Risk Up to 40% of pts may be undernourished on admission to hospital, and two-thirds of all pts lose weight during hospital stay. 60% of elderly pts are malnourished at discharge. More than 376,000 people depend on TPN per year in USA. Perioperative Risks of Malnutrition Decreased respiratory, cardiac, and skeletal muscle mass and strength. Up to 50% of heart failure pts are malnourished. Decreased visceral…
Uses Incidence in USA: 100 million prescriptions are written per year; 17 million Americans use NSAIDs daily. Have analgesic, anti-inflammatory, and antipyretic properties. NSAIDs are the first step in the analgesic ladder of WHO; typically considered drugs of choice for mild to moderate pain. Can be obtained OTC or by prescription for chronic somatic pain states (e.g., arthritis) and rheumatologic disorders. Are given IV, IM, IN…
Uses Primary indications include Hyperlipidemia: Hydroxymethylglutaryl coenzyme-A (HMG-CoA) reductase inhibitors (statins) are the major hypolipidemic drugs. Nonstatin drugs are used in pts with side-effects or those not responding well to statin therapy. Evolocumab also has an indication specifically for the treatment of homozygous familial hypercholesterolemia. Primary and secondary prevention of CV disease: CV benefits (reduction in myocardial infarction and stroke) in pts with hypercholesterolemia and mixed…
Uses Therapy for pts with angina. CHF In MI, can reduce infarct size. Prinzmetal angina. Can be given as a patch, paste, or pill taken sublingually as needed. Uterine relaxation for retained placenta, although a systematic review did not demonstrate the efficacy of NTG used alone. May be beneficial in reducing postop morphine usage for pain management. Perioperative Risks Development of hypotension Drug rash (rare) Worry…
Uses Children: Acute or chronic pulm Htn associated with persistent pulmonary Htn of newborn (PPHN), meconium aspiration, CHD, and congenital diaphragmatic hernia Adults: Acute or pulm Htn associated with ARDS, pulm embolism, placement of a LVAD, and cardiac surgery Perioperative Risks Methemoglobinemia (especially breathing >80 ppm NO) NO 2 and peroxynitrite formation Worry About Methemoglobinemia; measure metHb, especially in infants, within 6 h and then every…
Acknowledgment The author would like to acknowledge the contributions of Drs. Subramanian Sathishkumar and Sanjib Adhikary to this chapter in the previous edition. Uses NRTs are USA FDA-approved devices that are effective in helping treat tobacco dependence, acting on nicotinic acetylcholine receptors to mimic or replace the effects of nicotine, the highly addictive chemical from tobacco products. NRTs are available OTC (e.g., gum, transdermal patch, sublingual…
Uses Reverse the effects of opioid-agonist overdose (although IV therapy is preferred). Prevent relapse in pts (including physicians) addicted to alcohol and/or opioids. Oral route is most common and popular. Newer formulations (e.g., Vivitrol [naltrexone for extended-release injectable suspension]) are once-monthly forms that release the drug over a long period so that pts (1) do not feel the effects of opioids if they try to abuse…
Uses MAOIs are a broad class of psychoactive medications that affect the metabolism of multiple neurotransmitters. MAOIs are indicated for many psychiatric conditions including but not limited to atypical depression, refractory depression, depression with prominent anxiety, low psychomotor activity, and severe phobias. Other indications include Parkinson disease, narcolepsy, and intractable headache. Perioperative Risks Risks result from accumulation of physiologically active neurotransmitters because of decreased levels of…
Uses Treatment of type 2 DM, particularly in overweight pts, when dietary management and exercise alone do not result in adequate glycemic control. A reduction of diabetic complications has been shown in overweight type 2 diabetic pts treated with metformin as first-line therapy after diet failure. Side Effects Very common: Nausea, vomiting, abdominal pain Common: Taste disturbance Very rare: Lactic acidosis Perioperative Risks Hypoglycemia (rare) Metformin-associated…
Acknowledgment The authors would like to acknowledge the contributions of Drs. Joshua W. Sappenfield and Christopher T. Stephens to this chapter in the previous edition. Uses Antiemetic Appetite stimulation Analgesia Recreational Epilepsy Glaucoma Mood disorders Spastic disorders Perioperative Risks Cross-tolerance with barbiturates, opioids, benzodiazepines, and phenothiazines Tachycardia, vasodilation with hypotension, anxiety, dysphoria, hallucinations (acute use) Airway hyperreactivity from chronic smoking (carbon monoxide inhalation) Decreased efficacy of…
