早晨血压上扬， 建议高血压药服用时间

人的血压在早上会有~2小时的上扬。 作为一个正常的生理现象，当人早上起床时，血压会上扬来给大脑和全身供血，以及准备一天的活动。 同理可证，大多数的心脏病发作和中风都在早晨发生。 

许多高血压的药品，尤其是剂量比较低的时候，药效不能持续24小时。如果您早上服药，服药前的药效也许不能够压住早上的血压上扬。

药剂师建议- 如果您吃高血压的药品，把服药时间定位晚上。这样，不用改变剂量，就可以保证早上的药效可以足够保护您。

"Heart Burn" or reflux vs Heart Pain 胃酸上扬 对比 心绞痛

胃酸上扬：

• 发作： 一般为饭后，身体弯曲（ex.饱餐一顿后立刻坐着办公）
• 痛感： 火烧，大面积，胸前，食管
• 疼痛时间 - 不等。几分钟到几小时
• 其他症状： 口中有酸味。肌肉力度，呼吸应该均和平常一样。
• 治疗：服用antacids (ex. Gaviscon, Tums, Diovol, Milk of Magnesia)。 如经常出现，与医师药剂师讨论强化治疗和用药。

心绞痛：（一般心绞痛的病人有高血压，高血脂，家庭历史等风险因素）

• 发作： 可以是任何时间（很多人在坐着或睡觉时候会突然发作）；一般情况下为运动后，饭后，心情紧张后，忽然着凉等。
• 痛感： 胸口痛，时常有压迫，胸口紧， 挤压，“绞”，肿胀，重压，火烧等等。 痛感因人而异，甚至一个人2次心绞痛都可能感觉不一样。痛感做什么都无太大的改变。（无论你是呼吸，咳嗽或者改变身体姿势）
• 疼痛时间 - 一般只有几分钟（1-5分钟），很少很少超过20分钟。如果长时间疼痛，一般会伴有如下的“其他症状”。而且长时间心绞痛是一个很不好的前兆。
• 其他症状：因人而异 - 上身其他部位（脖子，下颚，肩膀，上臂，后背）不舒服； 呼吸紧张（呼吸供氧下降很大一部分是心脏功能下降导致）； 虚汗； 呕吐和晕眩； 严重的情况会血压下降。
• 治疗：需和医师药剂师讨论。舌下用的Nitroglycerin (硝酸甘油）一般是救急用品。硝酸甘油一般可以在1分钟内缓解疼痛。如果您第一次心绞痛，或者心绞痛严重，请立刻叫救护车。如果5分钟内疼痛没有缓解，可以服用第二剂硝酸甘油。（硝酸甘油需坐下，或躺下时服用；如果服用者在过去的24小时内服用过伟哥等治疗勃起功能障碍药物，不得服用nitroglycerin。会导致血压剧降！必须有急救人员在场方可服用nitroglycerin）

高血压多种药物; treating high blood pressure with multiple medications

高血压的治疗一向给很多人带来困扰。血压该如何合理用药物控制总是一个不解的问题。很多人认为用药数量越少越好，其实并非如此：

研究证明，很多高血压的药品，盲目增加剂量会是副作用大大增加，而药效的增加幅度却非常小。如果您服用一个降血压的药品，但血压仍就偏高，先有的研究推荐少剂量添加另一类降血压的药品。用2味药达到的降压效果超出仅用一种药双倍剂量的效果的4倍之多。同时，不同类型的高血压药，药理不同，所以低剂量的2味药产生的副作用远远小于高剂量的一味药。 

