l********y
发帖数: 2295 | 1 这个step1和step2都很爱考，希望自己考试的时候还能记住：
induction of P-450: 这个大家都知道吧，不知道的面壁。
Queen Barb Refuse Phen Sit Gray Car.
Inhibition of P-450: 不知道的面壁。
Inhibitors Stop Crying Kids from Eating Grapefruit.
Metabolsim by P-450:
话说阿Q被大赦，幸运的娶了茶宝宝，可是还是三天两头的吵架，pony就劝他别吵啦，
拍拍MP气就消了，就被450给代谢啦。
阿Q（AQ），No War,Please MP 茶 BB。
A:amide anesthetics
Q: quinidine
N: nifedipine
War: warfarin
P：Phenytoin
M: metoprolol
P: propranolol
茶：theophylline
B: benzodiazepines
B: barrbiturates |
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h*******r
发帖数: 182 | 2 Last Easter Sunday, We had dinner with friends. 男主人头发全白了, 看了让人难
过.
Earlier his wife called us, asking us praying for his health, especially for
his deteriorating renal function. When I asked the detail, he could not
give the exact number, but he said if it still goes down, he has to consider
dialysis. He took too many medications, a lot of them I don't quite agree.
Please take a look, and give some kind suggestions.
75 year old African American, 20+ years high BP,12+ year prostate cancer
after c... 阅读全帖 |
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p********t
发帖数: 411 | 3 说一句，metoprolol这种选择性的beta受体拮抗剂不是糖尿病的禁忌药物，国内心内科
大夫天天说。如果不用，弊大于利。 |
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R*********s
发帖数: 58 | 4 Metoprolol 是beta 1 选择性抑制剂，会掩盖低血糖的症状，是不应该用在insulin治
疗的糖尿病人吧？但哮喘病人可用，因为beta 2 不受影响。非选择性的则都不能用。
欢迎指正和讨论 |
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j*****o
发帖数: 137 | 5 A 43-year-old man comes to the physician for evaluation and management of
cardiac risk factors 8 weeks after sustaining a myocardial infarction. He
takes aspirin and metoprolol daily, and he does not smoke cigarettes. His
father and brother both had myocardial infarctions before the age of 50
years; their serum cholesterol levels are unknown. There is no family
history of diabetes mellitus. He weighs 86 kg (190 lb) and is 180 cm (71 in)
tall. His blood pressure is 130/70 mm Hg, pulse is 68/min, ... 阅读全帖 |
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j*****o
发帖数: 137 | 6 A 43-year-old man comes to the physician for evaluation and management of
cardiac risk factors 8 weeks after sustaining a myocardial infarction. He
takes aspirin and metoprolol daily, and he does not smoke cigarettes. His
father and brother both had myocardial infarctions before the age of 50
years; their serum cholesterol levels are unknown. There is no family
history of diabetes mellitus. He weighs 86 kg (190 lb) and is 180 cm (71 in)
tall. His blood pressure is 130/70 mm Hg, pulse is 68/min, ... 阅读全帖 |
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a********n
发帖数: 438 | 7 Atrial Fibrillation
这个是最常见的arrhthymia 啦。如果SYMPTOMATIC/UNSTABLE，那么需要Electrical
CARDIOVERT
如果病人血压正常，没有心悸，relatively asymptomatic, 那么有3点注意：
1>Control ventricular responsive rate , 常用药有calcium channel blocker: IV
diltiazem BOLUS followed by continous IV 5-10mg/hr. 超过15mg/hr 需要转送ICU
。注意血压。beta-blocker:IV metoprolol 5-10mg IV then q6hrly. 我这儿有个医
生特喜欢用SOTALOL。 IV DIGOXIN : 0.5mg IV x1, then in 6hrs 0.25mg IV q6hrx2
then standing dose 0.125mg -0.25mg in am.
