能，建议予以复方磺胺甲噁唑、那屈肝素钙、艾司奥美拉唑等。医师均采纳临床药师建议。患者经治疗后转归良好，未见明显不良反应及药物相互作用，顺利出院。结论艾滋病合并肿瘤患者病情复杂、治疗药物多，临床药师可通过开展药物重整、治疗药物监测等手段对这类患者开展药物治疗管理，为患者提供个体化药学服务，保障用药安全。 |
| ABSTRACT： | OBJECTIVE To provide a reference for drug treatment and pharmaceutical care in AIDS patients with tumor. METHODS For a case of AIDS complicated with pulmonary adenocarcinoma， interstitial lung disease occurred repeatedly in the course of targeted therapy， and bacterial and fungal infections could not be ruled out. Clinical pharmacists provided pharmaceutical care such as medication monitoring， drug reconciliation， and adverse reaction monitoring for the patient. RESULTS The patient’s use of Amivantamab is “highly likely related” to adverse reactions such as interstitial lung disease， and it is recommended by the clinical pharmacist that the targeted therapy drugs should be suspended， and hormone medication monitoring plans should be formulated. For the possible pathogens of AIDS opportunistic infection， it was recommended to stop ertapenem and foscarnet sodium， monitor voriconazole concentration in blood and follow up on the safety and antifungal course of voriconazole. According to the drug-drug interaction and the patient’s condition， the anti-AIDS drug was adjusted to bictegravir sodium， emtricitabine and tenofovir alafenamide. For the possibility of Pneumocystis carinii pneumonia， thrombosis and gastric mucosal injury， preventive drugs such as Compound sulfamethoxazole， nadroparin calcium and esomeprazole were recommended. Physicians followed the advice of the clinical pharmacists. The patient made a good outcome after drug treatment without any significant adverse reactions or drug-drug interactions， and was discharged smoothly. CONCLUSIONS AIDS patients with tumor have complex disease condition and use many therapeutic drugs. Clinical pharmacists should conduct drug treatment management as drug reconciliation and medication monitoring and provide individual pharmaceutical care for these patients to guarantee the safety of drug use. |
| 期刊： | 2024年第35卷第10期 |
| 作者： | 冉拓耀；李超 |
| AUTHORS： | RAN Tuoyao，LI Chao |
| 关键字： | 艾滋病机会性感染；间质性肺病；肺腺癌；表皮生长因子受体-酪氨酸激酶抑制剂；药物重整；药物相互作用；药学监护 |
| KEYWORDS： | AIDS opportunistic infection； interstitial lung disease； pulmonary adenocarcinoma； EGFR-TKI； drug |
| 阅读数： | 32 次 |
| 本月下载数： | 3 次 |
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