How to choose a treatment for knee osteoarthritis❓❓❓

Knee osteoarthritis can be painful and inconvenient for patients. The first symptom of knee osteoarthritis is pain. Pain initially occurs when going up and down stairs, squatting down, or sitting and then standing up. Later, the movement of the knee joint is further restricted, and eventually the patient may not be able to walk a single step. Knee osteoarthritis patients with mild initial symptoms can generally be relieved by non-drug treatment. However, patients with mid-stage knee osteoarthritis generally experience pain. They need medication to relieve the pain. This article will describe how to choose a drug to treat knee osteoarthritis.

Systemic analgesics.

Analgesics for knee osteoarthritis are not just for pain relief, they also have anti-inflammatory effects. Knee pain is caused by inflammation. Inflammation must be eliminated in order to eliminate pain in patients. The inflammatory cause of knee osteoarthritis is not caused by a bacterial or viral infection, so antibiotics or antiviral drugs are not used to treat it. Analgesic and anti-inflammatory drugs can eliminate the inflammation of knee osteoarthritis. Pain relief for knee osteoarthritis can be divided into three levels. Different levels of pain medication are used to treat different levels of pain. In clinical practice, drugs should be selected according to the individual situation of patients and the efficacy of drugs, so as to achieve the purpose of individualized medication.

First-level: Acetaminophen.

Acetaminophen is a drug that has been used for many years. It can be used short-term for mild pain and it has relatively low damage to the gastrointestinal tract, liver and kidneys. However, its anti-inflammatory effect is relatively weak, so it can only be used for mild pain. The total daily dose of acetaminophen should not exceed 4 g. Although its damage to the liver is relatively low, liver damage is still its main side effect, especially when taking the drug, patients should avoid drinking alcohol.

Second-level: Non-steroidal anti-inflammatory analgesics (NSAIDs).

For moderate pain, the most commonly used analgesics are NSAIDs. It can be divided into the following categories: acetic acid derivatives (such as diclofenac, indomethacin), propionic acid derivatives (such as ibuprofen, naproxen, ketobufen), fenamic acid esters (such as methyl chloride sulfonate), enolic acid derivatives (eg, piroxicam), and selective cyclooxygenase-2 inhibitors (eg, celecoxib). The most common side effects of these drugs are increased cardiovascular adverse events, gastrointestinal bleeding, liver and kidney damage.

Third-level: Weak opioids.

Weak opioids such as codeine or tramadol may be considered for patients with severe pain and poor response to first- and second-level drugs. The initial dose of these drugs should be low and then slowly and gradually increased to reduce side effects.

Joint topical medication.

Emulsions, ointments and patches of topical pain relievers such as NSAIDs or capsaicin. They can be used outside the body for pain relief. Topical topical analgesics are simply and directly applied to or rubbed on the painful area. Their active ingredients penetrate quickly into the skin and effectively relieve pain. Topical application avoids their irritation of the gastrointestinal tract, reduces side effects and is convenient to use. The following points should be paid attention to when using:

• Adequate amount of use: The dosage of topical drugs must be sufficient to achieve the best pain relief and anti-inflammatory effect.
• The location of the medication should be correct: Anti-inflammatory and analgesic external medicines are used in the acute inflammatory attack period, and the skin will appear red, swollen, hot and painful. Infrared hyperthermia topical medicine is used for chronic injury. There was no redness, swelling and pain at this time. In addition, opioid patches are absorbed through the skin and can be applied to any painful area. Therefore, they should be attached to the shoulders, the upper edge of the chest and the outside of the forearm, and try not to attach to other places.
• Use for less than 12 hours: Most topical analgesics should be used for less than 12 hours. If they are used for more than 12 hours, they may cause adverse effects on the skin.

Intra-articular injection of drugs.

Glucocorticoids: It provides temporary pain relief for patients. However, if high-dose glucocorticoids are used for a long time, patients will experience many adverse reactions such as hypertension, renal impairment, and lower extremity edema. Although the dose of intra-articular glucocorticoid injection is small and generally does not cause the above-mentioned adverse reactions, long-term application will still cause damage to the bones and joints. The bone and cartilage of the joints are damaged by prolonged use of glucocorticoids. This in turn worsens the patient's condition. Therefore, it is recommended that it should not be applied more than 4 times a year.

