Chapter 460 Drugs-Double-edged Sword
When it comes to drugs to treat gout, fat people are more familiar with them.
In order to treat my gout, I spent almost all my spare time studying the knowledge of gout.
People tend to be more confident in fields they are familiar with. Now Fatty Liang's confidence is getting stronger and stronger. He is eloquent. It used to feel so good to speak on stage that he couldn't stop himself.
"The treatment of gout is divided into acute phase and remission phase. The so-called acute phase is when the pain attacks. The treatment goal at this time is analgesia and anti-inflammation. Analgesia is to relieve pain, and anti-inflammation is to eliminate the inflammatory reaction. This inflammatory reaction is not what people are used to. What is considered to be purulent inflammation is sterile inflammation, so antibiotic intervention is not required. Don’t think that anti-inflammation means using antibiotics, which are completely different things.”
The lecture notes in Fatty's mind were 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 in any unnecessary way.
“There is a drug that can both analgesia and anti-inflammatory drugs, that is, non-steroidal anti-inflammatory drugs. Representative drugs include etoricoxib, celecoxib, diclofenac, ibuprofen, etc. Among them, etoricoxib is favored by Recommendations from some guidelines. Remember that during an acute attack, it is not about reducing uric acid, but about relieving pain and anti-inflammation. If you lower uric acid incorrectly, it will aggravate the pain. The timing of lowering uric acid is to start two weeks after the acute pain is controlled. Of course, if you are For uric acid-lowering treatment, you can continue to take uric acid-lowering drugs without stopping the medication.”
"Another acute-phase drug - colchicine! This drug is a mitotic toxin and is highly toxic. Once overdosed, there are no rescue measures. Special attention must be paid - the drug cannot be overdosed and must be used in low doses: the first dose is 1 mg, and thereafter 0.5 mg/time, 2 times/day. It is best to start taking the medication within 12 hours of an acute attack of gout. The efficacy will decrease significantly after 36 hours. Once the gout symptoms are controlled, stop taking the medication! ”
“Therefore, there are two first-line medications in the acute phase—nonsteroidal anti-inflammatory drugs and colchicine. Patients who are ineffective or have renal dysfunction can use glucocorticoids, but try to avoid their use. ”
Fatty's knowledge is by no means a random talk, but a comprehensive textbook, the latest guide, and recent relevant summaries of top international journals. Every sentence has been carefully considered and verified repeatedly.
"In the remission period of gout, the goal of treatment is to lower uric acid! The well-known drugs are allopurinol, febuxostat, probenecid, benzbromarone, allopurinol and febuxostat, which inhibit the synthesis of uric acid. Besycil and benzbromarone are drugs that promote uric acid excretion, and their functions are different. First of all, the latest concept tends to use drugs that inhibit uric acid synthesis, that is, allopurinol and febuxostat. ”< br>
"Allopurinol is cheap and very effective, but you should pay attention to its hypersensitivity reaction. Once a hypersensitivity reaction occurs, the fatality rate is 30%. It has now been determined that HLA-B*5801 gene positivity is associated with hypersensitivity reactions to allopurinol The occurrence of HLA-B*5801 is closely related. The positive rate of HLA-B*5801 is higher among Asians and 10%-15% among Han people. Therefore, before using allopurinol, you must conduct HLA-B*5801 gene testing. If it is positive, you must not do it. Use this medicine; if it is negative, you can use it normally.”
"Hypersensitivity reactions caused by allopurinol are dose-related, so start with a small dose, usually 50mg/day, and increase to 200-300mg/d after 2-3 weeks. The highest dose cannot exceed 600mg/d, taken in three divided doses; if hypersensitivity occurs A rash often occurs before the reaction, so if a rash occurs 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 their knowledge of internal medicine. They lack knowledge in this area. For doctors, lack of certain knowledge means running naked, which is very dangerous.
Doctors are always walking on thin ice. Only by continuously accumulating knowledge can they navigate the risks with ease.
"Febuxostat has potential cardiovascular risks, that is, it increases the incidence of myocardial infarction and stroke. People with cardiovascular diseases, such as hypertension, coronary heart disease, etc., should use febuxostat with caution."
"Probenecid and benzbromarone are drugs that promote uric acid excretion. Therefore, if you have excretion-impaired hyperuricemia, choose them only if the first two drugs are ineffective. With these two drugs, if you have kidney stones or renal dysfunction, , do not use. Both drugs will affect the kidneys. Probenecid has a greater impact on the kidneys than benzbromarone, and benzbromarone causes the greatest damage to the liver among the four drugs. In 2003, benzbromarone was It was withdrawn from the European market due to liver damage, but was re-registered in some countries in 2004. ”
Any drug has risks as well as treatment. Drugs are a double-edged sword. You must be able to take advantage of the advantages and avoid the risks. ”
"According to the principle of maximizing strengths and avoiding weaknesses, among the above four drugs, if HLA-B*5801 is negative, allopurinol is the first choice; if HLA-B*5801 is positive and there is no cardiovascular disease, febuxostat is the choice; if HLA-B*5801 If the patient is positive, has cardiovascular disease, and has no problem with kidney function, you can choose probenecid and benzbromarone. Liver function must be monitored when using benzbromarone.”
Although Fatty's introduction to these four medicines was simple, it was concise and detailed. The instructions were densely packed with hundreds of words.
Someone in the audience felt scared: "When you tell me, sweat breaks out on my back. My dad has been taking allopurinol and has never checked the HLA-B*5801 gene."
