On Sunday, Dr. Li, who was on the night shift, suddenly felt chills all over. Solid medical knowledge told her: maybe it was a fever!
Get up and take out the forehead thermometer from the drawer. “Clap” twice, 37.2 ℃.
Seeing this value, she was almost stunned: she has not had a fever for more than ten years! Even under the raging epidemic here, she never worried that she would have a fever, let alone that the fever caused by other reasons was mistaken for the new crown virus.
How about this? Her brain is spinning at high speed…
She doesn’t care if it’s just a fever. However, she faintly felt that the muscles of both legs had sunk, and the muscles of her lower back were getting more and more sore. This means that the disease is developing and it must be stopped!
Because there are no obvious symptoms such as coughing, sneezing or sore throat, the cause cannot be determined for the time being, and the top priority is to control the symptoms.
So she called the proctology department and asked them to prescribe a pain reliever.
This suppository is a non-steroidal drug with antipyretic and analgesic effects. It is a drug commonly used in anorectal surgery for postoperative analgesia. At the end of the operation, a plug is inserted into the anus. It is said that the effect is not bad.
After the suppository was put on, she was back in bed and waited for the medication to work. Praying in my heart: Don’t come to emergency surgery at this time! At the same time, she carefully felt the process and effect of the drug’s onset.
As an anesthesiologist, my knowledge of pharmacology is very solid. She is very clear about the theory of this anal drug. This time, she has to practice it well.
If you take the drug orally, you may experience sweating and other symptoms within a few minutes, but this time the anal drug was not so fast. At this time, she analyzed: the onset of anal medication may be slightly slower than oral.
At this point, she couldn’t help but worry about the side effects of the gastrointestinal reactions mentioned in the instructions. Past experience told her: she is an out-and-out dizzy and vomiting constitution. Whether it’s a car or a plane, it’s a spit.
After half an hour, the expected side effects are not so obvious, but I feel that the peristalsis of the intestines has accelerated.
Relieving muscle aches and a cold forehead, she knew the medication was working.
According to the dosage of the drug, she clearly felt that the effect of the anal drug was better than that of the oral drug. She immediately thought that it was because of the first-pass elimination effect of oral medication.
First-pass elimination: Drugs absorbed from the gastrointestinal tract through the portal venous system must pass through the liver before reaching the systemic blood circulation. If the liver has a strong ability to metabolize it or the amount of bile excretion is large, The amount of effective drugs entering the systemic blood circulation is significantly reduced, and this effect is called first pass elimination.
However, for anal medication, the drug is directly absorbed into the large circulation from the middle rectal vein, inferior vein and anal vein, thus avoiding intermediate “extraction” by the liver. In addition, sublingual medication can also avoid first-pass elimination.
Here I am, explaining a question that anesthesiologists are often asked: Would it be good to drink some anesthesia?
This answer is uncertain.
For example, some medicines are afraid of acid or alkali. Those who are afraid of acid will lose their martial arts the moment they see the acid in their stomach; those who are afraid of alkali will not be able to jump for a long time. After exiting the pylorus of the stomach, it immediately enters a sour and alkaline environment. How long you can “live” depends on the craftsmanship of the medicine.
Only those anesthetics that are not affected by acid or base are likely to work. However, due to the effect of the elimination of the first pass, only a few percent of its skill remains. Therefore, the oral dose must be increased.
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