2>ANTICOAGULATE，会上HEPARIN DRIP（check PTT q6hr |
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a****a
发帖数: 154 | 8 我只在med-surg实习过，现在记的仅限于书本有限记忆知识，列错了请更正我啊。
1. cardiac meds
digoxin，inocor,nitrate，nipride，tridil，beta blocker such as metoprolol，
ACEI such as captopril， enalapril， benzapril， calcium channel blocker
such as verapamil， nifedipine, ditiazem.
2 diuretics
lasix, ....不好意思，我得出门了，回来再尽量补充啊 |
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k******o
发帖数: 3328 | 9 haha, which medication, by the way.
I always want to know every mistake made by pharmacist so I can remind
myself
Here are some examples of mistake report I did for other pharmacists:
1.Metoprolol Succinate or Tartrate(Toprol XL & Lopressor).
2.Glipizide or Glipizide XL
3.Lithium ER or Lithium
Hope you guys can come up with more! |
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r********r
发帖数: 352 | 10 Mevalotin 是 Pravastatin
Betaloc 是 metoprolol tartrate
其它的在华人上回过MM了。 |
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a*****8
发帖数: 2115 | 11 well, bystolic is not recommended for HF anyway. if it is for HTN or prevent
post-op arrth metoprolol is a good choice. |
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R*Q
发帖数: 179 | 12 去年的考题, 大家体会一下感觉吧.
时限 30分钟: 20分钟准备, 10分钟口试答题.
Patient is a 68 year old female, very nice and pleasant, obese Caucasian
female with a past medical history of multiple medical problems. She was
unable to sleep last night because she could not catch her breath. Her son
brought her to the emergency room. Patient is still feeling short of breath
. She denies any acute chest pain at this point. She denies any recent
fever, chills, cough, or purulent sputum. All her prior records were
reviewed. Sh... 阅读全帖 |
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P*******D
发帖数: 523 | 13 补充一点。
Pioglitazone can cause CHF exacerbation. Might consider discontinuing it and
start another oral med since her A1C is not that bad. I also wonder if she
has AF with a HR of 98. But we don't have the number after she was treated.
Hopefully metoprolol can take care of some of that. I would follow up with
an EKG, if she does have, she might need an anticoagulant due to her CHADS2
score being high.
I would also recommend getting flu vaccine and pneumococcal vaccine for her. |
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w******e
发帖数: 42 | 14 start 25 mg captopril TID (Monitoring: looking for signs of hypotension (
dizziness, weakness).
Why you want to challenge the patient?
metoprolol tartrate is NOT apporved for CHF.
You are right about it. But in reality, some cardiologists do not care...
Since she has CHF now, beta blocker wouldn't be good choice.
Please refer the COMET trial.
she might need an anticoagulant due to her CHADS2 score being high.
Usually you do not need anticoagulation if pt do not have Afib and HF.
Please refer War... 阅读全帖 |
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b******8
发帖数: 1251 | 15 呵呵，课间10分钟，正在上HF的课：
第一个看到的就是，use ARB if intolerating ACE-i
2， should be metoprolol succinate, beta-blocker is fine when she is stable,
really stable.
3楼上的，你提的那些trails呀，我们老师要我们背呀，哪个trial证明了什么，我的天
呀，我保证我考完了马上忘。 |
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b**o
发帖数: 5769 | 16 我们才上了HF!又说HF不能用metoprolol tartrate, 要用XL. |
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b******8
发帖数: 1251 | 17 就只能用三个呀，bisoprolol, metoprolol succinate, carvedilol,BEST trial说了
it's not a class indication for beta blocker.后天考HF/AF/dysrhythmias.我们居
然要背所有的trials |
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g*******4
发帖数: 19 | 18 Trimetazidine Dihydrochloride Tablets 泽维尔
Metoprolol Tartrate Tablets 倍他洛克
Isosorbide Mononitrate Sustained Release Tablets 欣康
FluvastatinSodiumCapsules 来适可
Aspirin Enteric-Coated Tablets 拜阿司匹林
另两种是中成药。
谢谢!这些西药之间没有叠加作用？ |
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l******k
发帖数: 27533 | 19 What's the English name of the med your mom on?
