① Main sources of information: the main sources are periodicals and magazines. Advantages: the latest content, the reader's own evaluation of information, is not affected by other people's views; Disadvantages: readers should have the ability to evaluate medical literature, which is time-consuming;
② Secondary sources of information: the main sources are quotations and abstracts. Advantages: First-class literature can be quickly screened by index or abstract; Disadvantages: it takes several retrieval tools to find the required information;
③ Three-level information sources: the main sources are reference books, databases and comprehensive articles. Advantages: extensive content and convenient use; Disadvantages: it takes a long time to write, and the information provided is not the latest in this field.
Pharmaceutical consultation service and rational drug use guidance are also one of the important pharmaceutical services for pharmacists.
Doctor consultation usually focuses on new drug information, rational drug use information, therapeutic drug monitoring, adverse drug reactions, contraindications, interactions and so on. In order to improve the effect of drug treatment and reduce the risk of drug treatment.
(1) In terms of rational drug use, if the skin test of cefoperazone is positive and the skin test of ceftriaxone sodium is negative, you can choose ceftriaxone sodium. The side chain structure of ceftriaxone sodium and cefoperazone is quite different.
(2) The drugs to be monitored are: digoxin, aminoglycoside antibiotics, antiepileptic drugs and immunosuppressants (cyclosporine, mycophenolate mofetil).
(3) Adverse drug reactions
① Acyclovir can cause acute renal failure, renal dysfunction and renal tubular damage;
② Ribavirin: teratogenesis, fetal malformation, tumor, hemolytic anemia;
③ Human erythropoietin: pure red cell aplastic anemia;
④ Heparin: induced thrombocytopenia, followed by thrombotic complications;
⑤ Long-term and high-dose use of antibiotics such as cephalosporin: it causes gingival bleeding, surgical wound bleeding and other reactions. Therefore, it should be noted that vitamin K and vitamin B should be supplemented at the same time when cephalosporins are used.
(4) recall or withdrawal of a case:
① Gao Pei Park Jong-soo: Heart valve disease.
② Tegaserot: a serious cardiovascular and cerebrovascular adverse event.
③ gadolinium-containing contrast agents: nephrogenic fibrosis and skin fibrosis.
(5) Contraindications: Gatifloxacin may increase the hidden danger of hypoglycemia or hyperglycemia in diabetic patients and affect renal function, so it is forbidden for diabetic patients.
(6) Drug interaction
① Antidepressants: If fluoxetine and paroxetine are combined with monoamine oxidase inhibitors, it is easy to cause serotonin syndrome, and the interval between the two drugs should be at least 14 days;
② Hydroxyglutaryl-CoA reductase inhibitors (statins): If combined with CYP3A4 inhibitors, such as cyclosporine, itraconazole, ketoconazole, clarithromycin, roxithromycin, nefazodone, etc. The plasma level of statins will increase significantly; If combined with gemfibrozil and nicotinic acid, it is easy to cause rhabdomyolysis. Statins need to be monitored: aspartate aminotransferase, alanine aminotransferase and CK.
The contents of nurses' consultation mainly include: the appropriate solvent of drugs, the dilution volume of drugs, the dropping speed of drugs, the incompatibility of drugs and so on.
Suitable solvents for (1) drugs
① Do not use sodium chloride solution to dissolve: polyene phosphatidylcholine (turbid), oxaliplatin (reduced curative effect), amphotericin B (precipitate), erythromycin (turbid precipitate), pipecuronium bromide (reduced curative effect) and fleroxacin (crystal).
② Glucose injection is not suitable for dissolution: penicillin (β -lactam ring cleavage failed), cephalosporin, phenytoin sodium, acyclovir (weak acid and strong base salt, which can precipitate when mixed with acidic glucose solution), reteplase (reduced titer), etoposide, teniposide and nedaplatin (unstable).
(2) Dilution volume of drug
① Potassium chloride injection: direct intravenous injection is prohibited; Generally, the concentration of intravenous injection does not exceed 0.2%~0.4%, and arrhythmia can be 0.6%~0.7%.
② Ceftriaxone sodium: not combined with calcium, compound and Ringer (calcium gluconate injection, calcium chloride injection, compound sodium chloride injection, Ringer sodium lactate injection and compound sodium lactate glucose injection).
(3) Dropping speed of drugs
(1) Vancomycin: at least 100ml liquid should be added every 0.5g, and the drip time should be >; 1h, too fast dripping speed will cause "red man syndrome";
② Excessive intravenous vitamin K: causing facial flushing, sweating, chest tightness, blood pressure drop and collapse;
③ Drugs whose intravenous drip time should be controlled over 65438±0h hours: lincomycin, clindamycin, polymyxin B, chloramphenicol, erythromycin, thiamphenicol, fosfomycin, ofloxacin, anti-tuberculosis drugs, amphotericin B, vancomycin, caspofungin, fluconazole, etc.
④ Drugs that need shading during drip: sodium p-aminosalicylate, sodium nitroprusside, actinomycin D, vincristine, nimodipine, levofloxacin, pefloxacin and moxifloxacin.
(4) incompatibility of drugs
Black precipitate may appear during intravenous drip of phentolamine 20mg+ dopamine 20mg+ furosemide 20mg and 5% glucose injection 250ml. (Dopamine hydrochloride is acidic, furosemide injection is alkaline, and dopamine is easily oxidized into quinones to form black polymers, especially in alkaline environment).
(5) Consultation on pharmaceutical excipients, packaging materials and medical instruments.
① Propylene glycol can cause contact dermatitis; Large dose lactic acid poisoning and hemolysis; Too fast infusion leads to thrombophlebitis and respiratory failure.
② Paclitaxel: The injection should be administered in non-PVC infusion bottles and infusion tubes, otherwise its active ingredients will be easily absorbed by PVC materials, which will reduce the curative effect or even fail.
With the development of clinical pharmacy, communication skills have become the basic skills for pharmacists to carry out pharmaceutical services.
※ (1) communication skills and methods.
(1) Introduce yourself accurately and explain your purpose;
2 pay attention to protecting privacy, and try to be in a private environment;
③ Listen carefully, observe and evaluate;
④ Avoid using professional medical terms to communicate with patients;
⑤ Clarify the purpose of communication;
6. Give feedback to the other party in time;
⑦ Give correct medication guidance;
8 the conversation time should not be too long, and the information provided at one time should not be too much. Some publicity materials can be prepared and distributed to patients during consultation.
(2) communication between pharmacists and different types of patients
Elderly patients: It is necessary to explain the usage, dosage and special precautions of drugs repeatedly until the patients fully understand them. Write the usage clearly in words or put a reminder label on the medicine box, and explain it orally and tell it repeatedly. Conditional can be equipped with divided dose medicine box, and inform the elderly patients' families or caregivers to urge the elderly to do it on time.