CAJ | 학술논문

临床药师通过临床查房，与临床医师共同对老年冠心病并发肾功能不全患者制定治疗方案，对患者用药进行具体化药学服务和制定个体化监护计划。当患者出现血压偏低、白细胞减少、肾功能恶化等不良反应时，临床药师密切监测相关指标，及时调整药物，避免了临床治疗中潜在的不良反应。临床药师积极参与临床的治疗过程，可减少药品不良反应的发生，确保在院期间用药的安全性及有效性，提高了整体治疗水平。
림상약사통과림상사방，여림상의사공동대노년관심병병발신공능불전환자제정치료방안，대환자용약진행구체화약학복무화제정개체화감호계화。당환자출현혈압편저、백세포감소、신공능악화등불량반응시，림상약사밀절감측상관지표，급시조정약물，피면료림상치료중잠재적불량반응。림상약사적겁삼여림상적치료과정，가감소약품불량반응적발생，학보재원기간용약적안전성급유효성，제고료정체치료수평。
Objective To explore the pharmaceutical care plan of clinical pharmacist for elderly patients with coronary heart disease and renal insufficiency. Methods To develop the therapeutic schedule in cooperation with clinicians through clinical rounds, in order to offer specific pharmaceutical care and further develop individualized care plan during patient ' s hospitalization. Results Clinical pharmacists paid close attention to the indicators and adjusted administration time when the adverse reactions such as lower blood pressure, leukopenia, and deterioration of renal function occurred, and finally avoided further potential adverse reactions. Conclusion The incidence of adverse drug reactions were reduced, the safety and efficacy of drugs used were guaranteed, which can promote rational and effective use of drugs in clinic. The overall quality of healthcare was improved with pharmacist involvement.