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Medical students, and even non-neurologists who have been in the clinic for many years have this experience: Neurology is the most difficult major, and there is nothing complicated
.
God in the disease in addition to most of the cerebral vascular disease, almost all other incurable diseases, diagnosis is also the most difficult
Medical students, and even non-neurologists who have been in the clinic for many years have this experience: Neurology is the most difficult major, and there is no miscellaneous
Drug therapy is the "cornerstone" of neurological disease treatment
.
However, as a neurologist, I always feel unsure when I need to take medicine alone when I go to work or on duty
Drug therapy is the "cornerstone" of neurological disease treatment
1.
Aspirin
Aspirin 1.
Aspirin
1) Aspirin may cause severe allergic reactions, including measles, facial swelling, asthma (wheezing), shock
.
.
2) This product contains non-steroidal anti-inflammatory drugs (NSAIDS), which may cause severe stomach bleeding
.
.
3) Low-dose aspirin can induce gout
.
.
3) The following situations should be used with caution or prohibited:
3) The following situations should be used or prohibited with caution: 3) The following situations should be used or prohibited with caution:
a.
Reye's syndrome: Children and adolescents who have chickenpox or flu-like symptoms or are recovering from it should not use this product .
When using this product, behavioral changes such as nausea and vomiting may be an early sign of Reye's syndrome, which is a rare but serious disease .
Reye's syndrome: Children and adolescents who have chickenpox or flu-like symptoms or are recovering from it should not use this product .
When using this product, behavioral changes such as nausea and vomiting may be an early sign of Reye's syndrome, which is a rare but serious disease .
b.
Have ever had an allergic reaction to any other painkillers/fever medicine or a history of asthma
b.
Have ever had an allergic reaction to any other painkillers/fever medicine or a history of asthma
c.
History of gastroduodenal ulcer, including chronic ulcer, recurrent ulcer, gastrointestinal bleeding
.
History of gastroduodenal ulcer, including chronic ulcer, recurrent ulcer, gastrointestinal bleeding
.
d.
People who suffer from gout, diabetes or arthritis, and are taking other NSAIDS drugs (including ibuprofen or propanaxan, etc.
) should consult a doctor
.
People who suffer from gout, diabetes or arthritis, and are taking other NSAIDS drugs (including ibuprofen or propanaxan, etc.
) should consult a doctor
.
diabetes
e.
Do not use aspirin during the last 3 months of pregnancy unless under the explicit instructions of a doctor
.
Do not use aspirin during the last 3 months of pregnancy unless under the explicit instructions of a doctor
.
2.
Clopidogrel bisulfate
Clopidogrel Bisulfate 2, Clopidogrel Bisulfate
1) Like other antiplatelet drugs, patients who are at increased risk of bleeding due to trauma, surgery or other pathological conditions and receive aspirin, NSAIDS including Cox-2 inhibitors, heparin, platelet glycoprotein Ⅱb/Ⅲa (GPⅡb/Ⅲa) Clopidogrel should be used with caution in patients treated with antagonists
.
.
2) Combination of clopidogrel and warfarin is not recommended because it may make bleeding worse
.
.
3) In patients who need elective surgery, clopidogrel should be stopped 7 days before surgery
.
.
4) Missed dose within 12 hours of the regular medication time : the patient should take a standard dose immediately and take the next dose according to the regular medication time; missed medication after 12 hours beyond the regular medication time : the patient should take the next regular medication time Standard dose, no need to double the dose
.
Missed dose within 12 hours of regular medication time : The patient should take a standard dose immediately and take the next dose according to the regular medication time; missed after 12 hours of regular medication time Missed taking after taking more than 12 hours of regular medication : The patient should take the standard dose at the next regular medication time without doubling the dose
.
5) Patients who use selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) should be used with caution
.
.
3.
Atorvastatin/Rosuvastatin:
Atorvastatin/Rosuvastatin: 3.
Atorvastatin/Rosuvastatin:
1) Statins can cause myopathy with elevated CK.
For such patients, the drug should be stopped immediately
.
For such patients, the drug should be stopped immediately
.
2) Atorvastatin is mainly metabolized by the liver, and rosuvastatin is mainly metabolized by the kidneys.
Therefore, patients with abnormal liver function are recommended to use rosuvastatin, and patients with renal impairment are recommended to use atorvastatin
.
Therefore, patients with abnormal liver function are recommended to use rosuvastatin, and patients with renal impairment are recommended to use atorvastatin
.
3) Drugs that may interact with statins include:
3) Drugs that may interact with statins include:
a.
HIV protease inhibitors (such as lopinavir, darunavir, ritonavir);
HIV protease inhibitors (such as lopinavir, darunavir, ritonavir);
b.
Azole antifungal drugs (such as itraconazole, ketoconazole);
Azole antifungal drugs (such as itraconazole, ketoconazole);
.
c macrolide anti- infection drugs (e.
g.
, erythromycin, clarithromycin, telithromycin);
infection drugs (e.
g.
, erythromycin, clarithromycin, telithromycin); Infection
d.
Fibrates lipid-lowering drugs (such as gemfifibrate, bezafibrate);
Fibrates lipid-lowering drugs (such as gemfifibrate, bezafibrate);
Other e: nicotinic acid, nefazodone, cyclosporine, amiodarone, diltiazem, Cardiff the West acid
.
.
4.
Pregabalin
Pregabalin 4.
