48.3 🩺 內科專科考前版

48.3.0.1 📌 䞀頁重點

  • 22E: CHS 認可、emerging neurokinin antagonist
  • Gastroparesis management
  • Hyperemesis gravidarum management
  • Taiwan: H. pylori treatment 高 resistance issue

48.3.0.2 💊 進階

48.3.0.2.1 Gastroparesis (DM)
  • Glycemic control
  • Metoclopramide / domperidone
  • Erythromycin
  • Severe: gastric pacemaker (Enterra)
  • Refractory: pyloroplasty / G-POEM
48.3.0.2.2 Hyperemesis Gravidarum
  • Doxylamine + B6 first
  • Ondansetron (caution 1st trimester)
  • Promethazine, prochlorperazine
  • IV fluid + thiamine + electrolyte
  • Severe: NJ tube / TPN
48.3.0.2.3 Chemo-Induced N/V
  • Highly emetogenic: 5HT3 + dexa + NK1 (aprepitant) + olanzapine
  • Moderately: 5HT3 + dexa
  • Cisplatin: 4-drug regimen
48.3.0.2.4 CHS
  • 停 THC唯䞀根治
  • Acute: capsaicin cream + haloperidol + IV fluid
  • Patient education + addiction counseling

48.3.0.3 🌟 Pearls (6)

  1. CHS = THC chronic + hot shower
  2. Gastroparesis G-POEM emerging
  3. Pregnancy ondansetron caveat (1st trimester)
  4. H. pylori resistance rising
  5. Tardive dyskinesia with metoclopramide > 12 weeks
  6. Cyclic vomiting syndrome in adults related to migraine

48.3.0.4 📍 Taiwan Context

  • H. pylori treatment 高 resistance → quadruple
  • 健保 ondansetron, metoclopramide
  • Cannabis 非法 䜆 CHS rising 報告

48.3.0.5 🎓 內專重點

  1. N/V 病因 framework
  2. Antiemetic 機蜉 + 副䜜甚
  3. CHS22E
  4. Gastroparesis
  5. Hyperemesis gravidarum

⚠ AI 草皿。