1. Antihypertensive and anti-heart failure drugs
1. Calcium antagonist: (calcium channel blockers, CCB) The efficacy and range of antihypertensiveness are relatively strong, and the effect is good for elderly patients and alcohol-loving patients, and can be used in patients with diabetes, coronary heart disease, and peripheral vascular diseases. Not suitable for use in patients with heart failure, sinus node hypofunction or cardiac block. Orientals respond better to CCB and tolerate better.
1) Heartache (nifedipine tablet): 5-10mg Sublingually contains 10-20mg p.o tid 5mg/table
2) 学号 (nifedipine sustained release tablet): 20mg p.o bid 20mg/table
3) Degaoning (sustained release tablet): 10-20mg p.o bid nifedipine 10mg/table
4) Baixintong (controlled release tablet): 30mg p.o q.d nifedipine 30mg*7# Cannot be broken open, nifedipine release 24h is constantly released, anti-atherosclerosis, gulf peak ratio reaches 100%, single-drug control rate More than 70% are also effective for angina pectoris of coronary heart disease. (Imported) Morning INSIGHT and ACTION trials confirmed the efficacy
5) Boyedin: Felodildipine sustained release tablets 5-10mg p.o qd-bid (maintenance amount) 5mg/table 2.5mg/table *10# Morning take 10mg/d Gufeng ratio is only 33%. FEVER trial confirmed the efficacy
6) Nitrendipine: Lopps 10mg Bid; Shumait Capsules 10mg Bid (less application)
7) Nimodipine: Nitrenx 30mg Bid; mainly used to improve cerebrovascular blood supply, mild antihypertensive effect, treat mild cognitive dysfunction, and protect neurons. 30mg*20# Ordinary dosage form: 20mg/table
8) Luhuoxi (long-term effect), Shi Huida, Annezhen, Mailipin:
Luhuoxi 5mg p.o q.d 5mg*7# Amlodipine, can be broken open (suitable for patients with heart failure and hypertension) ASCOT ALLHAT trial proves the efficacy
Shi Huida 2.5mg p.o q.d 2.5mg/table AMlodipine
Annezhen 10mg p.o q.d 10mg/table
) Si Leping: Lasidipine Common side reactions: headache, dizziness, redness, palpitations (caused by dilatation) caused by reflex activation of the sympathetic nervous system, as well as edema in the anterior tibia and ankle, fatigue, insomnia, nausea, constipation, and abdominal pain.
10) verapamil (verapamil): You can first use 120mg (half tablet) per day, and then increment as needed. Maximum dose: 480mg/d (1# p.o bid). 240mg/tablet (less for lowering blood pressure, mostly for anti-arrhythmia; contraindications are contraindicated for use with digoxin) when sinus arrest is caused, calcium is used to fight it.
11) Hexinshuang, Hebeishuang sustained release capsules, Tianerxin (Diltiazole Diltiazem): (The antihypertensive effect is slightly poor, suitable for coronary spasm angina, etc.) Generally, 270mg/d is required to have a significant antihypertensive effect.
Hebeishuang: 90mg q.d-bid 90mg/particle*10#, injection 5-15mg/kg/min i.v.drip 10mg/branch (NORDIL test - Nordic diltiazem clinical study, 2000)
Hexinshuang: 30mg tid elderly people should not use it in combination with beta blockers, and AVB above is prohibited. Common adverse reactions: occasional dizziness, bradycardia, inhibition of myocardial contraction, AVB, flushing complexion, gastrointestinal discomfort and allergies.
* Note that non-dihydropyridine calcium antagonists (i.e. diltiazem, verapamil) should be avoided in combination with beta blockers to avoid aggravate or induce inhibitory effects on the heart. Pay attention to the interaction between drugs.
* When heart failure occurs and hypertension or angina pectoris occurs, amlodipine or felodipine should be used for CCB, which is safe for long-term use.
2, ACEI: (ACE inhibitors) are especially suitable for patients with hypertension accompanied by heart failure, myocardial infarction, IGT or diabetes. Contraindicated for: hyperkalemia, pregnant women, patients with bilateral renal artery stenosis, Scr﹥225μmol/L. (It is necessary for those with 50% of EF after MI)
1) jasida (Perindopril): Hypertension: 4mg p.o q.d Hypertension with coronary heart disease: 8mg p.o q.d Heart failure: 2-4mg p.o q.d Generally, starting from 2mg q.d, gradually increase the dose of 4mg*10 tablets of 3 generations to take antihypertensive drugs that can improve arterial endothelial-dependent vasodilation function
2) prilina (Benazepril): 10-20 mg p.o q.d 40mg/d 10mg/ tablets to reduce blood pressure and be used in combination with thiazide diuretics. White blood cell count should be monitored during treatment, and when facial edema (angioedema) or cholestatic jaundice occurs, lotinxin and bi-channel metabolism should be stopped.
3) Dashuang (Imidapril Imidapril): 5-10 mg p.o q.d 5mg/tablet; 10mg*10 tablets
4) Kaibotong (captopril Captopril): 25mg p.o tid 12.5mg*20 tablets first-generation
5) Kaifute (compound captopril preparation): 1-2#, bid-tid each tablet contains captopril 10mg, DHCT6mg.
6) Mono (Fosinopril Fosinopril): Normal initial amount: 10mg, p.o, qd 40mg/d 10mg*14 tablets of liver and kidney dual channel metabolism
7) Yueningding, Yinarin, Yisu (enalapril): 10-20mg p.o q.d 5, 10mg/table second-generation Ruitai (ramipril), Yiheng (quinapril), etc.
Main adverse reactions: irritating dry cough (hardkinin accumulation), (first dose) hypotension , hyperkalemia, angioedema, liver dysfunction, taste and gastrointestinal dysfunction, kidney deficiency, proteinuria, etc.
*Renal function and blood potassium should be monitored 1-2 weeks after the initial treatment. ACEI should be used indefinitely and lifelong for patients with heart failure (unless there are contraindications), and is generally used in combination with diuretics. Adverse reactions may occur early but do not hinder long-term use. The efficacy of heart failure treatment takes several weeks or only appears.
3, ARB: (Angiotensin II receptor blocker, angiotensin-II receptor blockers) The same as ACEI. Fewer adverse reactions.
1)Dawen (valsartan): 80mg q.d/bid 80mg*7 capsules can also enhance insulin sensitivity in patients with hypertension, have weak efficacy, and can enhance sexual function (while other antihypertensive drugs can cause sexual dysfunction).
2) Cosartan (losartan potassium): 50mg p.o q.d Treatment achieved the greatest anti-hypertensive effect for 3-6 weeks. 50mg/table 100mg*7 tablets
3) Mecarson (telmisartan telmisartan): 80mg p.o q.d lowers urine protein, protects target organs such as the heart and kidneys. Especially suitable for patients with abnormal glucose tolerance, equivalent to 1/3 of Vendiya tablets (chemical structure similar) 80mg*7#
4) Virya (candesartan): 4-8mg p.o q.d 4mg/tablet
5) Pilos (candesartan): 4-8mg p.o q.d 8mg*7# It specifically acts on the AT1 receptor. Among these drugs, the valley peak is the highest, it has a strong target organ protection effect, and has no significant impact on heart rate. T1/2 is 9h., which is dose-dependent. Adverse reactions: allergies, dizziness, headache, palpitations, etc. Antihypertensive effect: Bilos 8mg = amlodipine 5mg = losartan 50mg
6) Gerpine (irbesartan): 0.15-0.3 p.o q.d 0.15g/table
7) Ambovi (irbesartan): 0.3 p.o q.d 0.3, 0.15/table
8) Ambovi (irbesartan hydrochlorothiazide compound preparation): 150 mg p.o q.d 150 mg:12.5mg*7#
4. Beta-blockers: (beta-blockers) are suitable for different degrees of hypertension, especially Middle-aged and young patients with rapid HR or patients with angina pectoris; patients with high renin activity. Contraindicated for: acute heart failure, asthma, diseased sinus, AVB and peripheral vascular diseases.
1) Betalog (metoprolol metoprolol tartaric acid): 50-100 mg p.o q.d/bid 50mg/tablet*20# Treatment of heart failure: starting amount 12.5–25 mg qd; target dose 200 mg qd; injection 5mg/tip
2) Propranolol: 10mg po tid 10mg*100 tablets/bottle Used for hyperthyroidism caused by hyperthyroidism, supraventricular and ventricular cardiac rhythm hysteresis
3) Conco (bisoprolol): 5mg p.o q.d 5mg*10# 5mg is equivalent to Betalog 100mg Treatment of heart failure: 1.25 mg qd starts with a target dose of 10 mg qd, which has the highest selectivity for β1, and does not affect glycolipid metabolism, and clearance of the liver and kidney dual channels.
