※ 引述《everain (雨过天晴)》之铭言： : 大家好 : 小弟有药物治疗学国考题的问题 : 在问问题之前 : 先感谢 : k2412391药师 : Lr1药师 : cmvct723d药师 : 百忙抽空给予见解 : 以下是小弟的问题 麻烦好心的人提出见解或建议 谢谢 : 19 在为ClCr＝23 mL/min 的病人选用下?ACEIs 药品治疗时， : 何者最应依肾功能做剂量之调整？ : (A)benazepril(B)enalapril(C)fosinopril(D)trandolapril : 答案为(B) 以降低肾功能(GFR)副作用来想... 直接反射renitec(双侧肾动脉狭窄为禁忌症) 这应该算是治疗学的考古题 通常是比较旧的比较会发生...像是capoten与renitec Renal effects of ACE inhibitors in heart failure Authors Burton D Rose, MD Wilson S Colucci, MD FORM UPTODATE Studies in experimental animals suggest that there may be differences in the degree to which individual ACE inhibitors inhibit tissue converting enzyme in the presence of HF. As an example, enalapril may be a more potent inhibitor of renin ACE than captopril; rather than leading to a reduction in GFR, this change may lead to a moderate increase in sodium excretion, a possible reflection of diminished proximal sodium reabsorption due to removal of the normal stimulatory effect of angiotensin II [15]. The relevance of these findings to humans remains to be proven. : Applied 8th 提到ClCr传统单位标准直为75-100 mL/min : 所以此病人ClCr＝23 mL/min 明显偏低 : 小弟想问题目指的依肾功能做剂量之调整 : 是看此药物的Metabolism还是Excretion方式 : 小弟查 MICROMEDEX Healthcare Series得以下资料 : 我不太会用批踢踢颜色显示功能,所以请好心的人,耐心看我查的资料 : 之後我会问人如何使用批踢踢颜色显示功能已显示表达的重点 : 谢谢^^" : Benazepril : Metabolism : Systemic: Amlodipine- Hepatic : Benazepril- Hepatic: Active metabolite: benazeprilat : Excretion : Systemic: Amlodipine- Fecal: 20 to 25%; Renal: 70% : Benazepril- Renal : Elimination Half Life : Systemic: Amlodipine- 35 h Adults; 65 h Elderly : Benazeprilat- 10 to 11 h : enalapril : Metabolism : Enalapril (prodrug); hydrolysis : Active metabolite: enalaprilat (active drug) : Excretion : Fecal and Renal: 94% as prodrug and active drug (primarily in urine) : Enalaprilat (active drug), Renal: 40% : Enalaprilat (active drug), Dialyzable: yes (hemodialysis); yes (peritoneal : dialysis), neonates : Elimination Half Life : Enalaprilat (active drug): 11 h : Enalaprilat (active drug), Renal insufficiency: prolonged (glomerular : filtration rate of less than or equal to 30 mL/min) : Fosinopril : Metabolism : Fosinopril (prodrug)-Hepatic; esterases; hydrolysis : Metabolites: fosinoprilat (active), glucuronide conjugate of fosinoprilat and : p-hydroxy metabolite of fosinoprilat : Excretion : Fosinopril (prodrug), Fecal: approximately half of absorbed dose : Fosinopril (prodrug), Renal: approximately half of absorbed dose : Fosinopril (prodrug), Dialyzable: not well dialyzed : Fosinoprilat (active drug), Renal: (IV) : Fosinoprilat (active drug), Dialyzable: poorly removed (hemodialysis), 2% : removed; poorly removed (peritoneal dialysis), 7% removed : Elimination Half Life : Fosinoprilat (active drug), healthy subjects: (IV), approximately 12 h : Fosinoprilat (active drug), hypertensive patients: 11.5 h : Fosinoprilat (active drug), heart failure patients: 14 h : Fosinoprilat (active drug), pediatric patients: 11 h to 13 h : Trandolapril : Metabolism : Systemic: Hepatic: Metabolite: trandolaprilat : Excretion : Systemic: Fecal: 66%; Renal: 33%. : Elimination Half Life : Systemic: Trandolapril: 6 h. : Trandolaprilat: 10 h. --

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