肾移植高血压患者药学监护

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1、肾移植高血压患者药学监护胡永芳MajorContentsCauseofhypertensionintherenaltransplantationTreatmentofhypertensionintherenaltransplantrecipientAnti-hypertensionmedicationsCaseStudyPatientdetails(renaltransplantation)Number:4438420Sex:MaleWeight:63kgHigh:160cmDateofBirth:1943/02/09Age:63yearsDisease

2、:ChronicnephritisOperationdate:2006/04/19CadavericColdischemiatime(hours):12Heatischemiatime(minutes):5CurrentmedicationImmunosuppressiveregimentsCyclosporine100mgBid125mgBidALG250mgQDMizoribine100mgQD,50mgQNMycophenolatemofetil750mgBidMethylprednisolone500mgQd3dPrednisolone30mgQ

3、dCurrentanti-hypertensivemedicationsMetoprolol12.5mgQ12hNifedipineControlledreleased30mgqd30mgQ12hEnalapril10mgQ12hFurosemide40mgtid40mgqd172/89患者医师药剂师护士MedicalCareNursingCareDrugInformation　＆PharmaceuticalCareInformationDrugInformation　＆PharmaceuticalCareInformation以患者为中心、以人为本Ph

4、armaceuticalCarePharmaceuticalcareandpatientassessmentInitiaterelationshipwithpatientGatherpatientinformation(subjectiveandobjective)Assessinformation(patientassess)CompletetheinterventionDeveloppharmaceuticalcareplanImplementfollow-upGraftandpatientsurvivalKaplan–Meieranalyseswi

5、ththepopulationdividedintoquintilesofsystolicBPTutoneVK,etal.ClinTransplant2005:19:181–192.GraftandpatientsurvivalKaplan–MeieranalyseswiththepopulationdividedintoquintilesofdiastolicBPTutoneVK,etal.ClinTransplant2005:19:181–192.Summaryofanti-hypertensiveswithpatientandgraftoutco

6、mesBB,beta-blocker;CC,calciumchannelblocker;Loop,loopdiuretic;ACEI,angiotensinconvertingenzymeinhibitor;ARB,angiotensinreceptorantagonistDiagnosisandtreatmentofhypertensionintherenaltransplantrecipientContinueanti-hypertensivetherapyReassessperiodicallyAdministeranti-hypertensive

7、Agent(CA,ACEI,orotherBloodpressure>=140/90StableGFR?InterventionfailstonormalizeBPConsidersaltrestrictionand/ordiureticMultidrugregimen;addagentsofdifferentclassesasnecessaryReducedoseofcyclosporineortacrolimusEvaluateallograftfunctionOptimalbloodlevelsofcyclosporineortacrolimusE

8、CGvolumestatusacceptable?Adequaterespons