星期二, 12月 16, 2008
星期日, 12月 14, 2008
Cravit 的使用注意
clipped from 140.112.125.992041. Cravit dosage in patients with renal insufficiency? |
Ccr 20-49 mL/min: LD 500mg, MD 250mg QD
Ccr 10-19 mL/min: LD 500mg, MD 250mg QOD
Ccr 10-19 mL/min: LD 500mg, MD 250mg QOD
| 929. Cravit在HD是否會被洗掉? |
Levofloxacin is not appreciably removed from the body during HD or peritoneal dialysis.
| 980. HEMODIALYSIS 的病人,細菌培養報告為綠膿桿菌,若使用Cravit 如何調整劑量? |
HEMODIALYSIS
For the treatment of Acute Bacterial Exacerbation, Chronic Bronchitis, Community Acquired Pneumonia, Acute Bacterial Sinusitis, Uncomplicated Skin and Skin Stricture Infection, in patients undergoing hemodialysis the initial dose of levofloxacin is 500 milligrams (mg) followed by 250 mg every 48 hours (Prod Info Levaquin(R), 2005).
For the treatment of Acute Bacterial Exacerbation, Chronic Bronchitis, Community Acquired Pneumonia, Acute Bacterial Sinusitis, Uncomplicated Skin and Skin Stricture Infection, in patients undergoing hemodialysis the initial dose of levofloxacin is 500 milligrams (mg) followed by 250 mg every 48 hours (Prod Info Levaquin(R), 2005).
| 1125. Cravit打開之後可放多久?(已用掉半瓶) |
3小時內要丟棄
| 1537. Cravit & Avelox oral form可否磨粉 |
可以,無特別規定
| 2514. 請問cravit F.C.的懷孕安全分級？ |
Cravit F.C(levofloxacin)屬於quinolone類之廣效抗生素，對於青少年期以前的動物使用，曾有發現導致軟骨生長異常的報告出現。因此盡量不要使用於青春期以前的孩童。然而對於胎兒的影響還不十分明確，動物試驗下並沒有出現致畸胎的報告，唯在高劑量下，可能導致胎兒體重降低及活動力變差，甚至死亡的情形。
| 48. Cravit是否會造成QT interval延長? |
Yes (QT interval prolongation has been reported rarely in post-marketing reports)
Get Clipmarks - The easiest way to email text, images and videos you find on the web.
使用 KCl 的注意事項
clipped from 140.112.125.99| 623. KCL 2 amp可否泡250 mL N/S |
若從peripheral line給予,則濃度需小於40mEq/L, 也就是2 amp 需至少泡1000mL; 若可從central line給予,則濃度需小於80mEq/L, 2amp 至少泡500 mL
| 1126. KCL solution的K含量? |
6.7mEq of K and Cl/10ml
| 818. 請問KCL Injection,Magnesium Sulfate Injection ,與Vitacal Injection 20ml/amp (Ca 0.27mEq/ml)或Calglon Injection 10% (Ca 0.465mEq/ml) 10ml/amp可否同時混合給藥? |
由於考量可能生成硫酸鈣沉澱，故不建議將硫酸鎂加入Vitacal或Calglon [CALCIUM GLUCONATE (incompatible with magnesium sulfate; conditions not specified) (Reynolds, 1989)；Sulfates (calcium chloride is incompatible with soluble sulfates; conditions not specified) (Trissel, 1988) ]。
其餘(KCL + Vitacal or Calglon), (KCL + Magnesium Sulfate)可混合同時給藥。
註:經詢問病房，通常之給藥方式為3 amp KCl+ 1 Amp Magnesium Sulfate in 500 mL N/S，屬 Compatible。
其餘(KCL + Vitacal or Calglon), (KCL + Magnesium Sulfate)可混合同時給藥。
註:經詢問病房，通常之給藥方式為3 amp KCl+ 1 Amp Magnesium Sulfate in 500 mL N/S，屬 Compatible。
