CAJ | 학술논문

目的：探讨临床药师在华法林抗凝治疗时联用胺碘酮引起国际标准化值（INR）异常升高的处理方法及药学监护。方法通过对照华法林与其他药物相互作用的情况，确定引起INR值异常波动的药物，及时调整华法林剂量，加强凝血功能的监测，并从华法林与胺碘酮的作用机制、相互作用、两药联用后抗凝作用与两药的剂量、浓度相关性等方面阐述胺碘酮对华法林抗凝作用的影响。结果INR异常波动为华法林与胺碘酮联用所致，两药联用可增强华法林的抗凝作用，增加出血风险，通过停用华法林3d，INR恢复到目标值范围，继续给予华法林抗凝治疗，患者情况控制平稳，顺利出院。结论临床药师通过对患者有效的药学监护，可协助临床及时发现药物治疗相关问题。在使用与华法林有相互作用的药物时要考虑其对抗凝治疗的影响，一方面要充分了解药物合用时的药理学及药动学变化，另一方面要加强监测，以便及时调整用药方案，提高临床用药的安全性和合理性，更好地为患者提供药学服务。
목적：탐토림상약사재화법림항응치료시련용알전동인기국제표준화치（INR）이상승고적처리방법급약학감호。방법통과대조화법림여기타약물상호작용적정황，학정인기INR치이상파동적약물，급시조정화법림제량，가강응혈공능적감측，병종화법림여알전동적작용궤제、상호작용、량약련용후항응작용여량약적제량、농도상관성등방면천술알전동대화법림항응작용적영향。결과INR이상파동위화법림여알전동련용소치，량약련용가증강화법림적항응작용，증가출혈풍험，통과정용화법림3d，INR회복도목표치범위，계속급여화법림항응치료，환자정황공제평은，순리출원。결론림상약사통과대환자유효적약학감호，가협조림상급시발현약물치료상관문제。재사용여화법림유상호작용적약물시요고필기대항응치료적영향，일방면요충분료해약물합용시적약이학급약동학변화，령일방면요가강감측，이편급시조정용약방안，제고림상용약적안전성화합이성，경호지위환자제공약학복무。
Objective To explore the role of clinical pharmacists in analyzing and dealing with abnormal INR value fluc-tuations caused by the drug interaction of warfarin and amiodarone in a post heart valve replacement patient .Methods By com-paring interactions between warfarin and other drugs ,we investigated the drugs the patient was using ,found the cause of unu-sual INR value fluctuations ,and regulated warfarin dosage in time .After that ,we intensified the monitoring of coagulation function and offered detailed pharmaceutical care to the patient .In addition ,we studied the possible reasons for the phenome-non from the following aspects such as the drug action mechanisms of warfarin and amiodarone ;the interaction mechanisms of the two drugs ;the correlation of anticoagulation effects of warfarin ,the dosage and concentration of combined use of these two drugs .Results The reason for unusal INR value fluctuations was identified as the drug interaction between warfarin and amio-darone .Amiodarone can enhance the anticoagulant effects of warfarin ,increase the risk of bleeding .By stoping warfarin for 3 days ,INR value was restored to the target range .Then we continued the anticoagulant therapy ,and the condition of the pa-tient was controlled steadily ,and he was discharged smoothly .Conclusion Clinical pharmacists can help doctors find out prob-lems related to drug therapy in time by providing effective pharmaceutical care to patients ,so doctors may adjust the treatment in time .When using the drugs interacted with warfarin ,we have to consider the those drug effects on anticoagulant therapy .In order to adjust regimens in time ,we must understand the pharmacology and pharmacokinetics of the drugs we used at the same time;as well ,we must intensify monitoring .Therefore ,we can improve the safety and rationality of clinical medication ,and also can provide better pharmaceutical care for patients .