The Godfather of Surgery

Chapter 460 Drugs - A Double-Edged Sword

When it comes to medicines for gout, the fat man is more familiar.

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

People tend to be more confident in a field they are familiar with. Now Fatty Liang is more and more confident. He is eloquent. It used to be so refreshing to give a speech on stage, and he couldn't stop at all.

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 treatment goal at this time is analgesia and anti-inflammatory, analgesia is pain relief, and anti-inflammatory is to eliminate the inflammatory reaction. What you think of as purulent inflammation is aseptic inflammation, so you don’t need the intervention of antibiotics, and don’t think that anti-inflammation is just the use of antibiotics, which are completely different things.”

The script in Fatty's head was originally intended for ordinary people, but he suddenly found that the audience was all medical students, and there was no need to explain the concept of anti-inflammatory.

There is a drug that can both relieve pain and anti-inflammatory, that is, non-steroidal anti-inflammatory drugs, representative drugs are etoricoxib, celecoxib, diclofenac, ibuprofen, etc., among which etoricoxib is affected by Some guidelines recommend. Remember that the acute attack is not uric acid lowering, but pain relief and anti-inflammatory. If uric acid lowering is performed incorrectly, it will aggravate pain. The timing of uric acid lowering is to start two weeks after acute pain control. Of course, if you are For uric acid-lowering therapy, you can continue to take uric acid-lowering drugs without stopping the drug.”

Another acute drug-colchicine! This drug is a mitotic toxin and is highly toxic. Once the overdose lacks rescue measures, special attention must be paid--the drug cannot be overdose, and must be used in low doses: the first dose of 1 mg, After that, 0.5 mg/time, 2 times/day, preferably within 12 hours of acute gout attack, the curative effect will decrease significantly after 36 hours, and once the symptoms of gout are controlled, stop the medication!”

Therefore, there are two kinds of first-line drugs in the acute phase - non-steroidal anti-inflammatory drugs and colchicine. Patients with ineffective or renal dysfunction can use glucocorticoid drugs, but try to avoid them.

Fatty's knowledge is by no means just rambling, but a comprehensive summary of textbooks, the latest guides, and recent relevant summaries of top international journals. Every sentence has been carefully thought out and verified repeatedly.

During gout remission, the goal of treatment is to lower uric acid! The well-known drugs are allopurinol, febuxostat, probenecid, benzbromarone, allopurinol and febuxostat are drugs that inhibit the synthesis of uric acid, Benbenecid and benzbromarone are drugs that promote the excretion of uric acid, and their functions are different. First of all, the latest concept is to use drugs that inhibit uric acid synthesis, that is, allopurinol and febuxostat.”

Allopurinol is cheap and the effect is very good, but pay attention to its hypersensitivity reaction. Once a hypersensitivity reaction occurs, the fatality rate is 30%. It has now been determined that the positive HLA-B*5801 gene is related to allopurinol. Hypersensitivity reaction The occurrence is closely related. The positive rate of HLA-B*5801 in Asian population is higher, and the Han nationality reaches 10%-15%. Therefore, before using allopurinol, HLA-B*5801 gene test must be carried out. If it is positive, do not Use this drug; if it's negative, use it normally.

The hypersensitivity reaction caused by allopurinol is related to the dose, so start with a small dose, generally 50mg/day, and increase to 200-300mg/d after 2-3 weeks, and the highest dose cannot exceed 600mg/d, which is taken in three divided doses; hypersensitivity occurs. A rash often occurs before the reaction, so once a rash occurs after taking the medicine, stop the medicine and seek medical attention 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 this knowledge, for doctors, lack of certain knowledge means streaking, which is very dangerous.

Doctors are always walking on thin ice, and only by constantly accumulating knowledge can they manage risks with ease.

Febuxostat has potential cardiovascular risks, which is to increase the incidence of myocardial infarction and stroke. If people with cardiovascular diseases, such as hypertension, coronary heart disease, etc., should use febuxostat with caution.

Probenecid and benzbromarone are drugs that promote the excretion of uric acid, so if it is an excretion disorder type of high uric acid, the first two drugs are ineffective before choosing them. These two drugs, if there are kidney stones, kidney dysfunction, , do not use, two drugs can affect the kidneys, probenecid has a greater effect on the kidneys than benzbromarone, and benzbromarone has the greatest damage to the liver among the four drugs. In 2003, benzbromarone had Withdrew from the European market due to liver damage, but was re-registered in some countries in 2004.

Any drug has risks at the same time of 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 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 Positive, with cardiovascular disease and no problem with renal function, probenecid and benzbromarone can be selected, and liver function must be monitored when benzbromarone is used.”

The introduction of these four drugs, although Fatty said it simply, is refined and detailed. The instructions are densely packed with hundreds of words.

Someone in the audience felt scared: When you say this, my back is sweating. My dad has been taking allopurinol and has never checked the HLA-B*5801 gene.