| 1044. Potassium chloride + Magnesium sulfate + Calcium chloride可否加在一起給藥? |
Potassium chloride + Magnesium sulfate in N/S or D5W: compatible
but there's no information about Calcium chloride + Magnesium sulfate or Calcium chloride + KCl + MgSO4, 故不建議三者加在一起。
but there's no information about Calcium chloride + Magnesium sulfate or Calcium chloride + KCl + MgSO4, 故不建議三者加在一起。
| 1727. 病患需使用MgSO4及KCL但不需要補充太多液體 兩者可否加入同一大瓶點滴中(如台5)? 何種點滴較合適? |
MgSO4及KCL兩者可加入NS或D5W
| 1103. 請問Calcium gluconate, Magnesium sulfate, Potassium chloride可以一起加在Normal saline裡面嗎？ |
Potassium chloride + Magnesium sulfate in N/S: compatible
Potassium chloride + calcium gluconate in N/S: compatible
but there's no information about Calcium gluconate + Magnesium sulfate or Calcium gluconate + KCl + MgSO4, 故不建議三者加在一起。
Potassium chloride + calcium gluconate in N/S: compatible
but there's no information about Calcium gluconate + Magnesium sulfate or Calcium gluconate + KCl + MgSO4, 故不建議三者加在一起。
| 1645. AMINO k 可加入KCL INJ? |
不可
Y-SITE可
Y-SITE可
| 1074. KCL溶液味道不佳，請問可以與什麼飲料併服？ |
可與果汁併服，限鹽（鈉）患者避開蕃茄汁（鈉含量高）。REFER TO USPDI: For patients taking the liquid form of this medicine:
For patients taking the liquid form of this medicine--
This medicine must be diluted in at least one-half glass (4 ounces) of cold water or juice to reduce its possible stomach-irritating or laxative effect.
If you are on a salt (sodium)-restricted diet, check with your doctor before using tomato juice to dilute your medicine. Tomato juice has a high salt content.
For patients taking the liquid form of this medicine--
This medicine must be diluted in at least one-half glass (4 ounces) of cold water or juice to reduce its possible stomach-irritating or laxative effect.
If you are on a salt (sodium)-restricted diet, check with your doctor before using tomato juice to dilute your medicine. Tomato juice has a high salt content.
| 2222. 因為KCL必須稀釋才能喝小朋友才出生一週除了牛奶尚未開始喝其他飲料, KCL soln可不可以加在牛奶裡面一起喝? |
不建議, 怕KCL影響牛奶的味道, 小朋友連牛奶都不喜歡喝, 建議加一些開水稀釋KCL與牛奶分開餵比較好
Get Clipmarks - The easiest way to email text, images and videos you find on the web.
用 clopidogrel 的注意事項
clipped from 140.112.125.99plavix R是什麼樣的藥?在中樞神經系統方面有什麼副作用?如果發生中樞神經系統方面副作用該怎麼辦?
plavix學名為clopidogrel，是血小板凝集抑制劑。 中樞神經系統方面的副作用有：headache(7.6%) dizziness(6.2%),depression(3.6%),fatigue(3.3%) 由於剛使用plavix,如有上述副作用，請在按時服藥一陣子，看情況是否緩解，如副作用仍持續，請與醫師聯絡。
| 621. PLAVIX 的健保藥品給付規定有哪些？ |
PLAVIX 的健保藥品給付規定：
2.1. 抗血小板劑 Antiplatelet agents
2.1.7 clopidogrel (如Plavix 75mg)：
1. 限曾發生中風、心肌梗塞或週邊動脈血管疾病的粥狀動脈硬化病人，並符合下列條件之一者使用。
