What you should know about rivaroxaban?👀

Rivaroxaban is a new oral anticoagulant. It has been widely used in theprevention and treatment of venous thromboembolic disease, and stroke prevention in non-valvular atrial fibrillation. In order to use rivaroxaban more rationally, you need to know at least this knowledge.

The differences between rivaroxaban and other oral anticoagulants.

Commonly used oral anticoagulants include warfarin, dabigatran, rivaroxaban and apixaban. Among them, dabigatran, rivaroxaban, apixaban and so on. are called new oral anticoagulants (NOAC).

Warfarin exerts its anticoagulant effect mainly by inhibiting the synthesis of coagulation factors II, VII, IX and X. Because warfarin has no effect on synthetic clotting factors, its onset of action is slower.

Rivaroxaban mainly exerts its anticoagulant effect by inhibiting the activity of coagulation factor Xa and reducing the synthesis of thrombin. Since it does not affect the thrombin activity that has been generated, it has little effect on the physiological hemostatic function.

Dabigatran exerts its anticoagulant effect mainly by directly inhibiting the activity of thrombin.

Pathogenesis of pulmonary embolism and stroke.

Pulmonary embolism (PE) includes tumor embolism, air embolism, amniotic fluid embolism, fat embolism, and pulmonary thromboembolism (PTE). PTE is the most common type of PE. In clinical practice, PE is usually referred to as PTE.

Deep vein thrombosis (DVT) often occurs in the deep veins of the lower extremities or pelvis. It is the leading cause of pulmonary embolism. Once the deep vein thrombosis is dislodged. The thrombus can return to the right heart through the veins and then enter the pulmonary artery. This can cause a pulmonary embolism.

In patients with atrial fibrillation, blood tends to stagnate in the atria and form clots. Once the atrial thrombus is dislodged, it can enter the carotid artery and cause a stroke. About 20% of ischemic strokes are caused by atrial thrombus.

Clinical application of rivaroxaban

Factors such as slow blood flow, vascular endothelial injury, and blood hypercoagulability can trigger deep vein thrombosis. For example, some patients who have had a successful hip or knee replacement surgery die suddenly a few days after the procedure. This was most likely because the patient developed deep vein thrombosis after surgery. The thrombus dislodges and causes a pulmonary embolism that leads to death.

• To prevent venous thrombosis after hip or knee replacement: The first dose should be used between 6-10 hours after surgery. The recommended dose is 10 mg once a day. For hip surgery patients, the course of treatment is 35 days. For knee surgery patients, the course of treatment is 12 days.
• To treat or reduce the risk of recurrence of deep vein thrombosis and pulmonary embolism: For the first 1-21 days, 2 times a day, 15mg each time. After 22 days, 1 time a day, 20 mg each time. The course of treatment is at least 3 months.
• Reduced risk of stroke and systemic embolism in non-valvular atrial fibrillation: The recommended dose is 20 mg once daily and long-term treatment is required.

The differences between different dosage formulations of rivaroxaban.

Rivaroxaban tablets are available in three doses: 10mg, 15mg and 20mg. Rivaroxaban tablets are different from most medicines. Different doses of rivaroxaban tablets are used in different ways.

• Rivaroxaban Tablets 10mg: Food does not affect the absorption of rivaroxaban tablets 10mg. It is almost completely absorbed whether on an empty or full stomach. Its bioavailability is 80-100%.
• Rivaroxaban Tablets 15 and 20mg: Food can promote its absorption. Compared with taking the medicine on an empty stomach, the bioavailability of the medicine on a full stomach can be increased by 39%, and the peak concentration can be increased by 76%.

If the patient cannot swallow the whole tablet, rivaroxaban tablet can be crushed before taking the medicine, mix it with applesauce and take it orally immediately.

For missed doses:

• For the once-daily dose, missed doses should be made up immediately. However, the dose should not be doubled within 1 day in order to make up the dose.
• For treat or reduce the risk of recurrence of deep vein thrombosis and pulmonary embolism, the dose for the first 1-21 days requires a total daily dose of 30 mg. Therefore, if you miss a dose, you may need to take two 15mg tablets at a time.

Side effects of rivaroxaban:

The anticoagulant effect of rivaroxaban is predictable, with a wide therapeutic window, no accumulation after multiple doses, and few drug and food interactions. Therefore, routine coagulation monitoring is not required.

Its main adverse reaction is bleeding. It can present as minor bleeding, severe bleeding, or life-threatening bleeding. Rivaroxaban is rapidly absorbed, and the peak plasma concentration takes 2 to 4 hours. In severe bleeding, the time after taking the drug should be considered to determine whether gastric lavage is required.

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Some main points about drinking water.💧💧💧

Drinking plenty of water is good for your health. This is well known. But there
are some precautions when drinking water. In some cases, drink plenty of water. In some cases, you should drink less water. In some cases, you should not drink water. And you can add some honey, lemon, etc. to the water, which can have other effects.

You can drink a glass of boiled water when you wake up in the morning, which can help with bowel movements.

After a night of sleep, your body metabolizes a lot of water when you wake up in the morning. Drinking about 450 ml of boiled water at this time can not only help defecation, maintain blood vessels, but also have certain benefits in preventing colds, pharyngitis and certain skin diseases.

Drinking boiled water before bathing can protect blood vessels.

The skin wicks away perspiration when taking a hot bath. This causes the body to lose water. If you don't hydrate in time, it is easy to develop hypotension, causing dizziness, collapse and fainting. If the body loses too much water at once, it is easy to cause the blood viscosity to increase. For some people with cardiovascular and cerebrovascular diseases, there is also a risk of cerebral infarction and myocardial infarction. Drinking a glass of about 200 ml of plain water before bathing can store water for the body to prevent loss of water during bathing.

Drink warm boiled water before going to bed to prevent gout attacks.

In winter, some people will turn on the heating to sleep. This will make the indoor air more and more drier. Therefore, drinking a glass of boiled water before going to bed can moisturize the respiratory tract, which is especially important for people with respiratory diseases. Furthermore, gout attacks often occur at night. Drinking a glass of water before going to bed can also reduce the concentration of uric acid and prevent gout attacks.

👇However, in some cases you should not drink water.

When taking some medicines, you should not drink water.

In most cases, drink water when taking medicine. However, some drugs are special. Drinking more water will not only reduce their efficacy, but may also induce drug-induced diseases. The following types of drugs are common:

• Some medicines for stomach ulcers: Some medicines for gastric ulcers are either swallowed directly without drinking water, or chewed and swallowed dry, or only a very small amount of water is required for the medicine to be swallowed into the stomach. After these drugs enter the stomach, they will form a dense protective film covering the damaged (already ulcer) gastric mucosa to protect that gastric wall.
• Some cough medicine, cough syrup: In order to improve the efficacy of the medicine, the cough suppressant is specially made into a thicker shape, so that the medicine can adhere to the inflamed throat after taking it, and directly act on the diseased part, thereby playing an anti-inflammatory and therapeutic effect. If you drink plenty of water, it will flush out the active ingredients of the cough medicine sticking to the throat and trachea, reducing the therapeutic effect.
• Antiangina drugs: When taking it, you should chew the tablet directly, put it under the tongue, and do not drink water. Because the capillaries under the tongue are rich, they can quickly absorb into the blood and exert the effect of medicine. Do not swallow and do not drink water after it has been sublingual.

