A variety of medicines are often used in daily life. The correct use of medicines can cure diseases. If used improperly or abused, medicines can also cause disease or damage the body. Therefore, inappropriate medicines may give people It brings security risks and needs to be paid enough attention. This article summarizes the common misconceptions about drug use in respiratory medicine.
1
Avoid co-administration of levofloxacin and theophylline
Reason:Theophylline is a methylxanthine derivative that can relax tracheal smooth muscle, but has a narrow safety margin. Quinolones are chemically synthesized antibacterial drugs with broad-spectrum, high-efficiency and low-toxicity properties, and are used to treat infectious diseases caused by sensitive bacteria. Levofloxacin, one of the quinolones, has a broad-spectrum antibacterial effect.
In clinical practice, quinolones and theophylline drugs are often used in combination to treat respiratory diseases, but related studies suggest that quinolones can inhibit liver cytochrome P450, reduce the metabolism of theophylline drugs, and make blood Theophylline concentration increases or the half-life is significantly prolonged, and the effective blood concentration of theophylline is very close to the poisoning concentration, which can easily cause poisoning symptoms such as arrhythmia, central nervous system excitement and even convulsions.
Rational drug use recommendations:
When quinolones are used in combination with theophylline drugs, individual differences of patients should be considered. For patients with renal failure, appropriate doses and longer dosing intervals should be selected.
Monitor blood drug concentrations when necessary to avoid drug accumulation in the body and induce adverse reactions in the central nervous system, so as to ensure patient medication safety.
2
Digitalis drugs should be used with caution in patients with COPD/pulmonary heart disease
Reason: COPD patients are prone to long-term hypoxia due to poor lung function. Hypoxia will inhibit the sodium-potassium pump and reduce the tolerance to digitalis. In patients with pulmonary heart disease, the heart is overloaded due to pulmonary blood circulation disorder. If digitalis that enhances myocardial contractility is used, it will increase the burden on the heart and cause serious consequences. In addition, the therapeutic dose of digitalis is very close to the poisoning dose, and it is prone to toxic reactions.
Rational drug use recommendations:
Inquire about the medical history and medication history in detail before taking the medicine, actively correct symptoms such as hypoxia, monitor ions, and pay attention to observe the side effects and toxic side effects.
Elderly patients and patients with renal insufficiency have reduced tolerance to digitalis and are prone to poisoning, so close attention is required. At the same time, it is recommended that patients maintain a normal urine output when using digitalis, so as to prevent the decrease in urine output and cause the slowing of excretion and lead to poisoning.
Because the therapeutic dose is very close to the poisoning dose, the tolerance and elimination speed of patients vary greatly. It is recommended to comprehensively explore the optimal dose for different patients according to the condition, efficacy and other factors. .
3
Respiratory stimulants should be used with caution in patients with airway obstruction
Reason: Respiratory stimulants are central stimulants. By stimulating the medulla oblongata respiratory center, they can also stimulate the chemoreceptors of the carotid body and aortic body to stimulate reflex respiration Central, make breathing deepen and speed up, increase ventilation, increase blood oxygen partial pressure, reduce blood carbon dioxide partial pressure. When using respiratory stimulants, it is necessary to keep the airway open and reduce respiratory muscle resistance, otherwise it will promote respiratory muscle fatigue, increase oxygen consumption, and aggravate CO2 retention.
Rational drug use recommendations:
Respiratory stimulants are mainly used for respiratory failure caused by central depression and hypoventilation;
It should not be used for respiratory failure caused by pulmonary disease mainly due to pulmonary ventilation dysfunction;
Use with caution in patients with frequent convulsions due to uncorrected cerebral hypoxia and edema;
For patients with mild disease and mild disturbance of consciousness, the application of respiratory stimulants can mostly improve poor ventilation; for patients with severe disease, bronchospasm, and poor sputum drainage, the use of respiratory stimulants can improve ventilation. , must be combined with other measures to effectively improve respiratory function (such as the establishment of artificial airway, suction, etc.).
