Approaches For Clinical Care For Patients With...

OBJECTIVE: To explore the approaches for clinical pharmacsists in clinical treatment and provide pharmaceutical care for patients with pharmacotherapy and adverse drug reactionsz. METHODS: The clinical pharmacsists participated in glycemic management of a patient with type 2 diabetes mellitus (T2DM) following severe insulin resistance, presented with coma, mechanical ventilation with tracheotomy, enteral nutrition support. RESULTS: Considering the complexity of these issues, the clinical pharmacists make medication therapy modifications to assist physicians in achieving blood glucose and HbA1c goals and reduce adverse drug events. CONCLUSIONS: The participation of clinical pharmacsists can help clinical pharmacists in pharmacotherapy help†¦show more content†¦This is the first case report on blood glucose management with these conditions in worldwide. Clinical pharmacists assisted physicians in making individualized regimen to improve the therapeutic efï ¬ cacy and ensure the patient safety. Case report An 89-year-old Chinese woman (body mass index 29.3kg/m2) with a 4-year history of T2DM was diagnosed by Tianjin first center hospital in 2010. In 2013 due to cerebral infarction with coma and respiratory failure, this patient was in ICU treatment. Until now, the patient is still in coma, mechanical ventilation with tracheotomy, with nasointestinal tube feeding. The patient was in coma, unable to eat normally. The good glycaemic control with continued intravenous human insulin (Novolin R ®Ã¯ ¼Å'Novo Nordisk, Denmark) 2U/h therapy was injected to the patient, considering the creatinine clearance rate (Ccr 40ml/min), combined with pioglitazone (Actos ®, Takeda, Japan)22.5mg daily via nasointestinal tube for improving insulin resistance. Due to hyperglycemia and HbA1c 8.8%, the patient was added subcutaneous liraglutide (Victoza ®, Novo Nordisk, Denmark)1.2mg daily and a long-acting insulin analogues-glargine (Lantus ®, Sanofi-Aventis, France)40U daily; After these treatments, glycaemic control remained poor. So therapy was changed from insulin glargine to detemir (Levemir ®, Novo Nordisk, Denmark) 16U twice daily, then gradually increased to