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OBJECTIVE：To introduce the role of clinical pharmacists in the treatment of camrelizumab-induced toxic epidermal necrolysis （TEN），and to provide reference for the therapy of similar ADR. METHODS：The clinical pharmacist participated in therapy duration of a patient with TEN caused by camrelizumab. The patient was treated with Camrelizumab for injection combined with Apatinib mesylate tablet as anti-tumor therapy，and was admitted to hospital due to extensive skin lesions. After consulting relevant literatures and analyzing the patient’s admission diagnosis [severe epidermolysis bullosa，severe drug eruption（erythema multiforme），abnormal liver function，etc.] and examination results（hypokalemia，etc.），clinical pharmacists suggested to stop above anti-tumor drugs and given Methylprednisolone sodium succinate for injection（160 mg→80 mg→60 mg， qd，ivgtt） for anti-inflammatory treatment，Imiperan cilastatin for injection （1 g，q8 h，ivgtt） for an ti-infection treatment， Potassium chloride injection（1 g，qd，ivgtt）for electrolyte regulation，Compound amino acid injection（3AA）（10.65 g，qd，ivgtt） for nutritional support treatment，Pantoprazole sodium for injection（40 mg，qd，ivgtt）for acid inhibition and stomach protection， Reduced glutathione for injection（2.4 g，qd，ivgtt）for liver protection. Before medication，the patient was given cognitive and behavioral education and medication publicity. The changes of relevant indicators were closely monitored during medication，and the patient was given medication guidance when he was discharged. RESULTS：The doctors adopted the suggestions of clinical pharmacists，and 16 days after treatment，the skin lesions of the trunk and limbs were improved，and the double eyelids were still erosive and exuded a lot of secretions. The patient requested transfer for treatment. CONCLUSIONS：Clinical pharmacists assisted physicians to improve the treatment plan of patients with TEN caused by camrelizumab，and carried out cognitive and behavioral education and medication publicity for patients to ensure the effectiveness and safety of their medication.
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Objective To assess the efficacy and safety of different dosages of oxycodone plus acetaminophen for treating acute pain after oral surgery,in order to provide a reasonable dosage of combination in clinic. Methods Randomized controlled trials ( RCTs ) on effect of combination of oxycodone plus acetaminophen on pain relief after oral operation were searched from the following data-bases:PubMed,EMbase,MEDLINE ( Ovid) ,the Cochrane Library,CNKI,and WANFANG from the date of their establishment to January 2015. The data of RCTs meeting the inclusive criteria were extracted according to Cochrane methods by two reviewers independently,and after the quality was evaluated and cross-checked,meta-analyses were conducted using RevMan 5.2 software. Results A total of 11 studies in 10 literatures involving 1 028 patients were included and were designated to 3 different dosage groups (5 mg/325 mg,10 mg/650 mg,10 mg/1 000 mg,respectively). The results of Meta-analyses showed that pain remission rate was significantly higher in the 3 different dosages of oxycodone plus acetaminophen groups than in the placebo group (RR5 mg/325 mg=3.35,95%CI [1.74,6.45],I2=38%,P=0.000 3;RR10 mg/650 mg=6.88,95%CI [4.00,11.83],I2=0%,P<0.000 01;RR10 mg/1 000 mg=4.94,95%CI [3.23,7.56],I2=81%,P=0.005). In additional,the RR of oxycodone 10 mg/acetaminophen 650 mg and placebo groups for pain remission rate was higher than that of the other 2 dosages groups,moreover,more studies were enrolled and its low heterogeneity led to high reliability. Usage rate of remedial painkillers was significally lower in oxycodone plus acetaminophen groups than in the placebo group (RR5mg/325mg=0.71,95%CI [0.60, 0.85],P<0.000 01;RR10mg/650mg=0.50,95%CI [0.41,0.61],P<0.000 01;RR10mg/1000mg=0.77,95%CI [0.66,0.90],P=0.001) ,In addition, the RRs of usage rate in oxycodone 10 mg/acetaminophen 650 mg and placebo groups were significantly lower than the other 2 dosages groups. Incidence rates of adverse effects were similar in the 3 different dosages groups and higher than that of the placebo group. However,the adverse events were generally described as mild to moderate in severity and rarely led to drug withdrawal according to all reports in the studies ( only one event ) . Conclusion The present study showed that combination of oxycodone plus acetaminophen can provide better analgesia in acute pain after oral surgery with high safety. In addition,combination of oxycodone 10 mg plus paracetamol 650 mg may be better for acute pain relief after oral surgery.
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Objective To assess the effectivity and safety of oxycodone plus acetaminophen for postoperative acute pain re‐lief .Methods Randomized controlled trials (RCT ) on combination of oxycodone plus acetaminophen treating postoperative pain re‐lief were searched from the following data‐bases as PubMed ,EMbase ,MEDLINE(Ovid) ,the Cochrane Library ,CNKI and WAN‐FANG from the date of their establishment to September 2014 .The data of RCT meeting the inclusive criteria were extracted ac‐cording to Cochrane methods by two reviewers independently ,and after the quality was evaluated and cross checked ,meta analyses were conducted using RevMan 5 .2 sotware .Results A total of 18 studies involving 2 213 patients were included .The results of Meta‐analyses showed that compared with placebo group or the equal dosage oxycodone alone group ,the combinations of oxycodone plus acetaminophen were more effective in postoperative pain relief (P0 .05) .Adverse events occurred more frequently with combination therapy than placebo or acetaminophen alone group ,but were generally described as mild to moderate in severity and rarely led to withdrawal . There are no significant difference in the adverse events between the combination of oxycodone plus acetaminophen and the oxyc‐odone alone group .Conclusion The present study showed that combination of oxycodone plus acetaminophen is effective and high safe in postoperative acute pain relief .