Recent focus: scene
Since the opening of the pharmacological clinic, some images have appeared repeatedly and occasionally become a memory。
Underline, the old man, who comes with a bag of pills, sits down with the first sentence, "doctor, i take 78 pills a day, and i can't remember which meal to eat." we're opening the medicine box one by one, and we're helping them figure it out。
On the line, in the dialogue box of the internet pharmacological clinic, at 10 p. M., there is sometimes a message that mothers who are breast-feeding have fevers and do not want to take medication, and parents are concerned about whether they want to use recalcitrant pills at 38°c. We have responded with only a few words, but we have often allowed a family to spend the night。
And the "bringing people" from the clinician is another kind of gesture. In the case of patients with complicated medications or for unknown reasons, doctors will ask pharmacists to sift。
On 23 september 2025, there was a case of 81-year-old grandfather lu, who was uncomfortable and had problems with re-examination of his liver, and the doctors asked us to screen the drugs he had taken。
Trace
Patient, 81 years old, clinical diagnosis: medications such as coronary porridge hardened heart disease (after pci surgery), hypertension, long oral aspirin intestinal tablets, atodic calcium tablets and torasemes。
On 18 september 2025, grandfather luk began to be administered with acidic acid on the basis of a clinically diagnosed male breast development disorder (in the form of double masturbation). However, after a few days of “favouring”, when the elderly took one extra dose a day, the grandfather gradually became incompetent and dizzy, and his family brought him to the clinic。
On 23 september, the liver and kidney function was reviewed with alarming results: total cholesterol 49. 8 μmol/l (normal ceiling of 20. 5 μmol/l, approximately 2. 4 times higher), direct cholesterol was simultaneously elevated, and the trans-aminoase (alt/ast) was within normal range。
Analysis
I traced in detail the entire recent drug use of grandfather lu: the only new drug in the country, and there was a clear history of overdose — two daily doses, one of which was actually overdosed; the long-term aspirins, the atopiatin, the torasemi and others had no dose adjustment in the recent past and had been stable in the monitoring of liver function。
From the institutional point of view, he has a clear risk of liver damage in his own right, the type of liver damage being in the form of cholesterol, often in the form of an increase in cholesterol and alkaline phosphate, and a normal or only slight increase in aminoase. The patient's long-term atodic acidic metabolism of cyp3a4 is also competitively inhibited with his mossophine, which may increase the concentration of the latter's blood medicine, and the urea effect of torasemi may also alter the flow of liver blood. The risk is further amplified by a significant increase in the liver metabolic burden as a result of overdose. Grandfather luggar's pattern of normal liver abnormalities, mainly based on cholesterol, is consistent with the typical pattern of cholesterol liver damage caused by his mossophene, and is associated with drug metabolic enzyme competition and increased liver excretion load。
Therefore, this case cannot be attributed solely to “new drug overdose”, but rather to multi-pharmaceutical superstitious liver damage, which is the main incentive, and other combinations of drugs that may have a synergistic effect。
I suggested to the doctor that he should be suspended from the hepatics and that hepatic changes should be closely monitored。
Follow-up visits
I gave my grandfather and his family a follow-up note after cutting off the acid。
With regard to medications, we will record the adverse effects of this drug in the drug file。
At the same time, i explained to grandpa lu and his family that it doesn't matter if the medicine stops, and that breast pain still needs to be addressed. Follow-up visits should be made to specialized clinics, where specialists are assessed and other suitable drugs are exchanged. He has other options such as a drug with a relatively lower risk of liver damage or a joint drug programme. The choice of particular type requires a combination of the age, state of health and illness of grandfather lui by a specialist. Any change in medication is done under the direction of a doctor and the liver function is periodically reviewed。
Symptoms monitoring: they are instructed to observe daily changes in skin colours and urine, such as visible yellow dyes, increased strength or reduced appetite, and to contact pharmacists in a timely manner。
For review: the liver function is periodically reviewed after the agreement to stop the drug, and subsequent decisions as to whether to adjust alternative combinations should be made in the light of recovery。
Eating: informing fruit such as grapefruit and grapefruit can affect liver pharmaceutical metabolic enzyme activity and recommending temporary avoidance of consumption; keeping diets low in salt fat and reducing liver burden。
On 14 october, after three weeks of detoxification, a follow-up review was conducted: the liver function was restored。
Echo
More than a month later, two follow-up visits made me feel that the job had indeed been done in vain。
Grandpa lu said, "li pharmacist, i'm not dizzy right now, i'm strong enough to walk -- i really know how to take medicine!"
The doctor said something to me. I'll probably remember it for a long time:
"i'll send you all those patients who have a problem with the medication."
Figure 1 trends in total cholesterol
Figure 2
In 2026, during the first shanghai pharmacological out-patient skills competition, more than 600 pharmacists from all over the city competed with each other. The li xinvi pharmacist of the 6th people's hospital in shanghai received the first prize, and the first prize was awarded to the group in partnership
Pharmacy clinic skills competition
Pharmacist clinic in-depth coverage
Chinese drug transfer skills competition
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