هل تطبيق Medscape مناسب للبحث عن التداخلات الدوائية؟؟؟

🛑 treatment diabetes type 2
In hospitalized patients:

✅Do not use correction or supplemental insulin (formerly known as sliding-scale insulin) without basal insulin as the sole regimen in hospitalized patients (Strong recommendation).
##Dynmied

🛑when we use combination therapy antihypertensive or monotherapy???
✅Choose initial combination therapy with 2 agents from different classes if BP ≥140/90 mm Hg

✅Choose initial monotherapy if:

✅SBP 120-139 mm Hg or DBP
70-89 mm Hg

✅≥85 years old

✅Symptomatic orthostatic hypotension

✅Moderate to severe frailty

#Dynmied

حساب ميكروميدكس الجديد

User: univga

Password: 9ACDMDX

🛑Anticoagulant-related nephropathy (ARN

✅is a form of acute kidney injury (AKI) without an obvious etiology that may occur in the setting of excessive anticoagulation (for example, INR > 3 for warfarin therapy).

✅ARN was originally discovered in relation to excessive anticoagulation with warfarin therapy, but it is known to also occur in patients anticoagulated with direct oral anticoagulants (DOACS), such as, dabigatran, rivaroxaban, and apixaban

✅ARN is characterized by a distinct pattern of glomerular hemorrhage on a biopsy, and it is associated with an increased renal morbidity and all-cause mortality.

🛑Evaluation

✅Suspect ARN in patients with unexplained AKI (defined as an increase in serum creatinine by > 50% or > 0.3 mg/dL from baseline) in the setting of anticoagulation with warfarin (mainly, and at INR > 3) or DOACs.

✅ARN most likely occurs ≤ 2 months of starting anticoagulation therapy.

✅If gross or microscopic hematuria is present, ARN should be highly suspected.

✅If no hematuria is present, ARN should be considered

#Dynmied

حساب لكزيكمب الجديد
Lexicomp or Lexidrug

اسم المستخدم
UcPharmacy21
كلمة السر
skaggs21


تقدر تدخل عبر الرابط هذا الى الموقع
وسوف انزل فيديو توضيحي

فيديو توضيح لتسجيل الدخول


وهذا الموقع
https://online.lexi.com/lco/action/login

✅  11 معلومة  مهمه عن دواء hydroxyurea المستخدم من ضمن معالجة فقر الدم المنجلي SCD ⬇️⬇️
✅دواء hydroxyurea يعمل على زياده HBf بتالي يقلل من الحاجة الى نقل دم
✅الدواء يقلل من عدد مرات دخول مريض SCD المستشفى،يقلل من الألم و acute chest syndrome
✅يعطى في حاله moderate to sever SCD , للاطفال فوق سن ٦اشهر
✅جرعة الدواء 10_15mg لكل كيلو من الوزن ،ممكن نزيد كل ٨اسابيع بنسبه 5mg لجرعه 35mg/kg
✅الزيادة في الجرعة بناء على فحص MCV و Hbf 
✅نعمل Montoring CBC كل أسبوعين  في البدايه  ثم كل ست اسابيع عندما نستقر على جرعه ثابتة
✅الاستجابة للدواء تحتاج 3 الى 6 اشهر
✅يتم ايقاف الدواء في احدى الحالات التالية اذا نقص نسبه الهيموجلوبين Hb اقل من 4.5g/dl ,انخفاض absolute neutrophil لاقل من الفين ،او انخفاض الصفائح الدموية لاقل من ٨٠الف او reticulocyte لاقل من ٨٠الف
✅عند ارجاع الدواء بعد إيقافه نبدا بجرعه اقل مما كانت عليه ب 5mg
✅نعطيه مع الفوليك أسيد لان يعمل على اخفاء اعراض نقص الفوليك أسيد
✅لايعطى في الحوامل والمرضعات
#salah

حساب ليكزي الجديد (القديم إتقفل)


💠 New lexicomp access 💠



Username :commhealth

Password : commhealth

بما انه حساب Micromedex يتغلق كل فتره
فيه برنامج dynamedex مدموج بين برنامجين (dynamed +Micromedex ) يعتبر مدفوع لكن تقدر تعمل فيه حساب مجاني كل فتره وهذه الطريقه