A graduate student is familiar with benzbromarone: Benzbromarone's liver damage is its hard injury. It is best to check liver function regularly when taking it. Around 2003, a case of serious liver damage related to the drug was reported in Europe, but That is, the incidence of benzbromarone is only 1/17000 under the condition of high dosage of 100mg-200mg in the European population. The commonly prescribed dose in our clinic is 50mg, and very few patients can be prescribed 100mg. At this dose, cases of liver damage from benzbromarone are rare, but given its previous history, it is still cautious.

Febuxostat is in Asians, and there is currently no data to show that cardiovascular events are higher, so the safety is good, but people with cardiovascular disease try not to use it. Another graduate student added.

Dr. Liang, listening to you, these pieces of knowledge have been connected in principle. Now I have a clear understanding in my mind. Next time I take care of a patient and encounter gout, the choice of drugs will be much more free. Someone Sincerely thank the fat man.

It seems that Fatty has really spent a lot of thought on these commonly used drugs for the treatment of gout, especially several drugs for lowering uric acid, which are the advantages, disadvantages, risks, and how to use them.

So much has been said, but the key point has not yet been said. Under what circumstances do you need to reduce uric acid, and what level is appropriate to reduce uric acid? An intern listened to it for so long and still did not understand it.

Fatty thinks that everyone knows these basic knowledge: These textbooks and guides have them, I just skipped them, you go to the latest treatment guide: If the patient has tophi, chronic gouty arthritis or gouty arthritis Arthritis is frequently attacked, and the target of lowering uric acid is 300 μmol/L of blood uric acid, until the tophi is completely dissolved and the symptoms of frequent arthritis are improved, the target of treatment can be changed to 360 μmol/L of blood uric acid, and it can be maintained for a long time.”

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

Fatty immediately criticized: Which department intern? I don't have a good grasp of medical common sense! The normal range of uric acid in the human body has its important physiological functions. Too 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 therapy.”

The intern blushed immediately. He didn't fully understand the textbook, so he had to go back and look carefully.

Patients who have developed gout, that is, uric acid higher than normal, recommend uric acid-lowering treatment; without gout symptoms, simple hyperuricemia, you can try to change your lifestyle first - a balanced diet, exercise, abstain from alcohol, and drink more water Wait. One more thing. Wouldn’t there be a brother who doesn’t know the diagnostic criteria for hyperuricemia? Two fasting blood uric acid levels on different days—more than 420 μmol/L for men and more than 360 μmol/L for women.”

How is it, do you still have any questions? Fatty was satisfied, and he had to rest.

Fatty finally understood why when he was studying for a master's degree and doctoral degree, when his supervisor made a round of wards, once he grasped a certain issue and gave a lecture, he always forgot the time, and he was eloquent and eloquent.

It turned out that the feeling of lecturing is so sour!

Lecturer Liang Da, if you change careers and become a lecturer in a health care product company, with today's level of lectures, the annual income of millions is not a problem. Zhang Lin said seriously in the audience.

Fatty Liang waved his hand: Speaking of the eight classics, within the framework of evidence-based medicine, I can still fight; once I get out of 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. If you marry a wife in the future, your father-in-law will have a gout attack. He will get rid of the pain within a few hours, and your father-in-law's favorability value will double! Zhang Lin shouted, ready to end the lecture .

Dr. Yang! What's there to summarize? Zhang Lin turned to Yang Ping.

Fatty gave a lecture in simple terms, which was very exciting. Yang Ping felt that there was nothing to add. He stood up and reminded everyone: When everyone spreads this knowledge to relatives and friends, be sure to tell them that all medical science knowledge is for the purpose of It is better to see a doctor, not a substitute for seeing a doctor, because ordinary non-medical professionals lack basic medical knowledge, and if they make decisions on their own, it is easy to make mistakes, and you must be in awe of your unknown fields, 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, not to replace you with going to the hospital to see a doctor! Fatty Liang felt that Yang Ping was right.

Fatty has seen such relatives, read a few books on medical and health care, and felt that he was better than a doctor.

The growth of a doctor is not as simple as a few books. It takes five years for an undergraduate degree, three years for a master's degree, and three or four years for a doctorate. After many years of clinical accumulation, three years of resident examination, and five years of work, it is only eight years of work before the examination of attending doctor. If you are above the deputy high school, you will basically have more than ten years of work experience. During the accumulation of monographs and papers, you need to specialize in To install it in the study room, so as to be qualified to see a doctor.

Learning is endless. We are faced with human life and health. The more knowledge we have, the better, the deeper the better, the more the better! We must also have a reverence for knowledge. , In this way, we will be calm and confident when facing complex risks. Yang Ping encouraged everyone.

If there's nothing to do, let's end the meeting. Dr. Liang, you are ready. I recommend you to the hospital's health lecture hall 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, everyone retreated one after another.

There are many old ladies in the hospital's health lecture hall. 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.

Fatty disdain: 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. I heard that the mother of the flight attendant of China Southern Airlines, which department did you stay 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 summed up by combining textbooks and articles in top medical journals. Although it is simple, it is reliable and popular!