Acknowledgment The author would like to acknowledge the contributions of Drs. Subramanian Sathishkumar and Sanjib Adhikary to this chapter in the previous edition. Uses Treatment of hypomagnesemia and magnesium deficiency in critically ill pts Treatment of torsade de pointes, atrial or ventricular arrhythmias, digoxin toxicity Prevention of seizures due to preeclampsia/eclampsia Decrease risk of cerebral palsy in the early preterm fetus Management of conditions with catecholamine…
Uses For treatment of manic episodes of bipolar disorder and some schizoaffective disorders. Approved for maintenance therapy to help prevent episodes of mania or depression. As an augmenting agent for antidepressants. Has also been used to treat aggression, PTSD, and conduct disorder in children. For hyperthyroidism (e.g., Graves disease) (may eventually lead to hypothyroidism). Perioperative Risks Extremely narrow therapeutic level with desired serum levels of 0.4-1…
Uses Include the leukotriene receptor antagonists montelukast, zafirlukast, and pranlukast (not available in USA) as well as the 5-lipoxygenase (5-LO) inhibitor zileuton. Montelukast is the most commonly used drug of this class in USA. Montelukast is a once-daily oral drug approved for the prevention of exercise-induced bronchospasm. Most commonly used as adjuvant anti-inflammatory agents in the treatment of chronic asthma in addition to inhaled corticosteroids. Mixed…
Uses Treatment of pts with insulin-dependent DM, hyperglycemia, DKA, and hyperkalemia Overview/Pharmacology Produced by the beta cells of the pancreatic islets of Langerhans. Proteolytic cleavage of the connecting peptide from proinsulin produces the C-peptide and insulin (peptides A and B), which are released into the circulation in equimolar amounts. In healthy subjects insulin is secreted at a basal rate of 0.5–0.7 U The administration of insulin…
Uses Reversal of airflow limitation via relaxation of airway smooth muscle tissue Long-acting formulations used for chronic therapy and short-acting formulations for acute symptom relief. Diagnosis of COPD: FEV 1 /FVC <0.70 after bronchodilator treatment. Overview/Pharmacology Two classes: Beta 2 agonist and anticholinergic. Inhalational administration decreases systemic effects, increases potency, and shortens time to onset. MDI, DPI, or NEB routes. Airway responsiveness is measured by improvement…
Uses Prevention or alleviation of moderate to severe menopausal signs and symptoms such as vasomotor effects, depressive mood changes, vaginal dryness, urogenital atrophy, osteoporosis, cardiovascular disease, and cognitive dysfunction Treatment of physiologic and physical manifestations of primary ovarian insufficiency Perioperative Risks Increased risk of VTE due to increased generation of fibrin, reduction in plasma levels of protein S, resistance to activated protein C, and higher levels…
Uses Rheumatoid arthritis treatment for patients without sufficient response to initial treatment with NSAIDs, steroids, or other DMARDs. May have efficacy in pemphigus vulgaris, psoriatic arthritis, and palindromic rheumatism but lacks trials is and rarely used due to availability of other therapies. Availability of other DMARDs, such as biologic TNF inhibitors and methotrexate, has decreased the use of gold. Perioperative Risks IM gold associated with higher…
Uses Used to treat a wide range of illnesses including but not limited to autoimmune disorders, postop nausea and vomiting, and chronic pain Overview/Pharmacology Adrenal cortex produces and releases two different types of corticosteroids: Mineralocorticoids (maintain salt and fluid balance) and glucocorticoids (affect metabolism and inflammation). Glucocorticoids have significant, wide-ranging physiologic effects by binding to cell surface receptors and crossing cell membranes to modify genetic expression.…
Uses Prevention of folic acid deficiency Treatment of megaloblastic anemia Experimental treatment for major depressive disorder Treatment of folic acid deficiency caused by anorexia, chronic use of oral contraceptive and some antiepileptic drugs, alcoholism, malabsorption diseases (e.g., sprue), bowel resection, and diverticulosis Reduces incidence of neural tube defects (spina bifida) and congenital heart defects in developing fetus Reduces homocysteine; may have cardiovascular benefits (no evidence of…
Acknowledgment The author wishes to acknowledge the contribution of Dr. Donald D. Koblin to the previous edition of this chapter. Uses Fluoxetine, an SSRI, is one of the most commonly prescribed medications in USA. Prescribed for the treatment of depression, OCD, and bulimia nervosa. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a…