godfather of surgery

Chapter 460 Drugs - Double-Edged Sword

When it comes to medicines for gout, Fatty is more familiar with it.

In order to treat my own gout, I spent almost all my spare time studying gout knowledge.

People tend to be more confident in fields they are familiar with. Fatty Liang is now more and more confident.

"The treatment of gout is divided into the acute phase and the remission phase. The so-called acute phase is when the pain occurs. The goal of the treatment at this time is analgesia and anti-inflammation. Analgesia means pain relief. Anti-inflammation means eliminating inflammation. What you think of as suppurative inflammation is aseptic inflammation, so there is no need for antibiotic intervention, and don’t think that anti-inflammation means using antibiotics, which is completely different.”

The speech in Fatty's mind was originally prepared for ordinary people, but suddenly he found that the audience were all medical students, and there was no need to explain the concept of anti-inflammation at all.

"There is a drug that can both analgesia and anti-inflammation, that is, non-steroidal anti-inflammatory drugs, representative drugs include etoricoxib, celecoxib, diclofenac, ibuprofen, etc., among which etoricoxib is affected Recommendations from some guidelines. Remember that during an acute attack, it is not uric acid lowering, but pain relief and anti-inflammation. If you lower uric acid by mistake, it will aggravate the pain. The time to lower uric acid is two weeks after acute pain control. Of course, if you are For uric acid-lowering treatment, you can continue to take the uric acid-lowering medicine without stopping the medicine.”

"Another drug for the acute phase - colchicine! This drug is a cell mitotic toxin and is highly toxic. If there is no rescue measure in case of overdose, special attention must be paid - the drug must not be overdose, and a low dose must be used. Usage: the first dose is 1 mg, Thereafter, 0.5 mg/time, 2 times/day, it is best to start the drug within 12 hours of the acute attack of gout, and the curative effect will decrease significantly after 36 hours, once the symptoms of gout are controlled, stop the drug!"

"Therefore, there are two first-line medications in the acute phase—non-steroidal anti-inflammatory drugs and colchicine. Patients with ineffectiveness of these two drugs or renal dysfunction can use glucocorticoids, but try to avoid them. "

Fatty's knowledge is by no means just talking about it, but a summary of recent related textbooks, the latest guides, and top international journals. Every sentence has been carefully thought out and repeatedly checked.

"In the remission period of gout, the goal of treatment is to lower uric acid! Well-known drugs include allopurinol, febuxostat, probenecid, benzbromarone, allopurinol and febuxostat are drugs that inhibit uric acid synthesis. Bensulfencid and benzbromarone are drugs that promote the excretion of uric acid, and their actions are different. First of all, the latest concept tends to use drugs that inhibit uric acid synthesis, that is, allopurinol and febuxostat.”

"Allopurinol is cheap and effective, but attention should be paid to hypersensitivity reactions. Once hypersensitivity reactions occur, the fatality rate is 30%. It has been confirmed that HLA-B*5801 gene positive and allopurinol hypersensitivity The occurrence is closely related. The positive rate of HLA-B*5801 in the Asian population is relatively high, and the Han nationality reaches 10%-15%. Therefore, before using allopurinol, HLA-B*5801 gene testing must be carried out. If it is positive, resolutely do not Use the drug; if negative, use as normal."

"The hypersensitivity reaction caused by allopurinol is dose-related, so start with a small dose, usually 50 mg/day, and increase to 2-3 mg/d after 200-300 weeks, and the highest dose should not exceed 600 mg/d, and take it in three divided doses; when hypersensitivity occurs There is often a rash before the reaction, so once the rash appears after taking the medicine, stop taking the medicine and seek medical treatment immediately, there is no room for negotiation!"

HLA-B*5801!Remember this gene, many young doctors have almost forgotten the knowledge of internal medicine, lack of knowledge in this area, for doctors, lack of certain knowledge is streaking, which is very dangerous.

Doctors are walking on eggshells all the time, and only by constantly accumulating knowledge can they navigate risks with ease.

