core wisdom of Traditional Chinese Medicine

align with the rhythms of nature

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‌"To align with the rhythms of nature and attune to seasonal transitions is both the essence of health cultivation and the core wisdom of Traditional Chinese Medicine."

道医 - 崂山

‌Guidelines for Medication Administration: Solvents, Infusion Rates, and Dilution Volumes

By in Default, Disease Encyclopedia, Wellness Management

1. Compatible Solvents‌

‌A. Drugs Unsuitable with Sodium Chloride Injection (0.9% NaCl)‌

  • Cyclophosphamide
  • Cisplatin
  • Amphotericin B
  • Erythromycin
  • Pancuronium Bromide
  • Fleroxacin

‌B. Drugs Unsuitable with Glucose Injection (5% or 10% Dextrose)‌

  • Penicillins (e.g., Ampicillin)
  • Cephalosporins (e.g., Ceftriaxone)
  • Phenytoin Sodium
  • Acyclovir
  • Reteplase
  • Etoposide
  • Teniposide
  • Nedaplatin

‌2. Infusion Rate Considerations‌

  • ‌Vancomycin‌: Rapid infusion (>500 mg/h) risks ‌Red Man Syndrome‌ (flushing, hypotension). Infuse over ≥2 hours.
  • ‌Amphotericin B‌: Rapid infusion may cause ‌ventricular fibrillation/cardiac arrest‌. Infuse over ≥6 hours.
  • ‌Vitamin K‌: Rapid IV injection can trigger facial flushing, diaphoresis, chest tightness, hypotension, or collapse. Prefer ‌intramuscular (IM) administration‌.

‌Light-Sensitive Drugs Requiring Protected Infusion‌:

  • Aminosalicylate Sodium
  • Nitroprusside Sodium
  • Dactinomycin
  • Vincristine
  • Nimodipine
  • Fluoroquinolones: Levofloxacin, Pefloxacin, Moxifloxacin

‌3. Dilution Volume and Compatibility‌

‌A. Potassium Chloride (KCl) Injection‌

  • ‌Never administer undiluted‌—risk of cardiac arrest.
  • ‌IV concentration limits‌:
    • General use: ≤0.3% (20–40 mEq/L).
    • Severe hypokalemia/arrhythmia: 0.6–0.7% (40–60 mEq/L) with ECG monitoring.

‌B. Ceftriaxone Sodium Compatibility‌

  • ‌Avoid mixing with calcium-containing solutions‌ (e.g., Calcium Gluconate, Ringer’s Lactate, TPN with calcium) due to ‌particulate formation‌.

‌Key Recommendations‌:

  1. ‌Solvent selection‌: Verify compatibility to avoid precipitation or inactivation.
  2. ‌Infusion rate‌: Adhere to guidelines to minimize adverse reactions.
  3. ‌Dilution‌: Follow concentration limits and compatibility tables strictly.

Always consult institutional protocols or a pharmacist for drug-specific administration guidance.

‌Special Precautions for Medication Use

By in Default, First Aid Guide, Wellness Management

‌1. Medications Requiring Increased Water Intake‌

  • ‌Bronchodilators‌: Theophylline, aminophylline, diprophylline.
  • ‌Choleretics‌: Phenylpropanol, hymecromone, dehydrocholic acid, ursodeoxycholic acid.
  • ‌Protease Inhibitors‌: Ritonavir, indinavir, nelfinavir, amprenavir, lopinavir.
  • ‌Bisphosphonates‌: Alendronate, pamidronate, clodronate.
  • ‌Antigout Agents‌: Benzbromarone, probenecid, allopurinol.
  • ‌Antilithics‌: Herbal stone-expelling decoctions or granules (e.g., Paishi Tang).
  • ‌Electrolytes‌: Oral rehydration salts (ORS).
  • ‌Sulfonamides‌: Sulfadiazine, sulfamethoxazole, cotrimoxazole.
  • ‌Aminoglycosides‌: Streptomycin, gentamicin, kanamycin, amikacin.
  • ‌Fluoroquinolones‌: Ciprofloxacin, levofloxacin, etc.
    ‌Note‌: Alkalinize urine when using antigout drugs, sulfonamides, or aminoglycosides.

‌2. Medications Requiring Limited Water Intake‌

  • ‌Gastrointestinal Agents‌:
    • Bitter stomachics (e.g., gentian tincture).
    • Mucosal protectants (e.g., sucralfate, bismuth pectin).
    • Tablets meant to be chewed directly (e.g., antacid chewables).
  • ‌Antitussives‌: Cough syrups (e.g., licorice compound mixture).
  • ‌Antianginal Drugs‌: Sublingual nitroglycerin, Shexiang Baoxin Pills.
  • ‌Antidiuretics‌: Desmopressin.

