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  1. Join Date
    Apr 2010
    Posts
    1,118
    #71
    Quote Originally Posted by uls View Post
    Doc surgeon jm, tanong lang
    a friend was just diagnosed with hypertension
    he was prescribed a beta blocker (atenolol) then changed to an angiotensin II receptor antagonist (ibesartan)
    i understand there are many classes of hypertension drugs -- beta blockers (non-selective and selective), alpha blockers, ACE inhibitors, angiotensin II receptor antagonists, calcium channel blockers

    my question is this -- how do doctors decide which class of drug to prescribe? since the end goal is to control high BP and all those drugs can lower bp (but different mechanisms of action), how do doctors decide which drug to prescribe?
    marami factors sir uls.. on my part, i do not give beta blockers on elderly patients. they work by lowering your heart rate, lowering the amount of blood pumped out of heart, lowering bp. as we age, normally our heart slows down, so you cant afford to slow it down more. also beta blockers is the opposite of beta agonist (like salbutamol, w/c increases heart rate, palpitations as effects), that is why you cant give it to those with history of asthma, it can exacerbate it. combination drugs work better because the 2 drugs work synergistically (usually these 2 drugs are of different class, therefore different mode of actions, enhancing bp lowering effect)

    ace inhibitors are also good.. but the most common side effect is what the patient hates, COUGH. arb's present their action on the later part of the chain, eliminating the cough side effect. in the long run, lots of factors are involved in the decision making.. one thing important is the medication price, of which metoprolol is the cheapest. kaya you see most people who are hypertensives are started on this... esp the younger, non-asthmatic ones...

  2. Join Date
    Jun 2007
    Posts
    2,841
    #72
    *surgeon_jm: just curious. what are your thoughts about giving citicoline among acute post-stroke patients?

  3. Join Date
    Apr 2010
    Posts
    1,118
    #73
    Quote Originally Posted by scharnhorst View Post
    ^^^ sometimes depends on the comorbidities that the patient has..

    for example, ARBs and ACE-i's have beneficial effects in those with diabetes or with renal failure..

    beta blockers for those na nag MI na dati or with heart failure...

    nice one doc.. saang hospital ka ngayon?

  4. Join Date
    Apr 2010
    Posts
    1,118
    #74
    Quote Originally Posted by scharnhorst View Post
    *surgeon_jm: just curious. what are your thoughts about giving citicoline among acute post-stroke patients?
    for me? trivial.. but since other than citicoline and piracetam, no other meds are given as such..
    kaya lang protocol sya on most hospitals di ba?
    i think (out of the box and books) IV dexamethasone would be of better help..

  5. Join Date
    Jun 2007
    Posts
    2,841
    #75
    am currently still just a clinical clerk at PGH... hehe.

    Quote Originally Posted by surgeon_jm View Post
    for me? trivial.. but since other than citicoline and piracetam, no other meds are given as such..
    kaya lang protocol sya on most hospitals di ba?
    i think (out of the box and books) IV dexamethasone would be of better help..
    dexamethasone... for the edema? just noticed na left and right sa institution namin yung citicoline post-ictus. may evidence naman sya, pero afaik wala pa full blown meta analysis

  6. Join Date
    Apr 2010
    Posts
    1,118
    #76
    Quote Originally Posted by scharnhorst View Post
    am currently still just a clinical clerk at PGH... hehe.

    dexamethasone... for the edema? just noticed na left and right sa institution namin yung citicoline post-ictus. may evidence naman sya, pero afaik wala pa full blown meta analysis
    dito rin.. and as well as the big medical centers here both in davao and tagum cities. citicoline is used more often than piracetam. its classified as a neuroprotector right? so it would be far more better given as prior to stroke rather than after the incident.

    yup, for the edema. much like cva-bleed, or head trauma w/ bleeding, IV dexa would be better initially, but this is just my POV....

  7. Join Date
    Jun 2007
    Posts
    2,841
    #77
    citicoline supposedly helps neural regeneration, pero no effect on mortality..

    the trend here is to use mannitol for the edema... that and diuretics.

    hehe. am currently rotating in neurology... 90% of our ER admissions are strokes and I'm getting surprised with how many young stroke patients we have

  8. Join Date
    Nov 2005
    Posts
    34,249
    #78
    yehey! 2 medical professionals here

    docs jm and scharnhorst, question...

    since nasa stroke ang topic

    i understand there are 2 kinds of stroke -- embolic and hemmorhagic

    so when a patient is brought to you showing symptoms of stroke (slurred speech, weakness on 1 side of body etc) how do you find out what kind of stroke is it? i mean how do you find out really fast?

    coz i also understand there is a 3 hour window of opportunity to prevent permanent damage if you inject the patient with tissue plasminogen activator to dissolve the blot clot

    but you gotta find out first if the stroke is caused by a blood clot

  9. Join Date
    Nov 2005
    Posts
    34,249
    #79
    Quote Originally Posted by surgeon_jm View Post
    marami factors sir uls.. on my part, i do not give beta blockers on elderly patients. they work by lowering your heart rate, lowering the amount of blood pumped out of heart, lowering bp. as we age, normally our heart slows down, so you cant afford to slow it down more. also beta blockers is the opposite of beta agonist (like salbutamol, w/c increases heart rate, palpitations as effects), that is why you cant give it to those with history of asthma, it can exacerbate it. combination drugs work better because the 2 drugs work synergistically (usually these 2 drugs are of different class, therefore different mode of actions, enhancing bp lowering effect)

    ace inhibitors are also good.. but the most common side effect is what the patient hates, COUGH. arb's present their action on the later part of the chain, eliminating the cough side effect. in the long run, lots of factors are involved in the decision making.. one thing important is the medication price, of which metoprolol is the cheapest. kaya you see most people who are hypertensives are started on this... esp the younger, non-asthmatic ones...
    hey thanks doc

    abangan mo, you're gonna get a lot of questions from me hehehe

  10. Join Date
    Nov 2005
    Posts
    34,249
    #80
    Quote Originally Posted by scharnhorst View Post
    citicoline supposedly helps neural regeneration, pero no effect on mortality..

    the trend here is to use mannitol for the edema... that and diuretics.

    hehe. am currently rotating in neurology... 90% of our ER admissions are strokes and I'm getting surprised with how many young stroke patients we have
    i know a 35 yr old guy who just had his first heart attack recently

    nagpa-stent siya

    35 yrs old lang dude

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