f****o
发帖数: 2770 | 1 这个病没得治的，能活到86岁不错了。
如果她平时没有吃什么beta-blocker和其他一些maintenance的药的话，现在都住院了
，那很有可能就不行了。
不是什么病都有特效药的，特别是到了现在这个地步。
而且就算能买到药，你知道吃什么strength,dose,frequency么？这种事情不是你写在
网上我们就能做出therapeutic regimen recommendation的。
你还是告诉医院让他们治疗吧。如果不行了也没办法。而且会死的很突然。
你要是想尽最大努力和最大孝心，如果真要死，还是开始准备后事吧。 |
|
f****o
发帖数: 2770 | 2 GENERAL PRINCIPLES
The first step in managing chronic HF is to determine the etiology or
precipitating factors. Treatment of underlying disorders (e.g., anemia,
hyperthyroidism) may obviate the need for treatment of HF.
Nonpharmacologic interventions include cardiac rehabilitation and
restriction of fluid intake (maximum 2 L/day from all sources) and dietary
sodium (approximately 1.5 to 2 g of sodium per day).
Stage A: The emphasis is on identifying and modifying risk factors to
prevent developm... 阅读全帖 |
|
a*****8
发帖数: 2115 | 3 Sorry, can only type english at work.
Brentuximab vedotin was granted accelerated approval by FDA for the
treatment of patients with Hodgkin lymphoma after failure of autologous
hematopoietic cell transplantation (HCT) or after failure of at least two
prior multi-agent chemotherapy regimens in patients who are not candidates
for HCT. Phase II clinic trial is only on 100 patients. Without looking at
the trial it self along with PHASE III, it is really hard to tell the
efficacy. Based on the abstr... 阅读全帖 |
|
|
f******k
发帖数: 5329 | 5 高度怀疑第二个儿医开的是200mg/5ml，也许那个妈妈没看全？
另外，immediate release的QD确实不make sense。高度怀疑那个resident当成extended
release说的. |
|
l******k
发帖数: 27533 | 6 要么resident说错了，要么你看错了
应该是50mg/kg po qd， maximum 1000 mg per day for 10 days
一天两次已经超过治疗strep throat最大剂量了，用这么高是不是同时treat strep throat
and 手足口？ |
|
l******k
发帖数: 27533 | 7 有用高剂量治疗其他症状的，如acute OM, CAP...
第一个医生开的QD，因为当时娃只有strep
第二个医生增加到BID也是make sense的，因为当时娃的病已经发展到strep和手足口了
，这时增加剂量同时treat two infections也是有可能的
extended |
|
c****m
发帖数: 626 | 8 clinical pharmacology 是说的divide dose， q12hr.
其它几个资料也说吃两次，中间隔12hr。
那个楼的lz说她儿医说去年的conference说该成每天只吃一次了。
师姐用的哪个reference是50mg/kg po qd？
throat |
|
l******k
发帖数: 27533 | 9 我查的lexi-comp
clinical pharmacology确实可能信息比较旧，textbook一般都是要滞后几年的 |
|
l******k
发帖数: 27533 | 10 我记得ID module的时候老师介绍过几种不同的方案都可以用的
也许BID和QD都可以用，现在更prefer QD
不过我记不清了，也懒得去找笔记了:P
师妹要有兴趣，可以查查pubmed上有没有clinic trial比较这两种的 |
|
f******k
发帖数: 5329 | 11 那你还记不记得老师说为啥更prefer qd? |
|
a*****8
发帖数: 2115 | 12 I thought it is 25-50 mg/kd/day in divided doses every 12 hours.