The drug instructions have detailed usage and you should read it carefully before taking the drug and take it as required.

It is not recommended to drink water during exercise or just after exercise.

Many people drink a lot of water immediately after exercising, but this is actually bad for their health. During exercise, the functional status of each organ is adjusted. Organs related to exercise energy, such as the heart and lungs will be strengthen, the digestive and absorption functions of the gastrointestinal tract will be relatively weakened, and the rate of gastric emptying will decrease. Therefore, drinking a lot of water quickly at this time can easily cause water retention in the stomach. This can cause discomfort such as bloating, stomach pain, and nausea, and the burden on the kidneys and heart will also increase. Moreover, sodium is lost with sweat when sweating. If you drink a lot of water but do not pay attention to sodium supplementation, it is easy to cause hyponatremia. Severe hyponatremia can cause brain edema and pulmonary edema, damage the function of the brain and lungs, and even cause death. 

It is recommended to drink 400-600 ml of plain boiled water 1 to 2 hours before exercise, in divided doses. During exercise, if you feel thirsty, you can refill 100-200 ml every 15-30 minutes. Rehydration drinks should contain less than 6% sugar. If the exercise time is longer than 1 hour, it should also contain 0.5 to 0.7 grams per liter of sodium.

How much water should people drink every day?

Under normal circumstances, a normal adult needs 3000 ml of water per day. Through food, such as soup, vegetables and fruits, you can consume about 1000ml, and the rest needs to be supplemented by drinking water. Therefore, an average adult needs to drink about 2000 ml of water per day. In addition, drink plenty of water if you exercise a lot and sweat a lot.

The water temperature should not be too high.

Too cold or hot water is not good for your health. Drinking too hot water often can damage the esophagus and cause serious cancer. If the water temperature is too low, it will irritate the intestines and stomach. It can cause rapid contraction of gastric mucosal blood vessels, which can easily cause gastrointestinal discomfort and even diarrhea, especially for those with weak stomachs.

It is recommended that when the weather is hot, the water temperature can be close to room temperature. When the weather is cold, the water temperature can be slightly higher, but it should not exceed 40°C.

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People with constipation can eat more these foods.🌿🌿🌿

Constipation means that you have fewer bowel movements than normal. The stool will be dry and hard, and it will be difficult to defecate. Normal people usually defecate 1-2 times a day or once every 1-2 days. People with constipation generally have less than 3 times a week. It is one of the common problems of modern people. Even if it is not long-term constipation, most people will have tried to have poor bowel movements. Failure to excrete stool will not only make you feel bloated and uncomfortable. Constipation will increase the time you spend sitting on the toilet. If it takes too long, it will easily cause problems such as hemorrhoids. Frequent use of laxatives or enema can cause dependence. Therefore, the following will introduce some foods that can help defecation and relieve constipation.

1. Sweet potato leaves.

Sweet potato leaves were generally used as food for livestock in the past, but now it has become a popular healthy food. The most prominent function of sweet potato leaves is to help defecate. Sweet potato leaves are rich in dietary fiber. It can speed up the movement of food in the intestines and stomach and has the effect of cleaning the intestines. In addition, the nutrition of sweet potato leaves should not be underestimated. Compared with common vegetables, the content of minerals and vitamins in sweet potato leaves are superior, and the carotene content is even higher than that of carrots. It is worth mentioning that sweet potato leaves are rich in flavonoids. Flavonoids can combine with oxygen free radicals in the human body. This makes it have a variety of health effects such as anti-oxidation, improving human immunity, delaying aging, and preventing cancer.

2. Kelp.

Kelp is rich in polysaccharides and dietary fiber. It can promote stomach movements and bowel movements, prevent the reabsorption of bile acids, and make them excrete with feces. In addition, kelp is also rich in iodine. This is a very good food for pregnant women and breastfeeding mothers. During pregnancy and breastfeeding, the iodine requirement has increased by about twice as compared to usual, that is, the daily requirement is more than 200 micrograms. During pregnancy and breastfeeding, the iodine requirement has increased by about twice as compared to usual, that is, the daily requirement is more than 200 micrograms. Iodine supplementation through diet is the most useful. During this period, they can eat kelp, seaweed or other algae one more time a week.

In addition, when washing kelp, it should not be soaked for too long. The iodine, mannitol, potassium and vitamins in kelp are all in the epidermis of kelp. If it is soaked for too long, the nutrients will tend to be particularly lost. After the dried kelp is moistened with water, wash the soil and cook immediately instead of soaking it in water. If it is soaked after washing, the soaking water and kelp should be cooked together.

3. Dragon fruit.

Dragon fruit is a kind of fruit that can help defecation very much. Each 100 grams of white dragon fruit contains about 2 grams of dietary fiber. This exceeds the 1.2 grams contained in bananas and the 1.6 grams contained in apples. The dietary fiber can promote gastrointestinal motility and bowel movements. It leads to help defecation and relieve constipation. Therefore, if people with constipation eat more dragon fruit, they can alleviate the problem of constipation.

4. Oat.

The most prominent nutrient in oats is its rich β-glucan. It is a soluble dietary fiber. Oat can promote gastrointestinal motility and help defecation. Moreover, after people ate oatmeal, it will make them feel full easier. It has the effect of weight loss. However, there are many kinds of oat on the market, which one should you choose? It is generally recommended to consume the original oatmeal. Although instant oatmeal is more convenient and delicious to eat, it is more recommended to consume original oatmeal in terms of nutrition. The original oatmeal has a poor taste, needs to be cooked, and is troublesome to eat. However, the original oatmeal retains almost all the nutrients of oats. It does not add other substances, such as flavoring agents, preservatives, etc. This is more conducive to human health.

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Some medicines should not be taken with hot water.🌞🌞🌞

When people take medicine, they are concerned about the usage and dosage of the medicine. But in fact, there are also requirements for the water temperature for taking the medicine. Granules, effervescent tablets, dry suspensions, and powders are commonly used clinical dosage forms, especially suitable for children. However, some medicines will have physical and chemical reactions when exposed to heat, which will affect the efficacy and safety. Therefore, it is not suitable to take hot water (>40°C).

1. Vitamins.

Some vitamins, such as vitamin B1, vitamin B2 and vitamin C, are unstable in nature. They are susceptible to oxidation-reduction decomposition when exposed to heat and lose their efficacy. 

Vitamin C: Health products containing vitamin C should also be taken with cold water or warm water. Especially effervescent tablets, should be taken with a glass of cold water or warm water (about 200 ml).

2. Live bacteria preparation.

Under normal circumstances, live bacteria are not resistant to high temperatures. If it is brewed with boiling water or taken, the living bacteria will be killed and the therapeutic effect will be lost. 

• Live Combined Bacillus Subtilis and Enterococcus Faecium: It should be taken with warm boiled water or milk below 40℃. Granular preparations can be taken directly.
• Live Bacillus Licheniformis Preparation: It should be taken with warm water (≤40℃) or milk. When people with dysphagia are taking live Bacillus licheniformis capsules, they can open the capsules and mix the powder with a small amount of warm water (≤40°C) or milk before taking it.