如果您不介意吃多个药片，同时又对副作用有所顾虑，在您的医生提高药物剂量的时候，可以和您的医生讨论试用2味降血压药品的话题。 

Vitamin E as supplements NOT recommended routinely 减少维他命E的服用

Quite a number of patients are visiting the pharmacy for vitamin E supplements. I personally recommend against stand-along supplementation of vitamin E. Reasons are below,

vitamin E is an antioxidant that was marketed towards general health and boosting immune function many years ago. The marketing was based on the theory that antioxidants decrease free radicals in the body thus preventing cellular damage. Evidence did not exist in full strength then on the safety of supplementation. Multiple studies looking at such concern was published around 2004-2005, suggesting that supplementing with vitamin E can possibly cause HARM with NO BENEFIT in cardiovascular protection. It is suggested that vitamin E supplementation if necessay must be kept under 400IU daily and an intake of 400IU or greater has been shown to increase risk of heart failure minimally in high risk patients and increase all-cause-mortality with dose >400IU/day.

In addition, vitamin E has been noted to increase bleeding tendency in patients taking NSAIDs, Warfarin, ASA or other blood thinning products. It is suggested to limit supplementation to 200IU if necessary or discontinue supplementation if vitamin E is not necessary.

Vitamin E:
sources: nuts, seeds, vegetable oils
daily requirement ~22.4IU from natural sources daily for general population (value may vary with references)
Usual commercially available products, 200IU and 400IU from natural or synthetic sources

虫咬，野外植物过敏现象 - bug bites and plant contact allergy

虫咬或被植物蛰了过后，

1. 用水和肥皂洗净
2. 可以考虑用上敷药品 - Astringents, Oatmeal baths (Aveeno), Calamine Lotion，此类产品可以使皮肤舒服一些，止痒，晾干。
3. OTC非处方 hydrocortisone 也可以使用，但效果并没有处方类药品理想。如果情况不严重，不需要用hydrocortisone, 情况严重的话，建议见医生开处方类上敷皮质类固醇。
4. 口服过敏药效果未必理想，应为痒的感觉不完全是由于histamine release. 口服过敏药效果平平
5. 上敷过敏药，麻醉药（止痛药）以及抗生素也不建议，应为会刺激皮肤。

hydrocortisone和其他上敷皮质类固醇需1-2日才能见效，保留此类药为中等-严重蚊虫叮咬现象。

Hypoglycemia

These has been a lot of talk about treating hypoglycemia/low blood sugar,

Remain calm, Suggested treatment include - 15g of simple sugar (glucose or table sugar, etc), use 20g of simple sugar to correct severe hypoglycemia. This is about 3-4 glucose tablets, 5-6 hard candy and 120mL of REGULAR soda.

Suggest retesting 15min after a hypoglycemia episode,

and suggest a small meal after blood sugar has been corrected.

treatment of diarrhea - children

Always rehydrate.

Rehydration solutions are available and if diarrhea is not severe, rehydrate as needed. DO NOT over rehydrate with plain WATER. This may cause eletrolyte imbalance which can be dangerous as well.

Rehydration solution calculation (with rehydration solution)

Home-made rehydration solution - 1 teaspoon (5mL) of salt AND 8 teaspoon of sugar (40mL) in 1 litter of water. DO NOT use pop or certain juice, due to large amount of sugar. 

for mild-moderate dehydration,

50mL/kg over the first 4 hours (NOT ALL TOGETHER in one dose) 

moderate-severe dehydration, (must seek medical attention)

100mL/kg over the first 4 hours

rehydration should continue beyond 4 hours if needed. 

Plain water is harder to absorb than rehydration solution in case of diarrhea and plain water has no eletrolytes to replenish the loss.

Drugs

In case of suspected infectious causes - ex. unsanitized food, house hold, school, work place outbreak. Some drug therapy may not be used.

DO NOT use,

bismuth subsalicylate - Pepto Bismo - contains salicylate, not recommended in children. In addition, efficacy data is not firmly established.

Loperamide, Imodium - not approved to be used in children <2. Must consult physician <12. Risk of mental side effects with Imodium. 

Psyllium, metamucil - can be used with physician's guidance. Do not use products with laxative. 

Attapulgite - not recommended. very weak efficacy data.