器官移植临床案例二

CaseNum214PtNameAmy FarrahAddress10 SW Merlin CourtAge68Height5 11Weight125 lb三个xfRaceWhiteAllergiesCodeinesection name organ transplant ationCaseNameCardiac Transplantationchiefcomplaiinttransfer from ST . Andrew medical center in cardio log in shockhxpresilineassaf is a 68-year-old woman with coronary artery disease admitted 10 days ago with chest pain for about 3 hours，diaphoresison presentation，She was tachycardic And normal otensive，And EKG revealed loss of r waves across the anterior precaord ium with no acute ST OSshe was found to have normal renal function and normal hematocrit .an echo cardioram revealed anteroseptal akinesis，a laminar clot，Posterior And inferior right ventricular hypokinesis，severe tricuspidshe had a cardia index of 1.4 .the patient is on 100% no nrereather mask while plans are under way for heart transplant ation。PastMedicalHxCHFGoing for HHTx today帕金森s disease which is felt to be mild，managed only with ar tane which controls a mild tremor希阿塔赫尼亚Endometrial cancer盖德Severe kyphosis and scoliosissocial hxshe lives independently . she is married with very supportive family，church，and husband . she is active and drives . she is a retiresfamily hwh cludes a history of coronary artery diseasereviewofsystemsvs : temperature 37.5 c，blood pressure initially 155/85 mmhg，decreasing to 110-120/40-60，blood pressure initially 155/85 mmhgshe came with an intra aortic balloon pump 1:1 . initial swan numbers revealed A cardiac index of 1.49，a cardiac output of 2.55，a CVP of 10Physcalexampen : in general，she is sesdated and quickly becaame more awake and alert as propofol was decreated . she was intubate d and ventityHEENT: PERRLACardio vascular : S1，S2 . balloon pump made heart sounds difficult to assess further。LUNs : bilateral crackles to bilateral bases but bilateral exchange throughput。abdomen : bowel sounds were active . abdomen was soft . there was no obvious hepatosplenomegaly。exremities 3360 cool but pink . distal pullses were palpable . there was no edema。Labsanddxtestssologum 137meq/lPotasium 3.6 meq/lChloride 94 mEq/LHCO330 mEq/L副28mg/lCreatinine 1.1 mg/LMg 2 mg/dLWBC 7500/mm3Hematocrit 32.7%Platelets 158 x 109/Ldiagnosissica shock and heart transplant ationRxRecord日期4/34/38/113/113/114/34/34/34/2Rx常开触点D246631D45863D245702D256822D248926D24031D340983D320423D429824物理主义者Drug and StrengthSirolimus 1 mgTacrolimus 1 mgPrednisone 5 mgPrevcid 30mg地兰丁100毫克Atenolol 50 mgAmlodipine 5 mg po qdMVIMycelexQuantity200300500601001003060140西格2 mg po bid1 mg po bid2 po q am1炮bid300 mg po q hsUd1 po q am2 po qd10 mg poRefills33336633rphnotesnew admit for heart transplantCaseNum214QuestNum2131question when monitoring serum concentration of tacrolimus，the recommended range for a trough level is 3360AnswerChoiceA2-3 ng/mL/ml。Answeroiceb 5-15ng/ml。Answeroicec 150-250ng/ml。Answeroiced 250-500ng/ml。Answeroiceegreater than 500 ng/ml。CorrectAnswerBexplanation following oral administration，Approximately 20% of the dose is absorbed in the gi tract。tacrolimus concentration can be measureed in both plasma and blood .whole blood is the prefe Rred method for measureing tacrolimus blood concentration . tacrolimus levels should be maintained in a range of 5-15 ngCompetencyStmt1.2.6K-类型CaseNum214QuestNum2132question which of the following medications require close plasma theraperating？I.Azathioprine二.Steroids三.TacrolimusAnsweroiceai onlyAnswerChoiceBIII onlyAnswerChoiceCI and II onlyAnswerChoiceDII and III onlyAnswerChoiceEI、II、and IIICorrectAnswerBexplanation tacrolimus trough levels should be maintained in a range of 5-15 ng/ml . clinical pharmacoustic studenies do not suggest a strootCompetencyStmt1.2.6K-TypeKCaseNum214qid34/11D429828Fluconazole12100 mg po daily0QuestNum2133question which of the following is the dose-limiting toxicity of tacrolimus？I. Nephrotoxicity二.Alopecia三.迪娅里Answeroiceai onlyAnswerChoiceBIII onlyAnswerChoiceCI and II onlyAnswerChoiceDII and III onlyAnswerChoiceEI、II、and IIICorrectanswerexplanation a variety of adverse drugreactions have been reported with the use of tacrolimus .evidence suggests that tacrolimus-induced adverse druge re Actions are typically associated with a high blood concentration . alopeia and diadsCompetencyStmt1.2.4K-TypeKCaseNum214QuestNum2134question how would you monitor a patient taking tacrolimus？I. serum creatinine，cardiac fun