Somatotropin: Do not use in Prader-Willi syndrome.
Low corticosteroids: Could mean that there is no functioning adrenal glands.
Diluted urine in a patient with head trauma: Use vasopressin (ADH).
A 35-year-old female, no menses, facial edema, dry skin: That is myxedema.
Levothyroxine: Could lead to hyperglycemia.
Low thyroid hormone: Check for tachycardia; maybe the patient took too much T3 and T4.
Graves’ disease: Before surgery, we usually use PTU.
Calcitriol: Lowers calcium and lowers PTH.
Adrenocortical insufficiency: Taper slowly.
Type 2 diabetes: Related to obesity and hereditary factors.
NPH insulin: Should not be used IV.
Lispro: Rapid acting
Type 1 diabetes: We give glucagon if the patient is not conscious.
Insulin pump: Check glucose levels and count carbs.
Metformin: Can produce a metallic taste.
Lispro: Should be used when breakfast is ready to eat.
Insulin: Lowers glucose by increasing the use of glucose inside the cell.
Glargine: Used in type 1 diabetes and usually given at bedtime.
Insulin (regular): If the medication is given at 7:30 to 9:30, we should check glucose at 9:30 before giving any more glucose.
Beta-2 agonists: They could increase heart rate.
Metoprolol: It's safe for asthma.
Atenolol: Patients should rise slowly out of bed.
Beta blockers: Check for heart rate and blood pressure.
Non-specific adrenergic agonists: Dilate pupils.
Cholinergic agonists (indirect acting): They act on the enzyme acetylcholinesterase, which blocks the breakdown of acetylcholine, so you have more acetylcholine in the body.
Bethanechol: If blood pressure is 90/60, hold the medication. Excessive sweating is a normal side effect.
Benztropine: Suppresses tremors and lessens muscle rigidity in Parkinson's
Atropine: Do not use in patients with angle-closure (narrow-angle) glaucoma.
Anticholinergics: Use gum to prevent dry mouth.
Scopolamine: Change the patch every three days; use it at all times.
Parkinson's (Benztropine): Used to suppress tremors and reduce rigidity.
Myasthenia gravis: (No specific note given, but included for context.)
Sinus bradycardia: Use atropine.
Anticholinergics: They lead to dry mouth.
Epinephrine: Should not be used in patients with diabetes mellitus, pregnancy, cardiac problems, or glaucoma.
Albuterol: Too much of it can cause paradoxical bronchospasm.
COPD: Beta-blockers are contraindicated in patients with COPD.
Atropine: Used to reverse the binding of toxins to acetylcholine in organophosphate insecticide poisoning.
Meclizine hydrochloride: Can lead to vertigo.
Bethanechol: Treats urinary problems.
BPH: Shouldn’t be used with cholinesterase inhibitors.
Digoxin and Warfarin: Used together for atrial fibrillation.
COPD vs. heart failure: Use BNP (B-type natriuretic peptide) to differentiate the cause of symptoms.
Digoxin: If the patient sees green halos, hold the dose.
Nitroglycerin sublingual: Increases the rate of absorption.
Nifedipine: If blood pressure is 90/60, ask to switch to diltiazem.
Ventricular dysrhythmias: Do not stop the medication abruptly.
Hydrochlorothiazide: If the patient’s blood pressure is 160/95 and urine output is only 200 ml in 12 hours, hold the medication and check BUN and creatinine for kidney function.
Edema with low urine output: Use furosemide in that situation.
Furosemide and aminoglycoside antibiotics: Be careful with tinnitus due to toxicity risk.
Spironolactone: A thiazide diuretic patient must report decreased urine output.
Hydrochlorothiazide and digoxin: They can lower potassium, which is dangerous.
Spironolactone: Can increase potassium.
Hypertension: Reduce weight and sodium intake.
Black patients with beta blockers: Add a diuretic to the medication group for better effect.
Elderly patient on thiazide diuretics: Initiate fall precautions.
ACE inhibitors: If a patient develops a dry cough, consider switching to an ARB. They can also cause edema in the lips (angioedema), and in that case, hold the drug as it could be a hypersensitivity reaction.
Increased blood pressure (rapid rise): Use short-acting nifedipine to treat it.
Low molecular weight heparin: Use in post-op patients to prevent clots.
Clopidogrel: Patients should avoid garlic (no restriction on grapefruit mentioned). Also, stop clopidogrel and aspirin 7 days before surgery.
High cholesterol and triglycerides: If total cholesterol is 285, triglycerides 188, LDL 175, and HDL 40, use atorvastatin.
Cholestyramine: For hyperlipidemia, it can cause constipation, so use fluids and fiber.
Simvastatin: Take it at night to lower cholesterol.
Male patient (67) with angina: Use sublingual nitroglycerin but check if he’s on Viagra (sildenafil) and hold nitroglycerin if he is.
