f****o
发帖数: 2770 | 1 GENERAL PRINCIPLES
The first step in managing chronic HF is to determine the etiology or
precipitating factors. Treatment of underlying disorders (e.g., anemia,
hyperthyroidism) may obviate the need for treatment of HF.
Nonpharmacologic interventions include cardiac rehabilitation and
restriction of fluid intake (maximum 2 L/day from all sources) and dietary
sodium (approximately 1.5 to 2 g of sodium per day).
Stage A: The emphasis is on identifying and modifying risk factors to
prevent developm... 阅读全帖 |
|
l********8
发帖数: 491 | 2 The American Heart Associate recommends thiazide, ACEI, ARB or CCB as
equivalent options for the treatment of Hypertension. and JNC recommends
thiazide as initial drug therapy choice, with ACEI, ARB, B-blockers or CCB
as alternatives. But really, you can really use any of these as first line.
the only thing that is not good about ACEI is it causes dry cough in some
patients. |
|
l*h
发帖数: 4124 | 3 avapro is an ARB. it doesn't have effects on blood sodium and potassium
levels.
indapamide is a thiazide diuretic, which expels excessive sodium (and also
potassium) from the body. thiazide diuretic is the recommended first line
for most people, especially for those who have high sodium intake, such as
most Chinese people and African Americans. for long term use, potassium
supplement or a potassium-conserving diuretic should be taken at the same
time. this will require the patient's kidney funct... 阅读全帖 |
|
l*h
发帖数: 4124 | 4 general speaking, a higher percentage of patients experience some side
effects of ARB than thiazide diuretics, but the vast majority is very minor.
in patients with normal kidney functions, avapro does not have an effect on
blood potassium levels. from the mechanism of its actions, it is a kidney
function modifier. so you should report to your physician immediately any
signs suggesting reduced kidney functions.
thiazide diuretics are important in hypertension management. they are used
alone (or ... 阅读全帖 |
|
o******u
发帖数: 60 | 5 So far I understand that we could use thiazides in nephrogenic diabetes
insipidus.
the mechanism is working briefly like following:
Thiazides---->inhibit NaCl in Distal Tubule------>increased Na excretion----
-->ECF contraction---->decrease GFR------------>ultimately increase in Na
and water resorption in Proximal Tubule---->decrease urine output.
My question is "why we cannot treat with furosemide base on the same
mechanism?"
furosemide---->inhibit NaCl in loop of Henle------>increased Na excre... 阅读全帖 |
|
u****1
发帖数: 216 | 6 2013年prediabetes a1c 5.7-6.4%. 这类人群， 提倡减重和增加运动。 同时伴有htn
和水肿， thiazides类和loop类都同时升高血糖血脂。 torsemide, 口服loop类， 是
比较强的diuretics （相对thiazides类）。 还有一种k离子通道spring diuretics,
不升血糖。 但是同时病人又有心脏功能障碍和高血压，房颤， 使用k-sparing
diuretics， 有很大的危险。 可能现在而言， 利尿类使用这个还是不错的， 至少可
以降低血容量， 减低心脏负担。 同时降低血压。 至少可以减少水肿。
不知道各位前辈们什么评价。 |
|
u****1
发帖数: 216 | 7 2013年prediabetes a1c 5.7-6.4%. 这类人群， 提倡减重和增加运动。 同时伴有htn
和水肿， thiazides类和loop类都同时升高血糖血脂。 torsemide, 口服loop类， 是
比较强的diuretics （相对thiazides类）。 还有一种k离子通道spring diuretics,
不升血糖。 但是同时病人又有心脏功能障碍和高血压，房颤， 使用k-sparing
diuretics， 有很大的危险。 可能现在而言， 利尿类使用这个还是不错的， 至少可
以降低血容量， 减低心脏负担。 同时降低血压。 至少可以减少水肿。
不知道各位前辈们什么评价。 |
|
s*******y
发帖数: 851 | 8 帮老爸查了一下高血压的问题，找到一下资料，与各位共享，请指教。
饮食控制
1． 多吃水果，午饭和晚饭各吃一个
2． 少吃肉，不吃猪皮，鸡皮
3． 多吃稻谷，蔬菜，鱼
4． 只吃蛋清
5． 减少盐和钠的吸入量
6． 减少体重
7． 多活动
8． 少喝酒
9． 戒烟
10． 多吃含钾的食物
治疗高血压的药物
1． 利尿剂（Diuretics, Water pill）
。Thiazide diuretics（效果好）
。Potassium-sparing diuretics（对降压无用）
。Loop-acting diuretics（有效果）
2． 压力舒缓剂（Beta blocker or Beta Adrenergic Antagonist 效果好）
3． ACE抑制剂(ACE inhibitor, Angiotensin converting enzyme ACE 效果好)
4． 血管紧缩抑制剂（Angiotensin antagonist）
5． 钙抑制剂（Calcium channel blockers CCB 效果不好）
6． 阿尔法抑制剂（Alpha blocker）
7． 阿 |
|
E******r
发帖数: 40 | 9 How high is his over all blood pressure?