Sodium Hyaluronate: It is a component of the joint fluid in the joint cavity, which can repair the joints. In patients with knee osteoarthritis, the synovial fluid contains less sodium hyaluronate and becomes thinner. Intra-articular injection of sodium hyaluronate can supplement the lack of sodium hyaluronate in synovial fluid. This increases joint fluid viscosity and reduces joint friction. This can help relieve symptoms and slow the progression of the disease. It is effective in relieving mild to moderate knee osteoarthritis, but it is not very effective in severe advanced knee osteoarthritis. It is generally recommended to use it once a week, with 4 to 6 weeks as a course of treatment.

Disease-modifying drugs and chondroprotective agents.

In patients with knee osteoarthritis, the articular surface cartilage is damaged. These drugs can protect the cartilage and improve the condition. Commonly used drugs are glucosamine and chondroitin sulfate. They are the two major nutrients for articular cartilage.

• Glucosamine: Although it has been widely used in the prevention and treatment of osteoarthritis, its efficacy has been controversial. Osteoarthritis patients with mild or moderate abrasion of articular cartilage are best candidates for glucosamine therapy. It does not work well for people with osteoarthritis who have severely abrasion of articular cartilage. Glucosamine needs to be continuously taken at 1500mg daily for more than 8 weeks to have a certain effect. Taking it for more than one year will have a more stable effect.
• Chondroitin Sulfate: It provides nutrients to cartilage, absorbs and retains water in cartilage. This can help repair articular cartilage. 

Studies have pointed out that the simultaneous application of glucosamine and chondroitin sulfate can obtain a more precise effect.

Read More

Knowledge about antiplatelet drugs - ticagrelor.🩸🩸🩸

Ticagrelor is an antiplatelet drug. It is a potent P2Y12 receptor antagonist. For patients with acute coronary syndromes, ticagrelor is recommended as first-line treatment in the treatment guidelines of many countries. The following will introduce the knowledge about its use.

The mechanism of ticagrelor.

Platelet aggregation refers to the adhesion of platelets to platelets. Normally, glycoprotein IIb/IIIa (GP IIb/IIIa) receptor on the platelet membrane is not activated. It does not bind to fibrinogen. Early thrombus formation is because after GP IIb/IIIa receptor is activated and it binds to fibrinogen. Fibrinogen makes it be able to connect to adjacent platelets and causing platelets aggregation. 

GP IIb/IIIa receptor is directly inhibited by tirofiban and eptifibatide, so that fibrinogen cannot bind to it. 

Adenosine diphosphate (ADP) enters platelet through platelet P2Y12 receptor and then activating GP IIb/IIIa receptor. Ticagrelor reversibly inhibits P2Y12 receptor and the active metabolite of clopidogrel irreversibly inhibits P2Y12 receptor. These drugs prevent the P2Y12 receptor from binding to ADP. GP IIb/IIIa receptors are unable to activate and prevent platelet aggregation.

Adverse reactions to ticagrelor.

The most common side effect of ticagrelor is the risk of bleeding. It prolongs the bleeding and has no antidote. It is contraindicated in patients with active pathological bleeding or a history of intracranial hemorrhage. It should also not be enabled when a patient is undergoing emergency coronary artery bypass surgery.

In addition, it increases the concentration of adenosine in the blood. Elevated adenosine concentrations can cause other adverse effects of ticagrelor such as bradycardia and dyspnea. In addition, adenosine also promotes the synthesis of uric acid, which can lead to hyperuricemia or gout.

Difference between ticagrelor and clopidogrel.

Studies have shown that ticagrelor is more effective than clopidogrel in the first 12 months of acute coronary syndrome. However, ticagrelor has a higher incidence of side effects such as bradycardia, dyspnea, bleeding, and increased uric acid levels than clopidogrel.

Rapid antiplatelet therapy for acute coronary syndromes.

All patients without contraindications should be given aspirin immediately. The loading dose is 300 mg, followed by a long-term maintenance dose of 75 to 100 mg daily. All patients should receive a P2Y12 receptor antagonist for more than 12 months in addition to aspirin unless the patient has a high risk of bleeding or other contraindications. Among P2Y12 receptor antagonists, ticagrelor is the drug of choice. Its loading dose is 180 mg, followed by 90 mg twice a day. In patients with contraindications to ticagrelor, clopidogrel should be used. Its loading dose is 300 to 600 mg, followed by 75 mg once daily.