4
Use of anticholinergics with caution in older men
Reason: In elderly male patients, the bladder muscle gradually atrophies, the capacity decreases, the fibrous tissue proliferates, and the outflow tract is not smooth, which often causes the bladder to be neither full nor empty. Residual urine increased.
At the same time, degenerative changes such as smooth muscle atrophy, fibrous tissue hyperplasia, decreased glandular secretion, and flattening of epithelial cells gradually appear in the peripheral area of the prostate, as well as testicular atrophy and sex hormone disorders. The prostate gland of elderly male patients, especially in the transition zone, has glandular and stromal hyperplasia, which compresses the urethra and causes urination disorders.
Anticholinergic drugs such as tiotropium bromide and ipratropium bromide block M3 receptors on the smooth muscle of the bladder, relax the detrusor muscle of the bladder, contract the bladder sphincter, and cause urination Difficulty, causing urinary retention. The use of anticholinergic drugs in older men can exacerbate voiding disturbances and urinary retention.
Rational drug use recommendations:
For elderly men, anticholinergic drugs should be used with caution or not. If urinary retention occurs during the medication process, the drug should be discontinued in time. If the symptoms cannot be relieved in a short time, it should be promptly Catheterization relieves urinary retention in patients, and other causes of urinary retention need to be excluded by imaging tests.
5
Amiodarone should be used with caution in patients with interstitial pneumonia
Reason: Amiodarone, an iodinated benzofuran derivative, is currently the most effective drug for the treatment of tachyarrhythmias. However, its clinical application is limited due to many adverse reactions. Pulmonary toxicity is one of the most serious adverse reactions of amiodarone, such as interstitial pneumonia, organizing pneumonia, diffuse alveolar hemorrhage, and rare pleural effusion.
Although the target of amiodarone is in the heart, the concentration of its metabolites in lung tissue is often higher than that in the heart. The active metabolite of amiodarone is desethylamiodarone, which The concentration in the lung tissue can reach 5 times the drug concentration in the body. Amiodarone treatment lasting 6 to 12 months or even longer is a high-risk period for pulmonary toxicity, because the half-life of amiodarone is as long as 30 to 108 days. Even if some patients have stopped amiodarone, there is still a risk of pulmonary toxicity. risk.
Rational drug use recommendations:
Patients using amiodarone should be evaluated for their baseline lung status, and should be reviewed regularly. Once chest CT shows diffuse interstitial lung disease, amiodarone should be discontinued immediately. Elderly patients need more careful observation.
Pay attention to the dosage of amiodarone and avoid long-term high-dose use. Try to find the lowest effective dose to reduce the risk of adverse reactions and toxicity.
Early detection, early discontinuation, and early treatment. Generally, glucocorticoids are given for 2 to 6 months or even longer after drug discontinuation, and the interstitial lung lesions of some patients may recover.
6
Ambroxol and cephalosporins should be used with caution
Reason: Ambroxol hydrochloride is an effective metabolite of bromhexine, which can promote the excretion of viscous secretions from the respiratory tract and reduce mucus retention, thereby promoting expectoration. It is mainly suitable for patients with acute and chronic lung diseases accompanied by abnormal sputum secretion and poor expectoration function.
The pH of Ambroxol Hydrochloride Injection is 5.0, its free base is insoluble in water and cannot be mixed with other alkaline solutions with pH greater than 6.3, such as penicillins, cephalosporins, quinolones class of antibacterial drugs. Ambroxol free base precipitates due to increased pH.
In the process of extraction and separation of traditional Chinese medicine injection, there are incompletely removed tannins such as tannins, etc., and the components are relatively complex. For example, after the ambroxol hydrochloride injection is combined with Shenmai injection, Reduning injection and Danshen injection, the insoluble particles increase significantly, all exceeding the relevant regulations.