If his blood pressure is around 135/85, which means diastolic pressure (低压)
is 80 something, here in the US usually patients will just cooperate with
dietary changes to begin with.
When b.p. raises around 155/95, which is mild high blood pressure, patients
are prescribed with thiazide-type diuretics (li4 niao4 ji), trying to decease
overall blood volume.
If the b.p. is very high, say 160/100, usually a med combinations are applied,
such as ACE inhibitors, |
|
A**H
发帖数: 44 | 10 thiazide is the drug of choice. |
|
c********e
发帖数: 496 | 11 The Rx of hypertension is highly individualized one, so need more
information to throw any comments.
Roughly, the drug of choice is thiazide (HCTZ), but this patient needs at
least two antihypertensives to get the blood pressure well controlled. I
would like to say Captopril is the other.
By the way, if the stroke is ischemic one, aspirin is a must. |
|
l*h
发帖数: 4124 | 12 170/85 is way way too high. long term goal should be 120/80mmHg based on
current evidence of blood pressure management.
from what you said, his history of hypertension should be quite long. it is
very likely he has serious arteriosclerosis and reduced heart function.
there is very little reason to use a calcium channel blocker (尼夫达) as the
main drug in this situation.
unless his sodium intake is already much lower than recommended level, in
principle, he should take a thiazide diuretic plus an A... 阅读全帖 |
|
f****o
发帖数: 2770 | 13 HCTZ
Impotence
1) Impotence has been reported following hydrochlorothiazide use at doses of
25 mg or greater [69].
Sexual dysfunction
1) There may be some association between thiazides and decreased male sexual
function (impotence), especially if in combination with adrenergic-blocking
antihypertensive agents [180].
2) Hydrochlorothiazide may have a greater incidence of sexual dysfunction
associated with its use than prazosin. In a crossover study evaluating the
effects of both agents on sexual ... 阅读全帖 |
|
R**********n
发帖数: 473 | 14 This Q is from orientation of released CD, not CD Qs, so don't worry,
everyone can do it. It looks very simple though, but not sure which one is
the answer
A man passed a kidney stone, turned out to be calcium oxalate, what's the
best step of management?
A. give thiazide
C. more fluids.
Which one? I think both are right.
Many thanks! |
|
n***8
发帖数: 634 | 15 I saw this question some where, but now I can't remember the correct answer.
My cents, if the patient didn't have other contraindications to thiazide,
such as gout, lipid problem, then I will choose A.
Good luck to your CK. |
|
p********g
发帖数: 372 | 16 More fluids? More fluids can help patient pass more small stone. I think
Thiazide is preventing the recurrence of calcium stone not the best step for
management. Correct me if I am wrong. |
|
c********n
发帖数: 4762 | 17 Regarding to your mam's high bp (high gap between systolic and diastolic),
珍菊降压片 (thiazide + clonidine) is a good choice.
Every patient is different. A good drug for others may be toxic to your mam.