4) Bosu (bisoprolol fumarate): Selective β1 receptor blocker 5mg*10# Starting dose 2.5mg, qd, maximum dose not exceeding 10mg
5) Daliquan (carvedilol): Can block α1, β1, and β2 receptors, no intrinsic activity, antioxidant and antiproliferation, and can reverse ventricular remodeling.Effective for those with high diastolic blood pressure alone. Chronic heart failure: start with 3.125 mg bid; increase every two weeks to the target dose of 25 mg bid (60% of patients can reach the target dose) 6.25, 25 mg*10 tablets CAPRICORN Mogexing study, CARMEN Carmen study, COPERNICUS Copernicus study, COMET trials all confirm the efficacy of
6) Almol: It can block α (20%) and β receptors (80%) have better effects on those with high diastolic blood pressure alone. Short-acting Sig: 5mg p.o q.d The maximum available is 30mg/d 10mg/table
(COMMIT/CCS-2 study) β-blocker can improve and improve survival after MI, relieve stress, and work within 1 to 2 weeks. Side effects: orthostatic hypotension, worsening heart failure, depression, causing elevated blood lipids, hypoglycemia, peripheral circulation disorders, fatigue and tracheal spasm, inhibit myocardial contractility and cause conduction block. HR55bpm is considered to stop the drug. When
βRB, medication is required, CCB should be considered, and no thiazide diuretics should be added to avoid increasing the risk of diabetes. βRB is not used as a first-line drug in age55y patients (UK Guidelines 2006)
5. Diuretics: (diuretics) is suitable for mild and severe hypertension, is sensitive to salt, combined with obesity or diabetes, and has better efficacy in menopause and elderly patients. It can work synergistically with other antihypertensive drugs. Contraindicated for: gout and renal insufficiency.
1) Dihydrogen thiazide (hydrochlorothiazide): When used to treat hypertension: 12.5mg p.o q.d; small doses of diuretics are recommended, and the daily dose of double gram should not exceed 25mg. DHCT is used to treat edema diseases: 25-50mg p.o qd/qod; when used in heart failure, start with a small dose of 25mg qd. Generally, 100mg/d is used, and the maximum effect has been achieved.
2) Na-induced sustained release tablets diuretic, tube-diffusion thiazide 1# p.o q.d morning indapamide 1.5mg*10# acts on the distal tubular cortex, and has a tube-diffusion effect, reversing left ventricular hypertrophy and reducing microalbuminuria. Not used in people with sulfonamide allergy.
3) furosemide: mainly used for heart failure treatment, starting from a small dose 20mg po qd 20mg/table injection: 20mg/tipped diuretic effect is dose-dependent, and potassium excretion.
4)spironolactone: mainly used for heart failure treatment. Starting from a small dose, 20mg po qd 20mg/tablet is often used in combination with furosemide, and it also has anti-aldosterone effects, which can maintain potassium and is inefficient. There are side effects that cause feminization of men's breasts, which is rare at 100mg/d.
5) Wuduli: Compound diuretic preparation compound amiloride tablets, containing hydrochlorothiazide 25mg. The diuretic effect is strong, but the potassium-saving effect is weak. It acts on the distal flexural tubules and collecting tubes, and is used for mild heart failure. Sig: 1# q.d po
6) Diuretic mixture: mostly used in refractory heart failure and in high edema. Restricted moisture intake: Intravenous fluid intake is 800ml/day; urine volume is greater than the intake is more than 800ml. Sig: 5% sugar/salt 250ml + furure 200-300mg + dopamine 40mg iv drip 8-30 drops/minute saline 40ml + furure 120mg + dopamine 60mg 5ml/h Pump in Side effects: 1. Electrolyte disorder; 2. Affect the metabolism of blood lipids, blood sugar, and blood uric acid (elevated at large doses); 3. Azotemia.
If diuretic resistance occurs (often accompanied by worsening heart failure), you can use: (1) Intravenous diuretics (such as furure); (2) Combination of 2 or more diuretics; (3) Use drugs to increase renal blood flow, such as short-term use of small doses of dopamine.
6. α receptor blocker: (second line) The antihypertensive effect takes effect quickly and strongly, but the antihypertensive effect gradually weakens over time. The duration is generally shorter except for long-acting preparations. Advantages: Improve insulin resistance; main disadvantages: the first dose of orthostatic hypotension.
1) Oderman (terazosin): 2mg p.o tid α1 receptor blocker, slow onset and long time, can also treat prostate hypertrophy and hyperplasia. 2mg * 10 tablets are given half a tablet 1mg in the first dose, and lie flat after taking it to avoid orthostatic hypotension. The recommended maintenance amount is 1-5mg qd; it is generally believed that above 20mg does not seem to have any further impact on blood pressure, and no research has been conducted at 40mg/d.
2) Groterin (terazosin terazosin): 2mg p.o bid 2mg *10 tablets
3) Pentolamine (riquidine): 5mg i.v When used to lower blood pressure, please pay attention to monitoring vital signs. 10mg/piece 10-20mg+5%glucose 500ml i.v.drip (0.1-0.3mg/min) is often used in hypertensive emergencies, especially in the onset of pheochromocytoma.Sig: 10mg+5%glucose 50ml 5ml/h pump in, and then adjust according to blood pressure
4) Yaninding (铁接接): Uraldier hydrochloride injection 25mg: 5ml/branch blocks the effect of postsynaptic α1 receptor and blocks the effect of peripheral α2 receptors. Commonly used in the first choice for hypertensive emergencies. 【Usage】: Usually at the beginning of treatment, 60mg of urinating is taken twice a day, one pill at a time. Sig: 100mg+N.S 50ml Pumping starts at 3ml/h.
prazosin): sig: 0.5~2mg p.o tid is commonly used in pheochromocytoma, etc.
5) Lixiding (domestic Uralidil injection): 25mg/5ml Uralidil taboos: pregnant women and breastfeeding women, patients with aortic isthmus stenosis, arteriovenous shunt.
* The alpha receptor blockers (such as colenine) that act on the center are rarely used because of their obvious side effects. Commonly used alpha receptor blockers that mainly act on the peripheral include prazosin, doxazosin, uraladil, etc.
Adverse reactions: 1. Orthostatic hypotension: It is the main adverse reaction of this type of drug and is more likely to occur in elderly patients during the first dose. To avoid the occurrence of hypotension in the first dose, it is recommended to place the first dose before going to bed and reduce the first dose by half. During the administration process, the patient should be asked to move slowly when the position changes. 2. Tachocardia; 3. Water and sodium retention; 4. General reactions: including dizziness, headache, fatigue, dry mouth, nausea, constipation, rash, etc.
Treatment of hypertensive emergency:
Pentolamine (riquidine) Sig: 10mg + 5%glucose 50ml 5ml/h, and then adjust according to blood pressure Yaninding Sig: 100mg + N.S 50ml Pump in at 3ml/h Nitroglycerin Sig: 10mg + 50ml G.S/N.S 3ml/h, and then adjust Labelar Sig: 200mg + 20ml G.S/N.S 6ml/h, and then adjust (α, β receptor blocker, mainly used for hypertensive emergency during pregnancy and renal function)
Sodium Nitroglycerin Sig: 25-50mg + 50ml NS 2ml/h 50mg/branch ECG monitoring is especially suitable for acute left heart failure with pulmonary edema, and aortic dissection can cause mental disorders.
* New drug for the treatment of heart failure: conivapton (CNV) a novel arginine vasopressin antagonist. It can significantly increase the blood sodium level during hyponatremia during heart failure. AVP water retention and sodium discharge.
* Ultrafiltration treatment: For patients with acute decompensated heart failure, ultrafiltration treatment is a safe and effective treatment method to reduce volume load. For patients with high-volume heart failure, ultrafiltration treatment can further reduce the readmission rate than large doses of intravenous diuretics, and there is no significant difference in the impact on renal function. Combination treatment: breaking the main blood pressure maintenance mechanism - DASH
•D Direct (Autoregulation): CCB
•A Adrenergic mechanisms:α-B, β-B
•S Salt (Sodium chloride): diuretic
•H Humors/hormones (AU, NE, ET): ACEI, ARB
* Necessity of combined medication: 1. Reduce a single drug dose; 2. Neutralize compensation mechanisms; 3. Reduce side effects to the minimum; 4. Strengthen the protection of target organs.
* First-line antihypertensive drugs (ABCD): A: ACEI/ARB; B: Beta-blockers; C: CCB; D: Diuretics.
* Ideal heart rate: 55~65 beats/min, if the ability to tolerate it is better.
* Avoid the combination of drugs with similar antihypertensive principles: such as ACEI and β-B; ARB and β-B
* Orientals respond better to CCB and better tolerate it. Short-acting CCB can cause a rapid drop in blood pressure, which can aggravate coronary ischemia, so when choosing this type of drug, long-acting CCB is the first choice.
The reason for the treatment of hypertensive drugs:
Unexpected secondary hypertension: proaldehyde, renal vascular hypertension, renal parenchymal hypertension, pheochromocytoma, etc.
Poor compliance with treatment plans: such as failure to improve lifestyle, weight gain, heavy drinking, etc.
Excessive capacity load: such as insufficient diuretic treatment, high sodium intake, progression of renal insufficiency, etc.
