大雕药剂师 DD Pharmacist

大雕药剂师 DD Pharmacist 🦅👨‍⚕️大雕药剂师 🇲🇾 Phr Will (RPh)
📍培训师｜分享学习心得与成长故事
📍内容创作者｜聊健康常识 & 日常实用tips
📍希望用专业背景，把复杂的知识讲简单

23/08/2026

🚨 Interesting Drug Choice - part 15
✅ Answer: 2️⃣ Linagliptin

🧠 The hidden clues aren't the diabetes — they're the KIDNEY and HEART.

🚫 Why not saxagliptin?
◽️CKD:
Saxagliptin requires dose reduction to 2.5 mg once daily when eGFR

20/08/2026

Know your 💊 - cough syrup

14/08/2026

A journey — from learning to making a difference. 💊

07/08/2026

Interesting Drug Choice - part 14

🚨 Answer: 2️⃣ Nitrofurantoin

🦠 TMP-SMX has broader antimicrobial coverage.
So why not choose it?
🧠 The hidden clue = potassium.

Why not TMP-SMX
Trimethoprim:
➡️ Blocks renal ENaC
⬇️ K⁺ excretion
⬆️ serum K⁺

Combined with: ACE inhibitor + CKD
➡️ Hyperkalaemia risk

✅️Why Nitrofurantoin?
For uncomplicated cystitis:
● Targeted urinary activity
● Avoids trimethoprim's potassium-retaining effect

⚠️ But:
❌ Not for pyelonephritis
❌ Check renal function; generally avoid when eGFR

05/08/2026

Interesting Drug Choice - part 13
🚨 Answer: 2️⃣ Oral Semaglutide

🧠 The hidden clue isn't appetite… it's metabolic benefit.

✅️ Why oral semaglutide?
● ↓ Appetite
● ↑ Satiety
● Improves glucose control
● Greater weight reduction potential

📚 PIONEER Trials (NEJM, 2019)
➡️ Significant HbA1c reduction
➡️ Significant body weight reduction vs placebo and comparators in patients with type 2 diabetes

🚫What about naltrexone/bupropion?
● Reduces cravings
● Targets reward-driven eating

📚 COR-I Trial (Lancet, 2010)
➡️ Greater weight loss than lifestyle intervention alone
⚠️ Less weight reduction than GLP-1 receptor agonist therapy
⚠️ Monitor blood pressure and heart rate
⚠️ Use with caution in patients with cardiovascular risk factors

💡 Pharmacist Pearl
➡️Craving & emotional eating → Consider naltrexone/bupropion
➡️Weight + metabolic risk (e.g. prediabetes/T2DM) → Consider oral semaglutide

29/07/2026

Interesting Drug Choice - part 12
🚨 Answer: 3️⃣ Apixaban

🧠 The hidden clue? She needs excellent stroke prevention—but she's also an older patient, where bleeding risk becomes an important consideration.

🚫Why not Dabigatran?
❌ Higher GI bleeding risk in older adults
❌ More dyspepsia (indigestion)
❌ More dependent on good renal function (~80% renally eliminated)

✅️Why Apixaban?
● Excellent stroke prevention
● Lower major bleeding risk than warfarin (ARISTOTLE)
● Lower intracranial bleeding risk
● Lower GI bleeding risk than rivaroxaban in many real-world studies

✅ Apixaban - Better bleeding profile while maintaining excellent stroke prevention.

💡 Pharmacist Pearl
CHA₂DS₂-VASc tells you who needs anticoagulation.

Choosing the right DOAC also depends on:
✔️ HAS-BLED score
✔️ Renal function
✔️ Age
✔️ Previous bleeding history
✔️ Drug interactions

The best DOAC is the one that provides the best balance between stroke prevention and bleeding risk.

23/07/2026

Interesting drug choice - part 11
🚨 Answer: 2️⃣ Celecoxib (in selected patients)

🧠 The hidden clue isn't the MTX interaction… it's the overall risk.

