A*******s
发帖数: 9638 | 1 开版已经一年了，弹指一挥间， 总结一下有利进一步发展。
先说一下值得记忆的好事， 有一个ID attending搞了个case study， 水平很高， 可
惜坚持了几周就放弃了， 可能是参加讨论的ID太少吧。 Rose的医学文献大家读是个很
好的主意，只不过因为太枯燥了，大家的兴趣不高。 为了娱乐大家，我们搞了医版的
非诚勿扰， liudier， lexian， chiusmd， sumo2009 等等都很出彩，让人难以忘怀
。 Dr.Newbie和dojo的争论也很夺人眼球， 不知道为什么newbie突然人间蒸发了， 令
人扼腕。 我搞了几次征文， 得到了againstwind， Rubyheart， forestpark1，
medwater， hims等的积极支持， 在此向他们表示感谢。 特别值得一提的是后期
Rubyheart的参与， 她的热心和才智，为本版增添了光彩。
负面的就是圣诞节期间某些外来ID的捣乱， 感谢futurehw的正确处理。 另外就是天牛
教授在本版的招亲实践， 实在让人觉得俗不可耐。
下一步我们版该怎么发展？ 我一直以为应该有一个新版主站出来， 带动大家... 阅读全帖 |
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g***r
发帖数: 285 | 2
What
75
when your attending said treat the patient, not the lab, it means you have
to look at the patient first, lab is just a tool to help you understand the
patient's condition better;
for instance, a patient on dilantin 100mg tid and has not had a breakthrough
seizure for many years and for whatever reason you ordered a dilatin level
and find it subtherapeutic, you do NOT just increase the dose of dilantin,
for all the patients/case scenario you listed, i bet all the patients were
symptomati |
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m********e
发帖数: 148 | 3 Regarding your Dilantin question, beside liver failure, will prolonging GI
retention give that type of delayed reansorption picture? Is this an OD
attempt?
Very interesting. Dilantin has high protein binding percentage and probably
very high body distribution volume. Did I'dt ever come down? |
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f******I
发帖数: 769 | 4 wouldn't trust a whole lot of wikipedia,
temproal lobe seizure is often from the lesions in hippocampal region,
either sclerosis, or tumor(glioma), or vascular malformation, it is often
partial simple or complex seizure but can generalize, one of the old drugs,
like dilantin, is effective, one of the newer drugs keppra, i think would
also be quite effective,
regardless your relative would need a brain MRI imaging test to rule out
cancer,
sometimes if the foci of the lesion can be localized, surg |
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c**b
发帖数: 2999 | 5 trileptal现在有generic drug药卖了,比商标药便宜很多,要医生处方才能买到.这个药
的发现只有10-20年历史,副作用小,可以给小孩吃.如果小孩吃了有效果的话,用这个药
是最好最经济的方法.
dilantin早就有generic drug卖了,这个药从上世纪中期就有了,在大陆也肯定买得到.
a |
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g*****j
发帖数: 1211 | 6 Wow... You should not mess with anti-epileptic drugs.
This is a class of very dangerous drug, and should only be used under
supervision by a neurologist. Most primary care doctors will not feel
comfortable prescribing these medicine. Different type of seizure uses
different drugs. Many seizure specialists will not use generic drugs in
treating seizure disorder, because a precise dose is critical to achieve
good seizure control and minimal side effects. This is not a field one can
learn hims... 阅读全帖 |
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A*****a
发帖数: 52743 | 7 Antiviral drugs
Cases of encephalitis due to certain viruses usually require intravenous
antiviral treatments. Antiviral drugs commonly used to treat encephalitis
include:
Acyclovir (Zovirax)
Ganciclovir (Cytovene)
Foscarnet (Foscavir)
Some viruses, such as insect-borne viruses, don't respond to these
treatments. However, because the specific virus may not be identified
immediately or at all, treatment with acyclovir is often begun immediately.
This drug can be effective against the herpes simpl... 阅读全帖 |
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u***e
发帖数: 611 | 8 癫痫的治疗没有什么大的进展，还是用那些药物，什么phenytoin, valproic acid之类
的，美国也没什么先进的办法。我看那些癫痫的病人不发病的时候也都活得和正常人一
样，看不出什么明显的副作用。会导致人格障碍没有听说过。能用单药控制就用单药，
不要一上来就一堆药上去。有些病人一来,on dilantin,depakote,keppra.....还在
seizing,神啊。 |
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s******v
发帖数: 477 | 9 Why use brand names in prescriptions? What if I wrote Lorazepam instead of
ativan, phenytoin instead of Dilantin? It is hard to new interns to remember
all the names of medications. |
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k**********n
发帖数: 438 | 10 还没啥感觉呢，这个月elective，本来就不用早起。不过欠了一些债，被人追打，日子
也不很好过:) I guess it does not matter either you write lorazepam/ativan or
Dilantin/Phenytoin, pharmacy has to verify it anyway. |
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y******7
发帖数: 17 | 11 The following is what I collected when I was a student doing capstone in a
local hospital. Not sure if it is useful.
Lidocaine topical is a amide-type local anesthetic. for production of
topical anesthesia, relief of pain associated with postherpetic neuralgia,
reduction of gagging during dental procedures, prevention and control of
urethral pain, anesthetic lubricant for endotracheal intubation, and relief
of hemorrhoidal pain.
Polyethylene glycol(Miralax) is a nonabsorbed solution used to trea... 阅读全帖 |
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h***y
发帖数: 834 | 12 关于dilantin，刚去看了一下pfizer的网页：
Unusually high levels result from liver disease, congenital enzyme
deficiency, or drug interactions which result in metabolic interference. The
patient with large variations in phenytoin plasma levels, despite standard
doses, presents a difficult clinical problem. Serum level determinations in
such patients may be particularly helpful. As phenytoin is highly protein
bound, free phenytoin levels may be altered in patients whose protein
binding characteristics differ fr... 阅读全帖 |
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A*******s
发帖数: 9638 | 13 dilantin的pharmacology是usmle常考的， 也是attending们最爱问的。 lol
我觉得就两种情况：
1. Pharmacy mistake
2. 病人自己吃药
现在两者都不承认。
药物interaction我就不知道了， 入院后停了Prevacid， 加了topamax。
The
standard
in
Urinary |
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A*******s
发帖数: 9638 | 14 Estrogen increases Dilantin level, so a drop of Estrogen is supposed to do
something opposite.
The patient has no weight changes. |
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A*******s
发帖数: 9638 | 15 Sorry could not write Chinese.
The patient is doing better. I would repeat an EEG. If no active seizures,
wean off phenobarbital. Keep keppra as is. In case of any recurrent
seizures, use dilantin not phenobarbital.
Don't forget to get physical therapist to see her.
Good luck.
PET |
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w******y
发帖数: 4871 | 16 真的没啥好办法。脑动脉瘤出血能够恢复到能思考走路说话已经是万幸了。现在有
seizure也可以用用Dilantin,keppra之类的药 |
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