Causes of pseudo-stubborn hypertension: such as white coat hypertension.
Obstructive Sleep Apnea Syndrome (OSAS): It may be related to the repeated nocturnal hypoxia caused by it, and ACEI is preferred.
2. Anti-myocardial ischemia:
1. Nitrates:
⑴ nitroglycerin: Injection: 50ml G.S/N.S+nitroglycerin 10mg 3ml/h start pumping, and then adjust 5mg/pin 10ug/min start starting, generally 100ug/min maximum 200ug/min according to symptoms and blood pressure (full amount: HR ↑100bpm; symptoms are completely relieved; BP↓100/60mmhg; unwilling tolerate adverse reactions.) Adverse reactions: headache, blushing, heartbeat; do not use nitroglycerin for alcohol; insufficient intake and exit can lead to hypotension. Oral: 0.5mg/tablets are very effective. The effect is very good. 5min. The effect lasts for 30min. It contains three times and does not relieve it. → The sublingual smell of emergency department is spicy. It is ready to be used. Isosorbide nitrate is melted. (isosorbide dinitrate)
①Xinkang sustained release tablets: 40mg q.d p.o (morning treatment) Isosorbide mononitrate 40mg*24# Sig: 40mg+N.S 50ml starts pumping at 5ml/h.
②Lunnan Xinkang: Effective dose 2-7mg/h 10 days of treatment. In the early stage of administration, isosorbate mononitrate may cause symptoms such as headache and nausea due to vasodilation. Short-acting injection sig: 2-7mg/h 60-120ug/min i.v.drip tablet sig: 20mg po Bid /Tid 20mg*48#
③Sonit: Isosorbate mononitrate sustained release tablets cannot be chewed or crushed 60mg*10 tablets sig: 60mg p.o q.d Morning take 60mg*10# Starting from a small dose of 30mg qd, it can reduce the occurrence of adverse reactions such as headaches and increase the patient's tolerance and compliance.
④Relieve heartache (isosorbide isosorbide nitrate): 5mg/table sig: 10mg Tid orally takes 15-40 minutes and lasts for 4-6 hours; 2-5 minutes and takes 15 minutes to achieve the maximum effect; lasts for 1-2 hours; 30 minutes and sustains the sustained-release tablets for 30 minutes and lasts for 12 hours; 5-mono-isosorbide isotate
⑤Isosuji: Normal dosage form 2-7mg/h, can also be increased to 10mg/h. 2.5 mononitrite isoate is mainly 5-mononitrite; used for those with poor liver function; the solvent is not alcoholic and has no allergies; it does not adsorb with the tube wall; it occurs less headaches; it is more expensive. Sustained release tablets 20mg q12h maximum daily 80mg above 20mg *50#
⑥Aibe: Same and difference.
⑦ Long-acting sisoredine: sig: 50mg Qd 50mg/tablet (5mg fast + 45mg slow) Take medicine first and then get up, which is not suitable for treating acute acute infarction. Eliminate half-life 4-5h.
⑧Isordin: sig: 30mg p.o q.d-bid Morning Isorbate Mononitrate Sustained Release Tablets 30mg*7 Tablets 60mg*7 Tablets
⑨Imdo: sig: 30-60mg p.o Qd Morning, take with water, do not chew or grind, half-life 7 hours, mainly excreted through the kidneys. The blood drug concentration is stable and lasts for a long time. 60mg*7 tablets other: Ai Xin, An Xin Mai, long-term heartache treatment, excellent merit, Deming, Geffenda, Lizhu Xinle, etc.
Adverse reactions: 1. Hypotension: It is easy to occur during intravenous administration; 2. Headache and flushing: caused by vascular dilation, which often occurs in the early stages of medication. 3. Tachocardia: 4. Nitrate resistance. Note: It is contraindicated for acute myocardial infarction, acute left heart failure with filling and low blood pressure. Use with caution when angina occurs.
2, calcium antagonist: see
3, beta blocker: see
4, compound sanitary miltiorrhiza tablets: Salvia miltiorrhiza, Panax notoginseng, borneol and other Chinese patent medicines sig: 3# p.o tid Compound sanitary miltiorrhiza drop pills 2# p.o tid
sig: 1-2# tid One month is one course of treatment
5, Nodikon-San Sacred Land Rhodiola 0.28*20# is mainly used for patients with coronary heart disease and angina pectoris. It is used to invigorate qi and promote blood circulation, unblock the meridians and relieve pain, and is used for chest aphrodisiac caused by qi deficiency and blood stasis, and has a certain lipid-lowering effect.
6, Puerarin acupuncture (Plelin): 100-200mg i.v bid 200-400mg i.v.drip q.d Main adverse reactions: fever, allergic reaction (medicine rash/dermatitis/allergic shock), hemolytic reaction, and elevated aminotransferase.
7. Vioxin: Chinese patent medicine for DISABINE saponin tablets (main ingredients: Chuanshanlong water-soluble total saponin) Anti-myonal ischemia mechanism: 1) Improve myocardial blood supply and reduce myocardial oxygen consumption; 2) Protect myocardial suborganisms; 3) Reduce calcium load and protect hypoxia myocardial. sig: 80-160mg p.o tid 80mg/tablets: Dio Xinxuekang Capsule (1-2# p.o tid), Xinkeshu Tablets (Chinese patent medicine 4# p.o tid)
III. Nutritional support:
1, Wanshuangli: 20mg p.o tid Trimetazidine hydrochloride anti-angina pectoris, has the effect of fighting epinephrine, norepinephrine and vasopressin. 20mg*30 tablets are effective in treating diabetes with ischemic cardiomyopathy.
2. Aspartate potassium magnesium: Nutritious to the myocardium and improve the myocardium metabolism. The effect is accurate. sig: 20-60ml+5% glucose 500ml i.v.drip qd; 1-2# tid p.o sig: 25% magnesium sulfate 10ml+10% potassium chloride 10ml+5% glucose 500ml i.v.drip qd
3. Energized: Coenzyme Q10 SIG: 10mg p.o tid (orally taken after meals) 10mg/tablet*30# Indications for positive inotropic drugs with myocardial protective effects: It can be used for adjuvant treatment of CHF, viral myocarditis, hepatitis, and cancer. Mechanism of action: 1) Improve the production of ATP in the myocardium and improve myocardial contractility; 2) Anti-free radical action to protect ischemic myocardium; 3) Increase exercise tolerance.
4, Bovech, Shanfuping, Fodi, Ango: 1,6 Fructose diphosphate/Fructose sodium diphosphate has the effect and is more commonly used. sig: 5-10g i.v.drip q.d Bovech 5.0g/bottle (prepare, need to be dripped quickly). During the injection, the extravasation of the medicine liquid into the skin will cause pain and local irritation to be difficult to tolerate. It has the effects of directly supplying heat energy, replenishing body fluids and nourishing the whole body, and can also be used to treat acute ethanol poisoning. Anguo 10g: 100ml/bottle is generally recommended to enter the speed of 10ml/min. If it exceeds this speed, it may cause blushing, palpitations, and ants. Allergies are rare.
5. Connersin: 20mg/branch of cyclophosphate adenosine (CAMP) for injection is a protein kinase activator, a derivative of nucleotides, which improves myocardial hypoxia. Indications: used for angina pectoris, myocardial infarction, myocarditis and cardiogenic shock. (15 days for cardiovascular and cerebrovascular patients) Intravenous injection: 20mg dissolved in normal saline 10-20ml, twice a day. Intravenous infusion: 40 mg dissolved in glucose injection once a day. Adverse reactions: Occasionally fever and rash.
6. Ruianji: Fructose sodium diphosphate is a cellular metabolite found in the human body. It can regulate the activity of various enzyme systems in glucose metabolism and is an auxiliary treatment for myocardial ischemia. Sig: 10-20m1, p.o bid-tid.