‌3. Medications Not to Be Taken with Hot Water‌

  • ‌Digestive Enzymes‌: Pepsin, pancreatin.
  • ‌Vitamins‌: Vitamin B₁, B₂, C (heat-sensitive).
  • ‌Live Vaccines‌: Oral polio vaccine (sugar pill).
  • ‌Probiotics‌: Lactobacillus preparations (e.g., Lactasin, Zhengchangsheng).

‌4. Disulfiram-like Reactions‌

‌Avoid alcohol‌ when taking:

  • Metronidazole, tinidazole.
  • Cephalosporins: Ceftriaxone, cefoperazone.
  • Others: Chlorpromazine, furazolidone.

‌5. Interactions with Tea‌

Tea tannins bind to:

  • Metal ions (iron, calcium).
  • Proteins.
  • Tetracyclines, macrolides, and alkaloids (e.g., quinine).

‌6. Interactions with Vinegar‌

Avoid combining vinegar with:

  • ‌Sulfonamides‌, ‌antigout drugs‌, or ‌aminoglycosides‌ (these require urine alkalinization).

‌7. Interactions with Fats/Proteins‌

  • ‌Fats enhance absorption‌ of griseofulvin and fat-soluble vitamins (A, D, E, K).
  • ‌High-protein diets‌ reduce levodopa efficacy.
  • ‌Adrenal corticosteroids‌: Increase protein intake to counteract muscle wasting.
  • ‌Isoniazid‌: Avoid fish (risk of histamine toxicity due to impaired protein metabolism).

‌8. Grapefruit Juice Interactions‌

Grapefruit juice inhibits CYP3A4, increasing bioavailability of:

  • ‌Calcium channel blockers‌: Verapamil, dihydropyridines (e.g., nifedipine, ‌except amlodipine‌).
  • ‌Immunosuppressants‌: Cyclosporine.
  • ‌Statins‌: Atorvastatin, simvastatin.
  • ‌Sedatives‌: Triazolam, diazepam.

‌Note‌: Grapefruit juice has ‌no effect on amlodipine‌.

‌Key Reminders‌:

  • Follow dosing instructions precisely to avoid toxicity or reduced efficacy.
  • Consult a pharmacist or physician for personalized guidance on drug-food interactions.

‌Mechanisms and Characteristics of Procoagulant Agents

By in Default, Disease Encyclopedia, Wellness Management

Procoagulant drugs enhance blood clotting through diverse pathways. Below is a detailed classification of their mechanisms:

‌1. Coagulation Factor Synthesis Enhancers‌

  • ‌Vitamin K₁‌: Essential for hepatic synthesis of coagulation factors ‌II, VII, IX, and X‌. Deficiency leads to impaired clotting and prolonged ‌prothrombin time (PT)‌. Vitamin K₁ restores factor synthesis and exhibits mild analgesic properties.

‌2. Coagulation Factor Activators‌

  • ‌Etamsylate‌: Promotes platelet release of ‌clotting factors‌, induces ‌vasoconstriction‌, and shortens bleeding/clotting times to achieve hemostasis.

‌3. Antifibrinolytic Agents‌

  • ‌Tranexamic Acid‌ and ‌Aminocaproic Acid‌: Amino acid derivatives that ‌competitively inhibit fibrinolysis‌ by binding to lysine sites on plasminogen or plasmin, blocking fibrin degradation and stabilizing clots.

‌4. Vascular Permeability Modulators‌

  • ‌Carbazochrome‌: Reduces ‌capillary permeability‌ and enhances retraction of damaged capillary ends to accelerate clot formation.

‌5. Snake Venom Thrombin-like Enzymes‌

  • ‌Batroxobin‌ (from Bothrops atrox venom): A neurotoxin-free enzyme with ‌thrombin-like activity‌. Promotes ‌platelet aggregation‌ at injury sites without systemic coagulation effects.

‌6. Heparin Antagonists‌

  • ‌Protamine‌: A strongly basic protein that neutralizes heparin via charge interactions. Used to reverse ‌heparin- or low-molecular-weight heparin (LMWH)-induced anticoagulation‌, particularly in postoperative or overdose scenarios.

‌Clinical Notes‌:

  • ‌Vitamin K₁‌: First-line for warfarin overdose or malabsorption-related deficiencies.
  • ‌Antifibrinolytics‌: Preferred in hyperfibrinolytic states (e.g., trauma, menorrhagia).
  • ‌Batroxobin‌: Local hemostatic action makes it ideal for surgical or dental procedures.
  • ‌Protamine‌: Administer slowly to avoid hypotension or anaphylaxis.

Procoagulants are selected based on the underlying cause of bleeding, patient comorbidities, and drug-specific risks. Always monitor coagulation parameters (e.g., PT, aPTT) during therapy.