u***e
发帖数: 611 | 1 Rivaroxaban通过FDA了吗，dabigatran好像刚刚通过，但还没看到有人用的，pharmacy
都没有。 |
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s***x
发帖数: 1 | 4 Life's Simple 7 has really stringent criteria for BP and FG. FG<100? It's
lucky if I can get most of my patient's
FG to be <200. It's not really surprising that few people can reach this.
The diet order is also very hard to
execute. I'm not surprised the relatively poor Northern Manhattan hispanic
population aren't able to do it. |
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d****x
发帖数: 22 | 5 Springstep以后有机会也领导一个“辣椒素和心血管
疾病的关系”这样的临床大规模、随机、双盲、前瞻、对照的国际多中心协作试验——
吃重庆火锅的人群，心血管疾病的发生率似乎比同龄的北方人更低些，——自然，买买
提MD版和老刀版的XDJM都需要在分配在“重庆火锅组”，Dr. Newbie（Xiaoxiao）不听
我的话，我要下命令把你分到对照组！ |
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s*******d
发帖数: 1079 | 6 哈哈，超级赞！
明日新星，谁与争锋？----且看麦地春医生!!！ |
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s*******w
发帖数: 1879 | 8 这几天疯狂看clotting cascade的人很大鸭梨的飘过。 |
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s********p
发帖数: 1319 | 9 又换ID啦?!
Thanksgiving好!
"大鸭梨"什么意思?! |
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s*******w
发帖数: 1879 | 11 没有啊。就是换张照片呗。
这张照片像我本人啊。黑框+丸子头。
看到的时候就笑起来了。
很大鸭梨=很大压力 |
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l********y
发帖数: 2295 | 12 这个step1和step2都很爱考，希望自己考试的时候还能记住：
induction of P-450: 这个大家都知道吧，不知道的面壁。
Queen Barb Refuse Phen Sit Gray Car.
Inhibition of P-450: 不知道的面壁。
Inhibitors Stop Crying Kids from Eating Grapefruit.
Metabolsim by P-450:
话说阿Q被大赦，幸运的娶了茶宝宝，可是还是三天两头的吵架，pony就劝他别吵啦，
拍拍MP气就消了，就被450给代谢啦。
阿Q（AQ），No War,Please MP 茶 BB。
A:amide anesthetics
Q: quinidine
N: nifedipine
War: warfarin
P：Phenytoin
M: metoprolol
P: propranolol
茶：theophylline
B: benzodiazepines
B: barrbiturates |
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e******e
发帖数: 364 | 13 1. A 76-year-old woman is admitted to the hospital after a fall at her home
earlier in the day. She has been followed in your practice for several years
and is in generally good health. She drinks socially, does not smoke and
has been active in senior citizen groups. She takes ibuprofen occasionally
for pain, but no other medications. On admission she is alert and oriented,
and complains only of pain in her left leg. Her temperature is 36.1°C (97.0
°F), pulse is 72/min and regular, and blood pre... 阅读全帖 |
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l******g
发帖数: 278 | 14 Three days after undergoing colectomy for colon cancer, a 77-year-old
woman has the sudden onset of severe shortness of breath. She says she
cannot catch her breath. Current medications include subcutaneous heparin
and patient-controlled morphine. Her temperature is 37°C (98.6°F), pulse
is 140/min, respirations are 28/min, and blood pressure is 110/60 mm Hg.
Pulse oximetry on room air shows an oxygen saturation of 89%. Breath sounds
are decreased on the right. Abdominal examination shows an ... 阅读全帖 |
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H*****1
发帖数: 41 | 15 a 72-year-old female is brought to the ER with severe shortness of breath,
tachypnea and pleuritic-type chest pain. she had a similar episode 2 months
ago and has been treated with warfarin since the. she says that she has been
compliant with her medications. her PT is found to be sub-therapeutic.
which of the following concurrent medications is most likely taking?