(1) 對acetylsalicylic acid (如Aspirin) 過敏。
(2) 臨床診斷確定為acetylsalicylic acid (如Aspirin) 所導致之消化性潰瘍或上消化道出血、穿孔病史者。須於病歷註明發生時間。
(3) 最近一年內臨床診斷確定為消化性潰瘍者。病歷上應有 明確消化性潰瘍之典型症狀紀錄及發病時間。
(4) 最近一年內經上消化道內視鏡檢查或上消化道X光攝影檢查證實消化性潰瘍或發生上消化道出血、穿孔病史。須於病歷註明上消化道內視鏡或上消化道X光攝影檢查時間。但對acetylsalicylic acid無法耐受，且身體狀況無法忍受內視鏡或消化道x光攝影檢查者(如中風、心肌梗塞之高齡患者或長期臥床等患者)不在此限。
2. 經介入性支架置放術時及治療後3個月內得與acetylsalicylic acid (如aspirin)合併使用。須於病歷註明介入性支架置放手術之日期。
3. 用於已發作之非ST段上升之急性冠心症(不穩定性心絞痛和非Q波型心肌梗塞) 而住院的病人時，得與acetylsalicylic acid (如aspirin) 合併治療，最長9個月。須於病歷註明住院時間
2.1. 抗血小板劑 Antiplatelet agents
2.1.7 clopidogrel (如Plavix 75mg)：
1. 限曾發生中風、心肌梗塞或週邊動脈血管疾病的粥狀動脈硬化病人，並符合下列條件之一者使用。
(1) 對acetylsalicylic acid (如Aspirin) 過敏。
(2) 臨床診斷確定為acetylsalicylic acid (如Aspirin) 所導致之消化性潰瘍或上消化道出血、穿孔病史者。須於病歷註明發生時間。
(3) 最近一年內臨床診斷確定為消化性潰瘍者。病歷上應有 明確消化性潰瘍之典型症狀紀錄及發病時間。
(4) 最近一年內經上消化道內視鏡檢查或上消化道X光攝影檢查證實消化性潰瘍或發生上消化道出血、穿孔病史。須於病歷註明上消化道內視鏡或上消化道X光攝影檢查時間。但對acetylsalicylic acid無法耐受，且身體狀況無法忍受內視鏡或消化道x光攝影檢查者(如中風、心肌梗塞之高齡患者或長期臥床等患者)不在此限。
2. 經介入性支架置放術時及治療後3個月內得與acetylsalicylic acid (如aspirin)合併使用。須於病歷註明介入性支架置放手術之日期。
3. 用於已發作之非ST段上升之急性冠心症(不穩定性心絞痛和非Q波型心肌梗塞) 而住院的病人時，得與acetylsalicylic acid (如aspirin) 合併治療，最長9個月。須於病歷註明住院時間
請問我太太的用藥中，有哪些會影響到血中的鈉離子和鉀離子？ 92.6.25. 神經科門診 Rilutek (riluzole), MGO, Plavix (clopidogrel), Zoloft (sertraline), Xanax (alprazolam), Dilatrend (carvedilol).
經查USP DI ： Riluzole有hypokalemia, hyponatremia的報告。 Sertraline有hyponatremia的報告。 請再進一步和醫師討論。
| 2483. 請問下列報導是否屬實：在Circulation, 有關新發現的藥物交互作用:Lipitor---降血脂劑 (輝瑞)及Plavix---抗凝血劑(賽諾菲). Plavix的成份,clopidogrel, 是prodrug, 須經過代謝後才有活性; 雖然在人體尚不確定活化Plavix的酵素為何,但透過試驗觀察到Lipitor與Plavix的合併使用,會有藥物交互作用發生, 則預期Plavix是透過 CYP450 3A4活化 |
依所提供的資訊查詢Medline後，發現只有一篇文獻報導與您所附上的文章相同。(Circulation. 2003;10732-37) 我認為需要更多文獻來之支持此篇文章的結論。 在結果明確之前，建議使用Plavix (clopidogrel)時，如需併用會影響Cytochrome P450 3A4功能的藥物時，需小心監測血小板的功能。 另外此篇文章建議使用Plavix時，如併用Lipitor (atorvastatin) 或其他的lipophilic statin需由低劑量開始，或改用代謝途徑和其他statin類較為不同的pravastatin。並不建議在Plavix治療結束後再使用statin類，因為冠心病病人高血脂需要積極的治療，不能延遲。也不建議使用ticlopidine取代clopidogrel，因為clopidogrel的副作用較少且一天只需服用一次。
| 2562. 患者因為看了許多不同科別的門診，醫師處方了indapamide，irbesartan，clopidogrel，aspirin，simethicone，alendronate，Bio-cal，celecoxib，cetirizine，buclizine，alprazolam(台大醫院)，nabumetone，paroxetine，prochlorperazine，valproate(國泰醫院)。請問這些用藥一起服用會不會有不良反應？ |
基本上並無立即會出現的藥品交互作用，但是aspirin或clopidogrel與消炎止痛藥一起併用需注意有無消化道方面的副作用(如腸胃不適或出血徵兆)，而且不同醫院領取了celecoxib與nabumetone僅需使用一項即可；此外alendronate須在早餐前30分鐘服用，吃藥時需併服一大杯白開水，最好能站立約5分鐘，以避免對食道壁產生副作用，其餘用藥則依藥袋上之指示服用，回診時亦應讓醫師了解併用的所有藥品，以作為開方時的參考。
| 1464. Clopidogrel是否會引起腹瀉? |
Diarrhea has been reported with clopidogrel use in 4.5% of patients.
