高血鉀以bricanyl治療?病人雖不喘 是治療呼吸改善酸中毒嗎?謝謝~[ 本帖最後由 美式冰咖啡 於 2008-9-2 15:18 編輯 ] bricanyl和高血鉀有直接關係嗎? (呼吸 bricanyl和高血鉀有直接關係嗎? - 趣味新聞網

Hyperkalemia的治疗可以简单的分为几个大项

1. Calcium
2. Insulin and glucose
3. Sodium bicarbonate
4. Beta-2-adrenergic agonists
5. Loop or thiazide diuretics
6. Cation exchange resin
7. Dialysis

你所提到的bricanyl(terbutaline)是属于第4点的Beta-2-adrenergic agonists

底下附上较详细的资料~有兴趣可以参考一下

大纲帮你标上了粗体字

Beta-2-adrenergic agonists —

Like insulin, the beta-2-adrenergic agonists drive potassium into the cells by increasing Na-K-ATPase activity .  As a result, these drugs can be effectively used in the acute treatment of hyperkalemia, lowering the plasma potassium concentration by 0.5 to 1.5 meq/L.

The following doses have been used: albuterol (10 to 20 mg in 4 mL of saline by nebulization over 10 minutes or 0.5 mg by intravenous infusion), or epinephrine (0.05 µg/kg per minute by intravenous infusion). The peak effect is seen within 30 minutes with intravenous infusion, but occurs at 90 minutes with nebulization . Subcutaneous terbutaline has also been used successfully in end-stage renal disease .

As with sodium bicarbonate, there is a limitation to the use of epinephrine in advanced renal failure, since there is a blunted hypokalemic response in this setting . This effect appears to be related to the alpha-adrenergic activity of epinephrine. The alpha-receptors cause potassium movement out of, not into, the cells; for reasons that are unclear, patients with renal failure show an enhanced alpha effect, thereby limiting or even preventing any fall in the plasma potassium concentration  . Beta-adrenergic responsiveness is generally preserved, although 4 of 10 patients in one study had less than a 0.5 meq/L fall in the plasma potassium concentration after the administration of albuterol .

Thus, albuterol can be added to insulin plus glucose to maximize the reduction in the plasma potassium concentration in patients with severe hyperkalemia and end-stage renal disease . One problem in patients on maintenance hemodialysis is that lowering the plasma potassium concentration with albuterol can diminish subsequent potassium removal during the dialysis session (from 50 to 29 meq in one report), possibly leading to rebound hyperkalemia after dialysis .

The only side effects of the beta-2 agonists are mild tachycardia and the possible induction of angina in susceptible subjects. Thus, these agents should probably be avoided in patients with known active coronary disease. Furthermore, all patients with end-stage renal disease should be monitored carefully because they may have subclinical coronary disease.

如上面大大所讲的一样.在网路上也找到相关资料

正常情况下，β2-agonist与β2肾上腺素接受体结合，刺激c-AMP形成，这作用经由蛋白酶A(proteinase A)到磷酸基盐并活化Na-K-ATPase pump，使得K+流入细胞内。

   非选择性β-blocker竞争抑制β2肾上腺素接受体的作用，降低Na-K-ATPase pump功能，减少细胞内K+的再回流，同时抑制受激化之儿茶酚胺(catecholamines)-肾素(rennin)的释出，因而减少酫固酮的合成，导致肾脏钾泌作用减少。α-agonist会抑制胰岛素的释出，为造成高血钾的主要作用机转。据统计非选择性β-blocker会使4~15%住院病人产生或诱发高血钾。

Bricanyl Turbuhaler
药物分类： 肾上腺素受体激动剂
作用机转： β2肾上腺素刺激剂,刺激c-AMP形成,活化Na-K-ATPase pump，使得K+流入细胞内。

非常谢谢楼上2位大大!

蔣卓嘉打歌〈呼吸〉 謝安卓雅同眠

血液腫瘤－骨髓縴維化併發癥

護師節 白衣天使甘苦談

高血壓的人，為什麼要關注血鉀？因為血鉀過高或過低都有危險！

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