l******k
发帖数: 27533 | 1 【 以下文字转载自 Pharmacy 讨论区 】
发信人: lilybank (炎炎夏日何处去，采得青莲一茎香), 信区: Pharmacy
标 题: Re: 急问，妈妈睡眠不好，请问有什么好的保健药么？
发信站: BBS 未名空间站 (Tue Mar 13 21:51:34 2012, 美东)
nice search from Beer's list.
I don't look at it, but I believe the first generation antihistamine is not
contraindicated in the elderly. Reference is black and white, but the
patient is specific, the appropriate recommendation should be made based on
the patient's situation. Antihistamine is not the best drug for the elderly
insomnia, but for the healthy and the elderly in their sixties, we do
recommend first generation antihistamine especially the short half one like
chlorphenamine in the pharmacy. For the short half life one, the residual
and anticholinergic effects are transient and usually don't affect patients
function every much.
If the patient can not tolerate the first generation antihistamine bc of
anticholinergic AE, and she needs RX, I don't think it's appropriate to
recommend the second worst reagent TCA. The anticholingeric, antihistamine,
NE effects to increase cardiovascular are class side effects in TCA. These
risks are present in nortriptyline and desipramine though they have the
least anticholinergic effects. TCA has fell out of favor bc of its dirty AE.
Non-BZD is the drug of choice is the pt needs a sleep aid RX, and there
are FDA indicated long term use Non-BZDs.
Also, when we choose a drug to treat insomnia, the onset of action and the
duration are the major factors to consider. Before you recommended
nortriptyline, did you check its half life? I found its half life is more
than 16 hours. The sedation time is too long, the patient will have bad
residual effects, which will increase the fall risk of the elderly.
Do you still recommend TCA bc of that sentence you extracted from Beer's
list?:)
Again, short half life 1st generation antihistamine is not bad to be tried
firstly as occasional and short term use. If need long term therapy, refer
her to the doctor for Non-BZD, BZD, or antidepressants if the pt has
depression component.
Nice discussion with you:)
desipramine | l******k
发帖数: 27533 | 2 这个纯粹是BSO， 哈哈
码字这么多，一定要来显摆显摆
你们鄙视我吧，哈哈 | j***y
发帖数: 5098 | 3 牛，
看都看不下去，别说码这么多了
not
on
elderly
【在 l******k 的大作中提到】
: 【 以下文字转载自 Pharmacy 讨论区 】
: 发信人: lilybank (炎炎夏日何处去，采得青莲一茎香), 信区: Pharmacy
: 标 题: Re: 急问，妈妈睡眠不好，请问有什么好的保健药么？
: 发信站: BBS 未名空间站 (Tue Mar 13 21:51:34 2012, 美东)
: nice search from Beer's list.
: I don't look at it, but I believe the first generation antihistamine is not
: contraindicated in the elderly. Reference is black and white, but the
: patient is specific, the appropriate recommendation should be made based on
: the patient's situation. Antihistamine is not the best drug for the elderly
: insomnia, but for the healthy and the elderly in their sixties, we do
| l******k
发帖数: 27533 | 4 看不下去？
看来我写得太差了，哈哈
【在 j***y 的大作中提到】
: 牛，
: 看都看不下去，别说码这么多了
:
: not
: on
: elderly
|
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