慢郎中的住院門診大楼(只看性病+已診斷為艾滋病患者)

maileng

最近世界传染病大会,
新加坡的医生见猎心喜地把在他们那儿的案子PRESENT出来
我们这边几多人中
可不见有那位整理了发表

还是要等明年?

peying84

原帖由 青菜 于 5-8-2008 05:54 PM 发表
什么是见猎心喜？
不明白这个成语。

见猎心喜=比喻旧习难忘，看见有人在做自己所爱好的事情，便心情愉悦而跃跃欲试。

青菜

对不起，我得删除刚才提出成语什么意思的贴。
我接到警告信啦。
所以，对不起你们白回了。

为了不让人见猎心喜在捉我离题，我就回一些跟主题有关吧。

其实啊我国没什么流行在大会做什么报告吧，
就算报告ADVERSE DRUG REACTION都没什么流行吧，
大家就只管手上工作就是了。

那篇surrogate marker的文章改天再慢慢读。。。

就叫我蓝鲸吧！

allow me to write in english for this time.. my laptop doesnt have chinese programe.
i have one question, y in asthma case, we donot use cough suppressant?

peying84

原帖由 就叫我蓝鲸吧！ 于 6-8-2008 12:02 AM 发表
allow me to write in english for this time.. my laptop doesnt have chinese programe.
i have one question, y in asthma case, we donot use cough suppressant?

Cough suppressants shouldn't be used except as a last resort, as they're only band-aid solutions -- they don't heal, only cover up the problem. It's better to treat the underlying cause. If the cough is due to postnasal drip, for example, then an antihistamine/decongestant may be more appropriate. A cough due to asthma itself should be treated with anti-inflammatory medication, plus or minus bronchodilators. When patients' asthma becomes uncontrolled, they'll often require higher doses of their anti-inflammatory medication, such as steroids. For those who are severely affected, one can occasionally use cough suppressants while waiting to start treatment for the underlying cause, providing such agents are removed to check on the effectiveness of the management. Cough secondary to postinfectious hyper-reactivity responds to bronchodilators, plus or minus inhaled steroids, as well.

http://www.parkhurstexchange.com/qa/A.php?q=/qa/Respirology/2003-09-14.qa

maileng

原帖由 青菜 于 5-8-2008 11:11 PM 发表
对不起，我得删除刚才提出成语什么意思的贴。
我接到警告信啦。
所以，对不起你们白回了。

为了不让人见猎心喜在捉我离题，我就回一些跟主题有关吧。

其实啊我国没什么流行在大会做什么报告吧，
就算报告AD ...

当然还是有的
其实大马的一些高人在ASIA PACIFIC相当受欢迎
在台上风骚得很
只是公家医院的大都忙得喘不过气, 脸青口唇白
年轻一辈的表现好象不如东南亚其他国家

就叫我蓝鲸吧！

原帖由 peying84 于 1-8-2008 12:02 AM 发表
慢大人，是时候教课了
可以讲解鸡骨啃呀和登革的差别吗？现在这个病毒很像很热门哦
范大妈叫你給我們上課的 http://chinese2.cari.com.my/myforum/viewthread.php?tid=1272711&extra=&page=18

我拿了椅子 ...

什么是鸡骨啃呀和登革？英文叫什么？
小弟也想学。谢咯。。

peying84

原帖由 就叫我蓝鲸吧！ 于 6-8-2008 08:29 AM 发表

什么是鸡骨啃呀和登革？英文叫什么？
小弟也想学。谢咯。。

其实就是chikungunya和dengue
我们之前有在一些楼讨论过，你可以到http://chinese.cari.com.my/myforum/viewthread.php?tid=1272711&extra=page%3D1&page=19 和
http://chinese.cari.com.my/myforum/viewthread.php?tid=1178550&extra=page%3D1&page=45 看看。
慢慢爬贴，ignore一些灌水帖
或是可以到yice哥哥介绍的http://www.cdc.gov/ncidod/dvbid/Chikungunya/ 自己做下功课，不明白再上来发问。

jinreung

原帖由 maileng 于 6-8-2008 13:23 发表

鸡骨啃呀----是我先用的
虽然非正式名称
却觉得很不错哩
容易记

正是的名称是     基孔肯雅
曲弓热

青菜

最近没新的主题吗？
很想知道医院医生通常会问药剂师什么问题？
或是他们expect药剂师要懂什么？

因为很多时候药剂读的医生都懂了，
可是医生问的药剂那边有只看过皮毛。
就之前cyclosporin的例子就好了，那个问题如果不是去研究过是当场回答不出来了。。。

peying84

原帖由 青菜 于 6-8-2008 08:42 PM 发表
最近没新的主题吗？
很想知道医院医生通常会问药剂师什么问题？
或是他们expect药剂师要懂什么？

因为很多时候药剂读的医生都懂了，
可是医生问的药剂那边有只看过皮毛。
就之前cyclosporin的例子就好了，那个 ...

那个cyclosporine我们可是花了没很多时间才回答的
你又不早一点来，可以帮忙一下嘛

peying84

Aminoglycoside antibiotics are generally used for the treatment of severe gram negative infection. They are bactericidal, and exhibit concentration-dependent bacterial killing. Also, Aminoglycoside have a concentration-dependent postantibiotic effect.

Conventionally,aminoglycoside is administered as multiple daily doses (usually 8 hourly). However, due to the advantages of concentration-dependent bacterial killing and postantibiotic effect, extended-interval (once daily dosing) is also an option.