Pregabalin
1) It is mainly metabolized by the kidneys and is dose-dependent.
Patients with impaired renal function should adjust the dosage
.
Patients with impaired renal function should adjust the dosage
.
2) Patients with liver damage do not need to adjust their medications
.
.
3) Use with caution during pregnancy and lactation
.
.
4) Patients who are taking lorazepam, diazepam, alprazolam and other central nervous system depressants should use it with caution
.
.
5.
Carbamazepine:
Carbamazepine: 5.
Carbamazepine:
1) have other anti- epileptic patient drug, the dosage should be increased gradually, it may be necessary to increase the dose after 4 weeks of treatment, to avoid self-induced decline in plasma concentration due
.
Epilepsy 2) Taking it after a meal can reduce gastrointestinal reactions.
If you miss a dose, you should take it as soon as possible.
Do not take double the amount at a time, but can make up in divided doses within a day
.
3) The following situations should be used with caution or banned: the following situations should be used with caution or banned: a.
Known allergic to carbamazepine and related structural drugs (such as tricyclic antidepressants) or other ingredients of the preparation; b.
Atrioventricular block; c.
Severe abnormality of serum iron; d.
Patients with a history of bone marrow suppression; e.
Patients with a history of hepatic porphyria (such as acute intermittent porphyria, variant porphyria, delayed onset Skin porphyria), patients with a history of severe liver dysfunction; f.
Carbamazepine should be avoided in combination with monoamine oxidase inhibitors (MAOIs).
Before taking carbamazepine, stop taking MAOIs for at least two weeks .
6.
Sodium valproate 6.
Sodium valproate 1) Liver function should be measured before treatment and regularly monitored within the first 6 months of starting treatment .
2) Since the drug is converted into valproic acid in the body after taking this product, other drugs containing active ingredients that can be converted into the same compound should not be taken together with this product to prevent excessive valproic acid in the body ( Such as divalproate, valproamide, etc.
) .
3) Unless there are other effects, valproate should not be used for women with fertility .
4) The following situations should be used with caution or prohibited:
4) The following conditions should be used with caution or prohibited: a.
Patients with liver disease or liver dysfunction; b.
Patients with known mitochondrial diseases caused by mitochondrial DNA polymerase (POLG) mutations and those under two years of age suspected of being related to POLG Children with diseases; c.
Patients allergic to sodium valproate; d.
Patients with known abnormal urea cycle .
7, levodopa 7, levodopa 1) severe mental illness, serious arrhythmias , heart failure, glaucoma, digestive tract ulcers and have a history of seizures were banned .
Arrhythmia and digestion 2) Patients with severe cardiovascular , pulmonary, bronchial, kidney, liver and endocrine diseases should use medication with caution .
Cardiovascular 3) Users who receive MAOIs (such as phenelzine, isazozid) should stop taking the drug for two weeks before using this product .
4) Use with caution for children under 5 years old .
5) Overuse of this product has occasionally seen a decrease in blood potassium, an increase in plasma aldosterone, a slight increase in blood urea nitrogen, and an increase in serum alanine transoxygenase, lactate dehydrogenase, alkaline phosphatase and bilirubin.
Most patients can return to normal on their own after stopping the drug .
8.
Dexamethasone 8.
Dexamethasone 1) Patients with a history of allergies to this product and adrenal corticosteroids are contraindicated .
2) Hypertension, thrombosis
It is generally not suitable for patients with disease, gastric and duodenal ulcers, psychosis, abnormal electrolyte metabolism, myocardial infarction, visceral surgery, and glaucoma
.
Weigh the pros and cons of use in special circumstances, but should pay attention to the possibility of deterioration
.
Thrombus 3) Use with caution in patients with tuberculosis, acute bacterial or viral infections, and when necessary, appropriate anti-infective treatment must be given .
4) After taking the medicine for a long time, the dosage should be gradually reduced before stopping the medicine .
5) Use with caution in patients with diabetes, osteoporosis , liver cirrhosis, renal dysfunction, and hypothyroidism .
Osteoporosis 9, mannitol 9, mannitol 1) except for intestinal preparation, all should be administered intravenously .
2) Mannitol is easy to crystallize when cold, so it should be carefully checked before application.
If it has crystals, it can be placed in hot water or vigorously shaken until the crystals are completely dissolved before use .
When the mannitol concentration is higher than 15%, an infusion set with a filter should be used .
3) Use with caution in the following situations: 3) Use with caution in the following situations: a.
Obvious cardiac insufficiency or acute pulmonary edema, pulmonary congestion; b.
Hyperkalemia or hyponatremia; c.
Hypovolemia or severe water loss; d.
Patients with anuria or severe renal failure and reduced excretion who have been diagnosed with acute tubular necrosis; e.
Patients with active intracranial hemorrhage (except during intracranial surgery) .
10.
Flunarizine: 10.
Flunarizine: 1) Individual patients have adverse reactions such as fatigue and lethargy during the treatment, especially at the beginning of the course of treatment.
Be cautious when carrying out activities such as driving or operating dangerous machinery
.
2) The doctor should follow up regularly (especially during maintenance treatment) to ensure that the drug can be stopped in time when extrapyramidal or depressive symptoms appear .
3) Use with caution or forbidden for the following people: depression, Parkinson's disease, elderly patients with other extrapyramidal symptoms or the tendency to develop the above-mentioned diseases .
Well, the above are the ten most common medication precautions in neurology .
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