if it is otitis media 80-90 mg/kd/day divided every 12 hours
400 mg bid seems ok to me for kid weight 36 lb. I thought beta-lactam
killing are time above MIC, so I would rather dose more frequently than big
dose once daily though. |
|
f****o
发帖数: 2770 | 13 手足口是viral, antibiotics没用的
strep pharyngitis不吃抗生素自己也会好的。。。 |
|
w***0
发帖数: 222 | 14 同意第一句。
Strep Throat 用抗生素是对付可能的并发症的，不是治疗Pharyngitis。 所以你所说
的错倒是也没错。 |
|
l******k
发帖数: 27533 | 15 ：（（
懒了，没查是viral or bacteria infection
strep throat还是要治疗的，特别是小孩儿，为了prevent complications
你记不记得诊断的方法：先是诊所里做rapid antigen test.如果成人是negative,就不
treat了，如果是小孩，要进一步做culture确认的 |
|
w***0
发帖数: 222 | 16 其实不是的。没有那么复杂。
如果一个药可用QD,又可以用BID,在理论上两种方法有效药物浓度是可以维持的。不排
除个体差异的话。剩下的就是毒性问题。这种Strep Throat 的治疗，如果药物可以用
QD，大多药物 没有太多的副作用，安全度比较高。从临床上来说，QD 对孩子比较容易
。没有那么多的考虑。方便有效是主要的。
my
there' |
|
w***0
发帖数: 222 | 17 看了原帖。
这是这Poor Kid 得的： 他得是 手足口病。同时是 Strep 的携带者。 大约有 20%-30
% 的人是携带者。做 Rapid Strep 或Culture 会阳性。
这里有一个问题，一般三岁以下的孩子，得strep Throat 的比较少。通常是携带。
现在我们多Strep 阳性 实际上是 过度使用抗菌素。但也是情理中。
他的药物问题是这样的：如果使用Amoxil治疗Strep Throat ， 没有 QD 的 使
用建议。是 BID 或 TID 。使用剂量是 ２５－５０ ｍｇ／ｋｇ／２４ｈ． 分
两次 或三次。他是 ３６磅。合１４ 公斤。 大约日剂量是 ７００－８００ MG
。 这样他要两个ｔｓｐ （５ｍｌ／ｔｓｐ）每天。分两次的话，要一次一个Tsp.如
果是治疗中耳炎，剂量是 ８０－９０ MG/KG/24h
以下是UptoDate摘要：
DOSING: PEDIATRIC
(For additional information see "Amoxicillin: Pediatric drug information")
Usual dosage range:... 阅读全帖 |
|
l******k
发帖数: 27533 | 18 大家围绕这个case多讨论讨论挺好的，相互share ideas, 也算是课外不错的learning
process吧：）
理论来说，BID还是比QD能cover更多的时间above MIC的
one time large dose对beta lactams确实不常见
不过你说的easy dosing for kids是个很好的理由：） |
|
l******k
发帖数: 27533 | 19 uptodate是啥？
你们经常用这个做reference吗？好用不?
有时间我到想看看IDSA上怎么说的。。。
30
MG |
|
w***0
发帖数: 222 | 20 99.99% physicians will use Uptodate, once a while, in their life.
almost all the hospital library, college has subscription access.
www. Uptodate.com
普通人用也能受益。 |
|
w***0
发帖数: 222 | 21 MIC 是实验室的。临床用的是stead STATe， 介乎于最高浓度和最低浓度之间的一个范
围。通常是3-4个半衰期的药物以后就能达到的。是临床药理学的一部分。
确定是否QD 或 BID,或 TID 是根据半衰期 和 Steady State 的结果定的。
如果两者都能达到Steady State 同样话，你考虑的就是Pulse 峰浓度，因为再上线就
是毒性浓度。
这些是基本药理学里应当提到的。临床上以方便安全第一。
learning |
|
l******k
发帖数: 27533 | 22 。。。
我们在说ABX的MIC
dosing frequency for time dependent or concentration dependent ABX
这正是ABX跟其他一般药不同的地方，不是单看一般药代学的AUC或者SS。。。
还有，至少5个半衰期才能达到SS
对了，其实100%的physician用google的 |
|
a*****8
发帖数: 2115 | 23 Up to date drug information is copy from Lexi-comp
I don't think IDSA has treatment for strep throat though. |
|
l******k
发帖数: 27533 | 24 是的， 你说的没错
Keflex是500 mg，给qid也不会有啥伤害，但想找到最合理的regimen for best
practice嘛，这就比较time consuming了，周末我们的ID pharmacist 不在，我有一
堆ED的作业，所以来问问
用aztreonam是为了pseudomonas，这个case的问题是septic shock pt到底该用fast
killer 还是slow killer
Cross reaction 我查到的是1% for both，但是again,是基于理论，review，和一些
retrospective 的data，想问问是否我的research不够，有更好的evidence我没找到
★ 发自iPhone App: ChineseWeb 8.6 |
|
c*******n
发帖数: 1214 | 25 Can patient try another ACEI?
If patient has BP 160/56, high systolic and low diastolic blood pressure,
what will be the treatment regimen? |
|
c*******n
发帖数: 1214 | 26 Can patient try another ACEI?
If patient has BP 160/56, high systolic and low diastolic blood pressure,
what will be the treatment regimen? |
|
I****a
发帖数: 407 | 27 There is nothing wrong to go for surgery now. The treatment after that
depends on what they find during the surgery. If she has high risk disease
then adjuvant chemotherapy would be recommended, a regimen containing either
Taxol or Texetere would be better given her lack of response with CEF. |
|
y******a
发帖数: 590 | 28 来自主题: Medicalpractice版 - 结核抗体阳性 不是专家，也不是感染科的。你说的抗体检测是指quantiferon gold test么？这是
interferon gamma release assay in response to TB specific antigen. It is a
very specific test. So I think you do have latent TB. I was told during my
residency that after 9 months of INH, the risk of reactivation of latent TB
can be reduced from 10% to 1%. I've never looked into literature to
confirm whether it's true or not. The risk also depends on other factors,
whether you are immune suppressed or not, etc. BTW, there is a new
treatment r... 阅读全帖 |
|
s******v
发帖数: 477 | 29 Had the class today. I'd like to share with you the top ten list of DO's and
DON'Ts. I may update later when I have more time.
