Salamat Dok!!!!

[surgeon_jm]

hey docs, got another question

this time re blood thinners

i understand there are a number of blood thinners (antiplatelet drugs like aspirin, dipyridamole, clopidogrel. anticoagulant drugs like vit.K antagonists, heparin)

how do you doctors decide which to prescribe?

what factors do you look at?

hmmm.. new task ba? hehe!
lots of factors ulit. patient's well being, availability and cost of medicine, MD's preference, patient's condition, etc...

on heparin: mostly used as adjuct nowadays on insertion of IJ (intrajugular) axis for hemodialysis. as diabetic and hypertensive nephropathies getting common nowadays, so is hemodialysis.. tsk tsk... also used on those w/ metal heart valves, usually warfarin...

on aspirin: most cost effective anti-platelet treatment. mura kasi.. 1-2pesos lang yata ang 100mg.. biggest drawback, GASTRIC IRRITANT. kaya bawal sa mga may history of ulcers or a tendency to get one. kahit taken pa with food, it really stings (on personal experience w/ aspirin)

on clopidogrel: same action w/ aspirin.. more costly.. but can be taken w/out food 'coz it's not a gastric irritant like aspirin. also the ease of giving it, only 75mg tablet once a day, unlike aspirin w/c needs to be taken at intervals or larger dosages, making gastric ulcer always a sure possibility.

on dipyridamole: not a much fan of it, hehe!

HTH sir uls..

[chrismarte]

thanks doc jm for the replies

i can't get answers like that sa google hehe

i have a lot of questions i want to ask doctors

magpo-post uli ako

thanks again

baka maningil na yan ng PF....hehehe

[uls]

a ok

thanks doc jm for the reply

i appreciate it

i'll be back

[uls]

btw doc jm, you mentioned dumadami ang dialysis patients

i understand that diabetes and hypertension damage the kidneys

how exactly does diabetes and hypertension damage the kidneys?

sa diabetes, high blood glucose clogs up blood vessels depriving the kidneys of blood and the kidneys die?

sa hypertension, high bp puts a lot of pressure on the kidneys overworking the kidneys destroying the kidneys' filter allowing protein to pass thru?

(i understand sa urinalysis pag may protein detected sa urine that means may damage ang kidneys)

[scharnhorst]

*surgeon_jm: good job on managing that stroke patient! hehe. sana maging ganyan ako kagaling someday

btw doc jm, you mentioned dumadami ang dialysis patients

i understand that diabetes and hypertension damage the kidneys

how exactly does diabetes and hypertension damage the kidneys?

sa diabetes, high blood glucose clogs up blood vessels depriving the kidneys of blood and the kidneys die?

sa hypertension, high bp puts a lot of pressure on the kidneys overworking the kidneys destroying the kidneys' filter allowing protein to pass thru?

(i understand sa urinalysis pag may protein detected sa urine that means may damage ang kidneys)

hypertension: yung constant renal hyperperfusion due to hypertension leads to sclerosis (thickening) of the lining of the micro-vessels of the kidneys... eventually the perfusion is impaired (since lumiit na yung diameter ng blood vessel), leading to ischemia (lack of blood supply) and cell death.

diabetes: one mechanism of action is the accumulation of certain end products as a consequence of the constant high blood sugar... these substances can damage the cells lining the kidney's small blood vessels, again causing sclerosis and loss of function.

the thing with diabetes is, once the kidneys start getting hit... a consequence of this is the person becomes hypertensive - which causes further kidney damage.

blood proteins supposedly cannot pass through the kidney's intact filtration system. pag tinamaan na yan... the proteins "leak" into the urine.

kaya tinitingnan yung creatinine sa dugo to assess the renal function - normally it's excreted by the kidneys. pag nagkalat na yung filtration niya... it accumulates in the blood.

hehe

[uls]