Rate control by beta blocker is the first line treatment for A.fib, which
will reduce blood pressure. Metoprolol may have less blood pressure effects
than carvedilol
★ 发自iPhone App: ChineseWeb 8.7
★ 发自iPhone App: ChineseWeb 8.7
★ 发自iPhone App: ChineseWeb 8.7 |
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r********h
发帖数: 5638 | 20 发了站信
1）没有大于2
2）resting > 80,多数是87+
3）这个要时常监控，不知道是什么
我妈原来吃的倍他乐克是商品名，Betaloc，Metoprolol是化学名，血压降得太低，所
以医生给让吃可达龙。
请问其他什么药物她吃比较好呢？谢谢 |
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l********o
发帖数: 41 | 21 请问，可否介绍一下 warfarin vs Dabigatran/Apixaban/Rivaroxaban 的优缺点？
我父亲两年前开始用warfarin, inr一直控制在2左右，也没有什么不适的感觉。 最近
一次看医生，她说最近两年有很多人从wafarin转到Apixaban, 让我们考虑下是否也转
。 我查了一下Apixaban是两年前刚出的新药，有些纠结。能否给些专业的意见，非常
感谢！
P.S 我爸有糖尿病，高血压，房颤。 目前常规用的药有：METFORMIN,INSULIN,
SIMVASTATIN,LISINOPRIL,METOPROLOL,WAFARIN. |
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r********h
发帖数: 5638 | 22 1）现在，今天早上，低压67
2）心跳不齐是什么意思？我妈描述是心慌慌跳
3）Betaloc，就是那个Metoprolol药。 当是3年前，吃的小剂量，很小， 吃了半个月
，我妈说总是头晕，后来医生说是血压低，所以给换成可达龙。
主要是我不知道这种情况有没有危险，我妈怕突然发生什么事情，给我们添麻烦
我是想是否能找到专科医生，没有保险看看，但又不知道从哪里做起。 |
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u***e
发帖数: 611 | 23 The heart rate is acceptable , if no symptom, just stop metoprolol or amio |
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B*B
发帖数: 87 | 24 看见前两天有人问可达龙amiodarone的问题， 有很多人回答，我也想咨询下我父亲的
情况。
我父亲有心率不齐的病，发病时候心率很高，150+降不下来。
前几年发病过昏迷，进入医院抢救，那时候就装了一个pacer.
平时心率很低50左右，现在一直在吃可达龙amiodarone。
长期高血压，现在是早上血压140～80.
我父亲说医生把可达龙amiodarone当法宝给他用。
倍他乐克Betaloc/Metoprolol他一吃就会降低心率，他心率本来就很低，吃了以后就不
舒服，所以还是可达龙amiodarone好。
因为前两天看见帖子里说可达龙amiodarone副作用很多，
所以想看看还有没有别的替代药物？ |
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u***e
发帖数: 611 | 25 有pacer怎么心率还只有50，pacer一般设在60，去检查一下pacer有没有在工作吧。有
pacer就把metoprolol 剂量加上去就好了。不需要amio |
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s********4
发帖数: 64 | 26 Chief Complaint: “I have blood in my stool, and nausea with coffee-ground
emesis.”
History of Present Illness: TH is a 55-year-old man with a past medical
history significant for liver cirrhosis secondary to alcoholic liver disease
and portal hypertension with multiple episodes of esophageal varices who
presented to the emergency room with a two week history of black tarry
stools 2-4 times per day sometimes mixed with bright blood. He also had some
nausea with intermittent vomiting for the same ... 阅读全帖 |
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u*******s
发帖数: 688 | 27 没关系，讨论而已，没有必要在same page.
