1. Familiar with the guiding principles of clinical application of antibacterial drugs: its contents include: the basic principles of therapeutic and preventive application of antibacterial drugs; Basic principles of antimicrobial application under special pathophysiological conditions; Clinical application management of antibacterial drugs; Indications and precautions of various antibacterial drugs; Treatment principles and pathogen treatment of various bacterial infections; Guiding opinions on the application of antibacterial drugs to prevent and treat surgical infections. So, I hope you are familiar with and master it.
2. Be familiar with the Management Measures and Implementation Rules for Clinical Application of Antibacterials: its contents include: Management Measures for Clinical Application of Antibacterials; Detailed rules for clinical application of antibacterial drugs.
3. Be familiar with the Implementation Rules for Preventive Use of Antibiotics in Perioperative Period: Its contents include: the purpose of preventive use of antibiotics in perioperative period; Classification of surgical incision and indications of prophylactic use of antibiotics in perioperative period: guidelines for selection of prophylactic use of antibiotics in perioperative period; Bacteriology of surgical site infection and selection of preventive drugs: preventive application of antibiotics during perioperative period: other measures to prevent surgical site infection.
4. Familiar with the detailed rules for the management of clinical application of antibacterial drugs; Its contents include: the classification principle of antibacterial drugs; Measures for the hierarchical management of antibacterial drugs; Catalogue of classified management of clinical application of antibacterial drugs.
5. Familiar with prescription management methods; Its contents include: general provisions on prescription management; Acquisition of prescription right; Prescription; Prescription adjustment; Supervision and management, etc.
6. Others: Measures for the Administration of Clinical Application of Antibacterials, Provisions on the Administration of Pharmaceutical Affairs in Medical Institutions, 20 12 National Special Rectification of Clinical Application of Antibacterials, Notice of the General Office of the Ministry of Health on Relevant Issues Concerning the Administration of Clinical Application of Antibiotics, etc.
2. Prepare some reference books and consult relevant materials at any time, such as Guiding Principles for Clinical Application of Antibacterials, Newly Edited Pharmacology, Drug Clinical Information Reference, Drug Instructions, etc.
Familiar with and master the common diseases of relevant departments: for example, common diseases in respiratory department include bronchial asthma, pneumonia, chronic obstructive pulmonary disease, etc.
Four, familiar with and master the etiology, pathogenesis, treatment, dosage, precautions and adverse reactions of common diseases in relevant departments.
For example, 1: "Community-acquired pneumonia", we should know that the common pathogens of lung infection are Streptococcus pneumoniae, Haemophilus influenzae, Gram-negative bacilli (such as Escherichia coli, Klebsiella pneumoniae, Acinetobacter, Pseudomonas aeruginosa), Staphylococcus aureus, Mycoplasma pneumoniae and Chlamydia pneumoniae. If it is "hospital acquired pneumonia", there may be fungi and anaerobic bacteria.
Gram-negative bacilli infection can be selected from aminoglycosides (amikacin), broad-spectrum penicillins (piperacillin tazobactam, amoxicillin/sulbactam), second, third and fourth generation cephalosporins and quinolones (ofloxacin, levofloxacin and moxifloxacin). Carbapenems (Imipenem, Meropenem, Biapenem) can be used for severe infections.
Mycoplasma pneumoniae and Chlamydia pneumoniae can be selected from macrolides such as erythromycin, doxycycline and fluoroquinolones (ofloxacin, levofloxacin and moxifloxacin).
Staphylococcus aureus infection can be selected according to drug sensitivity: oxacillin, oxacillin, piperacillin tazobactam, first and second generation cephalosporins, etc.
MRSA infection can be selected from vancomycin, norvancomycin, teicoplanin and linezolid.
Example 2: The commonly used therapeutic drugs for patients with bronchial asthma are:
1. Glucocorticoids (inflammation control): including inhaled and systemic glucocorticoids, such as beclomethasone dipropionate, fluticasone propionate and budesonide aerosol; Prednisone, prednisolone, methylprednisolone.
2. Anti-leukotriene drugs (leukotriene regulators): montelukast, zalukast, isobutyrate, etc.
3.β2 receptor agonists (relaxing bronchial smooth muscle and relieving symptoms): salbutamol, terbutaline, salmeterol, formoterol, etc.
4. Theophylline (relaxing bronchial smooth muscle and relieving asthma): theophylline, aminophylline, doxofylline, dihydroxypropyl theophylline, etc.
5. Inhalable anticholinergic drugs (relaxing bronchial smooth muscle): ipratropium bromide, Schet bromide, etc.
5. Familiarity with laboratory test data or indicators: such as knowing which diseases may cause changes in reference values such as white blood cell count, neutrophil percentage, neutrophil count, erythrocyte sedimentation rate, C-reactive protein and procalcitonin.
Liver function damage: Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) values increased significantly.
Renal function damage: serum creatinine and urea nitrogen increased.
Rounds: Take part in daily medication in selected departments.