"Febuxostat has a potential cardiovascular risk, that is, it increases the incidence of myocardial infarction and stroke. If you have cardiovascular diseases, such as hypertension, coronary heart disease, etc., you should use febuxostat with caution."

"Probenecid and benzbromarone are drugs that promote the excretion of uric acid. Therefore, if it is hyperuricemia of the excretion disorder type, the first two drugs are ineffective before choosing them. These two drugs, if you have kidney stones, renal dysfunction , do not use, the two drugs will affect the kidneys, probenecid has a greater impact on the kidneys than benzbromarone, and benzbromarone has the greatest damage to the liver among the four drugs. In 2003, benzbromarone had Withdrawn from the European market due to liver damage, but re-registered in some countries in 2004."

Any drug has risks while treating it. Drugs are a double-edged sword. You must be able to take advantage of the advantages and avoid risks. "

"According to the principle of promoting strengths and avoiding weaknesses, the above four drugs, in fact, if HLA-B*5801 is negative, allopurinol is the first choice; if HLA-B*5801 is positive and there is no cardiovascular disease, choose febuxostat; if HLA-B*5801 If it is positive, there is cardiovascular disease, and there is no problem with kidney function, probenecid and benzbromarone can be chosen, and liver function must be monitored when using benzbromarone.”

For the introduction of these four medicines, although Fatty's explanation is simple, he is concise and detailed, and the instructions are densely packed with hundreds of words.

Some people in the audience felt terrified: "When you say it, my back is sweating. My dad has been taking allopurinol and has never checked the HLA-B*5801 gene."

A graduate student is quite familiar with benzbromarone: "Benzbromarone liver damage is a hard injury, and it is best to check liver function regularly when taking it. Around 2003, there was a case of serious drug-related liver damage in Europe, but That is benzbromarone under the condition of high dosage of 100mg-200mg in the European population, the statistical incidence rate is only 1/17000. Our current clinical prescription dosage is 50mg, and very few patients can be prescribed up to 100mg. At low doses, cases of benzbromarone liver damage are rarely seen, but in view of its previous history, it is still prudent."

"Febuxostat is in Asians. There is currently no data showing that cardiovascular events are higher, so the safety is good, but people with cardiovascular diseases try not to use it." Another graduate student added.

"Doctor Liang, after hearing what you said, these bits and pieces of knowledge have been connected in principle. Now I have a clear understanding in my mind. Next time I manage a patient, if I encounter gout, I will be able to choose medicines more freely." Someone said. Sincerely grateful to Fatty.

It seems that the fat man has really put a lot of thought into these commonly used drugs for the treatment of gout, especially the several drugs for lowering uric acid. What are the advantages, disadvantages, risks, and how to use them are clear.

"I have said so much, but I haven't said the key thing yet. Under what circumstances is it necessary to lower uric acid, and what level is the appropriate level for uric acid to be lowered?" One intern had heard it for so long, but still didn't understand it.

Fatty thinks that everyone knows these basic knowledge: "There are all these textbooks and guidelines, I just skipped it just now, you go to look up the latest treatment guidelines: If the patient has tophi, chronic gouty arthritis or gouty Arthritis frequently attacks, and the goal of uric acid-lowering treatment is blood uric acid 300 μmol/L, until tophi is completely dissolved and the symptoms of frequent arthritis attacks are improved, the treatment goal can be changed to blood uric acid 360 μmol/L, and long-term maintenance.

"The lower the blood uric acid, the better?" an intern boldly proposed.

The fat man immediately criticized: "Which department is an intern? I have not mastered medical knowledge! The normal range of uric acid in the human body has important physiological functions. Low blood uric acid may increase the risk of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease." Therefore, the lower the better, the blood uric acid should not be lower than 180 μmol/L during uric acid-lowering treatment.”

The intern blushed immediately. He didn't understand the textbook thoroughly, so he had to read it carefully when he went back.

