一例高血压伴肾功能异常患者降压药应用方案的优化

Optimization of treatment strategy of antihypertensive drugs for a patient with hypertension and abnormal renal function

目的探讨1例高血压患者出现肾功能异常的原因及临床药师的作用。方法药师结合患者既往疾病史、现病史、用药史、既往检测指标和检测指标的追踪,通过查阅相关药品说明书、文献、书籍、指南,合理选用抗高血压药物。结果患者的肾功能异常与氯沙坦钾氢氯噻嗪片有关,临床药师建议氯沙坦钾氢氯噻嗪片调整为硝苯地平控释片或氨氯地平片+富马酸比索洛尔片或琥珀酸美托洛尔缓释片或单用福辛普利钠片,临床接受福辛普利钠片。结论当患者的基础疾病和治疗基础疾病的药物都可引起相似的并发症或不良反应时,临床药师应运用临床思维和药学思维综合判断,同时要熟悉疾病和药物特点,及时准确地判断并发症或不良反应的由来,并提供合理的治疗方案建议。

Objective To explore the causes of abnormal renal function in a patient with hypertension and the role of clinical pharmacist. Methods Clinical pharmacists selected antihypertensive drugs reasonably by consulting related drug instructions,literatures,books and guidelines,in combination with past and present history of disease,history of drug use,past and present detection indicators,and detection indicators＇ trace. Results The abnormal renal function of the patient was associated with losartan potassium and hydrochlorothiazide tablets. Clinical pharmacist recommended that losartan potassium and hydrochlorothiazide tablets could be replaced by nifedipine controlled-release tablets or amlodipine besylate tablets combined with bisoprolol fumarate tablets,or metoprolol succinate sustained-release tablets,or sodium fosinopril tablets. The sodium fosinopril tablets were accepted clinically. Conclusion When the basic disease of the patient and corresponding therapeutic drugs can cause similar complications or adverse reactions,clinical pharmacist should assess the situation comprehensively by the clinical and pharmaceutical thinking,and get familiar with the characteristics of disease and drugs,judge timely and accurately from complications or adverse reactions and provide reasonable treatment recommendations.