After about a month and a half into my rotation, I felt pretty confident about the recommendations I was making, and my everyday routine. However, I continued to learn that I knew only a fraction of what was out there. Here is my second "edition" of questions I initially did not know the answer to.
1. What will 1 unit of platelets do for a patient? Increase the platelet count by 30-50K.
2. What could you use as a cathartic (diuretic) in a patient with CHF and a history of heavy alcohol abuse? lactulose!
3. When can you start different oral diabetic agents after using imagine that requires contrast? You can use glipizide right after contrast, but with metformin you have to wait 2 days after contrast.
4. What should you monitor when giving valproate? LFTs
5. How should you dose alpha blockers? These are the 'zosins, and they should be titrated up d/t orthostatic hypotension. For example, with terazosin, you could do 2mg x 1 week, 4mg x 1 week, and 6mg indefinitely.
6. What is the dose of ceftazidime for pseudomonas UTI? You could do 1g q8h, or 1g BID for renal dysfunction.
7. What can cephalosporins cause? Elevated transaminases.
8. What bugs can cause culture-negative endocarditis? HACEK - H. aprophilus, Actinobacillus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae.
9. What is the maximum gabapentin dose? 3600mg/day.
10. What lab value is indicative of jaundice? bilirubin >4.
11. What are you worried about in a patient with FEV1 < 1.0? You're worried about CO2 retention when you're replenishing O2.
Recommendations: I noticed that a patient was not being started on an ACEI post MI, and when I looked into it, the patient had an ACEI allergy. So, I recommended trying losartan instead. I also started a patient on ASA 81mg, since I saw that he wasn't on it and had a history of drug-eluting stents. I also recommended that a patient be started on calcium and vitamin D supplements, since the patient was on chronic prednisone therapy for his COPD.
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