Rational drug use recommendations:
For the compatibility and use of ambroxol hydrochloride, during the infusion of different drugs, add glucose injection or 0.9% sodium chloride solution to rinse for 5~10 minutes, which can avoid the direct effect of the drug to produce liquid medicine Precipitation, turbidity, pH changes and other incompatibilities can reduce the occurrence of adverse events;
Ambroxol hydrochloride injection should not be compatible with traditional Chinese medicine injection.
7
Mannan peptides are contraindicated in patients with bronchial asthma
Reason: Mannan peptides are polysaccharides, which are extracted from the deep culture medium of Streptococcus alpha hemolyticus isolated from the throat of normal people. It is a kind of biological response modifier, which has the functions of activating immune cells, improving the immunity of the body, stimulating the hematopoietic function of the bone marrow, and increasing the level of white blood cells.
The average relative molecular mass of mannan peptides is 3000~6000. It enters the blood as an antigenic substance and binds to plasma proteins, causing a heterotopic protein reaction, thereby inducing type I allergic reaction. The mannan peptide instruction manual mentions: those who are allergic to this product, rheumatic heart disease, bronchial asthma, and bronchitis are prohibited, and those with high sensitivity are prohibited.
Rational drug use recommendations:
Mannan peptides are prohibited for those allergic to peptide preparations and penicillin;
Patients who use this product for the first time need to do a skin allergy test;
Medication should be started from a low dose, and observation of medication should be strengthened. Especially in the early stage of administration, the user should be observed for chest tightness and dyspnea, and the diagnosis and treatment of abnormal conditions should be done at any time during the medication process.
8
Metoclopramide is contraindicated in patients with gastrointestinal bleeding, mechanical ileus or perforation, and breast cancer
Reason: Metoclopramide is a dopamine D2 receptor antagonist, and also has a serotonin 4 (5-HT4) receptor agonistic effect. 5-HT3 receptors have a mild inhibitory effect. Metoclopramide mainly increases the CTZ threshold by inhibiting the dopamine receptors in the central emetic chemoreceptor zone (CTZ), reducing the impulse of afferent autonomic nerves, thus showing a strong central antiemetic effect.
At the same time, it can also inhibit the relaxation of gastrointestinal smooth muscle and increase the cholinergic response of gastrointestinal smooth muscle. Patients with gastrointestinal bleeding, mechanical intestinal obstruction or perforation may cause gastrointestinal bleeding due to medication. The power of the road increases, and the condition aggravates.
Metoclopramide can increase the relative content and activity of estrogen, resulting in long-term overstimulation of breast tissue by estradiol, resulting in breast lesions. Neither ESMO nor ASCO antiemetic guidelines recommend metoclopramide for nausea and vomiting after chemotherapy in breast cancer patients.
Rational drug use recommendations:
Avoid use in breast cancer patients, switch to serotonin inhibitors, and temporarily use if other antiemetics are ineffective or explosive vomiting.
Metoclopramide should be contraindicated in patients with gastrointestinal bleeding, mechanical ileus, or perforation to avoid exacerbation.
9
Compound licorice tablets should be used with caution in patients with hypokalemia
Reason: Compound Licorice Tablets is an antitussive and expectorant drug with low price and definite curative effect. Clinically, it is mainly used to treat upper respiratory tract infection, bronchitis and cold cough, expectoration.
Compound licorice tablets contain glycyrrhizic acid, which is hydrolyzed into glycyrrhetic acid in the body, and glycyrrhetic acid can inhibit the activity of 11β-hydroxysteroid dehydrogenase, resulting in the activation of unconverted cortisol The mineralocorticoid receptor in the kidney leads to an increase in the level of hydrocortisone in the blood, and hydrocortisone can play a mineralocorticoid-like effect, making the body appear clinical manifestations of water and salt metabolism imbalance such as hypokalemia, edema, and hypertension. .
Rational drug use recommendations:
Inquire about the patient’s past history and medication history in detail during admission. If unexplained hypokalemia is found, one should be alert to adverse drug-induced adverse reactions.