Oral antiplatelet therapy in stable coronary heart disease.

In patients with stable coronary heart disease without contraindications to aspirin, daily 75 to 100 mg of aspirin should be used as a long-term treatment. If the patient is intolerant to aspirin, it recommends taking a P2Y12 receptor antagonist. Ticagrelor 60 to 90 mg twice daily or clopidogrel 75 mg once daily. Aspirin combined with ticagrelor (60 mg twice a day) can be considered as a long-term treatment if the bleeding risk is not high in patients at high risk of thrombosis.

Precautions while using ticagrelor.

Food has only a small effect on ticagrelor, so it can be taken before or after meal.

If the patient cannot swallow whole ticagrelor tablet, it can be crushed and taken or given by nasogastric tube.

Since the half-life of ticagrelor is approximately 7 hours and the half-life of its active metabolite is approximately 9 hours, if a patient misses a dose, another dose is not required. One missed dose has limited effect on the antiplatelet effect.

The clinical efficacy of ticagrelor is reduced by high doses (greater than 100 mg) of aspirin. In addition, ticagrelor can cause severe and even fatal bleeding when used in combination with maintenance doses of aspirin greater than 100 mg/day. Therefore, the maintenance dose of aspirin should not exceed 100 mg, typically 75 to 100 mg per day.

The metabolism of ticagrelor is via CYP3A4. Therefore, strong CYP3A4 inducers (such as carbamazepine, phenobarbital, phenytoin, dexamethasone, rifampin, etc.) and strong CYP3A4 inhibitors (such as voriconazole, itraconazole, clarithromycin, etc.) should be avoided taking with ticagrelor. Additionally, because ticagrelor metabolism requires depletion of CYP3A4, it is a CYP3A4 inhibitor. When simvastatin or lovastatin is used in combination with ticagrelor, the dose of simvastatin and lovastatin should not exceed 40 mg.

Read More

Herpes zoster virus infection and treatment.👿👿👿

Herpes zoster is an infectious skin disease caused by the varicella-zoster virus that is latent in the human body and then activated. It is a clinically common viral skin disease. This article will introduce the knowledge about the pathology, prevention and treatment of herpes zoster.

How can you get herpes zoster?

Varicella-zoster virus causes chickenpox in people who are first infected. When a chickenpox patient is cured, the virus is not completely cleared from his body. The rest of the virus lurks in the ganglia along the sensory nerves. When his immunity declines, these latent viruses reactivate. The viruses do a lot of replication, and then they spread along the sensory nerve fibers to the areas of the skin that these nerves control. It can cause herpes zoster. When the body's immunity is good, although herpes zoster will not be caused, the virus can remain dormant in the ganglia waiting to be activated. 

What kind of disease is herpes zoster?

The varicella-zoster virus is a DNA-like virus. It is characterized by being close to the skin and close to the nerves. It always spreads along the nerve and is distributed in strips. It generally occurs only on one side of the patient's body and does not go beyond the midline. Herpes zoster consists of dense clusters of blisters. Its course is usually 2 to 4 weeks. Postherpetic neuralgia is a common complication of herpes zoster. This can last for months or even years. The older the patient, the more severe the symptoms of neuralgia. In addition, the risk of developing herpes zoster is greater for women than for men.

What is the treatment for herpes zoster?

Goals of treatment: Relief of acute pain in patients, limitation of spread of skin lesions, promotion of repair of skin lesions, prevention or alleviation of postherpetic neuralgia.

Medications for herpes zoster:

Antiviral: It can promote the healing of herpes, effectively shorten the course of the disease, reduce the formation of new herpes and prevent the spread of the virus to the internal organs. Antiviral medication should be started within 24 to 72 hours of the blisters. This allows the drug to reach the effective concentration quickly and obtain the best therapeutic effect. Commonly used drugs are as follows:

