【病例学习第34期】Test Your Skills

clinphar · 发表于 2010-7-24 18:28:07

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.)

AD is a 55-year-old man with a history of alcoholic liver cirrhosis. Over the prior 6 months, he reports experiencing 2 episodes of markedly elevated serum ammonia levels (normal levels are <35 μmol/L) accompanied by an altered level of consciousness (an episode of overt hepatic encephalopathy) despite being on 3 (10 g/15 mL) cups of lactulose a day. At his most recent visit, AD’s gastroenterologist provided him with a prescription for rifaximin 550 mg to be taken by mouth twice daily to prevent recurrent bouts of hepatic encephalopathy. AD, while searching a consumer medical Web site, reads that rifaximin is an antibiotic. When dropping off his prescription, AD asks the pharmacist, “Did my doctor make a mistake? He said nothing about an infection!”
How should the pharmacist respond to AD?

ANSWER
Hepatic encephalopathy is a worsening of brain function—ranging from confusion to coma—that often occurs repeatedly in patients with liver dysfunction. When the liver is not working properly, it no longer optimally removes nitrogenous waste from the bloodstream. The increased levels of nitrogenous waste are converted to ammonia, which is thought to play a role in the development of hepatic encephalopathy. The pharmacist should explain to AD that rifaximin is in fact an antibacterial agent. It kills off gut bacteria responsible for the generation and conversion of nitrogenous waste to ammonia. Consequently, it can reduce ammonia levels in the bloodstream and prevent the recurrence of overt hepatic encephalopathy. In March 2010, the FDA approved rifaximin for this indication. The pharmacist should inform AD that the addition of rifamixin to his lactulose is not a mistake. The pharmacist should also notify AD that rifaximin, unlike antibiotics he may have previously taken for infections, will likely be prescribed to him for an extended period of time.

AD是一个有着酒精性肝硬化病史55的岁的男子。与前6个月相比，尽管每天3次，每次服用3杯（10克正/ 15毫升）乳果糖，他述说自己有2次血清氨浓度显着升高（正常水平的时期是<35μmol/ L的）并伴有意识水平改变（即伴随着明显的肝性脑病的插曲）。在最近的访问中得知，AD由于胃肠病给予利福昔明550毫克处方的处方药，每天2次，口服，以防止肝性脑病的经常发作。AD在消费者的医疗搜索网站上得知利福昔明是一种抗生素。当AD要放弃了他的处方时，他咨询药剂师，“难道我的医生犯了一个错误？他说，感染是没有什么！“
药剂师应如何应对AD？
答案：
肝性脑病可使脑功能恶化，对于经常出现反复的肝功能障碍患者，可使患者从昏迷到混乱。当肝脏不能正常工作时，它不再有效地去除血液中含氮废物。血液中的含氮废物的水平增加可转换为氨，在肝性脑病的病情发展中发挥了作用。
药剂师对AD解释到：利福昔明是一种抗菌剂，它杀死了肠道细菌，减少产生含氮化合物从而减少氮废物转化为氨。因此，可以降低血液中氨的水平，防止公开的肝性脑病的复发。在2010年3月，FDA核准利福昔明用于此适应症。药师应告知AD，与乳果糖相比，医生给他服用利福昔明并不是一个错误。药剂师也应通知AD，利福昔明不像使用抗生素采那样用于感染，医生很可能会较长的时间开药给他服用。

lrpin999 · 发表于 2010-9-14 09:43:35

本帖最后由 lrpin999 于 2010-9-14 09:45 编辑

测试你的技巧（资料来源于药学时代）
AD是一个有着酒精性肝硬化病史55的岁的男子。与前6个月相比，尽管每天3次，每次服用3杯（10克正/ 15毫升）乳果糖，他述说自己有2次血清氨浓度显着升高（正常水平的时期是<35μmol/ L的）并伴有意识水平改变（即伴随着明显的肝性脑病的插曲）。在最近的访问中得知，AD由于胃肠病给予利福昔明550毫克处方的处方药，每天2次，口服，以防止肝性脑病的经常发作。AD在消费者的医疗搜索网站上得知利福昔明是一种抗生素。当AD要放弃了他的处方时，他咨询药剂师，“难道我的医生犯了一个错误？他说，感染是没有什么！“
药剂师应如何应对AD？
答案：
肝性脑病可使脑功能恶化，对于经常出现反复的肝功能障碍患者，可使患者从昏迷到混乱。当肝脏不能正常工作时，它不再有效地去除血液中含氮废物。血液中的含氮废物的水平增加可转换为氨，在肝性脑病的病情发展中发挥了作用。
药剂师对AD解释到：利福昔明是一种抗菌剂，它杀死了肠道细菌，减少产生含氮化合物从而减少氮废物转化为氨。因此，可以降低血液中氨的水平，防止公开的肝性脑病的复发。在2010年3月，FDA核准利福昔明用于此适应症。药师应告知AD，与乳果糖相比，医生给他服用利福昔明并不是一个错误。药剂师也应通知AD，利福昔明不像使用抗生素采那样用于感染，医生很可能会较长的时间开药给他服用。