In fact, traveling for business and staying in hotels is unavoidable, and carrying around a lot of electronic products: computers, cell phones, other important devices or documents, and other important items. Although the hotel has its own management system, but even if you did not check out, the room will have cleaning and other staff come in to clean and health, so it is best not to put valuables into the hotel, if you feel troublesome to carry, then you can put in the safe provided by the hotel, safety and security is higher than in other places in the hotel.
Hotel safes often have a carpeted interior to prevent scratches and damage to the stored items. They may also have additional features such as an internal light, a removable shelf, or multiple compartments to organize belongings.
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How to regulate the rational use of antihypertensive drugs for treatment?
[ China Pharmaceutical Network Health and Health ] How to regulate the rational use of antihypertensive drugs? Hypertension is a common chronic disease. It requires long-term medication control. There are many types of antihypertensive drugs. What clinical knowledge should we master?
(How to regulate the rational use of antihypertensive drugs for treatment? Image Source: Baidu Pictures)
Author: Zhumadian City, Sixth People's Hospital medical director physician Chen Quanfeng
1. What are the types of antihypertensive drugs?
The clinical first-line antihypertensive drugs are roughly divided into five categories:
(1) angiotensin converting enzyme inhibitor (ACEI): commonly used drugs are captopril, enalapril, etc.;
(2) angiotensin II receptor antagonist (ARB): commonly used drugs are valsartan, telmisartan, etc.;
(3) diuretics: commonly used drugs are hydrochlorothiazide, furosemide, spironolactone, indapamide, etc.;
(4) β-blockers: commonly used drugs are metoprolol, labetalol, etc.;
(5) calcium ion antagonist (CCB): commonly used drugs are nifedipine, amlodipine, verapamil and the like.
Other types of antihypertensive drugs are:
(1) α-blockers: commonly used doxazosin, prazosin, etc.;
(2) Compound preparations: such as losartan potassium hydrochlorothiazide, compound antihypertensive tablets, etc.;
(3) Central antihypertensive drugs: such as clonidine, methyldopa, etc.;
(4) direct vasodilators: such as minoxidil, hydralazine, etc.;
(5) Chinese patent medicine: such as Zhenju antihypertensive tablets.
2. How does the antihypertensive drug exert a blood pressure reduction effect?
(1) Diuretic effect: reduce blood volume and extracellular fluid volume, decrease cardiac output, and achieve antihypertensive effect. Commonly used drugs: hydrochlorothiazide and indapamide, in addition, ACEI or ARB also has certain diuretic effect.
(2) Dilatation of blood vessels: The blood pressure lowering effect is produced by reducing the peripheral resistance. Commonly used drugs are: calcium antagonist (CCB); ACEI or ARB; sympathetic inhibitors (reserpine, clonidine); direct vasodilators (肼Benzoxazine); a receptor antagonist (prazosin, terazosin, etc.).
(3) to reduce the heart contraction, slow down the heart rate to reduce blood pressure, commonly used drugs beta blockers: propranolol, metoprolol, bisoprolol, arolol, carvedilol and so on.
3. What are the side effects of antihypertensive drugs?
(1) CCB may have blushing, headache, lower extremity edema, swollen gums, etc.
(2) ACEI/ARB. In addition to dry cough, the side effects of ACEI may cause an increase in serum creatinine, elevated blood potassium, abnormal liver function, edema of vascular nerves, and effects on fetal development. ARB is similar to ACEI except that it rarely causes dry cough. ARB has a risk of neutropenia and rhabdomyolysis.
(3) Diuretics are prone to increase uric acid, disorders of glycolipid metabolism, electrolyte imbalance, etc., and patients with diabetes and gout are not suitable.
(4) The main adverse reactions of β-blockers are: fatigue, cold feeling in the limbs, bradycardia, etc., and sudden withdrawal of the drug will cause a significant increase in heart rate rebound, some non-high selectivity β receptor resistance Stagnation agents may affect glycolipid metabolism and induce asthma; in patients with coronary heart disease, sudden withdrawal may induce angina pectoris. Patients with asthma or high-grade atrioventricular block are banned with beta blockers, chronic obstructive pulmonary disease, and heart rate less than 60 beats/min are also used with caution.
(5) Reserpine and a combination preparation containing reserpine may cause depression and sexual dysfunction.
4. How to choose a buck treatment plan?
Most uncomplicated patients may choose to administer the drug alone or in combination. Currently, it is recommended that the second-grade hypertension be treated as a combination. The recommended combination is as follows:
(1) Main recommendations: calcium antagonist + ACEI or ARB; ACEI or ARB + ​​diuretic; calcium antagonist + beta blocker; calcium antagonist + diuretic
(2) Secondary recommendation: diuretic + beta blocker; a receptor antagonist + beta blocker; calcium antagonist + potassium-sparing diuretic; phenothiazine diuretic + potassium-sparing diuretic .
(3) If the control is poor, three drug combinations can be used: such as calcium antagonist + ACEI or ARB + ​​diuretic.