• Acyclovir: It is indicated for patients with severe and immunocompromised herpes. The usual dose is 5 to 10 mg intravenously per kg, 3 times a day for 7 consecutive days. Crystals may form in the kidneys at high doses. Therefore, patients should drink plenty of water during the medication. In addition, it is neurotoxic. Clinical manifestations include epileptic seizure, paresthesia and neurological confusion.
• Valacyclovir: It is a precursor to acyclovir. The same applies to patients with severe and immunocompromised herpes. Its bioavailability is 3 to 5 times that of acyclovir. The usual dose is 0.3g orally three times a day for 7 consecutive days. Also crystals may form in the kidneys at high doses. Patients should drink plenty of fluids during the medication. It is also neurotoxic. Clinical manifestations include epileptic seizure, paresthesia and neurological confusion.
• Famciclovir: It is present in higher concentrations in infected cells and has a longer half-life. Its efficacy is similar to that of valacyclovir. The usual dose is 0.25g 3 times a day for 7 consecutive days. Its common side effects are headache, nausea and diarrhea. It can also cause hives, hallucinations and confusion, especially in the elderly.
• Foscarnet: It is indicated for patients with herpes who are resistant to nucleoside analogs. The usual dose is 100 mg intravenously per kg, twice a day. It is nephrotoxic and neurotoxic. Serum creatinine is elevated in more than half of patients and headache in about 25%. In addition, it has the side effects of hypocalcemia, hypokalemia, and hypomagnesemia.

Analgesics: Calcium channel modulators (eg, gabapentin or pregabalin) and tricyclic antidepressants (eg, amitriptyline) are first-line therapy. Opioids and tramadol are second-line treatments. Aspirin and acetaminophen have limited effects. 

• Gabapentin: It is a 1st generation calcium channel blocker. Its pharmacokinetic profile is nonlinear. The starting dose is 300 mg orally per day, and the usual effective dose is 900 to 1800 mg per day. Common side effects include drowsiness, dizziness, blurred vision, edema, dry mouth, weight gain, and abnormal thinking.
• Pregabalin: It is a second generation calcium channel blocker. Hyperalgesia and central sensitization will be inhibited by it to achieve analgesic effect. The starting dose is 150 mg orally per day, which can be increased to 300 mg per day within 1 week, with a maximum dose of 600 mg per day. Common side effects are the same as gabapentin.
• Amitriptyline: It inhibits the reuptake of norepinephrine and serotonin and blocks various ion channels. The descending pathway of pain conduction is where it primarily works. The starting dose is 25 mg orally per day and the maximum dose is 150 mg per day. Common side effects include blurred vision, dizziness, tremor, drowsiness, sweating, dry mouth, constipation, dysuria, and orthostatic hypotension.

Anti-inflammatory drugs: Oral corticosteroids can suppress the inflammatory process in the early stages of an acute herpes zoster attack. It reduces the healing time of skin lesions and the duration of acute pain. However, it has no effect on postherpetic neuralgia that has already occurred. In addition, patients should not use topical corticosteroids. It does not recommend the use of glucocorticoids alone in the absence of systemic antiviral therapy.

• Prednisone: Start with a daily dose of 30 to 40 mg and then gradually reduce the dose. Its course of treatment is 1 to 2 weeks.

Neurotrophic: It is helpful for nerve pain and link neuroinflammation, but its therapeutic effect is limited. Commonly used drugs are vitamin B1, methylcobalamin and vitamin B12, which can be injected intramuscularly or orally.

Topical medicines: Its main purpose is to reduce inflammation and dryness.

• Acyclovir cream, penciclovir cream and calamine lotion: These can be used topically when the herpes is not broken.
• 3% boric acid solution or 1:5000 nitrofurazone solution (wet compress), 2% mupirocin ointment and 0.5% neomycin ointment: After the herpes has ruptured, these drugs may be used as appropriate.
• 5% lidocaine patch: It can be used for postherpetic pain. Place 1 to 3 patches on the painful area, each patch for up to 12 hours.

How to prevent herpes zoster?

The herpes zoster vaccine is effective in preventing the occurrence of herpes zoster, shortening its duration, and reducing the incidence of postherpetic neuralgia. Generally, herpes zoster recurs only once in a lifetime. However, very few patients can relapse several times. Adults ≥50 years of age should get the herpes zoster vaccine even if they have ever had herpes zoster.

Read More

Knowledge of calcium channel blockers.📓📓📓

Calcium channel blockers are one of the most commonly used
antihypertensive drugs in clinical practice. It has been used for many years. Its efficacy and safety have been proven. It plays an important role in the clinical treatment of cardiovascular disease. Therefore, for calcium channel blockers, you should have the following knowledge.