Aminoglycoside is usually given as a short-term (0.5 - 1 hour) infusion. Cpeak is usually measured 0.5 hour after end of 0.5 hour infusion or immediately after infusion if 1 hour infusion is used. If aminoglycoside is infused over 0.5 hour, the end-of-infusion concentrations are higher because the serum and tissues are not in equilibrium. Thus, 30 minutes waiting time required for drug distribution and to avoid distribution phase. If aminoglycoside are infused over 1 hour, the distribution phase is very short and serum concentration can be obtained immediately.



Blood sample should be taken after 3-5 half-lives or when the drug concentration reaching steady-state (usually 3-4 doses after initiation of therapy).

Usual therapeutic range:

	Amikacin	Gentamicin
Peak	20-30mg/l	5-10mg/l
Trough	2.5-10mg/l	<2mg/l

Usual Sampling Time:

	Multiple dose daily
Peak	1 hour after completion of infusion
Trough	Just prior to the next dose (~15-30 minutes)

exceeding peak steady-state concentration =>increase risk of ototoxicity.
exceeding trough steady-state concentration =>increase risk of nephrotoxicity.

Monitoring Parameter:
serum creatinine (SrCr) to detect nephrotoxicity (aminoglycosides are eliminated almost completely, >90% unchanged in urine)



reference book: Clinical Pharmacokinetics Handbook writted by Larry A. Bauer

[ 本帖最后由 peying84 于 8-8-2008 11:45 PM 编辑 ]

就叫我蓝鲸吧！

合我胃口。。
在读antibiotic。。
aminogycoside is given in IV form because of low bioavailability due to first pass metabolism. it acts on 30s of the ribosome.
it often used as combination theraphy with vincomycin.
correct me if i am wrong.
小弟对这antibiotic知识不多， 这forum 还蛮不错的。。学习很多。。

peying84

原帖由 就叫我蓝鲸吧！ 于 8-8-2008 01:11 PM 发表
合我胃口。。
在读antibiotic。。
aminogycoside is given in IV form because of low bioavailability due to first pass metabolism.
acts on 30s of the ribosome.
it often used as combination theraphy with vincomycin.
correct me if i am wrong.
小弟对这antibiotic知识不多， 这forum 还蛮不错的。。学习很多。。

是vancomycin。。
你念therapeutic drug monitoring（TDM）了吗？

就叫我蓝鲸吧！

原帖由 peying84 于 8-8-2008 02:23 PM 发表

是vancomycin。。
你念therapeutic drug monitoring（TDM）了吗？

还没有。。现在在啃着antibiotic...那个Syed 先生单单antibiotic 药已经是四五lectures 了。。 他说senior complain 不够。。

ShyCao

原帖由 范逍遥 于 8-8-2008 10:12 PM 发表


有没有好好的想过这一段为什么重要？

Once daily dosing 基本上能够达到 more frequent dosing 的 therapeutic effects
而且相对来说 risk of ototoxicity and nephrotoxicity会比较小 （因为当concentration达到 certain threshold后便会呈现 binding site saturation)
而如果使用 frequent dosing的话反而会造成更严重的toxicity
所以如果在病人的pharmacokinetic正常的情况下
once daily dosing应该是里多于弊的

题外话
今天老板问了我一个问题
什么pain killer can interact with ciprofloxacin and leading to unwanted effects...
想了好久都没头绪

peying84

Conventionally,aminoglycoside is administered as multiple daily doses(usually 8 hourly). However, due to the advantages of concentration-dependent bacterial killing and postantibiotic effect,extended-interval (once daily dosing) is also an option.

原帖由 范逍遥 于 8-8-2008 10:12 PM 发表


有没有好好的想过这一段为什么重要？

这个问题有想过，也是有跟朋友讨论过。

是不是因为这个aminoglycoside是concentration-dependent bactericidal，rate of bacteria killing is increased if the drug concentration is greater than the bacteria's MIC. So a single large dose is given so that it is sufficient to eliminate the bacteria.

再来，因为有postantibiotic effect，所以就算the level of aminoglycoside concentration drop after a prolonged of time (e.g 24 hours),还是有bactericidal effect．　

[ 本帖最后由 peying84 于 8-8-2008 11:50 PM 编辑 ]

peying84

原帖由 范逍遥 于 8-8-2008 10:14 PM 发表


如果 TDM 超出参考指标那么你会有什么建议？
打开书依样葫芦照抄一遍，然后就出报告？
有没有想过为什么要给课本里的建议？

如果TDM超过指标，我们通常会重新calculate patient's creatinine clearance，volume of distribution, elimination rate等等的patient's own pharmacokinetics. 所以patient's data, like serum creatinine, body weight, age, gender等等都很重要。当然sampling time (pre- and post- dose), time of administration也要清楚地写好。

再来，我们也会算算医生给的dose是否overdose，因为如果是patient的clearance比一般人慢，accumulation在身体的机会也较高，为了避免nephrotoxicity，我们会重新算过patient适合的dose, recommend doctor to reduce the dose.

一般上，我们都会先recommend doctor to withhold the next dose, 我们会calculate要withhold多久，recommend doctor to resample the blood for TDM. 一旦patient's serum drug concentration within the therapeutic range, recommend doctor to start the next dose (recommended adjusted dose) and resample the blood 3-5 doses after initiation of the new dose.

[ 本帖最后由 peying84 于 8-8-2008 11:44 PM 编辑 ]

peying84

原帖由 ShyCao 于 8-8-2008 10:35 PM 发表


题外话
今天老板问了我一个问题
什么pain killer can interact with ciprofloxacin and leading to unwanted effects...
想了好久都没头绪

会不会是NSAIDs？
possible risk of fits？

就叫我蓝鲸吧！

according to bnf, there is a posibility increased risk of convulsions when quinolones given with NSAIDs...