目的:通过对治疗方案的优化干预和对患者的药学监护,探讨临床药师在合理用药中的作用.方法:对1例基础疾病为冠心病和糖尿病肾病、合并多器官功能衰竭、存在多种药物的禁忌证、经常规药物治疗效果不佳的患者,临床药师结合该患者病理生理状况、经济状况和药物的特点,提出用药调整、补充,对治疗全过程用药进行干预和优化,并对患者进行必要的患者教育.结果与结论:临床药师参与药物治疗方案设计和患者教育,有利于促进药物使用的安全、有效和经济.%OBJECTIVE: To explore the roles of clinical pharmacist in rational drug use by intervening and optimizing therapeutic regimen and providing pharmaceutical care. METHODS: Due to primary disease, i.e. coronary heart disease and diabetic nephropathy, complicating with multiple organ failure, drug contraindication and unsatisfactory curative efficacy, according to pathological state, economic level of the patient and characteristics of drugs, the therapeutic regimen was adjusted and supplemented, medication was optimized and patient education was provided by clinical pharmacists. RESULTS&CONCLUSION: The participation of clinical pharmacist in therapeutic scheme design and patient education contributes to safe, effective and economical drug use.
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