| 1520. 病患使用plavix若要進行手術須於手術前多久停藥 |
依據micromedex資料
Clopidogrel may increase the risk of serious bleeding during an operation or some kinds of dental work. Therefore, treatment may have to be stopped about 7 days before the operation or dental work is done.
Clopidogrel may increase the risk of serious bleeding during an operation or some kinds of dental work. Therefore, treatment may have to be stopped about 7 days before the operation or dental work is done.
| 2083. ticlopidine和plavix 一 樣嗎? |
different,ticlopidine 商品名是 licodin, 本院有250mg tablet, Plavix 為 clopidogrel 75mg/tab 1
Get Clipmarks - The easiest way to email text, images and videos you find on the web.
使用Levophed 的注意事項
clipped from 140.112.125.99| 29. Levophed應從何處給藥? |
應注射於大靜脈
Ref: Micromedex
| 55. Levophed in D5W與N/S, 可否用3-way同時滴注? |
Dextrose content provides protection against oxidation of norepinephrine, dextrose containing solutions are recommended. Dextrose in saline solutions can also be used.
因此與N/S可以由3-way 給藥
因此與N/S可以由3-way 給藥
Ref: MicromedexDrug information handbook
| 53. Dopamine, Levophed及Adrenaline可否與鹼性溶液加在一起? |
均不可與鹼性溶液加在一起
Ref: MicromedexAHFS
| 2410. Levophed 可否用NS稀釋? |
Levophed dilute solution:D5W or D5W in NS, do not use NS alone.
Ref: 台大醫院注射劑給藥指引
| 2571. 請問處方集中Levophed 0.2% (0.1% BASE)，其中的BASE是什麼意思呢？ |
Base代表不含鹽類的部份，Levophed含norepinephrine bitartrate，norepinephrine bitartrate濃度為0.2 %，norepinephrine base濃度為0.1%。
Ref: 仿單
Get Clipmarks - The easiest way to email text, images and videos you find on the web.
星期四, 12月 11, 2008
Right Upper Quadrant Pain and a Normal Abdominal Ultrasound
clipped from www.medscape.comFrom Clinical Gastroenterology and Hepatology
Right Upper Quadrant Pain and a Normal Abdominal Ultrasound
Posted 12/02/2008
Furqaan Ahmed; Evan L. Fogel
Author Information
Information from Industry
Learn about a new approach to treating fibromyalgia
Watch this Webcast featuring Dr. Michael R. Clark, Director, Adolf Meyer Chronic Pain Treatment Programs.
View now
Watch this Webcast featuring Dr. Michael R. Clark, Director, Adolf Meyer Chronic Pain Treatment Programs.