The main inconvenience of 珍菊降压片 is patients will pee a lot. |
|
c********n
发帖数: 4762 | 18 Of course clonidine is not the first line, thiazide is. |
|
l********y
发帖数: 2295 | 19 汗，这个不肯定了，好像也许，，没有用。。。
我的理解是不管有没有冠心病表现，这类病人都应该做心脏彩超和平板试验，同时服用
aspirin和beta－blocker。。可是国内的医生没有让做这些啊，我也半懂不懂，没有建
议。
ACEI还是我考了step1让换的，以前降压用的居然不是ACEI，是thiazide！ |
|
i**********d
发帖数: 853 | 20 首先声明：我的分数很普通，所以这个帖子也没有任何炫耀的意思，只是我在考前
，每天都来看看有没有考经，也经常拿自己的模考成绩和考经中的对照一下，看看自己
复习的效果，从前辈的考经中学到很多。所以，本贴得唯一目的是：希望能给还在准备
step1的朋友们一点提示，吸取我的教训，都考出一个好成绩。
正文：
我是8/06/2012考的Step1，昨天（8/29/2012）早上9:19am拿到成绩---242/85，还
好，和自己估计的成绩240 +/- 5基本一致。万分感谢我的家人的理解和支持，十分感
谢曾经一起学习的战友们和校友们的鼓励和帮助，感谢麦地版的前辈们的考经和经验介
绍。曾经许诺一旦成绩上了230，就写一篇考经，下面就把我的备考经历和一点心得体
会向麦地版的战友们作一汇报，也算是对自己这段人生的一个总结：
一、题库、模考及考试成绩+时间：
UW qBank: 正确率最早25%，考前80-90%
Kaplan qBank: 只做了解剖、遗传，没有统计正确率
Dec 18, 2011, Form3 --- 350
Feb 25, 2012， F... 阅读全帖 |
|
i**********d
发帖数: 853 | 21 Jeff的75条口诀：
1).
Chloramphenicol inhibits 50S peptidyltransferase.
喷着氯气的ram(羊)拦住(抑制) 50岁的亚裔太太搬家(转移)(50S亚基肽键转移酶)
Clindamycin & chloramphenicol block peptide bond formation.
克林顿用氯气 吓唬老婆 --> 防止太太贱(肽键)形成
Aminoglycosides bind 30S and inhibit formation of the initiation complex and
cause misreading of mRNA.
Amigo绑架了30S亚裔,抑制了她婚姻的起始,造成她男友的误读
Macrolides block translocation.
带着大沿帽子的人（城管？）挡道--> 不让别人换地方translocation
2).
下肢淋巴回流：
小隐隐于城外蝈蝈窝棚，大隐隐于城内富人水沟
（小隐收集小腿外侧淋巴液，注入腘窝；
大隐收集下肢内侧淋巴液，注入腹股沟；）
3)
imprinting diseas... 阅读全帖 |
|
i**********d
发帖数: 853 | 22 首先声明：我的分数很普通，所以这个帖子也没有任何炫耀的意思，只是我在考前
，每天都来看看有没有考经，也经常拿自己的模考成绩和考经中的对照一下，看看自己
复习的效果，从前辈的考经中学到很多。所以，本贴得唯一目的是：希望能给还在准备
step1的朋友们一点提示，吸取我的教训，都考出一个好成绩。
正文：
我是8/06/2012考的Step1，昨天（8/29/2012）早上9:19am拿到成绩---242/85，还
好，和自己估计的成绩240 +/- 5基本一致。万分感谢我的家人的理解和支持，十分感
谢曾经一起学习的战友们和校友们的鼓励和帮助，感谢麦地版的前辈们的考经和经验介
绍。曾经许诺一旦成绩上了230，就写一篇考经，下面就把我的备考经历和一点心得体
会向麦地版的战友们作一汇报，也算是对自己这段人生的一个总结：
一、题库、模考及考试成绩+时间：
UW qBank: 正确率最早25%，考前80-90%
Kaplan qBank: 只做了解剖、遗传，没有统计正确率
Dec 18, 2011, Form3 --- 350
Feb 25, 2012， F... 阅读全帖 |
|
i**********d
发帖数: 853 | 23 Jeff的75条口诀：
1).