3. β-lactam antibiotics:

β-lactam antibiotics are easily hydrolyzed. Their hydrolyzed substances will not only lose antibacterial activity, but also increase the risk of allergic reactions. when you take β-lactam antibiotics (Especially granules or suspension formulations), you should pay more attention. Commonly used β-lactam antibiotic granules include amoxicillin granules, amoxicillin clavulanate potassium granules, cefixime granules, cefpodoxime proxetil granules and so on.

• Amoxicillin granules: It should be taken with cold boiled water and should be taken as soon as possible.
• Azithromycin dry suspension, granules: Azithromycin is unstable. Pour it into a glass, add an appropriate amount of cold boiled water, dissolve and shake well before taking it orally.

4. Digestive enzymes.

Enzymes are active proteins that will denature and solidify when exposed to heat. This can lead to decreased or loss of efficacy. Commonly used enzyme drugs include pepsin granules, yeast tablets, multi-enzyme tablets, pepsin mixture, and compound amylase oral solution.

• Compound pepsin granules: It needs to be sealed and stored in a cool and dry place (not exceeding 20°C). It should not be taken with hot water.

5. Herbal medicines or Chinese patent medicines containing volatile oil.

Herbal medicines contain fennel, ageratum, dried ginger, mint, borneol, turmeric, nutmeg, nepeta and so on. The volatile oil in them has a greater medicinal value and is easy to volatilize and decompose when exposed to heat. Many Chinese patent medicine granules and granules also contain volatile oil.

6. Cough Syrup.

Such as cough and phlegm syrup, compound licorice mixture, Chuanbei loquat ointment and so on. They are a class of medicines prepared by dissolving cough and anti-inflammatory ingredients in syrup or extract. After the patient takes it, the syrup or extract covers the surface of the inflamed pharyngeal mucosa to form a protective film, which is convenient for quick control of cough and relief of symptoms. If it is taken with hot water, the viscosity of the syrup will be reduced and the efficacy of the protective film will be affected. It is also recommended not to drink water immediately after taking them.

7. Capsule drugs.

Hot water may melt the capsules quickly and lose their efficacy. It may also cause side effects such as damage to the esophagus and gastric mucosa.

8. Lozenges.

Lozenges only need to be in the mouth. After it slowly melts, the medicine can act on the lesion and it don't need to be taken with water. The same is true for sublingual lozenges. You only need to press the pill under the tongue, and it will be effective soon after it melts, and you don't need to drink water to take it.

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Energy may be an important factor to Alzheimer's disease.💥💥💥

Alzheimer's disease is a common chronic neurological disease in the elderly, which is caused by patients with extensive cerebral cortex atrophy and degenerative diseases. It is mainly dysfunction and behavioral personality disorder. The early manifestations are progressive memory loss and decreased temporal and spatial orientation. In the late stage, he can't take care of himself, and even has difficulty eating, incontinence of urine and feces, unknowing pronunciation, and finally in a vegetative state. This will require dedicated care and will bring a great burden to the family. Researchers at the University of Adelaide in Australia have found out a relationship between the route of cells produce energy for brain function and the mutant genes of patient with Alzheimer's disease. They published this finding that can prompt people to further study this relationship. This may be regarded as the basic and potential pathogenic factor of human Alzheimer's disease in the early stage.

What did the study do?

In this study, the researchers analyzed genetic mutations in the brains of younger adult zebrafish that are associated with early-onset Alzheimer's disease. The zebrafish were chosen as the research object because their family is very large, which makes it easier to detect subtle effects through them. The research team uses mathematical analysis and advanced genetic technology. They compared the gene activity of zebrafish and found subtle differences between normal fish and mutant fish. Although the researchers found that different mutations in distinct genes can have many various effects on the function of fish brain cell, they also found that mutations in Alzheimer's disease can affect a very important function of cell, which is the utilize of oxygen in the cell to make energy.

The lead researcher of this study, Dr. Karissa Barthelson, thinks that this discovery is very interesting. Because they know that when Alzheimer's disease is finally progressed, people's brains will become severely lacking in energy. After they discovered the results of above research, they took this research to a deeper level. They knew that a research team had studied an important Alzheimer's disease-related gene in mice. They reanalyzed the research data of that research team. After reanalysis, they can see similar results. This strengthened their confidence in the results of their research. They believe that their research has discovered a basic, early pathogenic factor for Alzheimer's disease of  human. 

Prospects for the future.

The brain is composed of many different types of cells. These cells have complex ways of producing and sharing energy. The following, the research team at the University of Adelaide wants to study how Alzheimer's disease genetic mutations affect these different cell types. They are very satisfied that this study has found out an important and common early factor that induces the development of Alzheimer's disease. 

The researchers pointed out that the cost of Alzheimer's disease to society is very huge. Not only does it take human and financial resources to take care of those who cannot take care of themselves, but as the patients' cognitive and memory decline, they will also lose the relationship with their relatives and friends. 

Energy manufacturing is the most constitutional and basic cell activity that supports all other functions, especially in highly activated organs such as the brain. If people can understand in detail what is wrong with the utilize of oxygen and energy production. We may discover a method to stop the Alzheimer's disease before it starts. This will greatly benefit the elderly population.

My thoughts

Alzheimer's disease is a disease that lacks a cure. For some family members of patients, they may be even more painful than the patient during the long-term care of the patient. Therefore, they may begin to seek the help of professional elderly care institutions and nursing staff. This will increase their financial burden. Under the influence of these pressures, those family members are exhausted physically and mentally, and then suffer from illnesses. Although the US Food and Drug Administration approved Biogen's new drug for Alzheimer's disease, aducanumab, in mid-2021, the target, efficacy and price of this drug have been controversial. In addition, its treatment procedures are also very complicated. Its sales in the third quarter of 2021 were far worse than expected. Therefore, this discovery may provide a new idea to develop drugs for Alzheimer's disease.

If you want to know more detail, please read this article below👇:

Karissa Barthelson, Morgan Newman, Michael Lardelli; Brain transcriptomes of zebrafish and mouse Alzheimer's disease knock-in models imply early disrupted energy metabolism. Dis Model Mech 2021; dmm.049187. doi: 

https://doi.org/10.1242/dmm.049187

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How to choose valsartan and valsartan combined with hydrochlorothiazide?😵😵😵

Valsartan and hydrochlorothiazide tablets are commonly used clinically combined preparations. Clinically, what is the difference between valsartan hydrochlorothiazide and valsartan? Which one should I choose? How to use valsartan and hydrochlorothiazide correctly?

1. How to use valsartan and hydrochlorothiazide tablet?

Currently, there is only one dose of valsartan and hydrochlorothiazide tablets (80mg/12.5mg), each containing 80mg of valsartan and 12.5mg of hydrochlorothiazide.

Dosage: One tablet each time, once a day. The maximum antihypertensive effect can be achieved within 2 to 4 weeks of taking the medicine. According to the efficacy of the drug, the dosage can be adjusted every 1 to 2 weeks.

