【摘要】 目的处方级联是对所使用的某个药物产生不良反应的曲解,相应而来的便可能是不合理处方。通过1例同时患有尿失禁和老年痴呆的门诊患者,探讨胆碱酯酶抑制剂和抗胆碱药之间所产生的处方级联问题。方法临床药师参与1例同时患有尿失禁和老年痴呆患者的药物治疗管理,识别并中断处方级联,为医生和患者提供用药建议。结果医生和临床药师共同衡量老年慢病患者服用胆碱酯酶抑制剂与抗胆碱药的风险效益比,调整药物治疗策略,患者的尿失禁得到了有效的缓解。结论老年痴呆患者服用胆碱酯酶抑制剂增加了尿失禁风险,同时若服用抗胆碱药治疗尿失禁又可对认知产生损害,胆碱酯酶抑制剂与抗胆碱药的处方级联应引起医生和临床药师的足够重视,应充分识别并中断处方级联,以优化处方,保障患者用药安全。更多还原

【Abstract】 OBJECTIVE To discuss about one patient with Alzheimer’ s disease and urinary incontinence and to investigate the prescribing cascade between cholinesterase inhibitors and anticholinergic drugs further more. METHODS Clinical pharmacists participated in a medication therapy management program aiming at one patient with Alzheimer’s disease and urinary incontinence. By doing this they successfully identified and interrupted a prescribing cascade. Then some constructive advices were provided to doctors and patients on the rational administration of drugs. RESULTS The drug treatment plan was adjusted by clinical pharmacists and doctors after evaluating the benefits and risks about the use of cholinesterase inhibitors and anticholinergic drugs in the elderly patient with chronic disease. And this change directly led to a significant relief of urinary incontinence in the patient. CONCLUSION The use of cholinesterase inhibitors in Alzheimer’s patients increases the risk of urinary incontinence,and at the same time additional use of anticholinergic drugs in the treatment of urinary incontinence can further damage the cognition. Therefore,clinical pharmacists and doctors should pay great attention to the prescribing cascade of cholinesterase inhibitors and anticholinergic drugs. To identify and interrupt prescribing cascades is important when clinical pharmacists and doctors are prescribing prescriptions for elderly patients with chronic diseases. They must work closely for the optimization of prescriptions and the improvement of medication safety in elderly patients.更多还原