I'D verify?
MM (PMH: MG) begins therapy for multiple myeloma and is ordered levofloxacin 500mg QD and acyclovir 400mg BID. He is ordered lorazepam 2mg PRN for anxiety.
Fluoroquinolones
“’Black box’ warning for this drug in MG. Use cautiously, if at all”
Lorazepam
Beta Blockers
"May worsen MG. Use cautiously”
BA (PMH: MG) is complaining of pain from a twisted ankle and a tummy ache. The team orders ibuprofen 200mg q6h, acetaminophen 650mg q8h, and oxycodone 5mg q6h PRN.
Be cautious with CNS depressants/opioids!
HP (PMH of MG) is found to have H. Pylori. The intern orders Amoxicillin 1g BID, Clarithromycin 500mg BID, and pantoprazole 40mg BID
Macrolides
"May worsen MG, use cautiously, if at all”
The cards resident sees WP (PMH: MG) has WPW syndrome. Two different interns put in orders for procainamide and ibutilide. Which one do you verify?
No procainamide!
"May worsen MG. Use with caution”
OD (PMH: MG) comes into trauma rm 1 with a GCS of 8. The resident prepares to intubate. The paralytic you grab is...
Not succinylcholine!
The first of this class was discovered in 1943 by Selman Waksman at Rutgers University from a strain of soil bacteria. It inhibited the growth of the organism that causes TB.
Aminoglycosides
“May worsen MG, use cautiously if no alternative treatment available”
DM is a 40 yo M (PMH: MG) with new diagnosis of diabetes. The team orders atorvastatin 20mg QD and an insulin aspart sliding scale. The pended discharge med rec includes metformin 500mg BID. Which medications do you verify?
Be careful with the statin!
“May worsen or precipitate MG. Use cautiously if indicated and at lowest dose needed”
AE (PMH: MG) arrives in trauma rm 3 with a seizure. By the time you get there, the resident is already talking about getting phenytoin, benzos, levetiracetam, and valproate ready. What do you grab?
Be careful with phenytoin, avoid benzos!