5. When do you choose to take antihypertensive drugs?
Normal people's blood pressure has two peaks and two lows in one day, namely sputum blood pressure: 9-11 in the morning and 4-6 in the afternoon is the highest blood pressure in the whole day; the first trough is from 12 noon to 2 pm, 8 in the evening. After the time, the blood pressure showed a slow downward trend, which was the lowest at 2 to 3 in the morning. Therefore, patients with chronic hypertension choose the time of medication, usually the first time the drug is used in the morning 6 to 7 o'clock, the second drug is used in the afternoon 3 to 4 o'clock, the antihypertensive drug lasts for 24 hours, usually once a day; Some people also showed no significant decrease in blood pressure at night, that is, less than 10% of nighttime blood pressure drops, called non-sputum blood pressure, or night blood pressure is 5% higher than daytime, medically known as ruminal blood pressure, such high Patients with blood pressure, if necessary, can consider taking the medicine after dinner, which is effective for controlling the increase of blood pressure at night; in addition, there is a significant decrease in blood pressure at night, which is more than 20% lower than that during the day, called squat type or super sputum type. Should take the morning medication, do not take it at night, so as not to cause excessive blood pressure at night to induce ischemic stroke
6. What are the advantages of antihypertensive drug sustained release tablets and controlled release tablets? What are the special requirements for the method of administration?
Compared with the controlled release tablets, the sustained release tablets have the advantages of reducing the number of times of administration, maintaining a stable and effective blood concentration, reducing toxic side effects, and reducing the total amount of medication.
Controlled-release tablets, enteric-coated tablets, capsules and most sustained-release tablets should be swallowed whole and cannot be rubbed, pressed or chewed. Some special sustained-release preparations can be taken apart, such as metoprolol sustained-release tablets. Consult a doctor or pharmacist before taking the medicine.
7. Does antihypertensive drugs affect sexual function?
Some antihypertensive drugs have an effect on sexual function. Such as reserpine, thiazide diuretics may increase the incidence of sexual dysfunction. Other antihypertensive drugs such as beta receptor inhibitors, angiotensin converting enzyme inhibitors or calcium ion antagonists may affect their sexual function. For other drugs, if you obviously feel dysfunctional, consider changing the drug. Angiotensin II receptor antagonist drugs are beneficial to the improvement of sexual function. In fact, it is not advisable to avoid taking antihypertensive drugs because of fear of affecting sexual function. Hypertension itself is an important factor causing sexual dysfunction.
8. What problems should be paid attention to when using antihypertensive drugs in elderly hypertensive patients?
In elderly patients with hypertension, the use of antihypertensive drugs should start from a small dose, the dose should be slowly adjusted, because the elderly are more likely to have adverse reactions, especially in elderly and frail patients, it is advisable to use a mild, slow preparation. The pressure should not be too fast, and the degree of blood pressure should not be too large. Do not adjust the dosage and change the variety.
9. How to choose antihypertensive drugs for patients with hypertension and diabetes?
Hypertension and diabetes are among the people that must be highly valued. Two types of antihypertensive drugs, ACEI and ARB, can prevent the appearance of microalbuminuria and diabetic nephropathy, and can slow the progression of diabetic nephropathy. Therefore, these two types of antihypertensive drugs should be used as the basic treatment for patients with hypertension and diabetes, and combined with other antihypertensive drugs such as calcium antagonists and diuretics.
10. How to choose antihypertensive drugs safely for pregnancy?
The principle of selection of antihypertensive drugs during pregnancy is to reduce the uterine placental perfusion as much as possible while preventing blood pressure and avoid adverse effects on the fetus and newborn.
Methyldopa, no fetal toxicity has been found, can be used during pregnancy; Labetalol can be preferred in beta blockers; nifedipine is preferred for early and middle pregnancy, but pregnant women take it Calcium antagonists may affect uterine contractions, and clinical applications need to be given attention; the safety of amlodipine, felodipine, diltiazem and verapamil on the fetus remains to be demonstrated; metoprolol extended release agent pair The impact of the fetus is also small, can be considered, but need to strengthen the monitoring of the fetus, alert to bradycardia and hypoglycemia; ACEI and ARB are banned, sodium nitroprusside, propranolol, atenolol, Not recommended for use.
references
[1]. Revised Committee of China's Guidelines for the Management of Hypertension at Grassroots. Guidelines for the Management of Hypertension in China (2014 Revision) [J]. Chinese Journal of Hypertension, 2015, 23(1): 24-43.
[2] Sun Juan. Observation and analysis of the effects of treatment with β-blockers in 160 elderly patients with hypertension [J]. Chinese and Foreign Medicine, 2014, 35:78-79.
[3]. Wen Shaojun, Liu Jielin, Liu Ya et al. Potential adverse reactions and prevention of blood pressure lowering drugs [J]. Journal of Adverse Drug Reactions, 2007, 6 (9): 172-176.
[4]. Lin Rongli, Liu Fubin. Clinical considerations of commonly used antihypertensive drugs [J]. Drug and Clinical, 2009,16 (16): 66-67.
[5]. Chinese Experts Association Hypertension Professional Committee Hypertensive disease hypertension management Chinese expert consensus [J]. Chinese Journal of Hypertension, 2012, 20 (11): 1023-1027.