1. Follow the clinician's rounds: you can focus on the patient's condition and treatment difficulties. You can consult the patient's medical records, check the patient's diagnosis, temperature change, biochemical examination, microbial examination, drug sensitivity test, imaging examination, etc. Understand the changes of patients' condition, and review whether the medication order, drug selection, dosage and route of administration are appropriate, and whether the drugs have adverse effects on liver and kidney. Timely intervention in irrational drug use. There must be an intervention record.
2. Clinical pharmacists make rounds by themselves: mainly for key patients under special circumstances (such as adverse drug reactions, critically ill patients, patients with complicated drug treatment and severe liver and kidney dysfunction, etc.). ), access to medical records, communicate with doctors, understand the condition, ask patients and their families, implement pharmaceutical care for key (critical and difficult) patients, and establish a pharmaceutical calendar. Have a work record.
3. Participate in consultation: put forward medication opinions and individualized drug treatment suggestions, and assist doctors in formulating drug treatment plans or adjusting treatment plans with poor treatment effects.
How to consult? (1) Look at the patient's diagnosis first; ⑵ Look at the patient's temperature changes; ⑶ Look at the laboratory inspection data; ⑷ Look at the results of microbiological examination and drug sensitivity; 5] See imaging examination and diagnosis; [6] See the course record; Once you see the medication order; Observe the patient's condition and signs.
Finally, according to the patient's condition, the patient's signs, the degree of infection, the possible pathogens of infection, and the drug sensitivity test of pathogenic examination, the appropriate drugs are selected for treatment.
4. Participate in the discussion of difficult and serious medical records and the treatment of critical patients in the hospital: participate in the formulation of drug treatment plans for patients, put forward drug treatment suggestions, assist and guide clinicians in rational drug use, avoid the harm caused by unreasonable drug use and drug abuse, and reduce the occurrence of drug-induced diseases and adverse drug reactions. Provide patients with the best drug treatment.
Seven, clinical pharmacists should constantly improve their professional level:
Clinical pharmacists must constantly learn the knowledge of pharmacy, medicine and laboratory science, constantly improve their own quality, read pharmaceutical journals, and actively participate in various knowledge lectures and trainings.
Eight, consultation and participation in the discussion of difficult and severe medical records:
1. consulting example: patient, male, 8 1 year old. Diagnosed as "chronic bronchitis complicated with pulmonary infection, emphysema and pulmonary heart disease", the effect of using cefmenoxime and aztreonam is not good. Please consult the clinical medicine department.
Consultation and analysis: The patient is old and has basic diseases. After treatment with cefmenoxime and aztreonam, the effect is not good, the patient's body temperature, white blood cell count and neutrophil percentage have not decreased significantly, and the patient's cough symptoms are aggravated. The effect of cefmenoxime and aztreonam on patients is not good, and the pathogenic bacteria may produce drug resistance (for example, bacteria may produce extended spectrum enzyme "ESBL"). Available drugs are: β -lactamase inhibitors (cefoperazone sulbactam or piperacillin tazobactam), aminoglycosides (amikacin) and carbapenems (imipenem cilastatin sodium, meropenem and biapenem). Considering that aminoglycosides (amikacin) have ototoxicity and nephrotoxicity, it is not suitable for use. Therefore, it is recommended to use meropenem 0.5g/ time, q8h once and intravenously. (Piperacillin and tazobactam can also be used).
2. Discussion on difficult medical records: The patient, a 59-year-old female, was diagnosed as "meningioma operation, hydrocephalus shunt, hydrocephalus, pulmonary infection (fungus) and intracranial infection" and was given antibiotics and antifungal treatment after admission. However, the patient's condition is critical, fever continues, hydrocephalus in the brain has not improved as before, carbon smear is positive, and Staphylococcus aureus is cultured in sputum. Please consult and discuss with multiple departments.
Advice from clinical pharmacists:
1. Considering that the patient has been using ceftazidime for 12 days after meningioma surgery and hydrocephalus shunt, the effect is not good. Considering that the pathogens of intracranial infection may include Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter. In addition, the patient cultured Staphylococcus aureus in sputum twice. Considering the high detection rate of methicillin-resistant Staphylococcus aureus in our hospital. It is suggested to use β -lactamase inhibitor (piperacillin/tazobactam 4.5g/ q 12h or cefoperazone/sulbactam 3g/ q 12h) combined with linezolid 0.6/ time twice a day (because Staphylococcus aureus is resistant to vancomycin in drug sensitivity test) or teicoplanin.
2. See if you can pull out the shunt. Pulling out the shunt helps to control infection.
3. The patient has diarrhea, which may be antibiotic-related diarrhea.
Microbiological agents such as Bifidobacterium can be used to regulate flora imbalance.
4. Pay attention to nutrition support and strengthen nutrition.
Clinicians accepted the advice of clinical pharmacists, and the infection of patients was controlled.
Clinical pharmacists can play their role only by constantly improving their professional level, assisting and guiding clinicians in rational drug use and timely intervening in clinical irrational drug use. Improve the level of rational drug use in hospitals and ensure that patients use drugs safely, effectively, economically and reasonably.