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Dandelion

Uses Rx for liver disease (e.g., liver congestion, hepatitis, jaundice) Rx for gallbladder disease Rx for appendicitis Rx for fluid retention (diuretic) Rx for appetite stimulate Less commonly used for mastitis, heartburn, boils, fevers, heart failure, among other uses Dietary supplement as a source of vitamins and minerals, including vitamin A, B, C, and D as well as minerals iron, potassium, and zinc Perioperative Risks No…

Creatine

Uses Medical: Historically used to lower cholesterol and treat rare conditions of heart failure due to creatine deficiencies; it has proposed benefits to decrease myalgias and myositis with statins. Fitness: Increased usage of creatine over past decade to increase muscle mass and enhance physical performance. Initially used by professional athletes, it is now used as a nutritional supplement in almost all areas of exercise fitness (in…

Cranberry

Uses Many cranberry juice consumers are aware of a beneficial link between cranberry juice and the prevention of UTIs. High in polyphenol activity. Potentially beneficial for prevention of upper GI ulcers, reducing the risks of CV disease, and improving oral hygiene. Native Americans and early American sailors used cranberries for treating wounds and blood poisoning, urinary illnesses, diarrhea, DM, and as an antiscorbutic agent. Perioperative Risks…

Chromium

Uses Body building (ineffective) May aid in glycemic control of type II DM and gestational DM Hyperlipidemia Hypoglycemia (reactive) Obesity Perioperative Risks Risks minimal Chronic ingestion associated in one case with thrombocytopenia, hepatic dysfunction, renal dysfunction You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Chondroitin Sulfate

Uses CS has been recommended for use as a nutritional supplement to reduce joint pain and inflammation associated with osteoarthritis. CS has been shown to have both anti-inflammatory and antioxidant effects on articular tissue; it modulates the anabolic/catabolic balance of the extracellular matrix. CS is commonly used in conjunction with glucosamine to provide an alternative therapeutic option with minimal side effects as compared with traditional treatments…

Chitosan

Uses Sustained-release drug carrier (chitosan glutamate) Transdermal drug delivery Weight-loss agent (poor) Decreases cholesterol and triglycerides and increases HDL total cholesterol ratio Cleaning petrochemical spills Water purification agent Hydrogel-based chitosan bandages for hemostasis and antibacterial properties Risk None known You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Carnitine

Uses Treatment of primary carnitine deficiency and deficiency secondary to complications of several inborn errors of metabolism, such as organic acidemia and fatty acid oxidation defects in children and adults, and acquired medical or iatrogenic conditions such as valproate and zidovudine treatment, cirrhosis, chronic renal failure on dialysis, etc. Treatment of valproic acid poisoning and/or overdosing and prevention of valproic acid–induced hepatotoxicity. Used for ADHD, erectile…

Blue Cohosh (Caulophyllum thalictroides)

Uses Commonly used by midwives as a uterine stimulant and for induction of labor. Major uses, therefore, include (1) inducing labor; (2) as an emmenagogue; (3) as an antispasmodic; and (4) as an abortifacient. Properties also include anti-inflammatory, antipyretic, diuretic, expectorant, vasoconstrictor, and smooth muscle relaxants. According to a national survey, 64% of midwives still use blue cohosh to induce labor and 7–45% of women use…

β-Sitosterol

Uses CHD and hypercholesterolemia. BPH and prostatitis. Gallstones. Enhances sexual activity. Prevents colon cancer. Boosts immune system. Topically for treating wounds and burns. Migraine headache, chronic fatigue syndrome, and symptoms of menopause. Asthma, allergies, bronchitis, SLE, and alopecia. Areas of potential application currently under investigation include the prevention of breast, ovarian, and lung cancers. Overview β-sitosterol is one of the major plant sterols found in humans.…

Androstenedione

Uses Testosterone replacement therapy Treatment of hypogonadal men Age-related sarcopenia HIV-related muscle wasting Increase in bone mineral density Prevention of age-related frailty and falls Perioperative Risks Coagulopathy Polycythemia You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Warfarin (Coumadin)

Uses Management of thromboembolic disorders: For prophylaxis, Rx, and prevention of recurrence of thromboembolic events including DVT, pulm embolism, thrombosis of grafts. Prevention of arterial emboli associated with prosthetic heart valves, nonvalvular AFib, acute MI. Prevention of MI, stroke, and recurrent MI. Rx for deficiency of antithrombin III, protein C, protein S. Unknown number of individuals receiving the drug. Perioperative Risks Hemorrhage (minor to major life…

