大家好 小弟有藥物治療學國考題的問題 在問問題之前 先感謝 k2412391藥師 Lr1藥師 cmvct723d藥師 百忙抽空給予見解 以下是小弟的問題 麻煩好心的人提出見解或建議 謝謝 19 在為ClCr＝23 mL/min 的病人選用下?ACEIs 藥品治療時， 何者最應依腎功能做劑量之調整？ (A)benazepril(B)enalapril(C)fosinopril(D)trandolapril 答案為(B) Applied 8th 提到ClCr傳統單位標準直為75-100 mL/min 所以此病人ClCr＝23 mL/min 明顯偏低 小弟想問題目指的依腎功能做劑量之調整 是看此藥物的Metabolism還是Excretion方式 小弟查 MICROMEDEX Healthcare Series得以下資料 我不太會用批踢踢顏色顯示功能,所以請好心的人,耐心看我查的資料 之後我會問人如何使用批踢踢顏色顯示功能已顯示表達的重點 謝謝^^" 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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