CAJ | 학술논문

目的：通过对1例原发性甲减合并心衰老年患者的药学监护，探讨实施药学监护的过程、方法及作用。方法临床药师对原发性甲减伴心衰老年患者在住院期间进行药学监护，主要包括：甲状腺功能、BNP、心肌酶、心室率、血压、液体出入量、电解质等指标的监测，并根据监测结果提出药物剂量调整及药物选择使用建议；同时对患者进行用药教育，保障患者用药安全有效。结果患者病情得到缓解，用药依从性提高。结论临床药师从药物药效学及药动学、药物相互作用、药品不良反应和患者教育方面，积极配合医师，为患者提供合理的用药方案，使患者的临床症状得到改善。
목적：통과대1례원발성갑감합병심쇠노년환자적약학감호，탐토실시약학감호적과정、방법급작용。방법림상약사대원발성갑감반심쇠노년환자재주원기간진행약학감호，주요포괄：갑상선공능、BNP、심기매、심실솔、혈압、액체출입량、전해질등지표적감측，병근거감측결과제출약물제량조정급약물선택사용건의；동시대환자진행용약교육，보장환자용약안전유효。결과환자병정득도완해，용약의종성제고。결론림상약사종약물약효학급약동학、약물상호작용、약품불량반응화환자교육방면，적겁배합의사，위환자제공합리적용약방안，사환자적림상증상득도개선。
Objective To explore the processe,method and role of pharmaceutical care for an elderly patient with primary hypothyroidism complicated with heart failure by clinical pharmacists. Methods Pharmaceutical care was given to the elderly patient with primary hypothyroidism complicated with heart failure by clinical pharmacists during the hospitalization period. Monitoring points of pharmaceutical care included the thyroid function, BNP, cardiac en-zyme,ventricular rate,blood pressure,liquid intake and output,electrolyte,etc. Clinical pharmacists gave recommenda-tions about drugs selection and dose according to the results of drug monitoring and provided medication education for the patient to guarantee the safety and effectiveness of drug use. Results The patient′s condition was improved,and the compliance in drug use was raised. Conclusion Clinical pharmacists help physician to provide reasonable medica-tion to improve clinical symptoms significantly from the aspects of drug pharmacodynamics,pharmacokinetics,interac-tion monitoring,adverse drugs action and patient education.