【病例学习第25期】Nasal Congestion鼻充血

From Pharmacy Times(www.pharmacytimes.com)
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.

Nasal Congestion

RM is a 33-year-old man who comes to the pharmacy counter with 2 boxes of phenylephrine nasal drops. The pharmacy technician asks the patient if there is anything else she can help him with today, and in a very congested voice, RM asks if he could speak with a pharmacist. When the pharmacist comes over to the counter, RM asks "are there any stronger nasal decongestants than these?" Upon questioning by the pharmacist, RM admits to using the phenylephrine nasal drops for the past week or so, noting "initially they worked great, but now not so much."

How should the pharmacist respond to RM's question?

ANSWER
The pharmacist should explain to RM that he is likely suffering from rebound congestion (rhinitis medicamentosa). This can occur due to prolonged (>3-5 days) nasal decongestant use and often results in decreased benefit from the spray despite increased use. Treatment of rebound congestion entails either "cold turkey" withdrawal or weaning off of the nasal decongestant. The former is generally a less comfortable method than the latter, but may result in relief of congestion faster (typically in 1-2 weeks). If the pharmacist recommends weaning off of the nasal product, he should explain to RM that the nasal decongestant should be discontinued in only one nostril initially, with continued use as often as desired in the other nostril. Once the rebound phenomenon subsides in one nostril, total drug withdrawal should then be suggested. The pharmacist also could suggest that RM contact his physician to get a prescription for a nasal corticosteroid to use while weaning off of the nasal decongestant, as they have been shown to increase the time to congestion relief.


鼻充血RM，男，33岁。他拿着2盒苯肾上腺素滴鼻液来到药房柜台前。药房技师问他需要帮忙吗，他托着浓浓的鼻音回答说要见药师。药师过来以后，他问：“有没有比这个更强力的缓解鼻塞的药？”RM承认自己过去的一周左右在用苯肾上腺素滴鼻液，但提到“一开始很管用，但现在不管用了”。药师如何回答RM的问题？
回答
药师应向RM解释，他目前可能是受反跳性鼻充血（药物性鼻炎）的困扰。这种情况的发生是由于应用鼻粘膜充血消除药时间过长（>3-5d）,并常出现使用频率增加效果下降的现象。反跳性鼻充血的治疗必须停用鼻粘膜充血消除药，或突然撤药或逐渐停药。前者通常没有后者舒服，但充血缓解更快（通常1－2w）。如果药师建议逐渐撤掉滴鼻药，他应向RM解释，鼻粘膜充血消除药应先停一侧鼻孔，另一侧还照常用。等一侧充血缓解了，再建议两侧鼻孔都停用。药师还可以建议RM与医生联系，撤药期间用一些鼻用皮质醇，因为皮质醇可以延长充血缓解的时间。

上文我已认领，尽量48小时内完成。

鼻充血
RM，男，33岁。他拿着2盒苯肾上腺素滴鼻液来到药房柜台前。药房技师问他需要帮忙吗，他托着浓浓的鼻音回答说要见药师。药师过来以后，他问：“有没有比这个更强力的缓解鼻塞的药？”RM承认自己过去的一周左右在用苯肾上腺素滴鼻液，但提到“一开始很管用，但现在不管用了”。药师如何回答RM的问题？
回答
药师应向RM解释，他目前可能是受反跳性鼻充血（药物性鼻炎）的困扰。这种情况的发生是由于应用鼻粘膜充血消除药时间过长（>3-5d）,并常出现使用频率增加效果下降的现象。反跳性鼻充血的治疗必须停用鼻粘膜充血消除药，或突然撤药或逐渐停药。前者通常没有后者舒服，但充血缓解更快（通常1－2w）。如果药师建议逐渐撤掉滴鼻药，他应向RM解释，鼻粘膜充血消除药应先停一侧鼻孔，另一侧还照常用。等一侧充血缓解了，再建议两侧鼻孔都停用。药师还可以建议RM与医生联系，撤药期间用一些鼻用皮质醇，因为皮质醇可以延长充血缓解的时间。

The pharmacist also could suggest that RM contact his physician to get a prescription for a nasal corticosteroid to use while weaning off of the nasal decongestant, as they have been shown to increase the time to congestion relief,这句话好难理解，撤药期间用一些鼻用皮质醇，因为皮质醇可以延长充血缓解的时间。延长充血缓解的时间，好起来不是更慢吗？

回复 4# flower
有道理，我也没弄明白

回复 4# flower
有道理，我也没弄明白

很好，辛苦楼主发这么有意义的帖