أمراض السكر من النوع الثاني نبداء له ك دواء اولي ب
Metformin
لكن السؤال متى أضيف وعلى أي أساس أضيف؟
يعتمد ال
Combination pharmacotherapy should be considered at treatment initiation if the presenting A1C is ≥1.5 above the target goal.
بمعنى انه اذا التراكمي 1.5 او اكثر من الهدف المطلوب تحقيقه هنا نضيف دواء
طيب ال target goal كيف اعرفه ؟
ع حسب الشخص موضح في الصوره اسفل
طيب بالنسبه لإضافة دواء ع ايش يعتمد ؟
يعتمد ع
The selection of additional agent(s) should be guided by patient-specific factors such as comorbidities, glucose-lowering efficacy, hypoglycemia risk, side effect profile, cost, patient preference and burden of use.

من الأشياء الخاطئة أنه أي مريض يدخل أحد الأقسام اجيب له مضاد حيوي ف كل قسم مشهور ب مضاد حيوي
المضاد الحيوي ليس مكمل غذائي أو مقوي للمناعة ليصرف هكذا
اشوف كل قسم له سياسه في صرف المضاد لكل مريض يدخل عنده
السفترياكسون ومنتشر في كل الأقسام بدون داعي للاستعمال ومشيناها
لكن أنه أجيب vancomycin لأي بيشنت دخل قسم الأطفال ع أساس أغلبهم الي يدخلوا القسم meningitis؟؟!
Vancomycin is an antibiotic used to treat serious gram-positive bacterial infections that requires careful dosing and monitoring to ensure efficacy and safety.

#ملاحظة
حسب اخر دراسه meta analysis
في حالة
patients with NSTEMI who will undergo PCI, we suggest intraprocedural anticoagulation with either unfractionated heparin or bivalirudin

The rate of major bleeding events was lower with bivalirudin, but the clinical significance of this finding is unclear; most patients in the analysis underwent femoral arterial access, while most patients in modern practice undergo radial arterial access, which reduces the risk of bleeding regardless of the anticoagulant used for PCI.

🛑 treatment major depression

✅Some clinicians recommend lifelong therapy for persons younger than 40 years with two or more prior episodes and for all persons with three or more prior episodes.

#Dipro

🛑Which of the following would be the most appropriate empiric antibiotic therapy for BB?
ANSWER CHOICES:
A. Cefepime
B. Ceftriaxone plus azithromycin
C. Linezolid plus piperacillin-tazobactam
D. Vancomycin plus cefepime

using combination therapy with a glucocorticoid plus mycophenolate as an option for patients with AIH who are at risk for side effects from high-dose glucocorticoid monotherapy

In a trial for adults with AIH, prednisolone plus mycophenolate mofetil resulted in higher rates of biochemical remission at six months compared with prednisolone plus azathioprine

According to new study
ACEi may reduce risk of kidney failure but may not decrease all-cause mortality or cardiovascular-specific mortality in adults with diabetic kidney disease

هنا يتكلم ع diabetic kidney disease
وليس يتكلم ع ال Heart Failure or CKD

🛑complications of massive blood transfusion

✅ Potassium abnormalities may include hypokalemia or hyperkalemia.

🉐Hyperkalemia:
(a) ATPase pumps become deactivated in stored blood, leading to elevations in potassium concentrations from 7 mEq/L to 77 mEq/L.

✅  After transfusion, the ATPase pump is restored, and potassium is shifted intracellularly.

✅ Although this generally leads to minimal sequelae, hyperkalemia may develop in those with renal insufficiency or severe tissue injury.

✅ Rapid transfusion through a central venous catheter has been associated with hyperkalemia-induced cardiac arrest.
✅For patients at risk, the recommended management is to slow the infusion rate to less than 100–150 mL/minute.

🉐Hypokalemia: Secondary to restoration of the ATPase pump on transfusion, shifting potassium intracellularly, metabolic alkalosis from citrate administration, release of hormones (e.g., aldosterone, antidiuretic hormone), and co-infusion of potassium-poor solutions (e.g., normal saline)

✅ Potassium should be closely monitoring and managed in a massive transfusion.

#Accp

إعادة نشر
حساب uptodate من ضمن البرامج الطبيه المهمه والمدفوعه
تستطيع أن تعمل حساب خاص بك فيه
عبر تقديم طلب في المنح،
فقط ادخل الرابط و أملاء البيانات المطلوبه ب اتباعك التعليمات الموضحه في ملف ال PDF
وخلال اسبوعين إلى ثلاثه يكون حسابك جاهز مجاني لمدة سنه

https://www.tg-me.com/clinical_Notes/3153

رابط التقديم
https://www.ariadnelabs.org/better-evidence/better-evidence-free-resources/

🛑Acyclovir  in renal impairment

✅If administered orally, the dose should be reduced for individuals with an eGFR ≤25 mL/minute/1.73 m2
✅If administered intravenously, the dose should be reduced for individuals with an eGFR ≤50 mL/minute/1.73 m2

✅Acute renal failure, produced by the precipitation of relatively insoluble acyclovir crystals in the renal tubules, is an occasional complication of intravenous therapy

✅The risk can be minimized by prior hydration (with the urine output maintained above 75 mL/hour) and slow drug infusion over one to two hours

#Uptodate2024

🛑imipenem in renal impairment
✅ if CrCl >70 to 89   ( use 1g every 8 hours not every 6 hours  to treatment  sever infections
✅Because  imipenem dose of 1 g given every 6 hours has been associated with an increased risk of seizures.

#Uptodate2024

#تذكر
✅في حاله حساب جرعه meropenem في مريض renal impairment بستخدم معادلة Cockcroft-Gault equation لتقيم crcl

✅في حاله حساب جرعه دواء Meropenem-vaborbactam بستخدم معادله MDRD equation  لتقيم crcl

#Uptodate2024

🛑مؤقت
✅تحبوا نسوي محاضرات اونلاين بخصوص مواضيع السريرية ؟

وضحكتها تشبهة دواء Escitalopram تعالج القلق لكنها تتلاعب بنبضات قلبي كعرض جانبي 😁😅

#غزل

🛑غالبا الجرعة الفموية لدواء ciprofloxacin بتكون 500ملجم مرتين في اليوم ،ولكن قد نعطي 750mg مرتين في اليوم في اي حالة ؟؟