Medicine of # of plan of # cool breeze is cure the sickness to save the patient originally, but dose is wrong, or short of treats the effect, or will be aggravating harmful response, bring toxicity even. So, when the doctor is opening medicine to the patient, should make to the patient use formulary record reasonably, include medicaments, the form of a drug, dosage giving drug, interval giving drug to wait.
Medicaments is the most important for certain, also be remedial foundation, choose pair of medicaments ability to develop treatment to the greastest extent only action, reduce harmful response. It is with hypertension exemple, medicationed purpose is to reduce blood pressure not only, more important is the function of tutelar body organ, reduce the risk of complication and mortality. Initiative it is to use only drug treatment, want the rate with hypertensive basis (light, medium, tall) and the patient is other disease circumstance (whether " 3 tall " , the heart is healthy, the age) logical choice. Of course, combination can increase step-down result with medicine, reduce harmful response, but the medicaments that is about to choose step-down mechanism to differ with medicine jointly, in order to achieve best step-down effect and the least side effect.
Logical choice depressor
Next, medicaments the form of a drug is very important also. Agent of inhalant of agent of agent of grain agent, tablet, capsule, injection, solution, syrup agent, sparge, ointment is waited a moment, this is the simplest classification. Tablet has various kinds again, for instance filmy garment piece, multilayer piece, alvine dissolve piece, dispersive piece, masticatory piece, fast dissolve piece, bubble is vacated piece etc, every kinds of the form of a drug has him distinctive commentate formulary type and commentate medical effect, will achieve medicationed different goal. It is with common tablet exemple, common tablet enters system inside hind, via absorbing, distributing, metabolization, hematic drug chroma is to rise first, hind faster drop, slow finally drop, eliminate till medicaments complete.
With process of change of chroma of drug of the blood after medicine
But accuse commentate piece with delay commentate piece medical effect is distinct, delay accuses commentate piece enter system inside hind, medicaments is released adagio, make sure hematic drug chroma is treating a window (between the smallest effective chroma and the biggest toxic chroma) inside limits, can produce medical effect, but give medical frequency to be able to reduce half or more than common preparation, with medicine more safe, the patient also prefers such kind that use drug (namely sex of patient comply with is good) .
Delay accuses commentate preparation and change of chroma of drug of common preparation blood are compared
The dosage that use drug and time-interval are two very serious problems, but often be ignored by everybody. The doctor also is taken sometimes forbid, just repeat the content of manual of medicines and chemical reagents, it is incorrect so actually. I lift a simple case to conduce to everybody's understanding. In using drug daily, have what need to use drug only rarely, besides certain analgesia medicine, hypnotic is reached stop spit medicine to wait, often want for many times to use drug, mix like cardiovascular disease diabetic belong to chronic, need to use drug for a long time more.
So the issue came, use drug often, won't medicaments be inside body save up?This is about to involve the issue with kinetic medicaments, generally speaking, if with medicine time interval is more than medicaments to eliminate half-life (chroma of content of haemal Chinese traditional medicine or the time that the medicaments inside body measures a bring down to need to the place when 1/2) 7 times, using drug the next time is the medicaments inside body has been eliminated complete, medicaments the process inside body and sheet second do not have distinction with medicine.
The different time-interval that use drug causes hematic drug pH indicator to differ
But if use drug time-interval is very short, still do not have with the medicaments inside the body when medicine the next time so be eliminated complete, such for many times iteration, the medicaments inside body is met gradually save up, increasing, increase as the frequency that use drug, the dosage inside body increases ceaselessly, increase no longer through the dosage or inside rear body of period of time, achieve stability (this is optimal uses formulary formula) ; Or medicaments is ceaseless save up, reach toxic consistency, cause serious and undesirable reaction.
The ideal time-interval that use drug
So, the time-interval that use drug must be carried out strictly according to the manual, cannot shorten arbitrarily or lengthen.
On the dosage that use drug, most person has an understanding error -- " take medicine for the first time should double, gift is nice fast! " . This is the means using drug of a serious mistake, in medication learn to go up to have really " head the agent is double " say, but most an antibacterial of be confined to content.
Generally speaking, using the goal with ultimate medicine for many times is the hematic drug consistency that should reach stability, treat effective chroma namely, but should achieve chroma of drug of stable state blood to need 3~4 medicaments eliminates half-life. If the elimination of medicaments half-life is longer, so the time that obtains need of chroma of drug of stable state blood is longer also, for instance the elimination of sulphanilamide pyrimidine half-life is 17 hours, want to achieve chroma of drug of stable state blood to need 56 hours at least. During this, because hematic drug chroma did not reach effective treatment consistency, so the influence medications the effect.
Below this kind of circumstance, with respect to need chroma of medicine letting blood reachs effective treatment consistency as soon as possible, need a larger dose with medicine for the first time normally so, but it is normal that the dosage using drug later must be returned to, can cause serious and undesirable reaction necessarily otherwise. Pass medicaments kinetic computation, "Head the agent is double " it is best choice, can shorten already the time having effect of medicaments, the security that also can assure medicaments and effectiveness (premise is according to the regulation time uses drug) . What say normally " dose is double " also point to only " head the agent is double " .
Black: Head the agent is double; Gray: Regular dose
This antagonism is very significant for bacterium medicaments, the use of antibacterial is to should be far from the smallest toxic chroma above all, if approach time of the smallest effective pH indicator,grow more at the same time, bacterial general may arise more quickly be able to bear or endure property of a medicine, cause curative effect not apparent or reduce. So, to control a symptom quickly, control bacterial hyperplasia and infection rate, ascendant speed of pH indicator of the medicaments in must accelerating blood, need namely " head the agent is double " .
Need the remedy with a double agent
But not all antibacterial needs " head the agent is double " . Resemble amino candy glucoside kind, the ester inside Zun of saltpetre of B of element of ketone of fluorine Kui Nuo, bisexual mildew, armour, ketone kind, closely related the remedial effect such as the medicine that fight impaludism and medicaments chroma, consider dosage issue with respect to need. And certain antibiotic is in fall there still is the effect that fight bacterium after the smallest effective chroma (effect of leucocyte of the hurried after including antibiotic aftereffect, antibiotic, inferior the antibiotic aftereffect below curb bacterium chroma) , below this kind of circumstance, although hematic drug concentration is again high, antiseptic action has reached saturation, continue to increase chroma to cannot add curative effect, can increase harmful response risk instead.
We return the case of depressor again, fall blood pressure wants as a child dosage begins, chase gradual amount, cannot fall too suddenly at a draught, otherwise dangerous and great (certain vitals may is not worth for blood) . After achieving satisfactory step-down result, give priority to in order to maintain, advocate reduce blood pressure wave motion with lasting effect depressor, also do not want midway to stop drug at will, change medicaments medicine is replaced stage by stage. Below this kind of circumstance, if remain the same dose is double, be very dangerous?
The curative substance that domestic some hospital already developed monitors a project
Anyhow, reasonable using drug also is " the university asks " , not be simple " answer read machine " . Different and individual medicine is moved learn to learn to also exist with medical effect difference, traditional experience pattern has achieved satisfactory remedial result hard with formulary case, at present very much large hospital also has begun to explore chroma of clinical blood drug to monitor (especially antibacterial content) , this is clinical medication the new trend of development, of course this tries hard from what do not open clinical apothecary among them.