Because hydrochlorothiazide can cause hyperuricemia, hyperlipidemia and hyperglycemia. They are related to the dosage. If the blood pressure still fails to reach the target after 4 weeks, the patient should not increase the dosage without authorization, and adjust the medication regimen under the guidance of the doctor. Food does not affect the absorption of hydrochlorothiazide. Although food can significantly reduce the absorption of valsartan, valsartan can be taken with or without food. In order to reduce blood pressure fluctuations, patients should take the medication at a fixed time, either before or after meal. For most patients, in order to avoid increased nocturia, it is recommended to take it in the morning.

2. The combination of valsartan and hydrochlorothiazide can exert the effect of 1+1>2.

Complementary mechanisms to reduce blood pressure:

Valsartan belongs to angiotensin II receptor antagonist. It can block the effect of angiotensin II. Angiotensin II is one of the important active ingredients of the renin-angiotensin-aldosterone system. It binds to specific receptors on cell membranes of various tissues and exerts different physiological effects, including direct or indirect regulation of blood pressure. Angiotensin II is a strong vasoconstrictor substance. It can exert a direct effect of raising blood pressure. It can also promote the reabsorption of sodium and stimulate the secretion of aldosterone. In addition, valsartan is a specific angiotensin II receptor antagonist. It does not inhibit angiotensin converting enzyme. This enzyme converts angiotensin I into angiotensin II and degrades bradykinin. The retention of bradykinin can cause coughing. Therefore, valsartan does not cause coughing.

Hydrochlorothiazide excretes natriuresis and diuresis. It can reduce blood volume. At the same time enhance plasma renin activity. This stimulates the production of angiotensin I and II. Hydrochlorothiazide mainly acts on the proximal end of the distal convoluted tubule. It inhibits sodium chloride transport at the proximal end of the distal convoluted tubule and inhibits the cotransport of sodium and chloride ions. This directly increases the excretion of sodium and chlorine, and indirectly reduces blood volume. Then increase plasma renin activity, aldosterone secretion and potassium excretion. This lowers the blood potassium concentration. Renin-angiotensin-aldosterone system is depending on angiotensin II. Combination with angiotensin II receptor antagonists can reduce blood potassium loss associated with thiazide diuretics.

Reduce the incidence of hypokalemia:

Hydrochlorothiazide promotes sodium and potassium ion exchange and aldosterone secretion. This increases the excretion of potassium ions, which can cause hypokalemia.

Valsartan inhibits the release of aldosterone mediated by angiotensin II and reduces potassium excretion, which can reduce the risk of hydrochlorothiazide-related hypokalemia.

3. How to choose valsartan or valsartan combined with hydrochlorothiazide?

For blood pressure less than 160/100mmHg, valsartan can be used.

Patients with blood pressure ≥160/100mmHg or higher than the target blood pressure of 20/10mmHg should prefer valsartan and hydrochlorothiazide.

People who are allergic to sulfanilamide drugs should not use valsartan and hydrochlorothiazide tablets. Patients with hyperuricemia and hypercalcemia should avoid valsartan and hydrochlorothiazide tablets.

4. Precautions for valsartan and hydrochlorothiazide tablets.

Valsartan and hydrochlorothiazide tablets can still cause hypokalemia:

In addition to hypokalemia, hydrochlorothiazide can also cause hypomagnesemia, hyponatremia and so on. Therefore, electrolyte levels should be monitored regularly during medication.

When combined with calcium supplements and vitamin D, valsartan and hydrochlorothiazide tablets should be used with caution:

Thiazide diuretics can reduce calcium secretion and increase blood calcium levels. During medication, if calcium supplements and/or vitamin D are used, serum calcium levels should be monitored. If it is necessary, adjust the dosage of calcium supplements and vitamin D.

Hydrochlorothiazide can cause photosensitivity rashes, moss-like reactions, and lupus erythematosus. Patients should avoid exposure to the sun during medication. Hydrochlorothiazide can reduce glucose tolerance. Patients with latent diabetes mellitus may have symptoms. Therefore, diabetics may need to adjust the dose of hypoglycemic drugs.

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Ten foods that can help lower blood lipids.🌽🍎🍠

Hyperlipidemia is a common disease at present. Due to the many pathogenic factors of hyperlipidemia, it is easy to cause a variety of serious complications, such as high blood pressure and other cardiovascular diseases. Poor eating habits in life are also a major factor in increasing blood lipids. Therefore, while medication is used to reduce blood lipids, dietary improvement can better assist in the treatment of blood lipid reduction. Here are ten foods that can help lower blood lipids:

1. Oats:

Oats have the effect of lowering cholesterol and blood lipids. Because oats contain rich soluble dietary fiber that other grains do not have. This fiber is easily absorbed by the human body and has low calories. It is not only conducive to weight loss, but also suitable for the dietary needs of people with heart disease, high blood pressure, hyperlipidemia and diabetes.

Oats

2. Corn:

Corn is rich in calcium, phosphorus, magnesium, iron, selenium, vitamins A, B1, B2, B6, E, carotene, etc., and is also rich in fiber. Regular consumption of corn can lower cholesterol and soften blood vessels. It can prevent cardiovascular disease. It also has an adjuvant therapeutic effect on cholecystitis, gallstones and diabetes.

Corn

3. Onion and garlic:

Onions contain compounds such as alliin and thiol, which help to dissolve blood clots. Moreover, onions contain almost no fat, so they can inhibit the increase in cholesterol caused by a high-fat diet and help improve atherosclerosis. Garlic can lower serum total cholesterol. The secondary metabolite of allicin, methpropylene trisulfide, can prevent thrombosis.

Onion and garlic

4. Yam:

Yam contains mucus protein. Mucin can prevent fat deposition in the cardiovascular system, maintain blood vessel elasticity, prevent arteriosclerosis, reduce subcutaneous fat deposition, and avoid obesity. Moreover, the dopamine in yam has the function of dilating blood vessels and improving blood circulation.

Chinese Yam

5. Sweet potato:

Sweet potato has a strong effect of lowering blood cholesterol, maintaining blood acid-base balance, delaying aging, and preventing cancer and cancer. Sweet potatoes are rich in dietary fiber and gums, which help defecation substances. It can help remove useless substances from the intestines.

Sweet potato

6. Kelp:

Kelp can be said to be a vegetable from the ocean. Its low-calorie and low-fat characteristics have attracted the attention of nutritionists. Algae contain phytochemicals such as plant polysaccharides. They have many physiological functions such as anti-oxidation, regulating immunity, suppressing tumor, anti-infection, lowering cholesterol, delaying aging and so on. Because of the high water content of the alginate in kelp, it can form a gel-like substance in the intestine, so it helps to eliminate toxins and prevents constipation and intestinal cancer.

Kelp

7. Tremella:

Tremella is a nourishing food. It is rich in dietary fiber, which can strengthen gastrointestinal motility and reduce fat absorption. Tremella polysaccharide is a plant polysaccharide, which has the functions of lowering cholesterol, enhancing immunity, anti-tumor, anti-aging and beauty moisturizing.

Tremella

8. Celery:

Celery has the effects of detoxification, invigorating the stomach, protecting the liver, reducing phlegm, removing edema, calming blood pressure, reducing weight and fat. Celery is more suitable for patients with cough and excessive sputum, viral hepatitis, hypertension, hyperlipidemia, coronary heart disease, vascular sclerosis, urinary tract infection, sore swelling, pharyngitis, and so on.