Mechanism of action of calcium channel blockers.

There are two types of calcium channel blockers: dihydropyridines and non-dihydropyridines. The pharmacological effects of both of them are to inhibit the influx of calcium ions into vascular smooth muscle cells by selectively blocking voltage-dependent calcium ion channels. This relaxes the smooth muscle of the blood vessels, which dilates the blood vessels. Peripheral vascular resistance will therefore decrease, to achieve a blood pressure lowering effect. They mainly dilate the arteries, especially the coronary arteries.

• Dihydropyridine calcium channel blockers have better vascular selectivity. It generally does not affect atrioventricular conduction, sinoatrial node function, and myocardial contractility at therapeutic doses.
• Non-dihydropyridine calcium channel blockers have poor vascular selectivity. It has a negative inotropic effect and negative conduction on the heart. Therefore, it not only lowers blood pressure but also lowers heart rate.

Calcium channel blockers commonly used in clinical practice.

Dihydropyridine calcium channel blockers:

Drug	Drug standard (mg)	Dosage (initial dose to full dose, mg/d)	Times of taking medicine (times/d)
Amlodipine	5、10	5 to 10	1
Barnidipine	5、10、15	5 to 15	1
Benidipine	2	4 to 8	1
Cilnidipine	5、10	5 to 10	1
Felodipine	2.5、5	2.5 to 10	2
Lacidipine	4	4 to 8	1
Lercanidipine	10	10 to 20	1
Levamlodipine	2.5、5	2.5 to 5	1
Manidipine	5	5 to 20	1
Nicardipine	20	40 to 80	2 to 3
Nifedipine	5、10	10 to 30	2 to 3
Nifedipine (Sustained Release)	20、30	10 to 80	2
Nifedipine (Controlled Release)	30	30 to 60	1
Nitrendipine	10	20 to 60	2 to 3

Non-dihydropyridine calcium channel blockers:

Drug	Drug standard (mg)	Dosage (initial dose to full dose, mg/d)	Times of taking medicine (times/d)
Diltiazem	30	90 to 360	1 to 2
Diltiazem (Sustained release)	200	200	1
Verapamil	40	80 to 480	2 to 3
Verapamil (Sustained release)	240	120 to 480	1 to 2

Characteristics of calcium channel blockers.

Their pharmacodynamics are dose-dependent and have a good antihypertensive effect. Single-agent therapy generally achieves the desired effect. Mild to moderate hypertension can generally be controlled by it. They are the first-line treatment in many national hypertension guidelines.

Stroke risk in hypertensive patients is significantly reduced by calcium channel blockers.

Many clinical studies have shown that calcium channel blockers can change the physiological activities related to calcium ions to affect atherosclerosis. They can slow the progression of atherosclerosis

Calcium channel blockers do not alter sugar and lipid metabolism. Therefore, it can be used by patients with diabetes and metabolic syndrome. In addition, levamlodipine besylate can dilate the bulbar arterioles and afferent arterioles. It reduces the resistance of the renal blood vessels without increasing the intra-glomerular pressure. These factors make it beneficial for hypertensive patients with diabetes mellitus and patients with parenchymal renal disease.

Calcium channel blockers have the effect of increasing sodium excretion. If the patient has salt-sensitive hypertension, its antihypertensive effect will be better. Its antihypertensive effect is not affected by a high-salt diet, so it is also suitable for people on a high-salt diet.

Calcium channel blockers have a good effect on volume hypertension such as isolated systolic hypertension and elderly hypertension.

Medium- and long-acting calcium channel blockers have a good safety profile, fewer side effects, and a lower incidence of hypotension. Their effects are gentle and long-lasting. Most only need to take 1 or 2 pills a day. This can improve patient compliance with medication and the efficacy of treatment.

Calcium channel blockers dilate the coronary arteries, thereby reducing coronary resistance and improving the ability of the heart muscle to supply blood. It can treat coronary heart disease, angina pectoris, hypertrophic cardiomyopathy and peripheral vascular disease, especially for variant angina pectoris caused by coronary spasm.

Non-dihydropyridine calcium channel blockers can also slow the heart rate and improve blood supply to the coronary arteries. It can prevent and treat coronary heart disease, arrhythmias such as premature atrial beats, and supraventricular tachycardia.

