1 case of pharmacological monitoring in patients with liver metastasis cancer in clinical pharmacists

The patient, a 67-year-old woman, was admitted to hospital on August 13, 2017 after being found to have liver for more than 3 months and 3d for nausea and vomitingWeight 58kg, height 164 cm1 year ago there was no obvious cause of narration, chest and back pain, untreated4 months ago found liver metastasis cancer, 3 months ago chest back pain no obvious cause of exacerbation, intermittent use of ampicheroxycodone 5 mg every 6h1 time to control pain, parallel liver artery catheterchemotherapy embolism 1 time, after surgery stable discharge3d before no obvious cause of nausea, vomiting, unable to eat, in my hospital emergency, for the march of step diagnosis and treatment income oncology intervention departmentAuxiliary Examination: Admission (August 13): Neutrophils 67.8%, WBC10.32 x 109/L, RBC3.7 x 1012/L, Hb118g/L; ALT 16.4U/L, AST26.5U/L, BUN9.6mmol/L, Cr48.5mmol/L; Arterial contrast shows the inherent artery of the liver artery, the left middle liver artery and the branch development, the right liver multiple tumor staining stoveadmissiondiagnosis: liver metastatic cancerpancreaticcancer liver arterial catheterization chemotherapy embolism, liver cysts, double kidney cystsSince admission to the hospital, the patient chest back pain, accompanied by nausea, vomiting, poor mental, poor diet, sleep can be, urinating normal, occasional constipation, weight no significant changeAugust 13, the nature of the pain is hepatometasis cancer-related pain, VAS score 6, pharmacists on the patient's previous medication in detail, patients from 3 months ago intermittent use of ammonia oxycodone 5 mg to control pain, to determine that the patient is not tolerated by opioidsconsidering the current moderate to severe pain, it is recommended to use hydroxycodone hydroxyketon slow release tablets 20 mg, every 12h1 times, for the background of dosage titration, outbreak pain, should be immediately given 10 mg of morphine tablets hydrochloric acid for rescueAt the same time, considering that constipation is the most common adverse reaction to opioids, it is recommended to give the oral solution of lactose 30 ml, 1 time/dThe patient was nauseatic and vomiting, given 5mg of hydrochloric acid toxamate injection, 1 treatment/d 16:10, the patient had an outbreak of pain 1 time, VAS scored 7, gave 10 mg of morphine hydrochloric acid tablets after relief August 14, VAS score 4, pharmacist recommended adjusting the titration background dose of 30 mg of hydroxycodone relief tablets, every 12h1, when outbreak pain occurs, immediately give hydrochloric acid morphine tablets 15mg for rescue; On August 15, VAS scored 4, the pharmacist recommended adjusting the titration background dose to 60 mg of hydroxycodone hydrocodone, every 12h1 times, when outbreak pain occurred, immediately give 25 mg of morphine tablets hydrochloric acid to rescue; On August 16, VAS scored 4 points, pharmacists recommended adjusting the titration background dose to 80 mg of hydroxycodone hydrocodone relief tablets, every 12h1 times, immediately give 30mg of morphine tablets hydrochloric acid to be rescued; August 17, VAS scored 1 to continue with the current treatment On August 22, the patient's iodized fool injection 35g joint injection with hydrochloric acid Gisitabin 0.8g hepatic arterial catheter chemotherapy embolism, after surgery, returned to the ward, VAS score 1 point, continue the current treatment plan After August 17, the patient's pain was well controlled and no further outbreaks of pain were on the other, and after the hepatic arterial catheter chemotherapy embolism on August 22, the tumor blood vessels aclosed On 24 August, the patient was generally in good condition and was discharged from the hospital discussion pain is one of the most common symptoms in cancer patients, seriously affecting the quality of life of cancer patients, who identified pain as the "fifth largest vital sign" after blood pressure, breathing, pulse, and body temperature If the cancer pain is not alleviated, it will seriously affect the patient's daily activities, self-care ability, communication ability and overall quality of life Therefore, appropriate treatment is required after careful assessment of the type and cause of pain At present, the main use of opioid analgesicdrugs to control moderate severe cancer pain, due to individual differences, opioids do not have a standard dose of medication, according to the patient's condition, the use of sufficient doses of drugs in order to ease the pain the record of this study
clinical pharmacists to 1 case of liver metastatic cancer patients drug monitoring, analysis of drug selection, drug titration adjustment dose and adverse reaction monitoring, explore how clinical pharmacists from the prevention , detection, solution of potential or actual drug problems to assist physicians, from the drug compliance, safety, indication, effectiveness and other aspects of help ingress 1) Pain Screening Pre-Assessment: All hospitalized patients should complete pain screening within 2h of admission, identify patients with pain, complete pain assessment within 8h, and distinguish whether they are subject to opioid tolerance In this case, patients with cancer pain, VAS scored 6, took opioids irregularly, and were not tolerated by opioids 2) Pain Treatment Management : VAS score of 4, dose titration can be done with short-acting opioids or long-acting opioids as a background, and when selecting a strong opioid starting dose, a distinction should be made between patients who are not tolerated and tolerated by opioids During the use of the long-acting opioid analgesics, the treatment of explosive pain should use pure opioid receptor agonists, giving 24h background to 10% to 20% of the amount of the drug In this case, liver metastatic cancer pancreatic cancer-related pain diagnosis clear, VAS score 6, opioid intolerance Therefore, the pharmacist recommends giving hydroxycodone hydrocodone relief tablets 20mg, every 12h1 times as the background Explosive pain is a short, severe pain that occurs on the basis of stabilizing pain and taking opioid analgesics In this case, during dose titration using hydroxycodone hydrocodone tablets, there were multiple bursts of pain, the pharmacist calculated the rescue dose for the patient according to the first 24h dose of the drug, and the patient was relieved by pain after 72h 3) Adverse reaction monitoring: the most common adverse reactions of opioids are constipation, and usually continue to occur in the whole process of opioid analgesic treatment, not due to the extension of the use of analgesic drugs and relief, this case patients in the use of hydroxycodone slow release tablet sashimi at the same time, to give lactose oral solution (30ml, 1 /d) prevention constipation, no related adverse reactions during hospitalization