今天又看了看,有几个问题：
levaquin在这里的作用是神马？没觉得有必要上abx啊
有几个liver meds，比如apap, lipitor之类的，discharge之后应该由pcp来解决。
metoprolol 12.5 mg bid又有必要吗？血压已经很低了。最好把lasix 和kcl一起get
rid of
还有protonix 8 mg/hr iv太多了，改成40mg qd or bid比较好吧。
不管是iv KCl 还是dc KCl, po KCl 肯定是要改的。
再给病人test for H.pylori |
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L*****r
发帖数: 722 | 28 Dr. Aplusplus (Hakuna Matata)：Good decision-making comes from experience,
and experience comes from bad decision-making.
Dr. Lexian (蒙古大夫)：ideally, get your experience from OTHER'S bad
decision making :-)
1. When you order cultures, please write “before antibiotics are given”;
while order starting antibiotics, please write “after blood and urine
cultures are collected” . 因为用抗生素会显著影响细菌培养的结果；
注意有些特殊情况，尤其要考虑先取材培养，再上抗生素。
（1）怀疑骨髓炎，应该先probe the bone to get deep tissue culture, since
superficial cultur... 阅读全帖 |
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g*2
发帖数: 658 | 29 刚刚把堆积了几个星期的nejm翻看了一下，居然在11月底的那期case discussion就是
讲得这个病
http://www.nejm.org/doi/full/10.1056/NEJMcpc1103565
Case 36-2011 — A 93-Year-Old Woman with Shortness of Breath and Chest Pain
Presentation of Case
Dr. Pooja Agrawal (Emergency Medicine): A 93-year-old woman was seen in the
emergency department at this hospital because of chest pain and shortness of
breath.
The patient had been in her usual state of health, with hypertension and
chronic renal insufficiency, until the morning of admission, wh... 阅读全帖 |
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e******e
发帖数: 45 | 30 想请教一下各位医生：
我妈妈今年56岁，1年前开始间断有胸闷等心绞痛症状，1周前在省会医院诊断冠心病。平常血压约
140/90。
医院出具的CT诊断：
右冠优势型。
RCA：近段见非钙化斑，15.2mm，管腔最狭窄约40%（Q2）
LM：(-)
LAD: 近段见非钙化斑，12.2mm，管腔最狭窄约60%（Q1）
LAX:(-)
动态心电图：
偶发室早，偶发房早伴非持续性房速，完全性右束支阻滞。
医生所开药物：
1.valsartan Capsules
2.metoprolol succinate sustained-release tablets
3.Rosuvastain calcium tablets
4.aspirin enterric-coated tablets
5.Isosorbide Mononitrate Tablets
医生还建议她安支架，说实际狭窄可能要比CT报告的严重，而且“病变位置很好放”。我有点担心医
生过度医疗，毕竟做了PCI就得长期抗凝，也有出血风险。所以想请教一下各位医生，我妈妈这种情
况是吃上述的... 阅读全帖 |
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h*******r
发帖数: 182 | 31 贴在Medicareer只有围观没人回应, 只好来这里求助.原来贴在Medicareer, 也是希望
教授,老师们能评点以下这一治疗方案,让成长的麦穗们学习一下.多谢多谢!
Last Easter Sunday, We had dinner with friends. 男主人头发半年之内全白了, 看
了让人难
过.
Earlier his wife called us, asking us praying for his health, especially for
his deteriorating renal function. When I asked the detail, he could not
give the exact number, but he said if it still goes down, he has to consider
dialysis. He took too many medications, a lot of them I don't quite agree.
Please take a look, and give some kind s... 阅读全帖 |
|
b*****l
发帖数: 8603 | 32 Endo--
A 57-year-old female with a past medical history (PMH) of hypertension (HTN)
and depression was admitted for mental status change and fever for 1 week.
On admission, she was diagnosed with multilobar pneumonia and antibiotic
treatment with azithromycin and Zosyn (piperacillin and tazobactam injection
) was started. Blood cultures showed gram positive cocci in clusters and
vancomycin was added. LP was negative for meningitis.
Home medications
Toprol XL (metoprolol succinate), Neurontin (ga... 阅读全帖 |
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