Indications for calcium channel blockers.

Calcium channel blockers are used for various types of high blood pressure. It is the first-line treatment for high blood pressure.

Dihydropyridine calcium channel blockers:

• Hypertension with atherosclerosis: Peripheral vascular disease, coronary atherosclerosis, carotid atherosclerosis or stable angina with hypertension.
• Volumetric hypertension: Hypertension with low sympathetic or low renin activity, isolated systolic hypertension and elderly hypertension.

Non-dihydropyridine calcium channel blockers:

• Angina pectoris, supraventricular tachycardia, carotid atherosclerosis with hypertension.

Combination medication.

Diuretics: The risk of stroke in hypertensive patients can be reduced by combining calcium channel blockers with diuretics. However, the hypotensive effect of calcium channel blockers reflexively activates sympathetic nerves. Diuretics also activate sympathetic nerves after reducing blood volume. Their side effects may be aggravated by this.

Angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists: They dilate arteries and veins. Calcium channel blockers can directly dilate the arteries. Therefore, their combined use will have a synergistic effect. Angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists can partially inhibit the side effects of increased heart rate and increased reflex sympathetic tone caused by calcium channel blockers. Ankle edema is a common side effect of dihydropyridine calcium channel blockers, which can be eliminated or alleviated by angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists.

β-blockers: It can inhibit the blood volume mechanism and sympathetic nerve, and achieve a significant antihypertensive effect. The reflex sympathetic excitation caused by vasodilation by calcium channel blockers is inhibited by β-blockers. The increase in peripheral arterial resistance caused by long-term use of β-blockers is also inhibited by calcium channel blockers. They are suitable for patients with angina pectoris, heart failure, tachycardia, myocardial infarction with hypertension.

Side effects of calcium channel blockers.

Edema: It is a common side effect of calcium channel blockers. Edema of the face, lower extremity pretibial, lower extremity pretibial edema may occur. It will improve after stopping the drug. Alternatively, it may try to replace the patient with other calcium channel blockers. The incidence of side effects with levamlodipine is relatively low.

Gingival hyperplasia: It may occur in patients taking calcium channel blockers for a long time. Among them, nifedipine caused the highest incidence of gingival hyperplasia.

Hypotension: Some calcium channel blockers, especially short-acting calcium channel blockers, may lower blood pressure too quickly and cause hypotension. Therefore, it recommends the use of long-acting calcium channel blockers (eg, amlodipine) to lower blood pressure. The patient's blood pressure should also be monitored after taking the drug.

Atrioventricular block: Non-dihydropyridine calcium channel blockers have negative effects on the heart. It inhibits sinus node and myocardial contraction. The main clinical manifestation is atrioventricular block. Therefore, patients with sick sinus syndrome and 2nd degree or higher atrioventricular block are contraindicated.

Heart failure: Calcium channel blockers dilate systemic blood vessels, reduce cardiac load and protect ischemic myocardium. However, the degree of heart failure can be aggravated, so it should be used with caution in patients with heart failure.

Tachycardia: Calcium channel blockers reflexively activate the sympathetic nervous system. It increases the heart rate. When necessary, calcium channel blockers should be combined with β-blockers to alleviate this adverse effect.

Headache and flushing: The dilation of blood vessels caused by calcium channel blockers may cause headaches and flushing. If the patient cannot tolerate it, other antihypertensive drugs should be used.

Constipation: Intestinal smooth muscle calcium transport may also be affected, resulting in constipation. If the constipation is more severe, it may consider changing the dressing or adding a laxative.

Caution with calcium channel blockers.

Short-acting nifedipine: It may drop blood pressure too quickly and cause low blood pressure. It will also increase the heart rate reflex reflex, blood pressure fluctuations and other problems. Therefore, it is mainly used in the clinical treatment of coronary heart disease and angina pectoris, and it can be sucked in the first aid.

Pay attention to the method of administration: Sustained-release or controlled-release tablets should be swallowed whole.

Avoid grapefruit or grapefruit juice: The activity of the CYP3A4 enzyme can be inhibited by grapefruit. In addition to no obvious effect on amlodipine, other metabolic rates will be reduced, thereby enhancing drug efficacy and the occurrence of adverse reactions.

