A physician orders 300gms of albumin post paracentesis, how many milliliters of 25% albumin do you need to give 300gms?
LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.
His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN's medication includes Dexamethasone 8 mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram 20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10 mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10 mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K 5.0 mmol/L, Na 135 mmol/L.
Which of the following medication may significantly cause QT prolongation?
Celexa causes dose-dependent QT interval prolongation, which can cause Torsades de Pointes, ventricular tachycardia, and sudden death. Celexa is not recommended for use at doses greater than 40 mg per day because such doses cause too large an effect on the QT interval and confer no additional benefit. Celexa should be discontinued in patients found to have persistent QTc measurements greater than 500 ms. Ondansetron and Famotidine may cause QT prolongation. Ondansetron may cause QT prolongation. However, this would be dose-dependent. Doses greater than 16 mg of Ondansetron IV are no longer recommended due to an increased risk of QT prolongation. Famotidine may prolong the QT interval; this has been reported in those with renal dysfunction. There have also been reports of torsade de pointes. Use of all three medications may result in an arrhythmia occurring since both have the potential to prolong the QT interval. Therefore, close monitoring is recommended or discontinuation of one medication. The other medications listed do not have this warning/precaution.
Which of the following medication may increase LDL?
LDL can be elevated by diuretics, cyclosporine, glucocorticoids, and amiodarone.
http://circ.ahajournals.org/content/129/25_suppl_2/S1
CJ is a 69-year-old male with a history of diabetes, hypertension and hypercholesterolemi
a. His fasting lipid profile is TC 530 mg/dL; LDL-C 125; HDL-C 48 mg/dL; and TG 640 mg/dL. His A1c 8.1, calculate creatinine clearance is 65mls/hr, BP 135/80 mm Hg, HR 70 beats /min.
His current medications include metformin 1000mg po bid, lisinopril 20mg daily, sitagliptin 50mg bid and atorvastatin 40mg daily.
What is the best pharmacological agent to initiate on CJ?
It is reasonable to add triglyceride-lowering medications such as fibrates or niacin to prevent pancreatitis in those with triglyceride levels >500 mg/dL, which applies to this patient as his TG level is 640 mg/dL . C. is wrong because gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis. Fenofibrate may be considered concomitantly with a low- or moderate- intensity statin when triglycerides are above 500 mg/dL,2, however he is on a high intensity statin therapy. For niacin, the IR dose should start at 100 mg TID2 and niacin does not lower triglyceride levels as much as fibrate do.4 Fenofibrates are dose adjusted for renal function lower than 60 mL/min to 54 mg/mL, so this dose is appropriate for this patient because of his renal function being above 60 mL/min. The best option is fenofibrate 162 mg daily, but this needs to be monitored for any symptoms of muscle pain exhibited by the patient, especially as the patient is at a higher risk due to being a diabetic. Fish oil is not a first line agent to treat hypertriglyceridemia.
http://circ.ahajournals.org/content/129/25_suppl_2/S1
LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.
His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN's medication includes Dexamethasone 8mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075mg po daily, Lisinopril 10mg po daily, Citalopram 20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock-out
every 6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/ dl, K 5.0mmol/L, Na 135mmol/L. The bioavailability of levothyroxine is roughly 50%.
The physician requests you for a dose recommendation to convert her home dose of 75mcg po daily to intravenous.
What would be the appropriate intravenous dose?
Since the bioavailability of levothyroxine is roughly 50% (given in the Question:). To convert
the home dose to intravenous, it would be 50% of the oral dose. So 50% of oral 75 mcg would be 37.5 mcg intravenously.
