肾移植高血压患者药学监护优秀课件
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Consider salt restriction and/or diuretic
Intervention fails to normalize BP
Multidrug regimen; add agents of different classes as necessary
Adequate response to therapy?
Tutone VK, et al. Clin Transplant 2005: 19: 181–192.
Graft and patient survival Kaplan–Meier analyses with the population divided into quintiles of diastolic BP
Adequate response to therapy?
Yes
No
Acceptable ADR?
Yes
Yes
Continue anti-hypertensive therapy Reassess periodically
Evaluate allograft function
Reduce dose of cyclosporine or tacrolimus
Baidu Nhomakorabea肾移植高血压患者药学监护
Major Contents
Cause of hypertension in the renal transplantation Treatment of hypertension in the renal transplant recipient Anti-hypertension medications
Develop pharmaceutical care plan Complete the intervention Implement follow-up
Graft and patient survival Kaplan–Meier analyses with the population divided into quintiles of systolic BP
200
systolic diastolic
150
Blood pressure(mmHg)
100
50
1
0
2
3
4
5
6
7
8
9 10 11 12 13
Date
Profiles of blood pressure
以患者为中心、以人为本
Drug Information ＆ Pharmaceutical Care Information
Operation date: 2006/04/19 Cadaveric Cold ischemia time (hours) : 12 Heat ischemia time (minutes) : 5
Current medication
Immunosuppressive regiments
❖ Cyclosporine
No
Re-evaluate allograft function and drug therapy Consider TRAS
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
ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor antagonist
Diagnosis and treatment of hypertension in the renal transplant recipient
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
医师
Medical Care
Pharmaceutical Care
药剂师
患者 Nursing Care护士
Drug Information ＆ Pharmaceutical Care Information
Pharmaceutical care and patient assessment
Initiate relationship with patient Gather patient information (subjective and objective) Assess information (patient assess)
Tutone VK, et al. Clin Transplant 2005: 19: 181–192.
Summary of anti-hypertensives with patient and graft outcomes
BB, beta-blocker; CC, calcium channel blocker; Loop, loop diuretic;
100 mg Bid
❖ ALG ❖ Mizoribine
125 mg Bid 250 mg QD 100 mg QD, 50 mg QN
Mycophenolate mofetil ❖ Methylprednisolone
750mg Bid 500mg Qd 3d
❖
Prednisolone
30mg Qd
Blood pressure>= 140/90
Stable GFR?
No
Yes
Optimal blood levels of cyclosporine or tacrolimus
Yes
ECG volume status acceptable?
Yes
No No
Administer anti-hypertensive Agent (CA, ACEI, or other
Intervention fails to normalize BP
Multidrug regimen; add agents of different classes as necessary
Adequate response to therapy?
Tutone VK, et al. Clin Transplant 2005: 19: 181–192.
Graft and patient survival Kaplan–Meier analyses with the population divided into quintiles of diastolic BP
Adequate response to therapy?
Yes
No
Acceptable ADR?
Yes
Yes
Continue anti-hypertensive therapy Reassess periodically
Evaluate allograft function
Reduce dose of cyclosporine or tacrolimus
Baidu Nhomakorabea肾移植高血压患者药学监护
Major Contents
Cause of hypertension in the renal transplantation Treatment of hypertension in the renal transplant recipient Anti-hypertension medications
Develop pharmaceutical care plan Complete the intervention Implement follow-up
Graft and patient survival Kaplan–Meier analyses with the population divided into quintiles of systolic BP
200
systolic diastolic
150
Blood pressure(mmHg)
100
50
1
0
2
3
4
5
6
7
8
9 10 11 12 13
Date
Profiles of blood pressure
以患者为中心、以人为本
Drug Information ＆ Pharmaceutical Care Information
Operation date: 2006/04/19 Cadaveric Cold ischemia time (hours) : 12 Heat ischemia time (minutes) : 5
Current medication
Immunosuppressive regiments
❖ Cyclosporine
No
Re-evaluate allograft function and drug therapy Consider TRAS
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
ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor antagonist
Diagnosis and treatment of hypertension in the renal transplant recipient
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
医师
Medical Care
Pharmaceutical Care
药剂师
患者 Nursing Care护士
Drug Information ＆ Pharmaceutical Care Information
Pharmaceutical care and patient assessment
Initiate relationship with patient Gather patient information (subjective and objective) Assess information (patient assess)
Tutone VK, et al. Clin Transplant 2005: 19: 181–192.
Summary of anti-hypertensives with patient and graft outcomes
BB, beta-blocker; CC, calcium channel blocker; Loop, loop diuretic;
100 mg Bid
❖ ALG ❖ Mizoribine
125 mg Bid 250 mg QD 100 mg QD, 50 mg QN
Mycophenolate mofetil ❖ Methylprednisolone
750mg Bid 500mg Qd 3d
❖
Prednisolone
30mg Qd
Blood pressure>= 140/90
Stable GFR?
No
Yes
Optimal blood levels of cyclosporine or tacrolimus
Yes
ECG volume status acceptable?
Yes
No No
Administer anti-hypertensive Agent (CA, ACEI, or other