"Patients who have developed gout, that is, uric acid is higher than normal, recommend uric acid-lowering treatment; if there is no gout symptom, simple hyperuricemia, you can try to change your lifestyle first--balanced diet, exercise, alcohol abstinence, drinking more water Wait. To add, there will be no brothers who don’t know the diagnostic criteria for hyperuricemia, right? Fasting blood uric acid levels twice on the same day—men are higher than 420 μmol/L, and women are higher than 360 μmol/L.”

"How about it, do you still have any questions?" Fatty felt refreshed enough, and wanted to rest.

Fatty finally understands why when he was studying for a master's degree and a doctor's degree, when his supervisor made rounds, once he grasped a certain issue and began to give a lecture, he always forgot the time and quoted extensively and eloquently.

It turns out that the feeling of giving lectures is so sour!

"Lecturer Liang, if you change your career and become a lecturer in a health care product company, with today's teaching level, it is not a problem to earn one million a year." Zhang Lin said seriously in the audience.

Fatty Liang waved his hand: "Within the framework of evidence-based medicine, I can still fight for serious things. Once I break away from this framework and rise to free play and cure all diseases, I can't say a word." come out."

"Do you still have any questions? Feel free to ask any questions. You must master this knowledge now. When you marry your wife, your father-in-law will suffer from gout. If you get rid of the pain within a few hours, your father-in-law's affection for you will double!" Zhang Lin yelled, ready to end the lecture. .

"Dr. Yang! What do you want to conclude?" Zhang Lin turned to Yang Ping.

Fatty gave lectures in simple terms, which was very exciting. Yang Ping felt that there was nothing to add. He stood up and reminded everyone: "When you popularize this knowledge to your relatives and friends, you must tell them that all medical science knowledge is for the sake of It is better to see a doctor, but not a substitute for seeing a doctor, because ordinary non-medical professional people lack basic medical knowledge, and if they make decisions on their own, it is easy to make mistakes, and they must remain in awe of areas that they do not know, especially when it comes to health!"

"Yes! Last reminder, see a doctor if you are sick! This knowledge is to help you make better decisions, and it cannot replace you to go to the hospital!" Fatty Liang felt that Yang Ping's words made sense.

The fat man has seen this kind of relative, read a few books on medical and health care, and feels that he is better than a doctor.

The growth of a doctor is not as simple as a few books. After five years of undergraduate study, three years of master’s degree, three or four years of doctor’s degree, even if the doctorate degree is combined, it takes eight years of study. I have accumulated many years of clinical experience, three years for the residency exam, and another five years and eight years of work before I can take the exam for attending medicine. Only in this way can I be qualified to see a doctor.

"Knowledge is endless. What we are facing is human life and health. The more knowledge we have, the better, the deeper the better, and the more the better! Knowledge must also be in awe. You must not scratch the surface, but make it clear. , In this way, we will be calm and confident in the face of intricate risks." Yang Ping shared his encouragement with everyone.

"It's nothing, let's end the meeting, Dr. Liang, you are ready, I recommend you to the health lecture hall of the hospital to the medical office." Finally Yang Ping said.

That's the big lecture hall, it's just an internal warm-up and eloquence practice.

After the meeting was over, everyone withdrew one after another.

"There are many old ladies in the health lecture hall of the hospital. Don't you want to try your luck to see if you can find your future mother-in-law?" Zhang Lin thought for a while.

The fat man disdains: "Dirty! With my current conditions, do you know how many head nurses want to introduce me to girlfriends?"

"No, no, let me think about it, but I heard that the mother of the stewardess of China Southern Airlines stayed in which department last time, and I asked you to take care of her? I heard that her mother is a loyal fan of our hospital's health lecture hall?" Zhang Lin Touch your chin.

The fat man blushed and was so stuttered that he couldn't speak.

　Fatty Liang's popular science is very reliable, it is based on the combination of textbooks and top medical journal articles. Although it is simple, it is reliable and popular!

　　
　
(End of this chapter)