DO...
1.Know how to properly decribe skin lesions and eruptions
2.Pick faorite generic low, medium and high potency topical steroids for
appropriate usage
3.Understand how to prescibe topical retinoids
4.Recommend sun protection to all rosacea patients, and educate on other
triggers
5.Reommend a consistent home therapy regimen to all wart patients
6. Discuss daily skin c... 阅读全帖 |
|
s*****e
发帖数: 404 | 30 Does he have known metastasis? If it is locally advanced tumor which is
unresectable, the strategy is systemic chemotherapy +/- radiology with the
goal of shrink the tumor and make it resectable. If it is metastatic disease
, the main treatment is systemic chemotherapy for palliation. If he has
very good performance status, use FOLFIRINOX; with OK performance status,
use gemicitabine based chemo regimens. If he has poor performance status,
recommend t focus on comfort care and no chemotherapy. ... 阅读全帖 |
|
L****n
发帖数: 12932 | 31 This is quickly becoming a board question.:-)
Intrathecal duramorph would not be first line choice of course. In a severe
post op pain patient who is allergic to morphine, has adverse reaction to
dilaudid, contraindicated to epidural, we have to take in the consideration
that true morphine allergy is extremely rare, vase majority comes from
preservative element in the regular morphine preparation. Placement of the
intrathecal injection is obviously done at the peri-operative area where
proper mo... 阅读全帖 |
|
a*********d
发帖数: 2763 | 32 case 3
A 30-year-old man sees his primary care physician for routine follow-up and
is documented to have a serum calcium concentration of 12.9 mg/dL. He is
admitted to the hospital directly from the clinic for further evaluation and
treatment. The patient states that he has a 5-year history of sarcoidosis,
but admits to nonadherence to his follow-up care and treatment regimen. He
had 1 episode of nephrolithiasis approximately 1 year ago and was told that
his kidneys are “abnormal.” Before admiss... 阅读全帖 |
|
s**********t
发帖数: 680 | 33 J Drugs Dermatol. 2012 Mar;11(3):357-64.
Treatment of scabies using 8% and 10% topical sulfur ointment in different
regimens of application.
Pediatric Clinics of North America
Volume 56, Issue 6, December 2009, Pages 1421–1440
Skin Disorders, Including Pyoderma, Scabies, and Tinea Infections
My email is b************[email protected]
Thanks! |
|
yf
发帖数: 272 | 34 It's unfortunate that such a young man is facing serious cancer problem. As
a oncologist, I am here to give my two cents though I haven't seen the
patient yet.
First: What is the type of lung cancer and what stage? This is very
important. If patient has stage four squamous cell carcinoma. There are
limited chemotherapy options. The chemo agent that can be used are Cisplatin
or carboplatin in combination with paclitaxol or Gemcitabine. Some old
regimens such as vinorelbine can be used too. Second... 阅读全帖 |
|
h*******r
发帖数: 182 | 35 来自主题: Medicalpractice版 - 求救！ AFP results:
10/6/14 10/13/14 10/20/14 11/10/14 11/17/14 12/1/14 12/8/14
2843.0 1783.7 905.5 221.5 267.1 823.9 2730.0
chest/abd/pelvic CT with contrast 12/1/14:
Impression:
1.New and enlarging liver metastasis.
2.Improving disease within the mediastinum.
3.Residual left upper lobe opacity may represent improving atelectasis.
4.Splenomegaly.
CMP: 12/8/14
AST/ALT 47/27
BUN/Cr 7/0.5
其中一个药是dexamethasone 4 MG tablet
Instructions: Take 8mg (2x4mg tablets) by m... 阅读全帖 |
|
d******g
发帖数: 258 | 36 Difficult case to discuss and to seek suggestions, please help!
15yo female with recent dx AML-M1 s/p DAE chemo in 8/15, twice IAE chemo in
9/15, BM biopsy noted for CR. Patient had fever, abd pain, and black stool
during the immune suppression state from the first chemo, improved after
antibiotics. All symptoms recurred with the last chemo and not responding
well to antibiotic, transferred to tertiary hospital after 40days treatment.
