OBJECTIVE To provide a reference for anticoagulation therapy， adverse drug reaction monitoring， and individualized medication adjustment in complex cases， such as those with thrombocytopenia following bioprosthetic heart valve replacement. METHODS Clinical pharmacists participated in the pharmaceutical care of a patient with thrombocytopenia following bioprosthetic heart valve replacement. For cardiac insufficiency， the pharmacists recommended maintaining oral bisoprolol， sacubitril/valsartan， spironolactone， furosemide， and potassium chloride， with levosimendan added to enhance myocardial contractility， while monitoring blood pressure， heart rate and serum potassium levels. For thrombocytopenia， based on literature- based risk assessment， the pharmacists advised administering recombinant human interleukin-11 （rhIL-11）， platelet transfusion， and employing anticoagulation therapy with nadroparin calcium bridging to warfarin， with warfarin dosage adjusted according to the international normalized ratio （INR）. For rapid ventricular rate atrial fibrillation， amiodarone and digoxin were recommended. For acute liver injury， suspected to be induced by amiodarone and rhIL-11， the pharmacists suggested discontinuing the relevant drugs and treating with ademetionine 1，4-butanedisulfonate combined with polyene phosphatidylcholine for liver protection treatment. The patient received anticoagulation medication education emphasizing strict INR monitoring and close observation for bleeding or thrombotic events. RESULTS The clinicians adopted these recommendations. Following the intervention， the patient’s liver function showed significant improvement， with alanine aminotransferase decreasing to 70 U/L and aspartate aminotransferase to 42 U/L. The ventricular rate stabilized at 70-100 beats per minute， cardiac function remained stable， the INR was maintained within the target range of 1.80-2.50， and the patient was ultimately discharged with improved condition. CONCLUSIONS Through balancing anticoagulation and bleeding risks， the clinical pharmacists applied pharmaceutical expertise to assist in developing personalized anticoagulation regimens， conducted adverse drug reaction monitoring and evaluation， and optimized medication strategies， thereby effectively ensuring patient safety and therapeutic efficacy.

OBJECTIVE To analyze the characteristics of levofloxacin-induced hypersensitivity reaction. METHODS Clinical pharmacists participated in the treatment for a case of levofloxacin-induced hypersensitivity reaction， and adjudged the relationship of levofloxacin with hypersensitivity reaction according to relative standards. Retrieved from CNKI， VIP， Wanfang database， PubMed and Embase， relevant literature about levofloxacin-induced hypersensitivity reaction was collected and analyzed. RESULTS Clinical pharmacists suggested checking the patient’s previous medication and allergy history based on symptoms such as fever and systemic rash， and determined that the drug hypersensitivity was “likely” or “highly likely” to be associated with levofloxacin. Clinicians provided symptomatic treatment to the patient based on the judgment of clinical pharmacists， and the patient improved after treatment. Results of the literature analysis showed that among 31 involved patients， there were 23 males and 8 females； 18 patients aged 50 and above； the incubation period of 24 patients was within 4 days after medication. The main adverse drug reactions were drug hypersensitivity syndrome， fixed drug eruption， erythema multiforme， etc. Most patients were improved after withdrawal and symptomatic treatment. CONCLUSIONS Hypersensitivity reaction is the rare adverse drug reaction of levofloxacin， mostly occurring within 2.5 h to 4 days after administration， and it is more likely to occur in middle-aged and elderly patients. Before clinical use， patients should be asked about their drug allergy history in detail； when patients experience fever or rash without obvious causes， medication should be stopped promptly and symptomatic treatment should be taken to ensure the safety and effectiveness of the patients’ medication.