View now
Clin Gastroenterol Hepatol. 2008;6(11):1198-1201. ©2008 AGA Institute
Clinical Scenario and the Problem
Clinical Scenario
A 30-year-old woman is referred for evaluation of a 1-year history of intermittent, debilitating, postprandial right upper quadrant pain associated with nausea and occasional vomiting. The pain can last from 30 minutes to 2 hours, often radiates to the upper back between the shoulder blades, and is not associated with bowel movements or exercise. The patient denies a history of weight loss, fever, chills, change in urine or stool color, or jaundice. She denies significant alcohol use. Trials of antacids, proton pump inhibitors, and antispasmodics have not been helpful. At times the pain has been severe enough to interrupt her daily activities. The patient recently presented to her local emergency department during an episode of pain. Blood work drawn in the emergency department included alanine aminotransferase 23 U/L (normal, 0–45 U/L), aspartate aminotransferase 29 U/L (normal, 15–41 U/L), alkaline phosphatase 86 U/L (normal, 25–125 U/L), bilirubin 0.6 mg/dL (normal, 0–1 mg/dL), amylase 101 U/L (normal, 25–161 U/L), and lipase 162 U/L (normal, 40–240 U/L). The patient reports that liver chemistries and amylase and lipase levels have been persistently normal during previous episodes of abdominal pain. A right upper quadrant ultrasound reveals a normal-appearing gallbladder without gallbladder wall thickening or gallstones. The intrahepatic and extrahepatic bile ducts are not dilated. The liver and limited views of the pancreas are also unremarkable. The patient underwent an esophagogastroduodenoscopy (EGD) 1 month ago that was normal.
What is the most likely cause for this patient's symptoms? What is the next step in the diagnostic evaluation of this patient?
The Problem
The right upper quadrant pain in this patient is suggestive of biliary origin. However, this pain syndrome accompanied by a normal gallbladder ultrasound and normal liver function tests suggests subtle acalculous gallbladder disease. When such patients are encountered, other causes for right upper quadrant pain need to be considered and reasonably excluded. These include peptic ulcer disease, choledocholithiasis and microlithiasis, pancreatobiliary neoplasia, irritable bowel syndrome, and musculoskeletal pain. Type III sphincter of Oddi dysfunction (SOD) is also in the differential diagnosis, but because of the risks of endoscopic retrograde cholangiopancreatography (ERCP), gallbladder evaluation is usually undertaken first. Peptic ulcer disease can be diagnosed with EGD. Although ultrasound and magnetic resonance cholangiopancreatography (MRCP) have relatively high sensitivity rates for the detection of common bile duct stones, small stones and microlithiasis might be missed. Endoscopic ultrasound and microscopic bile examination for microlithiasis might be useful in a subset of these patients.
The pathophysiology of acalculous gallbladder pain is not well-understood. Theories that have been proposed include those that implicate gallbladder outlet obstruction, those that point to a primary disorder of gallbladder motility, and those that implicate visceral hypersensitivity. Lack of coordination between gallbladder contraction and contractions of the sphincter of Oddi or relative cystic duct narrowing might cause functional gallbladder obstruction. Abnormal gallbladder motility might occur because of entrapment of supersaturated cholesterol crystals in the gallbladder wall, impaired response to cholecystokinin (CCK), or intrinsic defects in the gallbladder musculature. Visceral hypersensitivity might play a role in acalculous biliary pain (biliary dyskinesia) analogous to that in other functional disorders of the gastrointestinal tract.
The most prominent symptom of biliary dyskinesia is right upper quadrant pain. The characteristics of this pain have been defined in the Rome III diagnostic criteria for functional gallbladder disorders ( Table 1 ). Characteristic biliary pain is intermittent, often radiates to the right shoulder or back, is frequently associated with nausea and vomiting, and might be postprandial. Consensus criteria outlined in Rome III define this pain as not being associated with posture, exercise, or bowel movements. Jaundice and fever are usually not present. Physical examination is usually unremarkable except for mild right upper quadrant tenderness. Other Rome III requisite criteria for the diagnosis of acalculous gallbladder disease include an intact gallbladder and normal liver chemistries, amylase, and lipase.
Section 1 of 5
Get Clipmarks - The easiest way to email text, images and videos you find on the web.
訂閱：
文章 (Atom)