Ruled out intracranial infection, found to have multiple live... 阅读全帖 |
|
e******e
发帖数: 118 | 37 I have seen a similar case, mid age Asian female w AML, s/p induction in
remission but could not complete consolidation chemo due to many liver
lesions- abscess per image study, multiple biopsy and cultures but not
revealing, treated w many antibiotics and antifungal. don't remember if she'
s febrile then. Eventually discharged home w po antibx, observe for AML and
images to follow up liver change. had a discussion with one of the ID
attending at MDACC who thought the liver lesion might be autoi... 阅读全帖 |
|
i*********5
发帖数: 19210 | 38 Her bio:
http://lisabentley.com/bio/
Bentley had been diagnosed with CF but decided that it wouldn’t get the
best of her. She was determined to have a healthy and successful career as
an athlete. Her intense training commitment of 25 to 30 hours each week,
strict health regimen and steely determination have paid off.
In 2006, Bentley finished third at the Hawaii Ironman World Championships
and three weeks later finished second at the 70.3 World Championships in
Florida.
2007 was a tough year, pl... 阅读全帖 |
|
i*********5
发帖数: 19210 | 39 Reid Coolsaet 是加拿大当前最快的长跑运动员，他昨天赢了多伦多10K (28:35.7)，
今年还要代表加拿大去伦敦奥运会跑马拉松，下面是他的采访：
Given his running regimen, Coolsaet says he could basically “eat anything”
he wanted and still keep his rake-thin physique.
But at least 3,000 of the calories on his daily menu would pass Canada Food
Guide muster.
“I eat a lot of food, but I try to make the bulk of it your vegetables,
fruit, whole grain and meats,” he says. “I’m pretty big on cooking my own
meals and not ordering out and doing frozen meals and crap ... 阅读全帖 |
|
g**********r
发帖数: 1654 | 40 On behalf of serendip. I also read this article a couple of days ago. When I
read it, I cannot stop thinking about 版大. =D
------------------------------------------------------------------------
Stripping Down
by Chrissie Wellington
http://www.chrissiewellington.org/blog/stripping-down/
I first wrote this blog for 220 Magazine, but thought i would share it with
those not fortunate enough to be able to get their hands on copies of this
wonderful publication
So yes…..i wanted to say a few words ab... 阅读全帖 |
|
w****w
发帖数: 14828 | 41 分享一些狂犬病RABIES的信息，以供大家日后遇上意外情况时应对。
如地图所示，美国加拿大澳洲西欧这些国家都属于Category 2: low risk.新西兰
则没有狂犬病风险。
http://www.who-rabies-bulletin.org/travel/recommendations.aspx
The map shows the WHO categories of risk, from no risk (rabies-free)
countries or areas to countries or areas of low, medium and high risk (dog
rabies). Categorization is based primarily on the animal host species in
which the rabies virus is maintained in a country or area, e.g. bats and/or
other wildlife and/or dogs and on the availability of... 阅读全帖 |
|
z*****n
发帖数: 444 | 42 FDA approves Eli Lilly's Trulicity to treat type 2 diabetes.
For Immediate Release
September 18, 2014
Release
The U.S. Food and Drug Administration today approved Trulicity (dulaglutide)
, a once-weekly subcutaneous injection to improve glycemic control (blood
sugar levels), along with diet and exercise, in adults with type 2 diabetes.
Type 2 diabetes affects about 26 million people and accounts for more than
90 percent of diabetes cases diagnosed in the United States. Over time, high
blood suga... 阅读全帖 |
|
|
w*******y
发帖数: 60932 | 44 About this item
Beauty Bar and Hautelook are pleased to offer you a $40 e-certificate to be
enjoyed at BeautyBar.com for only $20. Enjoy browsing Beauty Bar's "virtual
boutique" of the best and premium beauty brands. Fall in love with a new
lipstick shade, pick out the perfect gift, or create the ultimate skin care
(head to toe) regimen with luxe items as you discover the latest and
greatest creations to hit the beauty world.
Additional information
HauteLook will email confirmation and e-certifi... 阅读全帖 |
|
w*******y
发帖数: 60932 | 45 For those of you who have been looking for the top of the line Powertap SL+,
this retails at $1395! this is a screaming deal for the capability it gives
you if you're a pro or training for a race, criterium, etc. This also comes
completely built on a rear wheel of your choice (the standard wheel is free
and does not change the cost). At $695 this will not last once word gets
out.
Link:
http://www.neuvationcycling.com/product329.html
For those of you who don't know what a Powertap is, please do r... 阅读全帖 |
|
w*******y
发帖数: 60932 | 46 NIKE Training Club:
http://itunes.apple.com/us/app/nike-training-club/id301521403?m
FREE
Description
Nike Training Club is a training app that gives you your own personal
trainer, anytime, anywhere. Get lean, toned and strong with over 60 custom-
built workouts, including new training regimens from five professional
athletes, while you earn NTC reward workouts from Lea Michele and Rihanna's
personal trainer, Ary Nu馿z.
Inspired by world-class athletes and developed by Nike professional trainers
,... 阅读全帖 |
|
|
|
