Courtney James, MD, Mayo Clinic School of Medicine, Rochester, MN. Marion T. Turnbull, PhD, Department of Neuroscience, Mayo Clinic, Jacksonville, FL. Jennifer B. Cowart, MD, Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL. Joel M. Reid, PhD, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN. W. David Freeman, MD, Departments of Neurologic Surgery, Neurology, Critical Care, Mayo Clinic, Jacksonville, FL.
J Neurosci Nurs. 2019 Oct;51(5):238-242. doi: 10.1097/JNN.0000000000000464.
Aneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke that is life threatening with high rates of mortality, and many survivors are left with permanent neurologic deficits. Nimodipine is the treatment of choice for aSAH with the goal of reduction of delayed cerebral ischemia. It is the only evidence-based medication that has been shown to have improved outcomes for delayed cerebral ischemia; therefore, it is important for neuroscience nurses to be knowledgeable of the pharmacology and pharmacogenomics properties of this medication, including cytochrome P450 (CYP450) enzymes.
This article reviews the CYP450 enzyme system including a review of the pharmacotherapy and pharmacogenomics of nimodipine for patients with aSAH illustrated with case study of a patient with abnormal drug metabolism.
CYP450 enzymes can be inhibited or induced by multiple medications resulting in clinically significant differences in drug metabolism. Food and Drug Administration-approved medication nimodipine is the only medication shown to improve outcomes in patients with aSAH. Hence, it is important to have awareness of potential drug-to-drug interactions and pharmacogenomics of nimodipine when caring for critically ill patients with aSAH.
蛛网膜下腔出血（aSAH）是一种危及生命的中风类型，死亡率很高，许多幸存者都留下了永久性的神经功能缺陷。尼莫地平是 aSAH 的首选治疗方法，目的是减少迟发性脑缺血。它是唯一被证明能改善迟发性脑缺血预后的循证药物；因此，神经科学护士了解这种药物的药理学和药物基因组学特性非常重要，包括细胞色素 P450（CYP450）酶。
本文综述了 CYP450 酶系统，包括对 aSAH 患者尼莫地平的药物治疗学和药物基因组学的回顾，并用一个药物代谢异常的患者的病例研究来说明。
CYP450 酶可被多种药物抑制或诱导，导致药物代谢的临床显著差异。经食品和药物管理局批准的尼莫地平是唯一被证明能改善 aSAH 患者预后的药物。因此，在护理患有 aSAH 的危重症患者时，了解尼莫地平的潜在药物相互作用和药物基因组学非常重要。