Celery

9. Hawthorn:

The pectin contained in hawthorn is soluble dietary fiber, which has the effect of lowering cholesterol and preventing atherosclerosis. Eating hawthorn can remove oil and greasiness and promote digestion.

Hawthorn

10. Apple:

Apple is one of the very good fruits. It is healthy and low in calories. Because apples are rich in dietary fiber, pectin. Pectin basically contains no calories. It just passes through the human body. But every time it passes through the human body, it always takes away something, such as fat and oil. This will help to remove oil and lose weight. Moreover, it will also make the skin brighter and moisturized.

Apple

In addition, if you suffer from cardiovascular problems such as hyperlipidemia and high blood pressure, you should be careful not to eat greasy and spicy foods, eat less high-cholesterol, high-protein foods, and not eat animal fat, animal offal, etc. Try not to smoke or drink. You should have a light diet, eat more fruits and vegetables, maintain a good attitude and mood, and the effect of lowering blood pressure will be more ideal.

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Will metformin harm the liver and kidneys❓❓❓

Metformin was originally just a blood sugar lowering drug, but it was later
discovered to have many other effects, such as anti-aging, anti-cancer, etc., and it has been widely discussed (the medication should follow the doctor's guidelines and do not use it indiscriminately). Although with the advent of SGLT2 inhibitors, metformin has been replaced by SGLT2 inhibitors to a certain extent, metformin is still the drug of choice for type 2 diabetes in general. The vast majority of drugs will have some damage to the liver or kidneys. Many people would also think that metformin also harms the liver and kidneys. Will metformin harm the liver and kidneys?

Why do many people think that metformin harms the liver and kidneys?

In fact, the doctor prescribes oral hypoglycemic drugs for a newly diagnosed type 2 diabetes patient. According to the guidelines, if there are no contraindications, metformin should be recommended first. At this time, the doctor will ask the patient if he has any problems with the liver and kidney function, and may even check the liver and kidney function. As a result, many patients think that metformin will harm the liver and kidneys, so doctors will ask about their liver and kidney function. Of course, the doctor will explain to the patient that it is not that metformin hurts the liver and kidneys, but that patients with poor liver and kidney function may not be suitable for this medicine. However, doctors often do not have much time to explain the reasons to patients in detail, and most patients often fail to understand this highly specialized content. Therefore, patients will only remember the first impression that metformin may harm liver and kidney function. Then pass on the impression they remembered to others.

Why do doctors ask about liver and kidney function?

In fact, metformin neither hurts the liver nor the kidneys, and even some studies have shown that metformin can improve the liver and kidney function of some patients in some cases. So, why should doctors pay special attention to the patient's liver and kidney function when prescribing metformin? 

• Renal function: Metformin is mainly excreted from urine in its original form and cleared quickly. Therefore, metformin itself does not damage the kidneys. Since the launch of metformin, a large number of clinical and practical data accumulated in the past 100 years have also proved this point. Therefore, metformin does not harm the kidneys. However, in patients with renal insufficiency, the renal clearance of metformin decreases and the elimination half-life is prolonged, which leads to an increase in plasma metformin concentration and an increased risk of lactic acidosis. Therefore, patients with renal insufficiency need to adjust the dosage or discontinue according to the renal function when using metformin.
• Liver function: Metformin is not metabolized by the liver in the body, nor degraded in the body, and does not require liver detoxification, so it will not increase the burden on the liver, and it has no liver toxicity. It will not cause liver damage when used within the recommended dose. Therefore, metformin does not hurt the liver. The reason why doctors ask about liver function before prescribing metformin is that severely impaired liver function will significantly limit the patient's liver's ability to clear lactic acid. Therefore, the guidelines recommend that serum transaminase exceeds 3 times the upper limit of normal or severe liver insufficiency Of patients should avoid the use of metformin. 

Therefore, it is not that metformin harms liver and kidney function, but that the patient's existing liver and kidney function problems may affect the use of metformin.

Can't you take metformin if you have problems with liver and kidney function?

Not all patients with liver and kidney problems cannot use metformin. For example, for patients with type 2 diabetes who have normal renal function but have a small or large amount of albuminuria, metformin is still the first choice. For another example, patients with type 2 diabetes with hepatitis B or cirrhosis can also take metformin if they do not have severe liver insufficiency. However, it needs to be used under the guidance of a doctor, and follow the doctor's advice for regular liver and kidney function monitoring. Metformin has more than 60 years of global clinical application experience and its safety has been fully tested. Years of clinical studies have fully confirmed that metformin has a strong anti-diabetic effect, weight loss, cardiovascular protection, blood lipid improvement, tumor risk reduction, anti-aging, anti-inflammatory, improved intestinal flora, safety and tolerance, and high cost-benefit ratio and other advantages. This also makes metformin widely used by doctors. 

Metformin does not increase the risk of hypoglycemia when used alone, and it does not harm the liver or the kidneys. Long-term use does not increase the risk of hyperlactic acidemia or lactic acidosis. A common side effect of metformin is gastrointestinal discomfort. Metformin sustained-release tablets can solve this problem well.

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5 bad habits that damage your health.💣💣💣

Good health is the wish of many people. But everyone's different ways of living and eating will have different effects on their health. In daily life, there are several common bad habits that may be causing harm to your health.

1. Taking medicine indiscriminately.

Modern people pay more and more attention to health. Many people, even if they are healthy, will take some herbal medicines and health care products that are good for their health. Although this idea is good, all medicines have certain side effects. The most common side effect is damage to the liver. The liver is the most important detoxification organ of the human body. It is the most important organ for drug concentration, transformation and metabolism. Most drugs are metabolized by the liver, and herbal medicines and health products are no exception. Once these drugs or their metabolites have a certain degree of toxicity, the liver will be the first to suffer damage. It can cause liver damage such as inflammation of liver tissue cells and cholestasis. Moreover, this kind of injury is often very complicated, including almost all types of liver disease. Once the liver is damaged, it will affect people's health. Therefore, you should not take medicine indiscriminately. If you feel unwell, you should go to the hospital as soon as possible. Don't deal with it by your own experience.

2. Smoking and drinking.

Smoking and drinking have a great impact on health. Heart health is one of them. For example, smoking can easily cause vasculitis, increase blood pressure, blood lipids, and even cause blood clots. Current research has also found that there are as many as 93 specific toxic substances contained in cigarettes and 78 specific carcinogens. In addition to the well-known lung cancer, cigarette-related cancers include bladder cancer, pancreatic cancer, colorectal cancer, and so on. Excessive drinking also has many health risks, including obesity, liver damage and even cardiovascular and cerebrovascular accidents. Ethanol in alcohol and its metabolite acetaldehyde are carcinogens, which can make cancer cells more aggressive and spread throughout the body. They are important causes of cancers such as liver cancer, oral cancer, esophageal cancer, and gastric cancer. Therefore, if you want to live healthier, it is better to quit smoking and quit bars.