a) aspirin
b) phenylbutazone
c) oxycodone
d) acetaminophen
e) metronidazole
f) cimetidine
g) phenytoin
h) amiodarone
i) diazepam
ans... 阅读全帖 |
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S******9
发帖数: 2837 | 16 药物合用导致的药物间作用，amiodarone+ warfarin。房颤的治疗 |
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m******r
发帖数: 1904 | 17 ☆─────────────────────────────────────☆
eyetoeye (望眼欲穿) 于 (Mon May 14 16:37:04 2012, 美东) 提到:
1. A 76-year-old woman is admitted to the hospital after a fall at her home
earlier in the day. She has been followed in your practice for several years
and is in generally good health. She drinks socially, does not smoke and
has been active in senior citizen groups. She takes ibuprofen occasionally
for pain, but no other medications. On admission she is alert and oriented,
and complains only of pai... 阅读全帖 |
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j**********0
发帖数: 391 | 18 treatment of DVT is warfarin, not aspirin. while Aspirin is used to prevent
heart attack. Both disease are caused be thrombi, why treatment is different
? Thanks. |
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f*******l
发帖数: 606 | 19 Warfarin is blocking the synthesis of VitK dependent clotting factors. Used
to prevent deep venous thrombosis. It takes few days to demonstrate effect.
When Pt has acute chest syndrome, aspirin and heparin are used to stop the
further development of preexisting clots. |
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m*****e
发帖数: 42 | 20 Which medicine should be used for brain ischemia stroke prevention? Aspirin
or warfarin? |
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J*********4
发帖数: 1274 | 21 非常感谢Victor的精彩讲演。真正的大牛是非常努力和Humble的。
赞一下Suzi 记得这么详细。
Victor 讲了他CrossCover别的Co-intern时，体检发现病人有新出现的瘀斑和下降的H&
H，联系病人的肚子痛和Warfarin，考虑到腹腔出血的可能，CT证实是有个2L的大血肿
，救了病人一命。 这些都提醒大家要注意病人的Daily变化和体检，作为Intern一定要
牢牢掌握住Every Detail about Patients, 因为我们的职业关系到人的生死。
再次谢谢Victor！ |
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发帖数: 1 | 23 国内没有DVT Prophylaxis那是因为中国人出现血栓的风险要比白人，黑人小很多，东
亚人种血栓的机会相对其他种族都要小。几年前日本的一个研究发现warfarin INR对日
本人最好控制在1.8左右，高了增加出血风险，不增加抗凝效益。
国内规范性可能是要差一些，但很多做法都是在实践中摸索的相对有效的做法，如果
DVT风险像其他种族那么高，早就会做DVT Prophylaxis。有人会说这种摸索的做法很不
科学，不是循证医学，但你要想到即使美国的guideline几年都会有很大的变化，甚至
完全相反的做法，连美国医生觉得莫名奇妙。所以大家都是摸索，方法略有不同而已。
很不赞成有人在这做了几年住院医生训练就觉得自己可以教训国内的同行了，只能说明
你眼界还是太低。抱歉措辞有些激烈，只是老看到有这种心态的人，所以忍不住跳出来
说说。 |
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m*****a
发帖数: 2160 | 24 没关系
我也挺希望多了解国内实践不同的地方背后的依据的，感谢科普
虽然个人对国内至少内科的不少做法仍然持保留意见，除DVT prophylaxis外
可以问下你是哪个speciality的吗？如果你不介意我可能会请教你其他国内的问题
[在 neutrophil99 () 的大作中提到：]
:国内没有DVT Prophylaxis那是因为中国人出现血栓的风险要比白人，黑人小很多，东
:亚人种血栓的机会相对其他种族都要小。几年前日本的一个研究发现warfarin INR对
日本人最好控制在1.8左右，高了增加出血风险，不增加抗凝效益。
:国内规范性可能是要差一些，但很多做法都是在实践中摸索的相对有效的做法，如果
:DVT风险像其他种族那么高，早就会做DVT Prophylaxis。有人会说这种摸索的做法很
不科学，不是循证医学，但你要想到即使美国的guideline几年都会有很大的变化，甚至
:完全相反的做法，连美国医生觉得莫名奇妙。所以大家都是摸索，方法略有不同而已
。很不赞成有人在这做了几年住院医生训练就觉得自己可以教训国内的同行了，只能说
明你眼界还是太低。抱歉措辞有些激烈，只是老... 阅读全帖 |
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y******7
发帖数: 17 | 25 The following is what I collected when I was a student doing capstone in a
local hospital. Not sure if it is useful.
Lidocaine topical is a amide-type local anesthetic. for production of
topical anesthesia, relief of pain associated with postherpetic neuralgia,
reduction of gagging during dental procedures, prevention and control of
urethral pain, anesthetic lubricant for endotracheal intubation, and relief
of hemorrhoidal pain.