Chloramphenicol inhibits 50S peptidyltransferase.
喷着氯气的ram(羊)拦住(抑制) 50岁的亚裔太太搬家(转移)(50S亚基肽键转移酶)
Clindamycin & chloramphenicol block peptide bond formation.
克林顿用氯气 吓唬老婆 --> 防止太太贱(肽键)形成
Aminoglycosides bind 30S and inhibit formation of the initiation complex and
cause misreading of mRNA.
Amigo绑架了30S亚裔,抑制了她婚姻的起始,造成她男友的误读
Macrolides block translocation.
带着大沿帽子的人（城管？）挡道--> 不让别人换地方translocation
2).
下肢淋巴回流：
小隐隐于城外蝈蝈窝棚，大隐隐于城内富人水沟
（小隐收集小腿外侧淋巴液，注入腘窝；
大隐收集下肢内侧淋巴液，注入腹股沟；）
3)
imprinting diseas... 阅读全帖 |
|
c*****t
发帖数: 625 | 24 昨天回来的早，花了点时间读了几篇相关的文献，写了一个minireview，供大家参考和
讨论。谢谢大家的参与和建议。
The literature does not indicate that beta1-
selective betablocking agents have adverse effects on
glucose metabolism, prolong hypoglycemia or mask
hypoglycaemic symptoms. Specifically, some studies described diminished
occurrence of tremor and heart-pounding, but increased sweating. In diabetic
nephropathy
betablockers are as nephroprotective as ACEI (J of internal medicine, 2001).
But beta-blockers should not be used as a first-line ch... 阅读全帖 |
|
J******Z
发帖数: 32 | 25 A 13 year old boy is brought to the physician office by his mother for an
examination prior to participation in sports .He has no history of serious
illness and takes no medication .his maternal and paternal grand fathers
have HTN and type 2DM..the pt is at the 95th % for height and above the 95%
for weight and BMI.His temperature is 36.7 and pulse is 84/min and RR is 16/
min and B.P is 130/83mmhg..(95th%).Examination shows no abnormalities.in
addition to recommending participation in sports ,wh... 阅读全帖 |
|
p********t
发帖数: 411 | 26 Nifedipine就不推荐用，我估计在国内用的是30mg拜新同。换成利尿剂吧。ARB（ACEi
）+Thiazide是个绝佳组合，不行可以再加amlodipine。另外，每个人情况不一样，不
能用你妈妈的药来对比你爸爸的。 |
|
i**********d
发帖数: 853 | 27 75条口诀：
1).
Chloramphenicol inhibits 50S peptidyltransferase.
喷着氯气的ram(羊)拦住(抑制) 50岁的亚裔太太搬家(转移)(50S亚基肽键转移酶)
Clindamycin & chloramphenicol block peptide bond formation.
克林顿用氯气 吓唬老婆 --> 防止太太贱(肽键)形成
Aminoglycosides bind 30S and inhibit formation of the initiation complex and
cause misreading of mRNA.
Amigo绑架了30S亚裔,抑制了她婚姻的起始,造成她男友的误读
Macrolides block translocation.
带着大沿帽子的人（城管？）挡道--> 不让别人换地方translocation
2).
下肢淋巴回流：
小隐隐于城外蝈蝈窝棚，大隐隐于城内富人水沟
（小隐收集小腿外侧淋巴液，注入腘窝；
大隐收集下肢内侧淋巴液，注入腹股沟；）
3)
imprinting disease: ch... 阅读全帖 |
|
i**********d
发帖数: 853 | 28 75条口诀：
1).
Chloramphenicol inhibits 50S peptidyltransferase.
喷着氯气的ram(羊)拦住(抑制) 50岁的亚裔太太搬家(转移)(50S亚基肽键转移酶)
Clindamycin & chloramphenicol block peptide bond formation.
克林顿用氯气 吓唬老婆 --> 防止太太贱(肽键)形成
Aminoglycosides bind 30S and inhibit formation of the initiation complex and
cause misreading of mRNA.
Amigo绑架了30S亚裔,抑制了她婚姻的起始,造成她男友的误读
Macrolides block translocation.