3. Stay up late.

Many people think that staying up late is just a lack of energy, poor skin, and dark circles under the eyes. In fact, the harm of staying up late is far more than that. People who often stay up late are more likely to get cancer. There are proto-oncogenes and tumor suppressor genes in the human body. Proto-oncogenes are the type that may stimulate the potential of cells to become cancerous. Tumor suppressor gene is to suppress tumor production. When people have some bad habits, such as often staying up late, proto-oncogenes may be activated and tumor suppressor genes may become weaker. Cancer cells will appear. Studies have shown that women who have worked night shifts for more than 30 years are twice as likely to develop breast cancer.

4. Long sitting.

Modern people are busy at work. Many people go to work in the morning and sit for a day. If they have to sit long time, they will have problems with their bodies. The damage to people's health caused by long sitting can be whole body, such as stiffness of the cervical spine, damage to the normal physiological curvature of the spine, arched back or bone hyperplasia, increased risk of hemorrhoids and so on. 

For men, long sitting will cause venous blood to accumulate in the scrotum and increase the temperature of the testicles. This results in venous masses on the surface of the scrotum, which affects spermatogenesis. In severe cases, it may also lead to infertility.

For women, long sitting is more harmful than men. Studies have pointed out that as long as women sit for more than 6 hours a day, the risk of dying early from various diseases is 37% higher than that of people who sit less than 3 hours a day, while men are 18% more likely to die.

5. Be in bad mood for a long time.

Modern people are under pressure in life and busy at work. They often don't have time to relax. If they don't pay attention, they are easily trapped in bad emotions. The World Health Organization once pointed out: By the middle of the 21st century, no disaster will bring people as much pain as a psychological crisis. Clinical statistics show that psychosomatic diseases caused by psychological and emotional factors account for up to 80-90% of the total number of patients. It can be seen that the negative emotions and excessive emotions of human beings are the main factors that threaten the physical and mental health of human.

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When omeprazole is used in combination with drugs, pay attention to the interaction.👀

Omeprazole is a proton pump inhibitor (PPI) that can be converted into sulfenamide compounds by protonation in an acidic environment. This compound can specifically bind to the α subunit of H+/K+-ATPase and inhibit its acid secretion activity. It is currently one of the most commonly used drugs for the treatment of acid-related diseases in clinical practice.

Omeprazole

The sulfinyl group in the chemical structure of omeprazole can be decomposed in acidic solution to cause polymerization and discoloration. Its stability may be affected by various factors such as the pH value of the solution, light, and temperature. This leads to contraindications between omeprazole and a variety of drugs.

1. The influence of pH.

Omeprazole is a benzimidazole compound and a weakly alkaline substance. The effect of pH change on its stability is particularly obvious, which can lead to its discoloration and precipitation. The main reasons are:

• Causes chemical structure changes: Omeprazole is relatively stable when the pH is around 9.0. It is easy to decompose in acidic environment to produce sulfone compounds and sulfide compounds, which cause discoloration of the solution.
• Causes solubility changes: Omeprazole is insoluble in water. After it is made into sodium salt, the solubility is improved. The maximum concentration commonly used in clinic is 40mg omeprazole sodium dissolved in 100ml normal saline (concentration is 0.4mg/ml). When the pH value of the omeprazole sodium solution decreases, free omeprazole is formed, causing turbidity or precipitation.

Acidic drugs: 

Omeprazole sodium is weakly alkaline. It will react with acidic drugs to produce new compounds. Reactions such as precipitation and discoloration will occur, and at the same time will lead to a reduction of active ingredients. Such acidic drugs include sulfacetamide, penicillin sodium, cefotaxime, piperacillin, fructose diphosphate sodium, vitamin C, vitamin B6, aminophylline, cimetidine, gentamicin and so on.

Drugs that depend on the pH of the stomach for absorption: 

Iron agents are mainly absorbed in the form of ferrous ions, which depend on the presence of gastric acid. The non-absorbed ferric iron can be converted into the divalent iron that can be absorbed under the action of gastric acid. Omeprazole can inhibit gastric acid, affect the absorption of iron, and reduce the efficacy. When the pH in the stomach rises, the tetracycline drug easily becomes insoluble free tetracycline, the absorption is reduced, and the curative effect is reduced. The absorption of ketoconazole also depends on sufficient gastric acid secretion. The acid suppression effect of omeprazole can reduce the absorption of ketoconazole and the blood concentration. The low acid environment can also reduce the absorption of itraconazole, so if necessary, acidic beverages can be used to take its capsule preparation.

2. Drugs related to metabolic enzymes.

Omeprazole is mainly metabolized to 5-OH-omeprazole by CYP2C19, or metabolized to omeprazole sulfone by CYP3A4, the former being the main metabolic pathway. Omeprazole can delay the elimination of drugs metabolized by the liver cytochrome P450 system in the body. Therefore, when omeprazole is combined with drugs related to CYP2C19 metabolizing enzymes, interactions are likely to occur.

Clopidogrel (CYP2C19 substrate):

Clopidogrel is a prodrug. It can only exert its antiplatelet effect after it enters the body and is metabolized by CYP2C19. Omeprazole is also metabolized in the liver by CYP2C19. The simultaneous use of the two may produce competitive inhibition. Clopidogdar does not have the effect of anti-platelet aggregation, which increases the risk of patients with ischemic stroke, compound stroke and myocardial infarction.

Diazepam (CYP2C19 substrate):

Omeprazole can weaken the metabolism of diazepam and increase its efficacy by inhibiting liver cytochrome P450 enzymes. Therefore, when used in combination, it should be monitored for enhanced sedation. If necessary, reduce the dose of diazepam.

Warfarin:

Omeprazole delays the clearance of warfarin by acting on the CYP450 enzyme system. The increase in warfarin exposure increases the international normalized ratio (INR) and prolongs the prothrombin time, which may lead to abnormal bleeding and even death. INR and prothrombin time should be monitored when used in combination. If necessary, adjust the warfarin dose to ensure that the INR is within the target range.

CYP2C19 or CYP3A4 inhibitors (such as voriconazole) and inducers (such as rifampicin):

Voriconazole can increase the exposure of omeprazole, except that patients with Zollinger-Eye syndrome may need to adjust the dose of omeprazole, and other generally do not need to be adjusted. Rifampicin can reduce the blood concentration of omeprazole. The combination of the two should be avoided.

Cilostazol (CYP2C19 substrate):

Omeprazole can increase the exposure of the active metabolite of cilostazol (3,4-dihydro-cilostazol). The dosage of cilostazol should be reduced to 50 mg once, twice a day.

Citalopram (CYP2C19 substrate):

Omeprazole can increase the exposure of citalopram and increase the risk of Q-T interval prolongation. The maximum dose of citalopram when used in combination should be 20 mg per day.

3. Other.

Methotrexate:

Omeprazole can inhibit the H+/K+-ATPase of the kidney. This will inhibit the active secretion of methotrexate and increase its blood concentration and toxicity.

Bismuth agent, montmorillonite powder, hydrotalcite, etc.:

They have a certain adsorption effect on omeprazole and can reduce the efficacy of omeprazole. In addition, the bismuth agent can better form a film in an acidic environment, and play the best role in protecting the gastric mucosa. If it is in a low-acid environment, its efficacy is reduced.