Polyethylene glycol(Miralax) is a nonabsorbed solution used to trea... 阅读全帖 |
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l********8
发帖数: 491 | 26 You don't appreciate a pharamist's job does not mean it is not important. A
Rph is working behind the counter, to ensure that you are getting the right
med, at the right dose and help you to take it correctly. I don't think you
can take warfarin which is a potent blood thinner dispensed by a high school grad(
technician) at a much higher dose without verifying with the MD and the patient ended up bleed to death, just because they cant' read the MD's hand writing. When
working with my colleaques |
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j*********3
发帖数: 12 | 28 1. Aricept has been used very common in u.s.for elderly to improve memory.
It is a Rx medication, but most insurances cover it.
2. For over the counter products, Ginkgo has been used a lot to help memory
improvement, but some people say it works, some not. It is a common
misunderstanding that herb products are not drugs, therefore, they are safe
to take. Since Ginkgo interacts with a lot of medications : blood thinners (
e.g., warfarin), aspirin, NSAIDs (e.g., ibuprofen, naproxen, ketoprofen),
t |
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u*****d
发帖数: 1009 | 29 Can't agree more. Just had something came up the other day, had a patient
whose blood glucose got to the 300's, the doctor was worried and decided to
give her a dose of lantus cuz he thought it was short-lasting, well, that
took a while to drop down the blood glucose
Another medical resident recently discharged a patient on both lovenox and
warfarin for 4 months, and pt's inr was already in the 3's when he was
getting discharged, but thank god the mistake was caught before he actually
left the h |
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c*******n
发帖数: 1214 | 30 Seemed that is just rumor. |
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w**r
发帖数: 479 | 31 我就考了一个dosing，所以我觉得dose不是重点，但是有很多关于formulation的题目
。drug interaction我记得考了几个，不多，我遇到到都是最基本的，记熟常见的
inhibitor和inducer，几个重点的药，像digoxin, warfarin, lithium, theophyllin
，triptan 类单独看一下也就差不多了。 |
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l******k
发帖数: 27533 | 32 你这是干嘛？
做research还是帮家人问疗法？
抛砖引玉，我没时间仔细查了
印象中是nitroglycerin/isosorbide and calcium channel blocker，beta blocker
来治疗coronary disease
NO是主要作用途径之一，是上面前两个药的代谢物，主要是vosadilation,扩张
coronary血管,让更多的血液能流入深层的心肌细胞，防止心肌缺血。。。
至于clots，严重的要手术，不手术用aspirin, clopidogrel, warfarin, heparin...
如果是MI，那有紧急破血块的药，不过要在一定时间内用才有效 |
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l******k
发帖数: 27533 | 33 是的，我回头看了下，那些对比试验确实是针对A.fib的
而且我也没有查新的chest
1月份我们还在讨论dabigatran的各种问题，没想到二月份chest就确定其地位，呵呵
MI这块我不说了，学了很久了，忘了不少，也没时间回头看
你们继续，我围观学习：）
indicated
atherosclerosis
plaque build up, different from the blood clot in DVT/PE. There are side
by
warfarin
in
patient with afib.
I
really don't know how easy INR routine monitoring is in China. At the
sometimes
it |
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l******k
发帖数: 27533 | 34 中风的预防可以用aspirin 325 mg
A.fib的问题可以用warfarin
我没有看出必须用pradaxa的必要，如果回国不方便买的话
大家的意见呢？
fiorio? wshr? rainflower?
还有潜水的高手们？ |
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l******k
发帖数: 27533 | 35 完全同意
我们的思路不同，但你的更严谨，哈哈
对stroke的预防，最近看到有文章总结说aggrenox更好。。。
A.fib已经证明了warfarin优于aspirin and clopidogrel，不过上次有牛人说pradaxa
更好 |
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f****o
发帖数: 2770 | 36 aggrenox is not for stroke prevention in AFibers
pradaxa reduce the stroke number just a little bit compare to warfarin, but
way more expensive, no follow up, no reversal agent... |
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l******k
发帖数: 27533 | 37 I follow an internal medicine doctor.
She specifically mentioned the importance of full strength aspirin to
prevent another stroke for stroke patient with low bleeding risk.
LZ's doctor also prescribed 325 mg aspirin.
I agree that aspirin and warfarin together highly increase bleeding risk.
But I don't see the high bleeding risk for LZ's case and the reason why
should not use full dose aspirin.
