Establishment And Evaluation Of Clinical Pharmaceutical Care Pattern In Epilepsy Therapy

Objective1.Establish the model of clinical pharmacy services for epilepsy patients;2. To explore the significance of clinical pharmacy services in epilepsy drugtreatment.Methods1. According to steady valley concentration data of carbamazepine and valproicacid,we haved used NONMEM programs to establish population pharmacokineticmodel of CBZ and VPA for epilepsy patients.2. In combination with relevant data and clinical experts opinions, write epilepsyeducation materials and epilepsy diary.3.Divided patients into experimental group and control group respectively.Pharmacists carry out clinical pharmacy services for experimental group, while didnot carry out clinical pharmacy services for control group. Followed up for8months,evaluation of the role of clinical pharmaceutical services.The evaluation indexsinclude curative effect, aware of knowledge about epilepsy, compliance, therationality of drug use, adverse reactions,target rate of plasma drug concentration anddrug charges.Result1. The final model of CBZ was:Ka(h^-1)1.2,CL （CL/F）（L/h）0.074×TAMT_CBZ^0.41×WT^0.267×A×B×C（if takingphenytoin,A is1.42; if taking Phenobarbital,B is1.18; if age greater than65yearsold,C is0.84）； The final model of VPA was:Ka(h^-1)=1.9,CL （CL/F）（L/h）=0.102（WT/60）^0.696×TAMT_VPA^0.197×A×B×C（if taking CBZ,A is 1.36; if taking Phenytoin,B is1.25; if taking Phenobarbital,C is1.11）,V （V/F）（L）0.14WT. In the Above equations, Ka is the absorption rate constant,CL is apparent clearance, V is apparent clearance, F is bioavailability, WT is weight,TAMT_CBZ、TAMT_VPAare daily dose of CBZ and VPA respectively. The final modelhad positive prediction for the samples outside the model.2.Established clinical pharmaceutical service model include quantitativeadministration, timed administration, medication and health education, application ofepilepsy medication diary, therapeutic drug monitoring and regular follow-up.3. The clinical curative effect, aware of knowledge about epilepsy, complianceand administration rationality have statistically significant difference betweenexperimental group and control group. Experimental group were superior to controlgroup （P＜0.05）. Blood drug concentration success rate between the two groups anddrug treatment there was no statistically significant difference（P＞0.05）.Conclusion1. Established the PPK model of CBZ and VPA. The final model had has goodpredictive, can provide the reference for clinical individualized medication.2. Clinical pharmacy services can significantly improve the clinical curativeeffect, epilepsy drug knowledge awareness, compliance, and rationality in patientswith epilepsy. So the pharmacist to carry out clinical pharmaceutical care is of greatsignificance in epilepsy patients.