【病例学习第31期】Time for a Refill?

From Pharmacy Times
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

以下为正文(需要翻译的部分),欢迎会员认领并尽可能在48小时内翻译完毕并提交,将奖励50威望和50金钱.

Time for a Refill?

YA is a 17-year-old woman with a medical history of mild persistent asthma. She comes to the pharmacy to pick up her inhaler refills, including Pulmicort Flexhaler 180 mcg, 1 puff twice daily, and ProAir HFA 90 mcg, 1 to 2 puffs every 4 to 6 hours as needed. The pharmacist asks YA how her asthma has been doing lately, and she replies that with the change in weather, she has noticed increased shortness of breath 2 to 3 times a week during the day. She notes, however, “taking a few puffs of ProAir usually does the trick.” YA also states, “Although I feel the ProAir on my throat, it hasn’t been working as well as it usually does.” The pharmacist notices YA has been filling her Pulmicort regularly; however, she has not filled her ProAir in several months. The pharmacist asks YA how she knows when it is time to refill her inhalers. YA replies, “Well, the Pulmicort has a window that shows when I am running low, but the ProAir doesn’t.” She continues, “My friend told me I can float the ProAir in water, so I do that.” YA notes that her ProAir inhaler still floats, so she assumes it is not empty yet.

How should the pharmacist counsel YA to help her determine when her inhaler is empty?


ANSWER

Patients may report using various strategies to determine if their metered-dose inhaler is empty, including floating the canister in water. Several dangers exist to this approach, including the inconsistent floating pattern among various inhalers and the lack of correlation between floating pattern and amount of medication remaining in the inhaler. These unreliable methods put the patient at risk of running out of medication and being unprepared for urgent situations such as acute asthma attacks. Another concern of floating an inhaler canister is that water may be introduced into the neck of the actuation valve and reduce the amount of medication released. The pharmacist should alert YA that the only reliable method to determine the contents of her inhaler is to subtract the number of sprays used from the total number in the inhaler. This may be cumbersome for some patients and difficult to track with inhalers that are used on an as-needed basis. Therefore, the pharmacist may also call YA’s physician to suggest changing the inhaler to a product with a built-in dose counter, such as Ventolin HFA. The pharmacist should also counsel YA on the proper technique for both her ProAir and Pulmicort inhalers to ensure that poor technique is not the reason for her reported reduced efficacy. Finally, the pharmacist should suggest that if YA continues to feel that her asthma is worsening, she should follow up with her physician, as her asthma may not be well-controlled, and medication dose adjustments may be necessary.

我来翻译这篇吧。

是不是该续充吸入器了？
YA 是一位17岁的女性，她有轻度持续性哮喘的病史。她到药房取吸入器的填充剂，包括：Pulmicort Flexhaler 180 mcg，1次一喷，1日1次；和ProAir HFA 90 mcg，每4到6小时1到2喷，按需。药师询问YA最近她的哮喘怎么样了，她回答说天气的变化，自己在白天每周会感觉到2到3次逐渐加重的气紧。但她又说，“常常是吸几次ProAir就好了。”YA还说，“尽管我能感觉到ProAir就在我喉咙里，但是作用不如以前了。”药剂师注意到YA一直在续充Pulmicort，可她有好几个月没有续充ProAir了。药剂师问她如何知道该续充吸入器了。YA回答，“嗯，Pulmicort有一个窗口显示它已经不满了，但是ProAir却没有。”她接着说，“我一位朋友告我说我可以把ProAir泡在水里，我也这样做了。”YA注意到自己的ProAir吸入器还浮在水里，便认为它还没有空。
药师该如何指导YA让她确定自己的吸入器什么时候就空了？

回答：

病人可能报告多种不同的办法确定自己的吸入器空了，包括把罐子浮在水中。这种办法有几个危险之处，不同的吸入器会以不同的方式浮在水中，以及它们的飘浮方式和吸入器中的药量缺乏相关性。这些不可靠的方法使病人有用完药物的危险和急性哮喘发作时未做好准备的危险。让罐子浮在水里的另一个问题是水可能进入到激动阀，使释放的药量减少。药师应该告诫YA确定吸入器内容物量唯一可靠的方法是用吸入器可使用的次数减去已使用的次数。这可能让一些病人感觉不爽，对于一些需要时使用的吸入器来说也不好计算。因此，药师也可以打电话给YA的医师建议他换一种有内置计数器的吸入器，如Ventolin HFA。药师还应该教YA使用ProAir和Pulmicort吸入器的技术，以确保YA报告的药效下降不是操作不当引起的。最后，药师应该建议，如果YA感觉她的哮喘在加重，她应该去找她的医师。因为她的哮喘可能没有得到有效控制，因此可能需要调整药物剂量。


没有仔细校对，请大家看有没有翻译的不恰当的地方。

回复 3# ecopsy


    1 puff twice daily应该是一日两次，一次一喷吧？  Pulmicort普米克

我没有看内容，就知道翻译的不对！！refill是持处方再次到药房取药的意思（吃完了再次取，但处方上药物，剂量都不変） 译者要自己将译文通顺了再发！！以免误导他人