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실험적 신질환 : 제 2형 당뇨 모델인 db/db mice에서 ACE inhibitor와 ARB의 병합투여가 인슐린저항성에 미치는 효과
이미화 ( Mi Hwa Lee ),송혜경 ( Hye Kyoung Song ),고강지 ( Gang Jee Ko ),강영선 ( Young Sun Kang ),권오성 ( Oh Sung Kwon ),한금현 ( Kum Hyun Han ),한상엽 ( Sang Youb Han ),한지영 ( Jee Young Han ),김형규 ( Hyoung Kyu Kim ),차대룡 ( 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1
증례 : 혈액투석으로 호전된 유지용량에서 발생한 리튬 중독 1예
윤수인 ( Su In Yoon ),김병철 ( Byung Chul Kim ),권순길 ( Soon Kil Kwon ),김혜영 ( Hye Young Kim ),김시경 ( Sie Kyeong Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1
저자들은 안정적인 혈중농도로 리튬을 복용해 오던 환자에서 혈압조절을 위해 안지오텐신 수용체 차단제와 클로로티아지드 혼합제를 복용한 뒤 리튬 독성이 발생하여 혈액투석 후 호전된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Lithium is a commonly prescribed drug for bipolar disorder. Because of the narrow therapeutic range, lithium intoxication continues to be prevalent. Drugs that alter renal function such as ACEI, ARB, NSAIDS, and thiazide can increase the risk of chronic lithium toxicity even to stable patients. A 65-year old woman was admitted for hand tremor, cognitive impairment, and lethargy. A medical history included major depressive disorder, mitral stenosis, atrial fibrillation, and hypertension. Her prescription included lithium, quetiapine, digoxin, furosemide, and warfarin. She recently received Atacand Plus (candesartan plus thiazide) for hypertension. At the time of admission, the patient was drowsy and confused. The serum lithium level was 4.25 mEq/L. The patient received hydration. Due to neurologic complications and the degree of lithium toxicity, a total of three sessions of hemodialysis were performed, and the post-dialysis serum lithium level was 0.54 mEq/L. The neurologic symptoms recovered completely after a third dialysis session. (Korean J Med 72:95-99, 2007)
정재원 ( Jae Won Jeong ) 대한내과학회 2010 대한내과학회지 Vol.78 No.6
Cough is one of the most common symptoms leading to referral to medical institutions, and can be triggered by various causes. Since chronic cough does not respond well to antitussives that are generally prescribed in outpatient clinics, it is most important to seek the underlying cause and provide appropriate treatment rather than to just simply relieve symptoms. Although chronic cough is induced by various causes, it is one of difficult symptoms to deal with in clinical settings, having no specific symptom for diagnosis or definitive diagnostic tool. While taking patient`s history, however, physicians can take a step closer to the treatment of chronic cough by asking more details about the character, frequency, onset, duration, and aggravating factor of cough, if any; the type of medication and time of its application; the response to previous treatment, etc. Underlying causes of chronic cough often require a long term treatment. Therefore, when treating patients, the physician must inform and discuss with the patient about the duration of treatment and what specifically he or she needs to do at home to maintain satisfactory compliance and expect good outcomes. (Korean J Med 78:670-673, 2010)
Pharmacotherapy for acute myocardial infarction
김성수,김현국 대한의사협회 2021 대한의사협회지 Vol.64 No.2
Clinical practice guidelines published by the European Society of Cardiology and the American College of Cardiology/ American Heart Association provide recommendations based on evidence, including randomized controlled trials and registry data, for clinicians to enable efficient clinical decision-making and improve prognosis for patients with acute myocardial infarction (AMI). However, there are several differences in practice, health systems, and races between Korea and Western countries; further, many studies on pharmacotherapy were conducted in the prepercutaneous coronary intervention era. An expert consensus document on pharmacotherapy for AMI was recently published following demands for the establishment of Korean guideline reflecting data in the modern percutaneous coronary intervention era. In this review, we summarized AMI guidelines from Europe, America, Japan, and Korea, and analyzed studies on pharmacotherapy for AMI including well-organized randomized controlled trials by Korean researchers and large-sized registry datasets, such as the Korea Acute Myocardial Infarction Registry and the Korean National Health Insurance Service.