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Briefly talk about the impact of hyperuricemia.(Part. 2)😎😎😎

Hyperuricemia (Part. 2)✌

1. Life management of patients with hyperuricemia.

Health education:

Patients should avoid high-purine diets, and avoid inducements such as fatigue, cold, and stress. Patients should also regularly monitor blood pressure, blood sugar and other risk factors. At the same time, the blood uric acid level should be monitored regularly and checked regularly to improve the treatment effect.

Patients try to avoid using drugs that raise uric acid. Such as low-dose aspirin, immunosuppressive agents (cyclosporine), anti-tuberculosis drugs, most chemotherapy drugs, etc. Many people have to use anti-tuberculosis drugs, chemotherapy drugs and other treatments because of certain diseases such as tuberculosis and cancer. After weighing the pros and cons, it is generally believed that the harm of patients with hyperuricemia is not enough to make them give up those treatments.

Patients should quit smoking and carry out weight management. Target BMI <20 kg/m^2, male waist circumference <90 cm, female waist circumference <80 cm. The patient should have proper aerobic exercise.

Diet:

Patients should eat more fresh vegetables, a low-sugar and low-fat diet, and limit the intake of red meat, fish, and foods containing fructose and sucrose. Patients should also avoid the intake of animal offal, crustaceans, thick soups and broths. The daily purine content of the patient's diet is controlled below 200 mg.

The patient should consume 300 mL of skimmed or low-fat dairy products, 1 egg, and maintain a water intake of more than 2L per day. Patients can drink water, tea or unsweetened coffee.

Patients should strictly control drinking alcohol, especially beer and hard alcohol. The total amount of alcohol consumed daily should not exceed 28 grams for men (650 mL of beer, 280 mL of wine, or 50 mL of liquor), and 14 grams for women.

2. Drug treatment of hyperuricemia.

National guidelines have different recommendations on whether patients with asymptomatic hyperuricemia need medication.

Drugs that inhibit the synthesis of uric acid: 

They reduce the synthesis of uric acid by inhibiting the activity of xanthine oxidase.

1. Allopurinol: It is recommended that the initial dose of 50 mg for adults is 1-2 times a day, and thereafter it is increased by 50-100 mg each time. The general dose is 200-300 mg/d, divided into two to three doses. The maximum daily dose is 600 mg. Patients with renal insufficiency must reduce the dose. When eGFR is less than 10 mL/min or for dialysis patients, it is contraindicated. Use the lowest effective dose to maintain blood uric acid below the target level.
2. Febuxostat: The recommended initial dose is 20-40 mg, once a day, with an increase of 20 mg each time, and the maximum daily dose is generally 80 mg. After the blood uric acid level reaches the target, maintain the lowest effective dose. It should be noted that the FDA black box warns that febuxostat may increase the risk of cardiovascular death in patients. Febuxostat should be considered only when the patient does not respond to or cannot tolerate allopurinol treatment, and the specialist must fully assess the patient's condition and the risk of cardiovascular events before taking the drug.

Uric acid excretion drugs: 

They promote uric acid excretion by inhibiting renal tubular uric acid-anion transporter 1 (URAT1) and inhibiting renal tubular uric acid reabsorption.

1. Probenecid: Urinary stones and renal insufficiency are relatively contraindicated. For patients with renal insufficiency with eGFR> 30 mL/min, the recommended starting dose for adults is 25 mg/d, and the maximum dose is 75-100 mg/d. Drink more water during the administration to increase urine output.

Allopurinol, probenecid and febuxostat are all first-line drugs for lowering uric acid treatment. Patients with asymptomatic hyperuricemia can choose the first two categories, and patients with gout can choose the above. For patients with chronic kidney disease, the above all three types of drugs can be used, but febuxostat is the first choice when renal function is severely impaired.

Alkalized urine:

Urine pH <6 is an important factor in the formation of uric acid kidney stones. For patients with hyperuricemia and gout, the optimal morning urine pH is recommended to be 6.2 to 6.9. When the urine pH is <6, alkaline drugs, such as sodium bicarbonate, citric acid preparations, etc., can be used to alkalize urine according to the drug's indications, contraindications, and the individual characteristics of the patient.

Treatment of acute episodes:

When hyperuricemia develops into an acute attack of gout, it is recommended to use anti-inflammatory analgesia as soon as possible to improve the pain. Patients can use small doses of colchicine or adequate, short-term non-steroidal anti-inflammatory drugs, or systemic glucocorticoids. For patients with more serious conditions (such as acute gout involving multiple joints, large joints, or combined systemic symptoms), systemic glucocorticoid therapy is recommended. When the patient has severe pain, polyarthritis, or cumulative seizures of ≥ 2 large joints, a combination of two or more analgesic drugs can be used. During an acute attack, there is no need to adjust the dose of uric acid-lowering drugs that have been used.

Choice of drugs when there are comorbidities:

The principle of medication for each disease should be considered for comprehensive treatment. Try to choose drugs that lower uric acid and avoid drugs that raise uric acid.

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Briefly talk about the impact of hyperuricemia.(Part. 1)😎😎😎

Uric acid is a catabolite of purine nucleotides in the human body. It is a weakorganic acid. 80% of purine nucleotides are produced by human cell metabolism and 20% are obtained from food. The main cause of the increase in uric acid is excessive uric acid production and decreased uric acid excretion. 90% of hyperuricemia is related to decreased renal uric acid excretion.

1. Uric acid metabolism.

Synthesis:

The catabolism of purine nucleotides in the body is mainly carried out in the liver, small intestine and kidney. The abnormality of various key enzymes in the metabolic process will lead to an increase in uric acid synthesis, which accounts for about 10%.

Excretion:

Uric acid is mainly excreted through the kidneys and intestines. Normally, the amount of uric acid excreted into the intestinal cavity through the liver every day is about 1/4 to 1/3 of that produced, and then it is decomposed by bacteria in the intestinal cavity and then excreted from the body. The remaining 3/4 to 2/3 are excreted in urine by the kidneys. The abnormality of uric acid transporter located in the glomerulus and renal tubules and intestinal tract can affect the excretion of uric acid.

2. Causes of hyperuricemia.

Hyperuricemia is a metabolic syndrome caused by a disorder of purine metabolism. At a body temperature of 37 ℃, the saturated solubility of monosodium urate (MSU) in serum is 404.5 umol/L (6.8 mg/dL). It is usually defined as hyperuricemia when the serum uric acid level is> 420 umol/L (about 7 mg/dL). According to the cause, hyperuricemia is mainly divided into two categories: primary and secondary.

Primary hyperuricemia is mainly caused by abnormal enzyme activity during purine metabolism.

Secondary urinary hyperuricemia is characterized by defects in enzyme structure, excessive purine intake, alcohol consumption, enhanced nucleic acid metabolism (such as leukemia, anemic hemolysis, and malignant tumors) and accelerated purine decomposition (such as type I glycogen accumulation disease, hypoglycemia, hunger or exercise). The main causes of secondary hyperuricemia are: blood system disease, kidney disease, drug-induced, and excessive production of organic acids.

3. The effect of hyperuricemia on the body.

When uric acid or urate exceeds the normal solubility limit in body fluids, it will form crystals and deposit in any soft tissues except nerve tissues, which will cause different pathological changes.

Gout:

Hyperuricemia is the main risk factor for gout. Uric acid crystals deposit on joints and cause gout attacks. It causes bone and joint damage. Studies have shown that about 5% to 12% of hyperuricemia eventually develops into gout.

