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单纯依赖病人的临床表现以确定给药剂量及给药间隔已为时很久。当今人们则着眼于药物性质和病人的症状、体征合理给药,以更好地控制病情。如果尿毒症的病人服用一种主要以原型经肾排出的常用剂量的降压药如胍乙啶及atenolol,由于药物在血浆中潴留,病人将出现立位性低血压、心动过缓等副作用。有些降压药易穿适血脑屏障,有时会导致中枢神经系统副作用,如抑郁、梦魇、失眠;高血压病人服用利血平或甲基多巴时常出现抑郁并有时有自杀倾向已为人熟知;嗜睡是可乐宁最常见的副作用之一,因此患脑血管病或抑郁症的病人应避免服用此类降压药。如果药物的生物半衰期较短,应多次服药以控制血压。目前长效降压药如atenolol,nadolol及具有长半衰期的缓慢释放剂型已开发,本类药物病人更易接受。肼苯哒嗪经肝脏乙酰化代谢,据报道有两种代谢遗传决定表型—慢乙酰化型和快乙酰化型。慢乙酰化者因肼苯哒嗪血浓度较高,会出现系统性红斑狼疮(SLE)样综合征,因此慢乙酰化的高血压患者应减少肼苯哒嗪的服用剂量。
Relying solely on the patient’s clinical manifestations to determine the dose and dosing interval has been a long time. Today’s people are focused on the nature of the drug and the patient’s symptoms, signs and rational administration, in order to better control the disease. If a patient with uremia is taking a commonly used antihypertensive drug such as guanethidine and atenolol, commonly used in the form of a primary, renal excretion, patients will experience orthostatic hypotension and bradycardia as side effects of retention in the plasma. Some antihypertensive drugs are easy to adapt to the blood-brain barrier, and sometimes lead to central nervous system side effects such as depression, nightmares, insomnia; hypertension patients often take depression and sometimes suicide tendency of reserpine or methyldopa are well known; Somnolence is one of the most common side effects of clonidine, so patients with cerebrovascular disease or depression should avoid taking such antihypertensive drugs. If the biological half-life of the drug is short, it should be taken multiple times to control blood pressure. At present, long-acting antihypertensive drugs such as atenolol, nadolol and slow release dosage forms with long half-life have been developed, and the patients in this category are more receptive. Hydralazine is metabolized by hepatic acetylation, and two metabolic determinants have been reported - slow acetylator and fast acetylator. Slow acetylation due to higher hydralazine blood concentration, there will be systemic lupus erythematosus (SLE) -like syndrome, so slow acetylated hypertensive patients should reduce the dosage of hydralazine.