Read More

How can kidney stones be prevented and treated?💎💎💎

Kidney stones are formed by the deposition of mineral crystals in the urine in the kidneys. It is one of the more common types of urinary system diseases. It is a type of urinary tract stone. In addition to kidney stones, other urinary tract stones include ureteral stones, bladder stones, and urethral stones, depending on where the stones are deposited.

Clinical manifestations of kidney stones.

Severe lower back or abdominal pain is one of the symptoms of kidney stones. Kidney stones can move within the calyces, renal pelvis, and ureter. It causes the smooth muscle of the kidneys to contract, spasm and block. Severe pain occurs in the corresponding area of the kidney. If the stone moves to the ureter, it can block the ureter. As a result, urine cannot be excreted normally. Urine accumulates in the renal pelvis. This can cause hydronephrosis. Symptoms of kidney stones include difficulty urinating, frequent urination, urgency, blood in the urine, nausea and vomiting.

People who are prone to kidney stones.

Male: Men are more likely to have kidney stones than women. This is because the urinary system of men is different from that of women. Men's urethra is longer than women's, which makes it easier for crystals to deposit in the urine, so they are more likely to have stones.

Drink too little water: If people drink too little water, their urine will be concentrated from too little water. It can make people more likely to have kidney stones.

Foods high in salt, fat, purines, and calcium: People who eat these foods regularly and drink alcohol are more likely to develop kidney stones.

Diseases: Patients with hyperthyroidism, diabetes, hyperuricemia, gout, obesity, urinary tract obstruction and urinary tract infection are more likely to have kidney stones.

Others: People who often hold their urine and sit for long periods of time are also more likely to have kidney stones.

How to prevent different types of kidney stones.

Common types of kidney stones include calcium oxalate stones, calcium phosphate stones, uric acid stones, cystine stones, magnesium ammonium phosphate stones, and mixed stones. Among them, calcium oxalate stones are the most common.

Calcium oxalate stones: Patients with these stones should limit their intake of high salt, sugar, fat, protein, and high doses of vitamin C. Foods high in oxalate such as spinach, celery, soybeans, black beans, peanuts, kiwi, grapes and mutton should also be eaten less.

Calcium oxalate stone

Calcium phosphate stones: Patients should avoid monosodium glutamate and carbonated beverages. Foods high in phosphorus such as red meat, bran, and whole milk powder should be avoided. They should eat more vegetables and fruits. When people consume too much phosphorus, it increases their calcium loss and increases the pH of the urine. If they don't drink enough water, calcium phosphate stones can easily form.

Calcium phosphate stone

Uric acid stones: Patients should limit their consumption of high-purine foods such as meat, seafood, and coffee. Drugs that increase the pH of the urine, such as sodium potassium citrate and sodium bicarbonate, can alkalize the urine and increase the excretion of uric acid.

Uric acid stone

Cystine stones: Meat, eggs, fish and other foods rich in methionine should be limited. Salt intake should also be reduced. Alkalizing urine reduces the risk of cystine stone formation.

Cystine stone

Magnesium ammonium phosphate stones: Because it mainly occurs after urinary tract infection, it is also called infectious stone. Prevention and treatment of bacterial infections are the main methods of prevention of magnesium ammonium phosphate stones. Patients over the age of 60 are at high risk of developing magnesium ammonium phosphate stones, and they are more common in women. Its texture is usually brittle, so when it is located in the renal pelvis or upper ureter, it can be crushed with extracorporeal shock wave lithotripsy.

Magnesium ammonium phosphate stone

How should kidney stone patients be treated?

If the patient's kidney stones are not too large, they can be tested regularly. They should drink plenty of water and do moderate exercise such as skipping rope. Kidney stones may pass out of the body on their own. Terazosin and tamsulosin are the most commonly used drugs for kidney stones. They can facilitate the passage of kidney stones. If the patient's kidney stone is too large, appropriate lithotripsy should be performed clinically according to the actual situation of the patient.

How to prevent kidney stone recurrence?

1. Drink more water and less beverages. 
2. Beverages high in sugar, strong tea, coffee and beer should be avoided or avoided as much as possible.
3. Do appropriate exercise.
4. According to the type of kidney stone, adjust the patient's eating habits.

Read More