7, Shenwei (Sanjiu) Ginseng and Mai: Chinese patent medicines such as Codonopsis pilosula, Ophiopogonis, etc. sig: 100ml iv drip qd qd boosting effect is accurate 50ml/branch
8, Jinwei Kailoxin: Cerebrosine carnosine needle 2ml/branch sig: 10ml+250ml G.S/N.S iv drip qd
9, Changtian Xinping: Fructose calcium diphosphate tablets sig: 2-4# po tid
10, 20% human albumin (belin): 50ml: 10g sig: 10g i.v.drip q.d
11, Becoin sig: 2-3 tubes + 5%Glucose 250ml i.v.drip q.d
11, Becoin sig: 2-3 tubes + 5%Glucose 250ml i.v.drip q.d
12. Xinbeike: 200u/branch coenzyme mixture sig: 200-400u+5%Glucose 250ml i.v.drip q.d
13. Sodium deoxynucleotide: 50mg: 2mlbranches One course of treatment in 15 days; cardioprotection effect; promote DNA synthesis, anti-aging; protect liver function; regulate body immunity; and anti-tissue hypoxia. 6-8 pieces as appropriate, 1-1.5 hours will be finished. sig: 150-200mg+250ml G.S/N.S iv drip qd
14, Naoxinshu Oral Liquid: sig: 20ml q.n p.o
15, Wuling Capsules sig: 2-3# po tid
16, Shenqi Fuzheng Injection, Codonopsis, Astragalus, etc. 250ml/bottle Yiqi Fuzheng, used for auxiliary treatment of Qi deficiency syndrome such as lung cancer and gastric cancer, to improve immunity; the treatment of angina pectoris and myocardial infarction is generally 7-10 days a course of treatment. Adverse reactions: mild bleeding, low fever, stomatitis, drowsiness. Can be used in patients with diabetes. sig: 250ml i.v.drip q.d
17, Baifuxin: Ginseng polysaccharide needle 2ml/branch to enhance immunity sig: 4-6ml+5%Glucose 50ml i.v.drip q.d
18, Astragalus needle: applied to viral myocarditis, etc., to enhance immunity. sig: 20ml+5%Glucose 250ml i.v.drip q.d; 10-20ml i.v q.d Astragalus mixture 10ml p. o t id
19, VitC: When applied to viral myocarditis, large doses are required sig: 5.0+5%Glucose 250ml i.v.drip q.d
20, energy mixture: ATP 40mg+ CoA 100u+ VitC 3.0+ VitB6 0.1+Inosine 0.4 +5%Glucose 500ml i.v.drip q.d
21, placental peptide: 4ml/branch to regulate immune allergic reactions can be seen. sig: 8ml+5%Glucose 250ml i.v.drip q.d
IV. Anticoagulant and antiplatelet aggregation drugs:
1, Bay aspirin : 100mg p.o q.d 100mg*30# The day before the operation 300mg load volume After PTCA+ stent surgery, the previous month after the arrhythmias radiofrequency ablation of arrhythmias was 300mg p.o q.d
2, aspirin : 100mg inhibition of platelet aggregation is obvious. It is generally recommended to use 100mg/day for the first and second prevention of long-term cardiovascular and cerebrovascular diseases (Multiple countries guide).75-150mg/d 25mg/table adverse reactions: 1. Allergic reactions; 2. Elevated abdominal discomfort, nausea, and poor appetite; 3. Upper gastrointestinal bleeding; 4. Skin bleeding points; 5. Impact on surgical procedures.
3, Polivi : 75mg p.o q.d clopidogrel (clopidogrel) antiplatelet aggregation 75mg*7 tablets are used to routinely test blood. The first dose is 300mg, 300mg the day before the operation; the most abundant dose is 600mg/d ADP receptor antagonist ① After general drug stent surgery, 150mg will be taken for 2 weeks, 75mg will be taken for 12 months. ② If you plan to undergo CABG surgery, stop the medicine about 5 days in advance, and it will be 7 days best. Adverse reactions: Mainly bleeding, generally severe bleeding occurs in the first month of medication and is related to the dose.
4, kerlide : 1-2# p.o q.d ticlopidine hydrochloride antiplatelet aggregation 250mg/tablet adverse reactions: 1. Elevated liver enzymes: 2. Granulocyte deficiency and/or decreased platelets; 3. Rash; 4. Hemorrhage tendency; 5. Effect on surgical procedures. Due to the great side effects, it was basically replaced by clopidogrel.
5, dipyridamole : Biphasic inhibition of ADP, TAX-A2, antiplatelet aggregation ischemic heart disease: 25-50mg tid Thromboembolism: 100mg orally each time, the total daily amount reaches 400mg; take 1h before meals. Large doses cause "coronary blood stole"
6, Dan'ao : (Ozagre sodium injection for injection) 20mg/Zhidanlun and Dan'ao Usage: 80-100mg + 500mlN.S/5%G.S i.v.drip bid, 2 weeks is a course of treatment. Mechanism: High-efficiency and powerful thrombin synthase inhibitors are also good antiplatelet aggregation drugs. Indications: Mainly used to treat acute thrombotic cerebral infarction and motor disorders accompanied by cerebral infarction. Side reactions: gastrointestinal and allergic reactions, occasional elevation of GPT/BUN.
7, lantern : 5mg (1ml). Usage: 1-2 pellets + 5%-10%Glucose 500ml i.v.drip q.d, each course of treatment is 10 days, a total of 2 courses. Mechanism: The effect of dilating cerebrovascular, improving microcirculation, and anti-platelet aggregation. Used to treat ischemic cerebrovascular diseases.
8, Xinweining : tirofiban GPIIb/IIIa antagonist 100ml/flask antiplatelet aggregation Sig: ① Conservative drug treatment for ACS (UA/NSTEMI): 0.4 μg/(kg.min) at 30 minutes, followed by an intravenous drop rate of 0.1 μg/(kg.min) for 48-72h; ② ACS (UA/NSTEMI) PCI interventional treatment: initial dose 10 μg/kg, bolus injection is completed in about 3 minutes; 0.15 μg/(kg.min) at 48-72h; ② ACS (UA/NSTEMI) PCI interventional treatment: initial dose 10 μg/kg, bolus injection is completed in about 3 minutes; 0.15 μg/(kg.min) at 0.15 μg/(kg.min) at 48-72h; 2 ACS (UA/NSTEMI) PCI interventional treatment: initial dose 10 μg/kg, bolus injection is completed in about 3 minutes; 0.15 μg/(kg.min) at 48-72h; 2 ACS (UA/NSTEMI) PCI interventional treatment: initial dose 10 μg/kg, bolus injection is completed in about 3 minutes; 0.15 μg/(kg.min) at 0.15 μg/(kg.min) at 48-72h; 2 ACS (UA/NSTEMI) PCI interventional treatment: initial dose 10 μg/kg. 36h; it can also be continuously instilled during angiography; it takes fast onset and short maintenance time; it should be used as soon as possible before PCI, mainly for high-risk patients, and is generally used in combination based on aspirin, bolivir, and low molecular weight heparin.
9, g syr : Enoxaparin sodium sig: 0.4/0.6ml Q12h I.H is generally discontinued for 3-5 days. 6000 IU/branch
10, speed pyramine : low molecular weight heparin calcium (nadroparin calcium) has a high proportion of antifactor Xa and IIa activities. The total treatment time is no more than 6 days to prevent and treat thrombotic diseases. Injection 4100iu/0.4mlhtml
11, Qizheng : low molecular weight heparin 5000U q12h I.H
12, FaAnming : low molecular weight heparin sodium (daheparin sodium) 5000IU I.H q.d-qod once daily Usage: 200iu/kg body weight, subcutaneous injection once daily. Used for acute deep vein thrombosis treatment; prevent coagulation in the extracorporeal circulatory system during hemodialysis and blood filtration (at ALB20g/L); prevent surgery-related and thrombosis.
13, Warfaring : Can be used for anticoagulant treatment of atrial fibrillation, acute pulmonary embolism, etc. It has teratogenic effects and is prohibited for use in pregnant women. Starting amount 5mg p.o bid-tid 3mg/tablet*100# (imported); 2.5mg/tablet (domestic) Maintenance amount 2.5-10mg p.o q.d Monitoring PT+APTT+INR
* Generally used to prevent thromboembolic diseases, and the INR is controlled at 2.0-3.0.
*INR: 5-9 Discontinue the medication and take VitK 1-2.5mg orally; when INR 9, stop the medication and take VitK 3-5mg.
14, others: aximab, esitbatide (GPIIb/IIIa antagonist), etc.
△ Commonly used heparin intravenous injection of 5000 units, followed by continuous intravenous drip of 500-1000U/h, and 5000U can also be used, and intravenous injection every 6 hours. Heparin injection can cause hematoma. Deep subcutaneous injection of 5000-7500u is injected twice a day, usually without coagulation dysfunction. The injection site is appropriate to the left lower abdominal wall.The coagulation time (CT Li Huai's method, normal 6-12 min) was controlled within 20-30 min, and PT or APTT was extended to 1.5-2.0 times the control value.
△In recent years, low molecular weight heparin (Faanming 5000U, or 0.4ml or 40mg of kesey) is often used for subcutaneous injection, twice a day. No monitoring of PTT or ACT is required. Those who need to switch to oral anticoagulants usually need to use heparin together for 5-7 days. Heparin can be stopped when the prothrombin time is extended to 16-18 seconds.
△ Warfarin maintenance amount is 2.5-5.0 mg/d, the new anticoagulant tablets are 1-2 mg/d, and the course of treatment is at least 4 weeks. It is contraindicated for bleeding tendencies, severe liver and renal insufficiency, active ulcers or recent surgery and the wound has not been cured. Treatment should be stopped once bleeding occurs during the treatment period. Those caused by heparin use an equal amount of protamine to intravenously in the fight against the confrontation; those caused by new anticoagulant or warfarin use vitamin K1, each time 20 mg is intravenously injected, and blood transfusion is given if necessary.
