※ 引述《everain (雨過天晴)》之銘言： : 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) 以降低腎功能(GFR)副作用來想... 直接反射renitec(雙側腎動脈狹窄為禁忌症) 這應該算是治療學的考古題 通常是比較舊的比較會發生...像是capoten與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. --

※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 61.64.65.118 ※ 編輯: cmvct723d 來自: 61.64.65.118 (02/23 03:10)