Many think:
👉 "MTX patients cannot take NSAIDs."
❌ Not true.

For low-dose MTX (7.5–25 mg/week), NSAIDs can be used when necessary with monitoring.

⚠️ Both ibuprofen & celecoxib can affect MTX clearance
Why?
MTX is mainly cleared by kidneys.

NSAIDs may:
⬇️ Renal blood flow
⬇️ MTX clearance
⬆️ MTX toxicity risk

Higher risk with:
🚩 CKD
🚩 Elderly
🚩 Dehydration
🚩 High-dose MTX

✅️Why consider celecoxib?
Not because it avoids MTX interaction ❌
Because RA patients already have:
❤️ Higher cardiovascular risk
🤢 MTX-related GI side effects

Celecoxib:
● Similar pain relief
● Lower GI ulcer/bleeding risk than ibuprofen
● Comparable CV safety to ibuprofen at recommended doses (PRECISION trial)

💡 Pharmacist Pearl
RA pain management:
1️⃣ Control inflammation first → Optimize MTX/DMARD therapy
2️⃣ For symptom relief of RA flare→ Use the lowest effective dose for the shortest duration

Options:
Paracetamol → mild pain
Topical NSAID → localized pain
Short steroid course → flare
NSAID → if benefits outweigh risks

✅ Always assess:
✔️ Renal function
✔️ GI risk
✔️ CV risk
✔️ MTX dose

20/07/2026

Interesting drug choice - part 10
🚨 Answer: 2️⃣ Losartan

🧠 The hidden clue isn't the blood pressure… it's the uric acid.

Most people think:
👉 "All ARBs are the same."
❌ Not true.
Both lower blood pressure...
But only one helps lower uric acid.

🤔Why loaartan?
Most ARBs are uric acid neutral.

✅ Losartan is the only ARB with a clinically significant uricosuric effect.

It blocks the URAT1 transporter in the proximal renal tubule.
➡️ ↓ Uric acid reabsorption

➡️ ↑ Uric acid excretion

➡️ ↓ Serum uric acid

🚫Why not telmisartan?
✅ Excellent antihypertensive.
✅ Cardiometabolic benefits.
❌ Does not have a clinically meaningful uric acid–lowering effect.

💡 Pharmacist Pearl

For a patient with:
✅ Hypertension + gout
✅ Hyperuricemia
✅ Recurrent uric acid kidney stones

👉 Losartan is the preferred ARB (unless contraindicated).

Because it treats both hypertension and helps reduce uric acid—something other ARBs generally do not.

⚠️ Remember: Losartan is not a gout treatment and should not replace urate-lowering therapy (e.g., allopurinol) when indicated

17/07/2026

Interesting drug choice - part 9
🚨 Answer: 2️⃣ Amoxicillin-clavulanate

🧠 The hidden clue isn't the dental abscess… it's the WARFARIN.

Many people think:
👉 Anaerobic infection = Metronidazole
That's true…
But not in every patient.

🚫Why not Metronidazole
Metronidazole is one of the strongest antibiotics that interacts with warfarin.

What happens?
Metronidazole inhibits CYP2C9 ➡️Warfarin metabolism ↓➡️ INR ↑ ➡️Bleeding risk ↑

Possible consequences:
🚨 Easy bruising
🚨 Gum bleeding
🚨 GI bleeding
🚨 Serious hemorrhage (rare)

✅️Why Amoxicillin-clavulanate?
● Covers the common bacteria causing dental abscesses, including many oral anaerobes
● No clinically significant CYP2C9 inhibition
● Lower risk of a marked increase in INR compared with metronidazole

⚠️ Clinical Pearl
Even amoxicillin-clavulanate can occasionally affect INR.

Always advise patients on warfarin to monitor for bleeding and arrange INR monitoring when starting or stopping antibiotics.

14/07/2026

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