△Clepigre: The mechanism of action is the same as that of Kleid, but the incidence of adverse reactions (the impact on liver enzymes and on granulocytes and platelet count) is significantly lower than Kleid. In Western countries, Kleid has basically replaced Kleid in clinical practice.
antiplatelet aggregation drug clinical trial:
1, CAPRIE study: A comparative study on the prevention of ischemic events between clopidogrel and aspirin. The following five high-risk patients had cardiovascular events, clopidogrel, which was lower than aspirin: 1) patients with a history of CABG; 2) patients with more than one ischemia event; 3) patients involving multiple vascular beds; 4) patients with DM; 5) hypercholesterolemia.
2, CURE study: clopidogrel prevention and ischemic events in ACS recurrence.
3, CREDO study: Study on clinical events reduction in long-term clopidogrel.
4, other MATCH studies, CHARISMA tests, etc.
5. Nutritional nerves:
1. Folic acid: 0.4mg p.o q.d
2. VitB12 500ug i.m 2 times a week 500ug/brain or 1# p.o q.d
3. Adenosine BB12 500ug p.o tid
4. Myogenic needle: lyspore polysaccharide 0.4:2ml/brain 0.4 i.m q.d Regulate autonomic nerve function
5. All are welcome: 30mg p.o tid 30mg/piece Brain protection
6. Mikebao (methylcobalamin): 500ug q.d-tid 500ug/table 500ug: 1ml/tie 500ug i.v.drip q.d
7. guasu : 20mg tid 10mg/tie It regulates autonomic nervous system disorders and is used to treat cardiac neurological disorders.
8. Lizhu Sailer: Brain Protein Hydrolyte Injection 10ml/branch
sig: 40ml+N.S 250ml i.v.drip q.d
9. Yihuomin: Calf blood protein deprotein extract injection (2ml/80mg/branch, 5ml/200mg/branch)
sig: 10ml+G.S 250ml i.v.drip q.d Nutritize brain nerves and improve brain cell energy metabolism.
10. Odkin: Calf blood protein deprotein injection nourishes brain nerves and improves brain cell energy metabolism. 0.8g/5mlhtml
sig: 20-30ml+N.S 250ml i.v.drip q.d 2-3 weeks
6. Lipid-lowering drugs:
fiter mainly reduces triglycerides, and statins (HMG-CA reductase inhibitor) mainly lower cholesterol. Target value for lipid regulation treatment: The secondary prevention target for patients with coronary heart disease is: LDL-C is reduced to 2.6 mmol/L (100mg/dL) for patients with diabetes is: LDL-C is reduced to 2.6 mmol/L (100mg/dL)
1. Pragu, Mebacla (pravastatin Pravachol): suitable for primary hypercholesterolemia. Liver function should be checked regularly during treatment. 10-20mg p.o q.d Maximum 40mg/d 10mg/table Mebale Town 20mg*7 tablets
2. Laisieko Capsules (Fluvastatin Lescol): 20-40mg p.o q.n 20mg/table 40mg*7 tablets There are very few drug interactions, which are highly safe. The effect of raising HDL-C is better
3. Lipitor, Atorvastatin: Suitable for primary hypercholesterolemia and mixed hyperlipidemia.
Lipitor: 10-20mg p.o q.n 10mg/tablet 20mg*7 tablets Adjust according to blood lipid level 80mg/d
Ale: 10-20mg p.o q.n 10mg/tablet.
ASCOT study: significantly reduce cardiovascular and cerebrovascular events. TNT trials show that Lipitor 80mg/d reduces cardiovascular events better than 10mg/d.
4. Shujiangzhi, Zezhihao (simvastatin): Suitable for hypercholesterolemia, mixed hyperlipidemia, and coronary heart disease.
lipid-lowering: 10mg p.o q.n 10mg/table Coronary heart disease: 20mg p.o q.n 20mg*7# 40mg*5#
Xuezhikang: Simvastatin 2# tid has weak potency
lipid-right: 2# tid has weak potency Red Qu
5. Taizhi An: After meals, it is especially suitable for people with poor liver function. It has better TG-lowering effect and is expensive. (Traditional patent medicine) Sig: 3# p.o tid
6. Yiping: Aximus Capsules Niacin Derivative 0.25/capsules Lipolysis inhibitor, slightly poor safety and affect uric acid and glucose metabolism. Adverse reactions: facial flushing, limb itching; gastrointestinal reactions; allergic reactions, etc. Sig: 1# p.o bid-tid meal/post-
7. Being lipid lowering: (bezafibrate): 1# p.o bid-tid 200mg/table
8. Libifi: Fenofibrate sustained release capsule 0.25*20# Sig: 1# p.o bid-tid
9. Lipingzhi, Shitaining (fenofibrate): hypertriglyceridemia (main), hypercholesterolemia. Usually, the effect is obvious about 10 days after taking the medicine, and the blood lipid concentration returns to normal levels after about 2 weeks (about 4 weeks for severe patients). 200mg p.o bid-tid (during or after meals) 200mg*10 tablets
serum TC: 5.20mmol/L=20mg/dl; Serum LDL-C: 3.12mmol/L=120mg/dl
serum HDL-C: 1.04mmol/L=40mg/dl; Serum TG: 1.70mmol/L=150mg/dl
statins adverse reactions: 1. Elevated liver aminotransferase: As long as the patient is closely monitored, mild aminotransferase elevation (less than 3 times ULN) is still available. Biliary stagnation and active liver disease are classified as contraindications for the use of statins. 2. Myopathy, myalgia, myositis even causes rhabdomyolysis [with significant increase in CK (10 times higher) and increased creatinine]. 3. Gastrointestinal reaction.
Treatment of mixed hyperlipidemia:
1. If the increase in TC and LDL-C are mainly used, statins can be used;
2. If the increase in TG is mainly used, fibrate can be used;
3. If the increase in TC, LDL-C, and TG are significantly increased, the drug can be used in combination. For combined treatment, fibrate + cholic acid separator (such as colecamine), or cholic acid separator + niacin. Be cautious when used in combination with statins and fibrate/niacin. Although combined with statin and fibrate, it increases the risk of myopathy (CK elevation), it is safe for most patients and requires close monitoring.
7. Blood-activating and stasis-removing medicine:
1) Inj. 60-100ml i.v.drip q.d/q.o.d 20ml/branch Dilate the tube, improve myocardial ischemia, improve cerebral circulation 250ml i.v.drip q.d 250ml/bottle Side reactions: occasional rash, dizziness, and even allergic shock.
2) Xinxuetong inj. 10ml+N.S 100ml i.v.drip q.d 2ml/branch sarcoside sarcoside
3) (Yicangning) Ginkgo leaves: sig: 2-4# p.o tid Chinese patent medicine
4) Shuxuening inj. 20ml+G.S 250/500ml i.v.drip q.d 2ml/branch
Ginkgo leaves extract (mainly containing total flavonoids and total ginkgo lactone) has the effect of dilating coronary blood vessels and cerebrovascular vessels, increasing coronary flow and cerebrovascular flow, and improving heart and brain function.
5) Dan Shen inj: 20ml+N.S 250ml i.v.drip q.d 10ml/branch
6) Tongxinluo Capsules: lower lipids and anticoagulation, improve vascular endothelial function. Commonly used in coronary heart disease, angina pectoris; sequelae of cerebral infarction.
sig: 2-4# p.o tid Chinese patent medicine
7) Cervical spine No. II: sig: 3# p.o tid Chinese patent medicine
8) Jiannao No. 4: sig: 10ml po tid
9) Nuoxinkang: (tanshinone IIA sodium sulfonate needle) 2ml: 10mg/branch
sig: 10ml+N.S 250ml i.v.drip q.d 4-6
10) Butterfly Vein Ling: Kudian Needle 10ml/branch Mainly used to improve symptoms such as numbness of hands and feet in cervical spondylosis.
sig: 3-4 ts + N.S 250ml i.v.drip q.d
11) Yue Anxin: Bitter Butterfly Needle 10ml/tip
sig: 50ml+5%Glucose 250ml i.v.drip q.d
12) Xingxiong: Chinese patent medicine 250ml i.v.drip q.d
13) Gu Hong: Chinese patent medicine 5ml/tip
sig: 15-20ml+N.S 250ml i.v.drip q.d
14) Xing Ding: Ginkgo Damo Injection 5ml, 10ml/tip Suitable for the prevention and treatment of coronary heart disease and thromboembolic diseases.
compound preparation: 9.0-11.0 mg of total flavonoids in ginkgo and 3.6-4.4 mg of dipyridamole. Adverse reactions:
occasionally has nausea, vomiting, skin allergies, etc.
sig: 10-25ml+ N.S/G.S 500ml i.v.drip qd-bid
15) Dan Hong inj: Salvia miltiorrhiza, safflower. [Indications] Chest aphrodisiac and stroke caused by blood stasis and obstruction.2ml/branch
sig: 6-8ml+N.S 250ml i.v.drip q.d
7) Runtan: vinpocetine to promote blood circulation and remove blood stasis, dilate tube 2ml/branch It has a good effect in improving micro blood vessels, which can cause dizziness, headaches and other adverse reactions. It is used for cerebral hemorrhage, sequelae of cerebral infarction, etc.
sig: 6-8ml+N.S 250ml i.v.drip q.d
8) Madolkolan: 5ml: 50mg/branch tube dilation drug to improve peripheral and brain microcirculation (α receptor inhibitor). sig: 20ml+N.S 250ml i.v.drip q.d
9)Perda:cilotazole Antiplatelet aggregation drug, antithrombosis, tube dilation 50mg/table
sig: 50-100mg p.o q.d Used for ulcers, limb pain, intermittent claudication caused by chronic arterial occlusion, such as diabetic foot.