Vitamin B 12 (Cyanocobalamin)

Indications Incidence of deficiency in USA varies with age: 5% of those <55 y, 10% of those 55–64 y, 10–15% of those 65–74 y, and 24% of those 74–80 y old. Some 75% of those >64 y with vitamin B 12 deficiency do not have anemia or even RBC abnormality. CDC states that 1 in 31 individuals 51 y of age or older are deficient in…

Valproate

Uses Most widely prescribed antiepileptic drug worldwide. Used in treatment of epilepsy, acute mania, bipolar disease, impulse-control disorders, migraine headaches, and neuropathic pain. Perioperative Risks Hemorrhage Platelet dysfunction Coagulopathy Hyperammonemic encephalopathy Seizures with subtherapeutic plasma concentration Worry About Decreased factor VII levels, plt count and function, factor VIII, protein C, fibrinogen, factor XIII, increased lipoprotein (a) levels, acquired von Willenbrand disease. Serum valproate levels of >140…

Trimethaphan

Acknowledgment The author would like to acknowledge Dr. Tor Sandven’s contribution to this chapter in the previous edition. Uses Production of controlled hypotension during surgery to reduce bleeding into the surgical field Rapid reduction of BP in the treatment of hypertensive emergencies Treatment of acute dissecting aortic aneurysm, particularly when preexisting conditions make the use of beta=blockers a relative contraindication Emergency treatment of pulm edema in…

Tranexamic Acid

Uses To prevent bleeding due to fibrinolysis after surgery or trauma (cardiac surgery with and without cardiopulmonary bypass; liver transplantation; orthopedic surgery including spine; GU surgery; peripartum hemorrhage). Bleeding can be diagnosed clinically or via lab tests (prolonged thrombin time, reduced fibrinogen levels, increased d -dimer levels, classic teardrop shape on thromboelastography). Antifibrinolytic choice in cardiac surgery has shifted from aprotinin to TXA and epsilon-aminocaproic acid…

Tissue Plasminogen Activator

Uses Clinical indications for thrombolysis in treatment of pulmonary embolism, acute ischemic stroke, acute MI, and occluded central venous access devices. MI: Administration as soon as possible from symptom onset Stroke: Administration within 3 h from onset of symptoms Rapid clot lysis by t-PA offers advantages in comparison with streptokinase. May be used in combination with other anticoagulants such as heparin and aspirin. Also may be…

Thyroid Supplements

Uses More than 3 million chronic users in USA. T 4 prescribed for pts with chronic hypothyroidism. T 3 used in myxedema coma. T 3 successfully used as rescue therapy for cardiogenic shock after CPB. T 3 favorably administered to brain-dead donors before organ harvesting for heart or heart-lung transplantation. (Prophylactic use of T 3 has shown no benefit in recent randomized trials.) T 4 is…

Thiazolidinediones

Acknowledgment The authors would like to acknowledge the contributions of Drs. Ponnusamy Saravanan and Subramanian Sathiskumar to this chapter in the previous edition. Uses Oral insulin sensitizing agents for the treatment of type 2 DM. Their use in recent years has declined due to concern for increased risk of new or worsening heart failure. Furthermore, questions have been raised about a possible association between TZD use…

Tetracyclines

Uses Administered PO (most common), IV (fewer side effects), IM (rare, painful), topically (eyes only). Original broad-spectrum antibiotic with activity against gram-positive and gram-negative bacteria; species of Chlamydia, Rickettsia, and Mycoplasma (in adults); some protozoa. One of few agents active against organisms without cell walls. Resistance is increasing worldwide. Secondary uses: Alternative drugs in the treatment of syphilis, treatment of respiratory infections caused by susceptible organisms,…

Tacrolimus (FK-506)

Uses Rescue of primary immunosuppressant Rx following liver, lung, heart, pancreas, and limb transplant. Approximate number of candidates: 3000 awaiting liver transplant and 9000 awaiting kidney transplant in USA; 15,000 living liver transplant and 50,000 kidney transplant recipients are chronically receiving immunosuppressants. Has been used to suppress the inflammation associated with ulcerative colitis. Perioperative Risks Htn: CCBs may be effective in treating tacrolimus-associated Htn, but care…