Hypertension:

Hyperuricemia can activate the renin-angiotensin system. It reduces the synthesis of nitric oxide in vascular endothelial cells and stimulates the proliferation of vascular smooth muscle. This can lead to increased blood pressure through various mechanisms such as vascular remodeling. In addition, long-term hypertension also affects uric acid metabolism through glomerular arteriosclerosis and other pathways, thereby aggravating hyperuricemia.

Abnormal blood lipid metabolism:

There is a mutual influence between uric acid metabolism and fat metabolism. Hyperuricemia and blood lipids can cause a decrease in lipoproteinase activity. At the same time, hyperlipidemia will also increase the rise of uric acid. In addition, hyperuricemia and hyperlipidemia are risk factors for arteriosclerosis and hypertension.

Diabetes:

Hyperuricemia can directly damage the function of pancreatic β-cells, thereby affecting insulin secretion and leading to diabetes. It can also aggravate metabolic disorders and insulin resistance in diabetic patients. It promotes the occurrence of macrovascular and microvascular complications in diabetic patients. At the same time, diabetic nephropathy and insulin resistance can also lead to aggravation of hyperuricemia.

Arteriosclerosis:

Uric acid crystals stimulate the blood vessel wall and induce an inflammatory response that damages vascular endothelial cells. In addition, hyperuricemia can also promote the formation of atherosclerosis together with hypertension, hyperlipidemia and hyperglycemia.

Heart failure:

Most cardiovascular diseases eventually lead to heart failure. Hyperuricemia is a risk factor for heart failure. This is closely related to its occurrence, development and prognosis.

Kidney damage:

Uric acid crystals are deposited in the kidneys. It causes uric acid nephropathy, increases the incidence of kidney stones and the risk of kidney failure.

Androgenetic alopecia:

Studies have shown that there is a significant correlation between hyperuricemia and androgenic alopecia, especially in patients with early-onset androgenic alopecia (< 30 years).

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The difference between empagliflozin, dapagliflozin, canagliflozin and ertugliflozin. 😵😵😵

Nowadays, the pros and cons of hypoglycemic drugs are no longer based on the hypoglycemic value as an evaluation criterion, but whether they have heart and kidney protection while reducing blood glucose as the evaluation criterion. SGLT2 inhibitors are a new type of oral hypoglycemic drugs that have received great attention in recent years. In addition to the treatment of type 2 diabetes, it is also used for the treatment of chronic heart failure and chronic kidney disease. Empagliflozin, dapagliflozin, canagliflozin and ertugliflozin are very commonly used SGLT2 inhibitors. What is the difference between them?

1. Hypoglycemic mechanism.

The full name of SGLT2 inhibitors is sodium-glucose cotransporter 2 inhibitor. Normally, the glucose filtered through the glomerulus per day is about 180g/d, but all glucose will be reabsorbed by the sodium-glucose cotransporter (SGLT1, SGLT2) on the renal tubules. SGLT2 inhibitors reduce the reabsorption of glucose and sodium by the kidneys by inhibiting SGLT2. It can excrete 70~80g/d glucose from the urine, thereby exerting a hypoglycemic effect, and has a certain hypotensive effect. 

2. Other effects.

SGLT2 inhibitors can reduce glycosylated hemoglobin (HbA1c) 0.5-1.2%, weight 0.6-3.0kg, systolic blood pressure 3-5mmHg, and blood uric acid about 50μmol/L. They are all good for heart failure. SGLT2 inhibitors have shown cardiovascular and renal benefits in a series of large cardiovascular and renal outcomes studies. Among them, only empagliflozin and canagliflozin are beneficial to atherosclerotic vascular disease. Empagliflozin, canagliflozin and dapagliflozin are beneficial for delaying chronic kidney disease.

3. Clinical application.

The 2022 edition of "ADA Diabetes Medical Diagnosis and Treatment Standards" recommends:

For patients with atherosclerotic vascular disease, heart failure and/or diabetic kidney disease, it is recommended to use GLP-1 receptor agonists or SGLT-2 inhibitors as the initial treatment. According to the patient's blood sugar status, metformin is combined or not combined.

ASCVD/high-risk factors: It is recommended to use GLP-1 receptor agonist or SGLT2 inhibitor. Choose GLP-1 receptor agonists that have proven cardiovascular benefits: dulaglutide, liraglutide and semaglutide. Choose SGLT2 inhibitors that have proven cardiovascular benefits: empagliflozin and canagliflozin.

Heart failure: It is recommended to choose SGLT2 inhibitors that have been proven to be beneficial for heart failure: empagliflozin, canagliflozin, dapagliflozin and ertugliflozin.

Chronic kidney disease: 

Patients with chronic kidney disease and proteinuria should first choose SGLT2 inhibitors that can delay the progression of chronic kidney disease: canagliflozin, empagliflozin and dapagliflozin. If SGLT2 inhibitors are contraindicated/intolerant, choose GLP1 receptor agonists with cardiovascular benefits: dulaglutide, liraglutide and semaglutide. 

Patients with chronic kidney disease who do not have proteinuria should choose GLP-1 receptor agonists or SGLT2 inhibitors that have cardiovascular benefits.

4. Dosage.

SGLT2 inhibitor has diuretic effect. To avoid excessive nocturia, it is recommended to take it in the morning. They are not affected by meals.

Empagliflozin: It has a peak time of 1.5 hours and a half-life of 12.4 hours. Its recommended dosage is 10 mg once a day. The maximum dose is 25 mg once a day.

Dapagliflozin: It has a peak time of 2 hours and a half-life of 12.9 hours. Its recommended dosage is 5 mg once a day. The maximum dose is 10 mg once a day.

Canagliflozin: It has a peak time of 1-2 hours and a half-life of 10.6-13.1 hours. Its recommended dosage is 100 mg once a day. The maximum dose is 300 mg once a day.

Ertugliflozin: It has a peak time of 1 hours and a half-life of 16.6 hours. Its recommended dosage is 5 mg once a day.

5. Adverse effects.

Urinary and reproductive tract infections: SGLT2 inhibitors play a hypoglycemic effect mainly by promoting urinary glucose excretion. Due to the increased concentration of glucose in urine, SGLT2 inhibitors can significantly increase the risk of urinary tract infections and genital fungal infections. During the medication, you should increase the amount of drinking water and keep the vulva clean. If urinary tract infections and reproductive tract infections occur, symptomatic treatments such as antibacterial drugs (including antifungal drugs) are required.

Hypovolemia: SGLT2 inhibitors have an osmotic diuretic effect, which can lead to a decrease in blood volume. Elderly patients or those taking loop diuretics (such as furosemide) are at increased risk of hypovolemia. The main manifestations of hypovolemia are dehydration, orthostatic hypotension or hypotension.

Fracture risk: Patients with type 2 diabetes are more likely to fracture than the general population. The main fracture sites are the hip, foot and proximal femur. SGLT inhibitors can inhibit the reabsorption of sodium in the renal tubules and increase the reabsorption of phosphorus. This leads to increased blood phosphorus levels, stimulates parathyroid hormone secretion, and increases bone resorption. Canagliflozin can increase the risk of fractures.

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