A graduate student is familiar with benzbromarone: "Benzbromarone causes liver damage. It is best to check liver function regularly when taking it. Around 2003, a case of severe liver damage related to the drug was reported in Europe, but That is, when the European population uses a high dosage of 100mg-200mg, the statistical incidence rate of benzbromarone is only 1/17000. Our current clinical prescription dosage is 50mg, and very few patients can be prescribed 100mg. There are rare cases of liver damage caused by benzbromarone at high dosages, but due to its history, caution is advised. ”
"There is currently no data showing that febuxostat is higher in cardiovascular events among Asians, so it is safe, but people with cardiovascular disease should try not to use it," another graduate student added.
"Dr. Liang, after listening to what you said, these pieces of knowledge have been connected in principle. Now I have a clear understanding in my mind. Next time I take care of patients with gout, I will be able to choose drugs more freely." Someone said. Sincerely grateful to Fatty.
It seems that Fatty has really put a lot of thought into the common drugs used to treat gout, especially the drugs that lower uric acid. The advantages, disadvantages, risks, and how to use them are all clear.
"I've said so much, but I haven't said the key yet. Under what circumstances does it need to lower uric acid, and to what level is it appropriate to lower uric acid?" An intern listened to it for so long and still couldn't figure it out.
Fatty thought everyone knew these basic knowledge: "These textbooks and guides are all in them. I just skipped them. You can go and read the latest treatment guidelines: If the patient has tophi, chronic gouty arthritis or gouty arthritis, If arthritis attacks frequently, the treatment target for lowering uric acid should be 300 μmol/L. Until tophi is completely dissolved and the symptoms of frequent arthritis attacks improve, the treatment target can be changed to 360 μmol/L, and the blood uric acid level should be maintained for a long time. "Lower is better?" an intern boldly suggested.
The fat man immediately criticized: "Which department intern? You don't have any 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." risk, so 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. He should read it carefully when he goes back.
"Patients who have developed gout, that is, uric acid is higher than normal, are recommended to lower uric acid treatment; those who have no symptoms of gout and have simple hyperuricemia can first try to change their lifestyle - a balanced diet, exercise, abstinence from alcohol, and drinking more water Wait. By the way, are there any brothers who don’t know the diagnostic criteria for hyperuricemia? Fasting blood uric acid levels are higher than 420 μmol/L for men and higher than 360 μmol/L on two different days.”
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"How's it going? Do you have any questions?" The fat man was satisfied and wanted to rest.
The fat man finally understood why, when he was studying for a master's degree and a doctor's degree, his tutor would always lose track of time and quote eloquently once he grasped a certain issue during ward rounds.
It turns out that giving lectures feels so refreshing!
"Lecturer of Liang University, if you change your career and become a lecturer in a health care product company, with today's teaching standards, it is not a problem to make one million a year." Zhang Lin said seriously in the audience.
Fatty Liang waved his hand: "I can still fight for serious things within the framework of evidence-based medicine; once it breaks away from this framework and rises to the level of free expression and cure all diseases, I can't even say a word." Come out.”
"Do you still have any questions? If you have any questions, feel free to ask them. You must master this knowledge now. If you marry a wife in the future, if your father-in-law has a gout attack, you can get rid of the pain within a few hours. Your father-in-law's favorability towards you will double!" Zhang Lin yelled, preparing to end the lecture. .
"Dr. Yang! What do you want to summarize?" Zhang Lin turned to Yang Ping.
The fat man’s lecture was very exciting, and Yang Ping felt that he had nothing to add. He stood up and reminded everyone: “When you popularize this knowledge with your relatives and friends, you must tell them that all medical science knowledge is for It is better to see a doctor, not as a substitute, because non-medical professionals generally lack basic medical knowledge and are prone to making mistakes if they make decisions on their own. You must remain in awe of areas you 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, but cannot replace you to go to the hospital for treatment!" Fatty Liang felt that what Yang Ping said made sense.
The fat man has seen this kind of relative, and after reading a few medical and health care books, he feels that he is better than a doctor.
The growth of a doctor is far from as simple as a few books. It takes five years to study for a bachelor's degree, three years for a master's degree, and another three or four years for a doctorate. Even if you study for a bachelor's, master's, and doctoral degree together, you still need to study for eight years. After graduation, you need to be a senior doctor. After many years of clinical experience, three years to pass the residency test, another five years, and eight years of work before you can take the attending test. If you reach associate senior or above, you will basically have more than ten years of work experience. During this period, you will accumulate monographs and papers, which requires specialization. He installed it in his study room so that he could be qualified to treat people.
"There is no end to learning. What we are facing is human life and health. The more knowledge we have, the better, the deeper the better, the more the better! We must also be in awe of knowledge. We must not just scratch the surface, but understand it thoroughly. , Only in this way can we be calm and confident when facing complex risks," Yang Ping encouraged everyone.
"It's okay. Let's adjourn the meeting. Dr. Liang, get ready. I'll recommend you to the medical office to go to the hospital's health lecture hall." Yang Ping finally said.
That's the big lecture hall, this is just an internal warm-up and practice of eloquence.
The meeting ended and everyone retreated one after another.
"There are many old ladies attending the health lectures in the hospital. Don't you want to try your luck to find your future mother-in-law?" Zhang Lin thought for a moment.
The fat man said with disdain: "Dirty! With my current conditions, do you know how many head nurses want to introduce me to girlfriends?"
"No, no, no, let me think about it. I heard that the mother of that flight attendant from China Southern Airlines was asked to take care of you in which department she stayed in last time? 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 stuttered to the point of being speechless.
Fatty Liang’s popular science is very reliable. It is summarized by combining textbooks and top medical journal articles. Although it is simple, it is reliable and very popular!
(End of chapter)