【病例学习第36期】Test Your Skills

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.)



HC is a 57-year-old man who comes to the pharmacy counter to pick up his refill for clopidogrel 75 mg. When he goes to pay for his prescription, he hands the pharmacist a box of Prilosec OTC (omeprazole) and explains that he has recently been experiencing mild episodes of heartburn. HC wants to know if Prilosec OTC would work for him.

How should the pharmacist respond?

ANSWER
Although omeprazole (Prilosec OTC) is certainly an effective therapy for the self-management of occasional heartburn, it is a poor choice for HC. This is because patients at risk for heart attacks or strokes who use clopidogrel to prevent blood clots do not get the full effect of the drug when taken with cytochrome P450 2C19 (CYP2C19) isoenzyme inhibitors. Omeprazole is one of a number of drugs that inhibits the CYP2C19 isoenzyme responsible for the conversion of clopidogrel into its active metabolite. These effects are seen regardless of whether the 2 drugs are given at the same time or taken at different times during the day. As a result, studies have shown that when clopidogrel and omeprazole are taken together, the effectiveness of clopidogrel is reduced. The pharmacist should counsel HC about this drug interaction and recommend he try an OTC H2 blocker instead. Specifically, ranitidine, famotidine, or nizatidine are reasonable choices, whereas cimetidine, also a CYP2C19 inhibitor, is not. Although lansoprazole is also available over-thecounter, limited information exists about drug interactions between clopidogrel and proton pump inhibitors other than omeprazole and esomeprazole, making the recommendation to try lansoprazole more difficult.

HC，57岁，男性，到药店再次配方75mg氯吡格雷。当他交费时，他递给药师一盒普利乐西克（奥美拉唑），说他最近有胃部轻度灼热的症状，咨询药师能否使用普利乐西克？药师应该如何回答呢？
答复：
奥美拉唑（普利乐西克）对于偶尔的胃部灼热有确切疗效，是自我医疗中不错的选择。但对HC来说，用奥美拉唑却不太合适。理由如下：有心脏病发作或脑卒中危险的患者，在预防性使用氯吡格雷抗凝时，若同时应用细胞色素P450 2C19 (CYP2C19)酶抑制剂，氯吡格雷的药效将会降低。CYP2C19酶在氯吡格雷代谢为活性产物的过程中起着重要作用，而奥美拉唑是CYP2C19酶抑制剂。长期以来，人们忽视了这两种药应同时用，抑或在不同的时间点使用的问题。研究表明，氯吡格雷和奥美拉唑的合用，会导致氯吡格雷药效降低。药师应向HC说明这两种药的相互作用，并建议使用一种OTC的H2受体拮抗剂。应该特别指出来的是，雷尼替丁、法莫替丁以及尼扎替丁都是不错的选择。而西咪替丁，由于同样属于CYP2C19酶抑制剂，故不宜选。与奥美拉唑、埃索美拉唑这些质子泵抑制剂相比，同属OTC药的兰索拉唑和氯吡格雷的相互作用仍不清楚，因此也很难推荐使用兰索拉唑。

回复 1# clinphar

HC，57岁，男性，到药店再次配方75mg氯吡格雷。当他交费时，他递给药师一盒普利乐西克（奥美拉唑），说他最近有胃部轻度灼热的症状，咨询药师能否使用普利乐西克？药师应该如何回答呢？
答复：
奥美拉唑（普利乐西克）对于偶尔的胃部灼热有确切疗效，是自我医疗中不错的选择。但对HC来说，用奥美拉唑却不太合适。理由如下：有心脏病发作或脑卒中危险的患者，在预防性使用氯吡格雷抗凝时，若同时应用细胞色素P450 2C19 (CYP2C19)酶抑制剂，氯吡格雷的药效将会降低。CYP2C19酶在氯吡格雷代谢为活性产物的过程中起着重要作用，而奥美拉唑是CYP2C19酶抑制剂。长期以来，人们忽视了这两种药应同时用，抑或在不同的时间点使用的问题。研究表明，氯吡格雷和奥美拉唑的合用，会导致氯吡格雷药效降低。药师应向HC说明这两种药的相互作用，并建议使用一种OTC的H2受体拮抗剂。应该特别指出来的是，雷尼替丁、法莫替丁以及尼扎替丁都是不错的选择。而西咪替丁，由于同样属于CYP2C19酶抑制剂，故不宜选。与奥美拉唑、埃索美拉唑这些质子泵抑制剂相比，同属OTC药的兰索拉唑和氯吡格雷的相互作用仍不清楚，因此也很难推荐使用兰索拉唑。

回复  clinphar

HC，57岁，男性，到药店再次配方75mg氯吡格雷。当他交费时，他递给药师一盒普利乐西克（ ...
haojili2005 发表于 2010-7-24  22:06

     Good Job!!!!!!!!

译的真好，好好学学！

的确翻译的好啊

十分感谢2楼，给与的指导。

ANSWER
Although omeprazole (Prilosec OTC) is certainly an effective therapy for the self-management of occasional heartburn, it is a poor choice for HC.
虽然奥美拉唑(Prilosec OTC) [缓释片？]对偶发性烧心的自我治疗有确切疗效，但对HC来说却是个不适当的选择。
This is because patients at risk for heart attacks or strokes who use clopidogrel to prevent blood clots do not get the full effect of the drug when taken with cytochrome P450 2C19 (CYP2C19) isoenzyme inhibitors.这是因为有心脏病发作或中风危险，服用氯吡格雷来预防血液凝集的患者，在同服细胞色素P450同工酶抑制剂时，并不能获得该药（氯吡格雷）的全部疗效。
Omeprazole is one of a number of drugs that inhibits the CYP2C19 isoenzyme responsible for the conversion of clopidogrel into its active metabolite.
奥美拉唑是许多抑制细胞色素CYP2C19同工酶的药物之一，该酶使氯吡格雷向其活性产物活性代谢物转化。
These effects are seen regardless of whether the 2 drugs are given at the same time or taken at different times during the day.
这些作用出现与2种药物是否同时给予还是一天内不同时间给予无关。
As a result, studies have shown that when clopidogrel and omeprazole are taken together, the effectiveness of clopidogrel is reduced.
因此，多项研究表明当氯吡格雷和奥美拉唑同时给予时，氯吡格雷的疗效降低。
The pharmacist should counsel HC about this drug interaction and recommend he try an OTC H2 blocker instead.
药师应当告知HC该项药物相互作用并推荐他服用OTC类H2阻滞药进行替代。
Specifically, ranitidine, famotidine, or nizatidine are reasonable choices, whereas cimetidine, also a CYP2C19 inhibitor, is not.
确切的来说，雷尼替丁，法莫替丁或尼扎替丁都是合理的选择，然而西咪替丁， 同样是一种CYP2C19抑制剂，却不适合。
Although lansoprazole is also available over-thecounter, limited information exists about drug interactions between clopidogrel and proton pump inhibitors other than omeprazole and esomeprazole, making the recommendation to try lansoprazole more difficult. 虽然兰索拉唑也有OTC药物，但除奥美拉唑和埃索美拉唑外的质子泵抑制药与氯吡格雷相互作用的信息有限，这使推荐使用兰索拉唑更加困难。

学习了，谢谢