*surgeon_jm: good job on managing that stroke patient! hehe. sana maging ganyan ako kagaling someday



hypertension: yung constant renal hyperperfusion due to hypertension leads to sclerosis (thickening) of the lining of the micro-vessels of the kidneys... eventually the perfusion is impaired (since lumiit na yung diameter ng blood vessel), leading to ischemia (lack of blood supply) and cell death.

diabetes: one mechanism of action is the accumulation of certain end products as a consequence of the constant high blood sugar... these substances can damage the cells lining the kidney's small blood vessels, again causing sclerosis and loss of function.

the thing with diabetes is, once the kidneys start getting hit... a consequence of this is the person becomes hypertensive - which causes further kidney damage.

blood proteins supposedly cannot pass through the kidney's intact filtration system. pag tinamaan na yan... the proteins "leak" into the urine.

kaya tinitingnan yung creatinine sa dugo to assess the renal function - normally it's excreted by the kidneys. pag nagkalat na yung filtration niya... it accumulates in the blood.

hehe

hey thanks doc

RE:

diabetes: one mechanism of action is the accumulation of certain end products

you're referring to advanced glycation end-products right?

do you know any glycation inhibitor that's available in Mercury drug?

[uls]

since we're on the topic of diabetes, i got some questions

i understand that type 2 diabetes is caused by insulin resistance

drugs like metformin and glitazones lower blood sugar by improving insulin sensitivity

that i get. that makes sense

what doesnt make sense to me are those drugs that make the pancreas produce more insulin (sulfonylureas, meglitinides)

i mean the problem isnt that the body isnt producing insulin. the body is producing insulin but is no longer sensitive to it. so why force the body to produce more insulin? why not focus on restoring insulin sensitivity instead? (or reverse insulin resistance)

if you use drugs to force the pancreas to produce more insulin, arent you making the pancreatic (beta) cells burn out faster? eventually those cells will burn out and can't produce any more insulin and the patient has to inject insulin for life

you're suppose to preserve those beta cells instead of making them burn out faster right?

im amazed people with diabetes still eat lots of carbs. they say "may gamot naman eh"

umm... how about cutting carbs nalang so you don't have to take drugs?

with those insulin secretagogues -- it's like the medical community is saying -- "hey, we can't stop patients from eating carbs. they love carbs. so to keep patients' blood glucose under control, we have to prescribe drugs that make the pancreas produce more insulin"

it makes more sense to me to go back to what caused the insulin resistance in the first place -- decades of high carb diet, decades of exposure to high insulin causing the body to become resistant to insulin

cut the carbs. give the body a break

do i make sense?

[surgeon_jm]

baka maningil na yan ng PF....hehehe

don't worry sir chrismarte. di ako maniningil...

[surgeon_jm]

*surgeon_jm: good job on managing that stroke patient! hehe. sana maging ganyan ako kagaling someday



hypertension: yung constant renal hyperperfusion due to hypertension leads to sclerosis (thickening) of the lining of the micro-vessels of the kidneys... eventually the perfusion is impaired (since lumiit na yung diameter ng blood vessel), leading to ischemia (lack of blood supply) and cell death.

diabetes: one mechanism of action is the accumulation of certain end products as a consequence of the constant high blood sugar... these substances can damage the cells lining the kidney's small blood vessels, again causing sclerosis and loss of function.

the thing with diabetes is, once the kidneys start getting hit... a consequence of this is the person becomes hypertensive - which causes further kidney damage.

blood proteins supposedly cannot pass through the kidney's intact filtration system. pag tinamaan na yan... the proteins "leak" into the urine.

kaya tinitingnan yung creatinine sa dugo to assess the renal function - normally it's excreted by the kidneys. pag nagkalat na yung filtration niya... it accumulates in the blood.

hehe

the best scharnhorst! +1 ako dito, hehe!

[surgeon_jm]

you're referring to advanced glycation end-products right?
do you know any glycation inhibitor that's available in Mercury drug?

designer drugs are expensive just as designer clothes are expensive