8. Heart-strengthening medicine and others:
Heart-strengthening oral preparation is mainly digoxin, and the intravenous preparation is mainly Xidilan.
1. Xidilan inj. (lanatosiade C) 0.2-0.4 mg After dilution i.v, the total amount in 24 hours is 0.8-1.2 mg, especially for heart failure and atrial fibrillation. Xidilan 0.2+NS 20ml i.v Slow 0.4+GS 50ml i.v Slow
Note: 1. Blood potassium 4.0; 2. Not used in combination with calcium agents; 3. No electroreplication before and after use; 4. Poisoning: gastrointestinal tract, phenomenon. It has high specificity, poor sensitivity, arrhythmia, supraventricular hyperactivity with conduction block, and it is suspected that the drug will be stopped.
2. Digoxin: 0.125-0.25mg Qd; renal hypofunction or age 70y, 0.125 Qd.
0.25mg/tablet. Be careful to avoid the use of amiodarone, isoprodine, etc.
3. Sodium nitroprusside: directly acts on vascular smooth muscle, dilates the arteries and veins, and reduces the resistance of the systemic and pulmonary circulation, resulting in a role of reducing peripheral arterial impedance and increasing venous blood storage. It can reduce the anterior and afterload of the heart, thereby reducing central venous pressure, increasing cardiac stroke volume, and reducing pulmonary edema. Main side effects: hypotension and thiocyanate poisoning. Usage: It should start with a small dose, generally starting with 0.25ug/kg.min. If it is ineffective, it will increase by 0.25ug/kg.min every 5 to 10 minutes until the desired effect is achieved. The maximum dose is 7.5ug/kg.min-(300ug/min). Note: The medicine needs to be re-dispensed every 6 hours, and it is generally not continuously applied for more than 3 days.
4. Budaxiu: Potassium chloride sustained-release tablets 0.5/tablet adjusted according to the blood potassium level, which is relatively safe.
sig: 1-3# p.o tid
5. Allopurinol: 0.1/tablet uric acid-lowering
sig: 0.1 p.o tid
6. tepriligy: sulfur Priligy tablets 0.1*100# Antipsychotic drug
Indications 1. Chorea. 2.Tic - erotic syndrome. 3. Sexual psychosis. 4. Acute and chronic alcohol poisoning 5. Various pains: headache, painful cramps, neuromuscular pain, etc.
treatment of pain: start with 200-400 mg daily (average 300 mg) for 3 to 8 days, and severe cases have intramuscular injections of 200-400 mg daily for 3 consecutive days. Maintain the amount 50 mg each time, 3 times a day.
Adverse reactions: drowsiness, milk discharge, amenorrhea; 2. It can enhance the effects of central inhibitors.
7. Tapazole (MMI): Antihyperthyroidism drugs Imidazoles 5mg*100#
sig: 5-10mg p.o tid
8. Prothiourea (PTU): Antihyperthyroidism drugs Thiourea 50mg/table
Initial treatment period: (300-450mg/d) Oral administration in 2-3 times, lasting for 6-8 weeks. Re-examination once a month. A complete set of reduction period: Reduce once every 2-4 weeks, reduce each time by 50-100mg/d
Maintenance period: 50-100mg/d Maintenance treatment for 1-1.5 years
Maintenance treatment: ① Granulocytopenia; ② rash; ③ liver function damage, angioedema, etc.
9. Jiajing Antenatal: alprazolam 0.4mg*100 tablets/bottle. Less dependency
sig: 1# q.n p.o
10. Sule Antenatal: eszolam 1mg*30 tablets
sig: 1# q.n p.o
11. Mineral: petastin methanesulfonate 6mg*30#
sig: 1# tid p.o
12. YinoS: Venlafaxine hydrochloride tablets 75mg*14# regulates autonomic nerve function and improves sleep.
sig: 75mg q.d p.o
13. Sinnos: sig: 10mg p.o q.d Take Zolpidem tartrate tablets 10mg*7#
imidazole pyridine hypnosis, muscle relaxation, anti-anxiety, anti-convulsive, and taking it in bed. The effect is very good. Contraindicated for: OSAS, severe liver, respiratory dysfunction.
14. Prozac: sig: 1# tid fluoxetine tablets 20mg/table anti-anxiety depression
15. Delixin: sig: Early, middle each 1# flupexoxx melitricin tablets 20 tablets/box
Anti-anxiety depression, improve sleep The dose in severe cases can be added to 2 tablets in the morning. Elderly patients: Take 1 tablet in the morning. Commonly used in cardiac neurosis. Contraindications: Early stage of recovery of myocardial infarction, bundle branch block, untreated angle-closure glaucoma, etc.
16. Dena: Beprost Sodium Tablets Endothelin-1 Receptor Antagonist 20μg*10 Tablets
to treat pulmonary arterial hypertension; improve symptoms such as ulcer, intermittent claudication, pain caused by chronic arterial occlusion diseases.
sig: 40μg p.o tid Adjust
17. Zuoluoxia: Sertraline hydrochloride tablets 50mg/tablet antidepressant 50-200mg/d
18. Open the same: 4-8# p.o tid Compound α-ketolic tablets
combined with a low-protein diet (food protein 40g/d) to prevent and treat protein metabolism disorders in CRF. Side effects: Aggravate hypercalcemia and regularly check blood calcium levels.
9. Thrombolytic drugs
• 1. Nonspecific thrombolytic agents: They have effects on both thrombus sites or fibrinolytic systems in the circulatory system, such as urokinase (urokinaseUK) and streptokinase (streptokinase SK).
• 2. Selective thrombolytic agent: It selectively acts as the intrathrombus fibrinolytic system, degrades less coagulation factors and fibrinolytic proteins in the circulation, urokinase-type plasminogen activator (SCUPA), acetyl plasminogen one-strand kinase activator complex (APSAC), etc.
• 3. There are still various snake venom preparations (defibrase, plasmin, and antithrombin enzymes) in China. The exact effect and mechanism of their thrombolysis in acute myocardial infarction need to be further studied and verified.
thrombolysis method
• 1. Intravenous administration
• ① Urokinase is 1 million to 1.5 million U, input within 30 minutes to 60 minutes.
• ② Streptokinease is antigenic and can produce allergic reactions. Adrenal corticosteroids such as dexamethasone can be injected before intravenous injection. There are recombinant streptokinases, and their antigenicity is significantly weakened. Commonly used is 1 million to 1.5 million u and 1 hour of intravenous injection.
• ③rt-PA: First give 10 mg of impact amount within 2 minutes, then inject 1 h at a rate of 50 mg/h and weigh more than 65kg, then inject 2 h at a rate of 20 mg/h, and the total amount reaches 100 mg in 3 hours. The accelerated dosage regimen uses the first dose of 15 mg, followed by 50 mg within 30 minutes, and 35 mg within 60 minutes.
• ④SCUPA: First, 20 mg is injected, and then 60 mg is dripped for 1 hour.
• ⑤APSAC: 30mg of 1 bolus.
Complications:
• Mainly hemorrhage, mild cases of skin and mucosal hematuria, microscopic hematuria, severe cases of hemoptysis and gastrointestinal bleeding, and intracranial, spinal cord, mediastinal and pericardial bleeding can be life-threatening. Others with allergic reactions (using SK and APSAC, they manifest as rash, chills, and fever. They are more common during streptokinase infusion, and after it occurs, glucocorticoids can be used intravenously to relieve symptoms), hypotension, thromboembolic , and reperfusion arrhythmia.
10. Antiarrhythmic drugs:
IA: block I Na++ 1. Diisopropyramide; 2. Procainamide; 3. Quinidine
IB: block I Na+ 1. Lidocaine; 2. Phentoin; 3. Mexillid; 4. Tokani
IC: block I Na++ 1. Flecain; 2. Morecichin; 3. Cardiac Rhythm (propane)
II Category: β-blocker
block β1: atenolol, metoprolol, essmolarol
block β1, block β2: sotalol
III: block K+ channel, prolong repolarization. 1. Amiodarone; 2. Bromobenzylamine; 3. Dofetilide; 4. Ibutilide; 5. Sotalol
IV class: Ca2+ antagonist (narrow spectrum): such as isoproterenol, tiarxin
Others: adenosine, atropine, isoproterenol, digoxin, sidilan, etc.
