肾移植高血压患者药学监护课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,肾移植高血压患者药学监护,肾移植高血压患者药学监护,1,Major Contents,Cause of hypertension in the renal transplantation,Treatment of hypertension in the renal transplant recipient,Anti-hypertension medications,Major ContentsCause of hyperte,2,Case,Study,Patient details ( renal transplantation),Number :,4438420,Sex:,Male,Weight:,63 kg,High:,160 cm,Date of Birth:,1943/02/09,Age:,63 years,Disease:,Chronic nephritis,Operation date:,2006/04/19 Cadaveric,Cold ischemia time (hours) :,12,Heat ischemia time (minutes) :,5,Case StudyPatient details ( re,3,Current medication,Immunosuppressive regiments,Cyclosporine 100 mg Bid,125 mg Bid,ALG 250 mg QD,Mizoribine 100 mg QD, 50 mg QN,Mycophenolate mofetil 750mg Bid,Methylprednisolone 500mg Qd 3d,Prednisolone 30mg Qd,Current medicationImmunosuppre,4,Current anti-hypertensive medications,Metoprolol 12.5 mg Q12h,Nifedipine Controlled released 30 mg qd,30 mg Q12h,Enalapril 10 mg Q12h,Furosemide 40mg tid,40mg qd,Current anti-hypertensive medi,5,172/89,172/89,6,患者,医师,药剂师,护士,Medical Care,Nursing Care,Drug Information,Pharmaceutical,Care,Information,Drug Information,Pharmaceutical,Care,Information,以患者为中心、以人为本,Pharmaceutical Care,患者医师药剂师护士Medical CareNursing,7,Pharmaceutical care and patient assessment,Initiate relationship with patient,Gather patient information,(subjective and objective),Assess information (patient assess),Complete the intervention,Develop pharmaceutical care plan,Implement follow-up,Pharmaceutical care and patien,8,Graft and patient survival KaplanMeier analyses with the population,divided into quintiles of systolic BP,Tutone VK, et al. Clin Transplant 2005: 19: 181192.,Graft and patient survival Kap,9,Graft and patient survival KaplanMeier analyses with the populationdivided into quintiles of diastolic BP,Tutone VK, et al. Clin Transplant 2005: 19: 181192.,Graft and patient survival Kap,10,Summary of anti-hypertensives with patient and graft outcomes,BB, beta-blocker,;,CC, calcium channel blocker; Loop, loop diuretic;,ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor antagonist,Summary of anti-hypertensives,11,Diagnosis and treatment of hypertension in the renal transplant recipient,Continue anti-hypertensive therapy,Reassess periodically,Administer anti-hypertensive,Agent (CA, ACEI, or other,Blood pressure= 140/90,Stable GFR?,Intervention fails to,normalize BP,Consider salt restriction,and/or diuretic,Multidrug regimen; add agents,of different classes as necessary,Reduce dose of cyclosporine,or tacrolimus,Evaluate allograft function,Optimal blood levels of,cyclosporine or tacrolimus,ECG volume status,acceptable?,Adequate response to therapy?,Acceptable ADR?,Adequate response to therapy?,Re-evaluate allograft function,and drug therapy,Consider TRAS,No,Yes,Yes,Yes,No,No,No,No,Yes,Yes,Yes,Diagnosis and treatment of hyp,12,Frequency of hypertension,60-85 % renal transplant recipients,90 % renal transplant recipients administrated CsA,Frequency of hypertension60-85,13,Cause of hypertension,免疫抑制剂的使用,移植肾相关的因素,急、慢性排斥反响,慢性移植肾病,肾动脉狭窄,复发性或新发性肾病,药物肾毒性,尿路梗阻,原肾高肾素潴留,红细胞增多症,Cause of hypertension免疫抑制剂的使用,14,Risk Factor,免疫抑制剂的升压,移植肾功能受损,移植肾动脉狭窄,RTRs 的平均动脉压每升高10mmHg ,其移植肾脏功能衰竭的发生率上升30 %,肾移植后合并血压升高者急性排斥反响发生率远远高于血压降低者,尸体肾移植较活体肾移植发生率高,Risk Factor免疫抑制剂的升压,15,Diagnosis hypertension,Blood pressurereadings consistently over 140/90 mmHg,Assessment of allograft function, extracellular fluid volume (ECF) status, and immunosuppressive dosing,If these variables are stable, it is reasonable to proceed with antihypertensive therapy,Diagnosis hypertensionBlood pr,16,Treatment hypertension,130/85 mmHg for renal transplant recipients without proteinuria,125/75 mmHg for proteinuric patients,Treatment hypertension130/85,17,Treatment hypertension,Drug,Modification of the immunosuppressive therapy,Calcium channel block,ACE inhibitor,ARB,Treatment hypertension,18,Treatment hypertension non drug,Avoidance of an increase in body weight,Salt restriction,Exercise,Surgery,Treatment hypertension,19,Anti-hypertensive,medications,in the renal transplant recipient,Calcium antagonists,(CA),are effective agents and may offer the added benefit of attenuating cyclosporine induced changes in renal hemodynamics.,Verapamil, diltiazem, nicardipine, and mibefradil increase blood levels of cyclosporine and tacrolimus and should be used with caution.,ACEI and ARB are also effective; their use requires close monitoring of renal function, serum potassium levels, and hematocrit levels,Diuretics frequently are useful adjuncts to therapy in recipients owing to the salt retention that often accompanies cyclosporine,Anti-hypertensive medications,20,参与临床用药工作,发现,解决 潜在的或实际存在的用药问题,预防,参与临床用药工作发现,21,药物治疗中的问题,与适应证不符,需要其他的药物治疗,药物治疗无效,药物剂量过低,药物治疗中出现的不良反响,药物剂量过高,顺从性或依从性较差,药物治疗中的问题与适应证不符,22,平安合理用药教育,医生,肾移植患者抗高血压药的使用,肾移植患者抗生素的使用,护士,多巴胺、氯化钾等注射液输注药物浓度、滴注速度,患者,肾移植患者药物使用,可能出现不良反响,饮食、出院用药等,平安合理用药教育医生,23,药学监护,Pharmaceutical,Care,肾移植出,现的药物,治疗问题,确定处理预防,药学监护肾移植出确定处理预防,24,北京大学第三医院药历,北京大学第三医院药历,25,肾移植高血压患者药学监护课件,26,临床工作的一天,临床工作的一天,27,Action,IS PRIMARY!,Care patientsprotect healthcare personnel,promote quality healthcare!,Everybody action,Action Care patientsprotect,28,