당뇨병이 동반된 고혈압 환자에 대한 항고혈압제 선택의 변화: 포항 · 경주 1차 의료 연구망을 중심으로
윤주영,이동욱,정휘수,박기흠,김동익,기재만,조경래,송준석,최석,우창호,정태호,정숙형,김성우,이신형,박정재,김익 대한가정의학회 2009 Korean Journal of Family Medicine Vol.30 No.3
Background: Angiotensin converting enzyme inhibitors (ACEIs) or Angiotensin Ⅱ type 1 receptor blockers (ARBs) are compelling indication drugs for hypertensive patients with diabetes mellitus. But prescription rate in 2005 year study of Pohang · Gyeongju area was only 30.8%. Therefore, a study on the change of prescription rate in the same area after 3 years was done. Methods: During three months from January 2008, 152 hypertensive patients with diabetes mellitus on their prescribed antihypertensive medications by 9 family physicians in visiting order were analyzed. After the analysis, the infl uencing factors for such prescriptions were ascertained by directly visiting each physicians who prescribed them. Results: A regimen of 16 antihypertensive agents were prescribed by these family physicians. Prescription count of ACEIs or ARBs was 101 cases (66.4%). ACEIs single therapy was 19 cases (12.5%), ACEIs combination therapy was 7 cases (4.6%), ARBs single therapy was 31 cases (20.4%) and ARBs combination therapy was 44 cases (28.9%). The ACEIs or ARBs which were selected by physicians that followed "compelling indication" was 5 (55.6%), "excellent reduce pressure effect" was 3 (33.3%) and "public relations of new medicine" was 1 (11.1%). Conclusion: In prescribing antihypertensive agents for patients with diabetes mellitus, selection of ACEIs or ARBs was increased from 30.8% to 66.4%. Education of recommended standard by participating in such study and developing of excellent new medicines may increase such change. 연구배경: 당뇨병이 동반된 고혈압 환자의 항고혈압제는 angiotensin converting enzyme inhibitor (ACEI) 또는 angiotensin Ⅱ type 1 receptor blocker (ARB)가 일차선택약제로 권고 되고 있 다. 하지만 2005년 포항 · 경주 지역 개원의 대상 연구에서는 처 방률이 30.8%에 지나지 않았다. 이에 3년이 지난 후 동일 지역 개원의 처방률 변화에 대한 연구를 시행하였다. 방법: 연구에 동의한 9명의 가정의학과 개원의들이 2008년 1 월부터 3개월간 방문 순서대로 20개씩 제출한 당뇨병이 동반 된 고혈압 환자의 처방전 152개를 분석하였다. 분석 후 연구에 참여한 개원의들에게 직접 방문하여 약물의 선택의 이유를 확인하였다. 결과: 항고혈압제 처방 행태는 총 16가지였다. ACEI 또는 ARB 처방 수는 101개(66.4%)였다. 이중 ACEI 단독요법이 19 예(12.5%), ACEI 병용요법이 7예(4.6%), ARB 단독요법이 31예 (20.4%), ARB 병용요법이 44예(28.9%)로 나타났다. ACEI 또는 ARB의 선택 이유는 권고 기준 이행 5명(55.6%), 강압효과 3명 (33.3%), 신약홍보 1명(11.1%) 순이었다. 결론: 당뇨병이 동반된 고혈압 환자에 대한 항고혈압제로서 ACEI 또는 ARB 선택이 30.8%에서 66.4%로 크게 증가하였다. 약제 선택 이유는 연구 참여에 따른 권고 기준 습득과 강압효 과가 뛰어난 새로운 약제의 개발로 인해 크게 증가된 것으로 생각된다.