*quinidine : Class IA It is mainly used for the maintenance of post-reverse sinus in atrial fibrillation and atrial flutter and life-threatening ventricular arrhythmia.
oral: 0.75-1.5g, taken in batches within 6-12 hours. It is usually necessary to use it in combination with drugs that slow down heart rate such as (digoxin, beta receptor blockers). This year someone suggested 0.2 tid po for three consecutive days.
Possible side effects: QT prolongation, torsional ventricular speed. GI discomfort, hypotension. Quinidine syncope and induce torsional acupoints usually occur during the first 3 days of medication.
*lidocaine (lidocaine): Class IB narrow spectrum, only effective for ventricular heart rate arrhythmia
Sig: First dose 1.5mg/kg, dilute slowly and intravenously, repeat after 5-10 minutes if necessary. The total amount shall not exceed 300mg/h.
maintenance amount: 1-4mg/min. The maximum dosage within 1 hour is ≤200~300mg.
* peaked at 10s-3min after intravenous injection, and the action time remained at 10-20min.
*Mexilu : Class IB Slow Heart Rhythm Tablet 50mg/ Tablet
Sig: 150-200mg po id
Features of this type of drug: ① Shorten the Q-T interval; ② Less impact on heart contractility: can be used in patients with heart failure; ③ Less impact on cardiac conduction system: can be used in patients with diseased sinus.
*propafenone : Heart rhythm IC 50mg/table; 70mg/piece
Oral: 450-600mg/d Initial 150mg tid po; 200mg tid po when needed; maximum amount 200mg qid po.
Intravenous: 1.5-2mg/kg After intravenous injection in 10-20min
sig: 70-105mg+ N.S 20ml i.v Slowly static push (within 5-10min)
* Functional characteristics: It starts to take effect around 5 minutes and can last for 3-4 hours; if the first dose is ineffective, 35-70mg can be repeated after 20min; generally the total amount does not exceed 300mg within half an hour. Effective for ventricular/supraventricular heart rate arrhythmia.
Side effects: Hypotension quickly causes atrial flutter. Use with caution in patients with coronary heart disease and heart failure. The relevant evidence is insufficient
* Severe heart failure, severe bradycardia and conduction block, and is prohibited for those with hypotension.
*Medoxinan: Category II: Beta blocker
5mg diluted and then slowly intravenously (five minutes), and repeat after 5 minutes if necessary.
* Esmolol: Class II: β-blocker 200ug/kg/min
* Amiodarone (amiodarone): Codalone Class III Tablets: 0.2/tablet Injection 150mg: 3ml/pin
The only anti-heart rate abnormal drug that does not increase mortality is controlled, large doses are maintained, and there are many side effects.
oral administration: Loading amount: 600 mg/d (0.2 tid), lasting for 7 days; maintenance amount: 100-200 mg/d (the minimum effective dose should be used according to the individual reaction).
Intravenous: The venous load is 3-5 mg/kg. Generally, 150 mg is given first, and after dilution, it is intravenous for at least 10 minutes. If necessary, 1.5-3 mg/kg can be repeated after 15-30 minutes or later when needed; the intravenous maintenance amount should be started immediately after the load amount, and the dose should be started at 1.0-1.5 mg/min (equivalent to 300 mg + NS 50 ml 10 ml/h pumped).
*The amount will be reduced according to the condition. It is best to maintain the vein for no more than 4 to 5 days.
Side effects: mainly hypotension (mainly related to excessive injection), bradycardia. QT prolongation, torsional ventricular speed (rare), GI discomfort and constipation. Intravenous drops may cause phlebitis.
1. Thyroid function Check the A-sound before and after use, and then check it after 3 months.
2. Pulmonary toxicity: Pulmonary fibrosis, organogenic pneumonia, chest x-ray before, chest x-ray after six months. Treatment: Azithromycin 0.5 Qd 3 days off for 4 days and 2 months; hormones.
3. Corneal particles deposition, skin pigmentation, etc.
* before application, pay attention to checking blood electrolytes, especially for patients with fast HR and poor heart function. The medication must be stopped when HR55bpm is taken during the medication period. Blood pressure needs to be monitored. When applying
*, please pay attention to monitoring the changes in the Q-T interval, and control the extension of the Q-T interval to not exceed 1/4 of the previous medication, or 0.5s of the Q-T interval.
Note: Follow-up examination ① blood pressure; ② electrocardiogram; ③ liver function; ④ thyroid function, including T3, T4 and thyroid stimulating hormone;
⑤ pulmonary function, lung X-ray; ⑥ Ophthalmology.
Note : Used in conjunction with β-blockers or calcium channel blockers can aggravate sinus bradycardia, sinus arrest and atrioventricular block. Increase warfarin anticoagulation effect.
should be disabled in the following situations: ① Those with abnormal thyroid function or previous history; ② Those with iodine allergies; ③ AVB with Ⅱ or Ⅲ degrees, double bundle branch block (unless there is a pacemaker); ④ SSS; pregnancy, breastfeeding.
*verapamil: verapamil class IV narrow spectrum, good effect on AVNRT negative muscle strength, conduction
Sig: 5mg+GS 20ml Slow intravenous injection after dilution (about 5min) The maximum dose shall not exceed 15mg
3-5 minutes to play a role, reaching the peak of blood drug. Repeat after 30 minutes if necessary.
Note: ① The speed cannot be too fast, as it can cause adverse reactions such as blood pressure reduction, bradycardia and conduction block; ② The elderly, especially those with heart failure, whose blood pressure is low and those with sick sinus should not be used.
*Sulphurazolone: Class IV 0.25 mg/kg, diluted and intravenous injection, the intravenous injection time is greater than 2 minutes, and repeat after 15 minutes if necessary.
*adenosine/ATP: It is generally only used for the termination of rapid acute attacks on the ventricular and sinoatrial nodes. It is the best drug for the treatment room speed and the shortest return time.
Sig: Adenosine 6-12mg Quick Intravenous Injection ("Polka-type" Bounty Injection) Single dose should not exceed 12mg
ATP 20mg Quick Injection. Single dose should not exceed 30mg
Adverse reactions: facial flushing, general discomfort, shortness of breath, nausea, bradycardia, conduction block, etc. Generally, it lasts only a few seconds-1 minute, and does not require special treatment (the adenosine half-life is the shortest, only 1.5-10 seconds). Use with caution for those with poor function of the diseased sinus and atrioventricular nodes.
Note: Do not dilute or add liquid to infusion. It is best to push in through the central vein, and the speed should be fast.
After myocardial infarction, ventricular premature or ventricular speed
• Amiodarone 150mg is diluted in normal saline 20m1, and injected intravenously within 5 to 10 minutes. Then, 1 mg/min is intravenously dripped with 1 mg/min for 6 hours, and then the infusion is maintained at 0.5 mg/min.
• Inject lidocaine intravenously with 1 mg/kg, and bolus every 8 to 10 minutes until the premature stroke disappears, the total amount is <4>
3 mg/min. After the condition is stable, you can change to mexillo 100-150 mg, once every 6-8 hours, or amine
iodoone 200 mg,
2-3 times a day 0• Intramus sotalol 1.5 mg/kg, and after effective, switch to oral 80 mg twice a day.
Antiarrhythmia Chinese patent medicine:
1. Box Yangning tablets: sig: 4# p.o tid can reduce the frequency of premature atrial
2. Step length Wenxin granules: sig: 1 bag Take tid 4 Monday treatment course, mainly used for functional arrhythmia, such as early
beat, sinus speed .
3. Fuxin Tablets: sig: 2-4# p.o tid Chinese patent medicine
4. Xinbao Capsules: sig: 2-4# p.o tid Chinese patent medicine
5. Shensongyangxin Capsules: ginseng, Ophiopogon japonicus and other Chinese medicines Anti-arrhythmia
sig: 4# p.o tid 0.4g/ Tablets 4 Monday treatment courses significantly reduce the frequency of arrhythmia; significantly relieve symptoms such as palpitations, shortness of breath, fatigue, insomnia; good myocardial protection effect.
11. Anti-shock and blood pressure booster
1. Dopamine: has the stimulation effect of α and β adrenergic receptors, and is currently the most commonly used blood pressure booster.
[Usage]: Add 40-120 mg of dopamine to 5% glucose 250m1 intravenous drops starting from a small dose (2-5 μg/kg/min), and gradually adjust according to blood pressure. Pharmacological effects: Dopamine is the precursor of norepinephrine, which can excite α and β receptors, which can not only cause the dilation of blood vessels, but also cause the contraction of blood vessels. Its main effect depends on the dosage of medicine: small doses (2-5ug/kg.min) to stimulate dopamine receptors in various organs such as renal blood vessels, mesenteric blood vessels, cerebral blood vessels and coronary blood vessels, causing the dilation of blood vessels, especially the dilation of the arterioles of the kidney afferent artery, which increases the renal blood flow, significantly increases the filtration rate of the glomerulus and increases by 50%, so it has a significant diuretic effect and reduces the preload of the heart. In addition, it can cause the vascular constriction of the skin and skeletal muscles. The medium dose (6-10ug/kg.min) directly stimulates the β1 receptor of the myocardium, enhances the contractility of the myocardium, dilates the coronary artery, and improves segmental ventricular wall movement of myocardium hypoxia. Large doses (10ug/kg.min) can cause all arteries and veins to contract, which is the result of excitation α receptors, mainly due to the boosting effect. It is often used in various shocks: such as septic shock, cardiogenic shock, hemorrhagic shock, etc. Features: The effect time is short and needs to be maintained intravenously. Common adverse reactions of
:
1) tachycardia;
2) ventricular arrhythmia (1, 2 is caused by the excitation of the heart β1 receptor);
3) Increased blood pressure and increased peripheral resistance (caused by the large dose of drug administration, excitation of peripheral α receptor).