هذا الفيديو شرح طريقه عمل حساب ديناميدكس(dynamedex ) مجاني
ب تدخلوا الموقع ذا
https://www.dynamedex.com/
تسجلوا فيه بحساب مجاني الي هو لمدة شهر فقط
بالنسبه للبيانات الي اضفتها هي عشوائيه تقدر تفعل الي تشتي
بالنسبه للايميل فيه موقع يجب ايميل وهمي كل فتره تعمل واحد فيه وتعمل حساب جديد
هذا الموقع
https://temp-mail.org/

@clinical_notes

Vassopressors drugs in septic shock

🛑 vassopressors drugs in septic shock patients with history of chronic hypertension

✅In septic shock patients with a history of chronic hypertension, current evidence suggests that the standard mean arterial pressure (MAP) target of ≥65 mmHg may be insufficient to optimize organ perfusion, particularly renal function. Instead, a higher MAP target around 80–85 mmHg is often recommended for these patients.

الف الف مبرووووك لدكتور عاطف السمان
الدعوة عامه شرفونا بالحضور
#افراح_ال_سمان
#الدكتور_يحتفل

🛑New Recommendations for Antithrombotic Therapy in Patients with Acute Coronary Syndromes

✅Consider early use of aspirin (upon symptom onset) and P2Y12 inhibitors (within the first 24 hours, earlier for STEMI) in all patients (class 1).

✅In patients considered for percutaneous coronary intervention (PCI), ticagrelor or prasugrel are preferred over clopidogrel, unless there are contraindications, high bleeding risk, or issues with availability or affordability (class 1).

✅If the patient is considered for PCI but the procedure will be delayed for >24 hours, start an oral P2Y12 inhibitor up front (class 2b).


✅Do not routinely use glycoprotein IIb/IIIa inhibitors (class 3) but consider using them for bailout (large thrombus burden or no flow; class 2a).


✅Administer dual antiplatelet therapy (DAPT) for 12 months, unless there is high bleeding risk, in which case consider de-escalation to ticagrelor monotherapy (class 1) or clopidogrel monotherapy (class 2b) after 1 month


✅Consider anticoagulation in all patients prior to PCI (class 1).


✅Bivalirudin is preferred over unfractionated heparin to reduce mortality and bleeding in STEMI (class 1) and to reduce bleeding in non-STEMI ACS (class 2b).

✅If bivalirudin is used for procedural anticoagulation in STEMI, continue a high-dose post-PCI infusion for 2 to 4 hours


✅Do not use fondaparinux in patients undergoing PCI because of the risk for guide catheter thrombosis (class 3).

✅If patients have an indication for oral anticoagulation (e.g., atrial fibrillation), continue DAPT plus anticoagulation for 1 to 4 weeks only, followed by anticoagulation with single antiplatelet therapy, preferably clopidogrel (class 1).

#NEJM watch 2025

🛑Fresh Frozen Plasma and Platelet Transfusions in Critically Ill Adults

✅In stable, nonbleeding patients with thrombocytopenia but without high risk for spontaneous bleeding, platelet transfusion is suggested when levels drop below 10,000/µL.

✅In stable, nonbleeding patients with thrombocytopenia with high risk for spontaneous bleeding (IMPROVE bleeding score, ≥7), platelet transfusion is suggested when levels drop below 30,000 to 50,000/µL.

✅In patients with thrombocytopenia and serious active bleeding, platelet transfusion is suggested when levels drop below 50,000/µL.

#NEJM watch guidelines 2025

Acute kidney injury: when and how to start renal replacement therapy
#CCR Journal Watch2025

🛑 steroids administered for septic shock in adult

✅ We suggest administering low-dose hydrocortisone (200-300 mg/day) to patients with septic shock unresponsive to initial fluid resuscitation and vasopressors for the purpose of recovering from shock (GRADE 2C).

🛑steroids administered for septic shock in pediatric patients

✅ We suggest against routine administration of steroids for pediatric patients with septic shock who are unresponsive to initial fluid therapy and vasopressors (GRADE 2D)

#Japanese guideline

#remember

✅Hypothyroidism ↓ clotting factor clearance → warfarin resistance

✅Thyroxine therapy ↑ clearance → increased warfarin sensitivity

✅Always reassess INR after any thyroid dose change

🛑 Anticoagulation in the Intensive Care Unit


✅Heparin remains the anticoagulant of choice in critically ill ICU patients due to its favorablepharmacokinetic properties, including a short half-life that allows for rapid titration or discontinuation,safety in patients with renal impairment-particularly with unfractionated heparin (UFH)-and theavailability of a specific reversal agent (protamine sulfate) in cases of bleeding or urgent procedures.

#Textbook of crtical care