带着大沿帽子的人（城管？）挡道--> 不让别人换地方translocation
2).
下肢淋巴回流：
小隐隐于城外蝈蝈窝棚，大隐隐于城内富人水沟
（小隐收集小腿外侧淋巴液，注入腘窝；
大隐收集下肢内侧淋巴液，注入腹股沟；）
3)
imprinting disease: ch... 阅读全帖 |
|
k******o
发帖数: 3328 | 29 因为heart failure会increase uric acid.不知道是不是也跟这方面相关.
另外side effect from thiazide 也会increase
问一下,我很想知道 |
|
c********y
发帖数: 33 | 30 准备第一步evaluation exam总结的，都是参考别的书的，也不是很全面，所以如果有
错误请多包
涵，如下：
Methyldopa —— galatorrhea, SLE
Levodopa - taste disturbance
Procainamide - SLE, agranulocytosis,torsade de points
Captopril - agranulocytosis
ACEI - taste disturbance, dark stool
Cyclosporin - acute gout, gingival overgrowth
Phenytoin - SLE, gingival overgrowth
Thiazide - SLE, pulmonary edema, gout
Sulfasalazine - Pulmonary fibrosis, SLE
Chlopramazine - SLE, seizure, dry mouth
Verapamil - galactorrhea, bradycardia
PTU - agranulocytosis, S... 阅读全帖 |
|
l******k
发帖数: 27533 | 31 随便看了一眼，好像有不少问题呀。
提几个：
captopril 就是ACEI，为什么分开？主要问题是multi-dosing吧。
Niacin: flushing
thiazide:出要是electrolytes,当然还有lipid的问题。
自己看书确实比较难，看来读个pharm.D.还是有好处的。 |
|
b**o
发帖数: 5769 | 32 今天我们还有Case讨论呢。不过主要针对hypertension。
就你这个case里面的hypertention用药，照我们老师教的用BB就很不合适，而且她还胸
闷，喘不过气来，这些应该都是BB的副作用引起的。
我们老师教的就是糖尿病，首选ACE and ARB，而且ARB还能减低尿蛋白，所以强力推荐
的是ARB.
还有diuretic首选是thiazid，不知道你这里用loop是不是主要因为她有CHF? 我们还没
有学到CHF呢。呵呵。
只能做一部分。 |
|
l******k
发帖数: 27533 | 33 哈哈，赞！
凭印象补充下NSAIDs对肾和血压的影响
NSAIDs constrict afferent arterioles of glomerulus, which may cause fluid
retention and therefore increase BP.
严重的情况是NSAIDS-LISINOPRIL-LOOP DIURETIC TRIAD contraindication
另外一种说法是NSAIDs有其他未知机理影响anti-hypertensive drugs efficacy like
beta blockers and thiazides... |
|
l******k
发帖数: 27533 | 34 哈哈，赞！
凭印象补充下NSAIDs对肾和血压的影响
NSAIDs constrict afferent arterioles of glomerulus, which may cause fluid
retention and therefore increase BP.
严重的情况是NSAIDS-LISINOPRIL-LOOP DIURETIC TRIAD contraindication
另外一种说法是NSAIDs有其他未知机理影响anti-hypertensive drugs efficacy like
beta blockers and thiazides... |
|
S**********e
发帖数: 1325 | 35 血钾？血钙？血肌酐？尿蛋白？其他合并什么疾病（比如说糖尿病）？还在吃着什么药
（for 别的疾病）？目前这两种降压药是什么剂量，有没有用到最大剂量？寿比山是推
荐的一线药物thiazides的一种,停药的特殊原因是什么？
调药是个综合复杂的思维过程，医生要考虑的各种方面远远比你所提供的信息要多。
难治性高血压的定义是,使用三种降压药,其中包含一种利尿剂，仍然达不到理想血压。
你母亲目前用着两种药物,而且不知道她更多的具体情况,所以不知道她个体化的理想血
压是多少,所以她目前还谈不上难治性高血压。
发包子！
★ 发自iPhone App: ChineseWeb 7.8 |
|
