Case Analysis of the Participation of Clinical Pharmacists in the Therapy for a Case of Serious Drug Erup-tion Due to Allopurinol / 中国药房

ABSTRACT

OBJECTIVE:To investigate the role of clinical pharmacists in the identification and treatment of serious drug erup-tion due to allopurinol. METHODS:Clinical pharmacists participated in the drug treatment for a patient with hyperuricemia. Through scanning the drugs used before and after hospitalization,suggesting to detect human leukocyte antigen(HLA)-B*5801 re-lated genes,and ultimately the cause of severe drug eruption was determined according to the detection result,i.e. allopurinol. At the same time,according to clinical symptom,genotype,lab detection indexes and results of drug sensitivity test,etc.,clinical pharmacists suggested to additionally use Ebastine tablets,Compound indometacin tincture,Triamcinolone acetonide and econazole nitrate cream and other symptomatic treatment;hormone+immunoglobulin shock therapy(Methylprednisolone sodium succinate for injection 80 mg,ivgtt,qd+Human immunoglobulin for intravenous injection 20 g,ivgtt,qd)replaced Allopurinol tablets to control allergic symptom;Bailing capsules and Compound α-ketoacid tablets were additionally used to improve renal function;Meropenem for injection and Voriconazole tablets were used to controll infection. Clinical pharmacists also provided pharmaceutical monitoring as therapeutic efficacy evaluation,electrolyte level monitoring,medication education and transferred-out follow-up,etc. RE-SULTSPhysicians adopted the suggestions of clinical pharmacists. The drug eruption of the patient gradually reduced,and pulmo-nary infection was improved. CONCLUSIONS:Severe drug eruption due to allopurinol has serious symptoms and long course of disease,and even endangers the lives of patients. It is suggested to screen HLA-B*5801 related genes before the use of allopurinol, and strengthen medical education to ensure the safety and effectiveness of drug use.