A 25-year-old woman received subcutaneous injection of semaglutide injection (semaglutide) 0.5 mg by herself for weight loss. She developed nausea and vomiting after medication but did not pay much attention to. On the 2nd week, semaglutide 1 mg was injected subcutaneously. Symptoms such as nausea and vomiting were aggravated, followed by stomach pain and distension, which could not be relieved. Laboratory tests showed alanine aminotransferase (ALT) 1 687 U/L, aspartate aminotransferase (AST) 809 U/L, alkaline phosphatase (ALP) 167 U/L, total bile acid (TBA) 178.8 μmol/L, total bilirubin(TBil) 106.3 μmol/L, direct bilirubin 64.0 μmol/L, and indirect bilirubin (IBil) 42.3 μmol/L. After excluding causes like viral hepatitis, autoimmune liver disease, obstructive jaundice, and concomitant drugs, acute liver injury caused by semaglutide was considered, and liver-protective treatments were given. Due to poor therapeutic effects, artificial liver treatment was given once, and then liver protective treatments were continued. On day 17 of treatment, laboratory tests showed ALT 579 U/L, AST 583 U/L, ALP 180 U/L, TBA 231.8 μmol/L, TBil 344.8 μmol/L, DBil 233.8 μmol/L, and IBil 111.0 μmol/L. After 6 months of treatments, the patient′s liver function returned to normal, with laboratory tests results of ALT 56 U/L, AST 33 U/L, ALP 99 U/L, TBA 2.7 μmol/L, TBil 10.5 μmol/L, DBil 3.2 μmol/L, and IBil 7.3 μmol/L.

A 25-year-old woman received subcutaneous injection of semaglutide injection (semaglutide) 0.5 mg by herself for weight loss. She developed nausea and vomiting after medication but did not pay much attention to. On the 2nd week, semaglutide 1 mg was injected subcutaneously. Symptoms such as nausea and vomiting were aggravated, followed by stomach pain and distension, which could not be relieved. Laboratory tests showed alanine aminotransferase (ALT) 1 687 U/L, aspartate aminotransferase (AST) 809 U/L, alkaline phosphatase (ALP) 167 U/L, total bile acid (TBA) 178.8 μmol/L, total bilirubin(TBil) 106.3 μmol/L, direct bilirubin 64.0 μmol/L, and indirect bilirubin (IBil) 42.3 μmol/L. After excluding causes like viral hepatitis, autoimmune liver disease, obstructive jaundice, and concomitant drugs, acute liver injury caused by semaglutide was considered, and liver-protective treatments were given. Due to poor therapeutic effects, artificial liver treatment was given once, and then liver protective treatments were continued. On day 17 of treatment, laboratory tests showed ALT 579 U/L, AST 583 U/L, ALP 180 U/L, TBA 231.8 μmol/L, TBil 344.8 μmol/L, DBil 233.8 μmol/L, and IBil 111.0 μmol/L. After 6 months of treatments, the patient′s liver function returned to normal, with laboratory tests results of ALT 56 U/L, AST 33 U/L, ALP 99 U/L, TBA 2.7 μmol/L, TBil 10.5 μmol/L, DBil 3.2 μmol/L, and IBil 7.3 μmol/L.

A 37-year-old male patient with acute myelomonocytic leukemia received cytarabine combined with idarubicin for 4 times. The patient did not develop rash or skin damage during the chemotherapy except for myelosuppression and vomiting. The patient developed slight itching on the extremities on the 4th day after the 5th intravenous infusion of idarubicin (20 mg once daily, on day 1) and cytarabine (1 900 mg once per 12 hours, on day 1 to 4), and no special treatment was given. On the 2nd day after finishing the chemotherapy, the patient developed obvious dark brown pigmentation on both cheeks and red papules on his back and bilateral waist, which was considered to be related to combination use of cytarabine and idarubicin. Chlorphenamine maleate 4 mg orally once per 12 hours, and IV infusions of 20% vitamin C injection 5 ml+0.9% sodium chloride injection 100 ml+10% calcium gluconate injection 10 ml once daily were given. Seven days later, the red papules on his back and waist disappeared; 24 days later, his facial pigmentation disappeared basically.

A 37-year-old male patient with acute myelomonocytic leukemia received cytarabine combined with idarubicin for 4 times. The patient did not develop rash or skin damage during the chemotherapy except for myelosuppression and vomiting. The patient developed slight itching on the extremities on the 4th day after the 5th intravenous infusion of idarubicin (20 mg once daily, on day 1) and cytarabine (1 900 mg once per 12 hours, on day 1 to 4), and no special treatment was given. On the 2nd day after finishing the chemotherapy, the patient developed obvious dark brown pigmentation on both cheeks and red papules on his back and bilateral waist, which was considered to be related to combination use of cytarabine and idarubicin. Chlorphenamine maleate 4 mg orally once per 12 hours, and IV infusions of 20% vitamin C injection 5 ml+0.9% sodium chloride injection 100 ml+10% calcium gluconate injection 10 ml once daily were given. Seven days later, the red papules on his back and waist disappeared; 24 days later, his facial pigmentation disappeared basically.