It should be emphasized that the patient should take the medicine according to the doctor’s advice, and must not arbitrarily increase the dose and take it for a long time. If it exceeds 3 to 7 days, the doctor should be consulted.
Once hypokalemia occurs after taking compound licorice tablets, the licorice preparation should be stopped immediately, and intravenous potassium supplementation should be used.
Aldosterone receptor antagonists, such as spironolactone, may be used in patients with persistent hypokalemia. Under normal circumstances, hypokalemia caused by licorice preparations is reversible, and serum potassium will gradually return to normal after licorice is discontinued.
10
Caution with vasopressin in hypertensive patients
Reason: The main components of vasopressin are oxytocin and antidiuretic hormone. Antidiuretic hormone has a strong vasoconstriction effect. Side effects such as chest tightness, abdominal pain, and increased blood pressure. The study found that the treatment of vasopressin almost can cause varying degrees of blood pressure. The greater the dose of vasopressin and the longer the time, the more likely serious adverse reactions such as hyponatremia will occur, and the incidence and severity of hyponatremia are positively correlated with the dose of vasopressin.
Rational drug use recommendations:
Strictly grasp the indications and dosage of pituitary hormone, and should be used with caution or not in elderly patients with hypertension, coronary heart disease, arteriosclerosis, etc.;
Pay attention to the changes in blood pressure, consciousness, and urine output during use, and dynamically monitor electrolytes, renal function, and blood pressure. If cardiovascular adverse reactions occur, slow the drip rate, stop the drug, and give Vasodilator and other measures.
11
When sputum scabs are suspected in the large airway, use sputum-reducing drugs (ambroxol, etc.) with caution by inhalation
Reason: The aerosol produced by atomization during inhalation has lower temperature, higher concentration and larger amount of mist released per unit time. When the sputum in the large airway is thick and it is suspected that there is sputum scab, the airway is in an obstructed state. At this time, the use of phlegm-reducing drugs (ambroxol, etc.) for aerosol inhalation may cause the sputum to loosen, and the swelling may lead to insufficient ventilation or even suffocation. Threats to patient safety.
CombinationRational Medication Recommendations:
When sputum scabs are suspected in the large airway, the sputum scabs should be removed actively. If the sputum is thick, the sputum-reducing drugs can be inhaled by atomization, and the patients can cooperate with deep breathing, postural drainage, and chest tapping. Physical expectoration methods such as back and suction help improve the expectorant effect.
The patient’s ability to expectorate should be assessed prior to aerosol inhalation therapy.
12
The dose of moxifloxacin does not need to be reduced in patients with renal insufficiency, and the dose of moxifloxacin needs to be adjusted in patients with hepatic insufficiency
Reason: Following oral or intravenous infusion of 400 mg of moxifloxacin, 44% to 48% were excreted unchanged from feces (25%) and urine (20% ) excretion; approximately 52% are excreted in the urine (16.5%) or bile/feces (36%) after biotransformation by the liver, a balanced metabolic pattern that makes moxifloxacin in patients with impaired renal or hepatic function The possibility of accumulation is minimized.
The pharmacokinetic parameters of moxifloxacin did not change significantly in patients with mild, moderate, severe, or end-stage renal disease. Even patients with renal impairment [including those requiring hemodialysis (HD) or continuous bed rest peritoneal dialysis (CAPD)] do not require dose adjustment. At the same time, mild and moderate hepatic insufficiency (Child-Pugh A, B) does not require dose adjustment.
At the same time, although most adverse reactions of moxifloxacin are mild, there are also rare serious adverse reactions of moxifloxacin, including fulminant liver failure.
Rational drug use recommendations:
At the time of clinical application, attention should be paid to asking patients about drug allergy history, and patients with allergic constitution or previous drug allergy history should be avoided.
Severe hepatic impairment and transaminases greater than 5 times the upper limit of normal are contraindicated.
Regular monitoring of changes in liver function is recommended during moxifloxacin use.
Source | Breathe New Frontiers
Writing | Love Knock CP’s Rice Cake
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