If you think long term use of the combination is not appropriate, what's
your recommendation on the du... 阅读全帖 |
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f****o
发帖数: 2770 | 38 Afib guideline不是either aspirin or warfarin没有说一起用么。。。
afib stroke prophylaxis和post-stroke management不同的啊。。。 |
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u*******s
发帖数: 688 | 39 我觉得hospital的工作比retail还是有意思一些。我在医院工作，看药剂师有专门在
floor上巡查的，有专门specialize某一个诊所的，有am care warfarin clinic的，有
在ER里做Med rec的。如果坐在电脑前，就是常规的verify orders,answer phones,等
等。医院经常组织开会，培训，各种项目，感觉工作内容很丰富多彩。药剂师也都很喜
欢自己的工作，每天大家上班都开开心心的。不过唯一就是晚班挺累的就是了。晚上只
有一个药剂师和一个tech，忙起来也是昏头转向的。医院能够应用的临床知识更多一些
，可能药剂师觉得自己的价值也更大。当然，我说的只应用于我的医院，别的医院工作
环境也许不一样。
我所工作的独立药房就更像连锁药房一样了。不过灵活多了，没那么多要达标的数量问
题，钱的问题也好说。我们药剂师都能坐下来的。 |
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l******k
发帖数: 27533 | 40 天天重复的事情，我实习了几周就boring了，呵呵
monitor renal, dose adjustment per renal function, change from IV to po,
antibiotic and warfarin monitoring and dosing, TPN...
最有挑战的还是医生一个电话来让你查文献，然后坐电话边等你来做review，太大压力了 |
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a*********8
发帖数: 296 | 42 我们step1讲的HIT的病人不要用warfarin因为容易引起skin necrosis，还有抗十因子
确实也用，想问问argatroban和hirudin就是单价双价什么区别？ |
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l******k
发帖数: 27533 | 43 Warfarin用没问题
引起skin necrosis机理是什么？rate是多少？
Argatroban 不是唯一选择，用这个是因为formulary
★ 发自iPhone App: ChineseWeb 8.6 |
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l******k
发帖数: 27533 | 44 谢谢分享
这是个observational 推理,没有很强的联系，所以不是contraindication
Monitoring necrosis/skin reaction是合理的
Rivaroxiban 也有这个risk吗？还是就是warfarin?
a
★ 发自iPhone App: ChineseWeb 8.6 |
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a*********8
发帖数: 296 | 45 我们step1讲的HIT的病人不要用warfarin因为容易引起skin necrosis，还有抗十因子
确实也用，想问问argatroban和hirudin就是单价双价什么区别？ |
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l******k
发帖数: 27533 | 46 Warfarin用没问题
引起skin necrosis机理是什么？rate是多少？
Argatroban 不是唯一选择，用这个是因为formulary
★ 发自iPhone App: ChineseWeb 8.6 |
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l******k
发帖数: 27533 | 47 谢谢分享
这是个observational 推理,没有很强的联系，所以不是contraindication
Monitoring necrosis/skin reaction是合理的
Rivaroxiban 也有这个risk吗？还是就是warfarin?
a
★ 发自iPhone App: ChineseWeb 8.6 |
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j******e
发帖数: 50 | 48 first month是在warfarin clinic, 现在感觉好喜欢，工作也很简单轻松，病人也很靠
谱，而且好像基本都不需要residency的。但就是不知道这种工作好不好找，或者以后
会不会被其它 newer blood thinner 替代然后就下岗？
大家来讨论讨论 |
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u*******s
发帖数: 688 | 49 这个房颤是阵发，还是持续?
1.先看看病人的CHA2DS2-VASc分数决定中风的风险，(>2就可以用anticoag),再根据肾
功能决定anticoag的选择和剂量。（warfarin, or dabigatran, apixaban, or
rivaroxaban）
2.rate control (resting <80) with beta blockers or non-dihydropydirine CCB。
这个病人只吃amiodarone，但是amiodarone的pk/pd比较难掌握，毒性比较难manage，
应该在别的药物都fail的情况下才考虑的。所以不应该第一时间就上amiodarone.
3.rhythm control要根据病人的心脏其他情况来选择，比如MI, CAD的状况。可以考虑
sotalol，但是要经常监控ECG。
amiodarone虽然是很有效的rhythm control，但是drug interaction和副作用等毒性很
多，有明显的qt prolongation,所以不是常用的第一选择。
还有就是2014年的指南中不再用aspirin了... 阅读全帖 |
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u***e
发帖数: 611 | 50 Just continue to use warfarin
？ |
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