2. Metahydroxylamine (alamine) and norepinephrine: an alpha and beta adrenergic receptor stimulant, which has the effect of enhancing myocardial contractility and contracting peripheral blood vessels. Short-term application when dopamine cannot maintain blood pressure.
[Usage]: 10-30 mg of methylene hydroxylamine dissolved in 100ml of 5% glucose solution. If necessary, increase the dose. In case of emergency, 5-10 mg can be injected intravenously.
3. dobutamine : acts as β1 adrenergic receptor, increases myocardial contractility and cardiac output, has weak effects on β2 and α receptors, which can increase systolic blood pressure and reduce PCWP. The positive muscle force effect is more obvious than the positive frequency effect, which causes less tachycardia and has a smaller impact on heart rate; the effect of improving left ventricular failure is better than dopamine; it can be used for heart failure complicated by myocardial infarction.
[Usage]: The commonly used dose is 2.5~10μg/kg/min.
is not suitable for those with atrial fibrillation because this medicine can accelerate atrioventricular conduction and increase the ventricular rate. This drug has weak anti-shock effect, and can enhance the efficacy of dopamine. Generally, the medication should not be taken for more than 3 days, and the maximum should not be exceeded one week.
4. Adrenaline : α and β receptor agonist 0.5mg/branch
sig: 0.25-0.5mg I.H/subcutaneous
0 is used in ① Cardiac arrest: used for cardiac arrest caused by drowning, anesthesia, surgical accidents, drug poisoning and cardiac block; ② The preferred drug for allergic shock; ③ Acute attack of bronchial asthma; ④ Local hemostasis
5. Isoprenaline : β1, β2 receptor agonist 1mg/branch Pay attention to controlling heart rate, ECG monitoring Adverse reactions: dry oropharyngeal hair, palpitations, dizziness, etc.
is applied to ① Cardiac arrest: sig: intracardiac injection 0.5-1mg
②Third degree atrioventricular block: HR40bpm sig: 0.5-1mg+5% G.S 250ml i.v.drip
6. Atropine: M-choline receptor blocker 0.5mg/branch
is applied to: ①Slow arrhythmia: used to treat SAB, AVB, etc. caused by vagus nerve excitation. ② Anti-shock: For septic shock caused by explosive meningitis, toxic bacterial dysentery, toxic pneumonia, etc., high-dose atropine can be used to treat it. (Relieve vasospasm, diastolic peripheral blood vessels, and improve microcirculation)
Hyponatremia treatment:
130mmol/L: sodium supplementation in diet; 120mmol/L: sodium supplementation intravenously;
sig: 10% sodium chloride 50-80 ml/day 8-10 ml/hour Micropump pump 10ml/branch
D22. Antibiotic
1. Hai Super 0.4 i.v.drip q.d Gatifloxacin 100ml: 0.2/bag
2. Lifosun 0.4 i.v.drip q.d levofloxacin 100: 0.2/bag
3. Jiale Tongxin 0.3 i.v.drip q.d levofloxacin 100:0.3/bag
4. Tepixin 2.0+N.S 100ml i.v.drip q.12h cefopiptidine sodium 1.0/branch
5. Xinripxin 3.0+N.S 100ml i.v.drip q.12h cefopiperone sulbactam sodium (third generation) 1.5/bottle
6. Ruoqi 3.0+N.S 100ml i.v.drip q.d cefozole sodium deficit (third generation) 1.5/bottle
7. Xinliwei 3.0+N.S 100ml i.v.drip q.d Cefopilosa sodium (third generation) 0.5/bottle
8. Fengqingpolygonum, Zandixin Cefopilosa
9. Karen 4.5+ N.S 100ml i.v.drip q.d Melocilin sulbactam sodium 2.25/pin Kaiweike
10. Kailin 5.0+ N.S 250ml i.v.drip q.d
11. Amoxicillin sterilization 3.6+ N.S 100ml i.v.drip q.d Amoxicillin/clav.drip potassium needle 1.2/pin
12. Ambisin 0.25 po tid Ampicillin Capsules 0.25*24#
13. Xinpit 0.5 i.v.drip q.d 0.5:250 (prepared) N.S Azithromycin sodium chloride solution
14. Xianxin 1.2 i.v.drip q.d 1.2/bottle (prepared) Clindamycin 7-10 days treatment
15. Shi Fujie 0.25 po bid 0.25*6# Oral cefpropylene
16. Zaitai 1.0-2.0+ N.S 100ml i.v.drip bid Cefiperidate sodium 0.5/branch
Lanju: (Latigen B): Multivalent oral antigen lysates/multivalent bacterial vaccine (various small doses of bacterial antigens) 18ml/bottle
Characteristics: Milky white suspension
Indications: Effective for prevention and treatment of respiratory infections (especially upper sensation); prevention and treatment of recurrent respiratory infections; Upper sensation
Usage of children: ① Patients aged 6 months-12 years old: 7 drops each before breakfast and before going to bed, and take sublingual drops (keep in the mouth for a period of time so that the mucosa can fully absorb it) Course of treatment: Use one bottle in a row, and use another bottle after 2-3 weeks.
②12-year-old patient: 15 drops each before breakfast and before going to bed, and the sublingual drip is taken. The course of treatment is the same as above
Adverse reactions: The first medication may lead to a temporary aggravation of the symptoms; occasionally mild nausea.
basic medication for interventional surgery:
1. Normal saline: 500ml*8-10 bottles of
2. Dexamethasone 10mg
3. Atropine 10mg
4. Heparin sodium 12500u*2-3
5. Lidocaine 100mg*2-3 trunks or procaine 2ml*5-10 Preparation before coronary angiography: ECG; UCG; PT+APTT; the first three items of blood transfusion; precautions after liver and kidney function electrolyte
PTCA+ICS (stent implantation);
1. Extubation 24 hours after surgery;
2. Press with a salt bag for 6 hours after the tube; 6-8 hours can be raised to 30 degrees.
3. You can drink water, eat and urinate and defecate on the bed one hour after the operation;
4. Pay attention to the wound condition: whether there is bleeding, redness, swelling, pulsation of the dorsal artery of the foot, lower limbs, etc.
5. Pay attention to whether there is angina pectoris and cardiac function;
6. At the same time, anticoagulation is given: 1) Beaspirin: Take 300mg q.d in the first 3 months after the operation, and then change to 0.1 qd for life; 2) Bolivir (ticlopidine): 75mg qd application time depends on the specific situation. Generally, 150mg qd does not exceed 2 weeks, and then 75mg qd is maintained for 3 months, which is expensive. 3) Low molecular weight heparin sodium: such as KS, Faanming, etc., for 5-7 days, no more than 7 days. 4) Statins: Lipitor 10mg q.n can stabilize the endothelium and cell membrane. 5) Antibiotics: routine anti-inflammatory for 3-5 days.
7. It takes about one month to completely repair the blood vessels.
8. On the first day after the operation, the lower limbs cannot be bent or other activities, so that the femoral artery can be kept straight and you will be bedridden for one day. It is normal to feel numb near the lower limbs one or two days after the operation due to less activity. After that, you can get out of bed and move around and be discharged from the hospital within 4-5 days.
9. Vasospasm occurs after surgery: Hebeishuang tablets (90mg qd) have good effect. After stabilization, they will change to β-blockers, which do not require long-term use, and are generally less than 3 months.
* Patients should stay in bed for 72 hours after the placement of the pacemaker, try to avoid excessive exercise on the arm on the surgical side, and regularly follow up and review the function of the electrocardiogram to monitor the pacemaker.
Radiofrequency ablation: ECG (an electrocardiogram that can be diagnosed during the onset, or the esophageal electrophysiological induction is clear, or the intracardiac electrophysiological examination is agreed to undergo intracardiac electrophysiological examination during the operation); UCG; PT+APTT; the first three items of blood transfusion; liver and kidney function electrolyte
* Common situations of hypotension:
1. Reduced cardiac output; 2. Hypovolume hypotension: Pay attention to whether there is bleeding or blood loss. 3. Acute myocardial infarction; 4. Excessive fluid loss:
diarrhea, vomiting, etc.; 5. Drugs: such as improper taking antihypertensive drugs, etc.
