An interesting case
52 yo male scheduled for right thoracoscopy for tumor vs empiema (tough surgery was sure It was on the cancer side) with a history of heavy smoking over 20 years, HBP with no treatment, dilated miocardiopath, heart failure with FEV1 20%, recent onset AF. Current meds are digoxine, furosemide, enalapril and metoprolol. At the OR the patien was unstable with AF all over the place, my attending cancelled the case, but what would be your plan for this patient? (Source: Student Doctor Network)
Source: Student Doctor Network - January 2, 2021 Category: Universities & Medical Training Authors: Sleeplessbordernights Tags: Anesthesiology Source Type: forums
A fib
Guy comes in 50, 100kg, osa, htn no other problems. For an elective foot surgery. Found to have a fib in pre op. States he has no symptoms. Already on metoprolol for bp. Rates in 70s bp normal. What do you do? (Source: Student Doctor Network)
Source: Student Doctor Network - August 17, 2019 Category: Universities & Medical Training Authors: dabears505 Tags: Anesthesiology Source Type: forums
Metoprolol SUCCINATE Twice Daily??
I have seen multiple times in practice a patient prescribed Metoprolol Succinate prescribed BID. The only recommended dosing for this extended release formulation I can find is once daily. I can find absolutely 0 literature on Metoprolol Succinate dosed twice daily. Am I severely missing something? What would be the benefits/drawbacks of Toprol XL twice daily?? My moms pharmacist even said it was fine. I'm lost. Any information anyone has is requested! (Source: Student Doctor Network)
Source: Student Doctor Network - May 22, 2019 Category: Universities & Medical Training Authors: Arkorous Tags: Pharmacy Source Type: forums
Question AKI and HTN
Hi guys,
I would like to hear your thoughts in this case:
An 80yo patient was admitted into the hospital for AKI and Stage II hypertension. He is on lisinopril, HCTZ, and metoprolol for his HTN. He received 100mL NaCl to relieve AKI, but neither his AKI and HTN were improved.
At this point, do you think we should give him Lasix to help with his AKI, or should we give him more fluid? He has no signs of fluid overload.
Also, should lisinorpil be held until AKI is resolved?
Thanks. (Source: Student Doctor Network)
Source: Student Doctor Network - April 9, 2018 Category: Universities & Medical Training Authors: PharmRX0308 Source Type: forums
beta blockers and stroke volume
kind of confused about this point -- there is a usmle-rx question that says that metoprolol reduces contractility but does not reduce stroke volume - rather, it decreases heart rate and allows more diastolic filling time to increase SV.
however, in FA (p.273) it says that stroke volume is affected by contractility (??)
so i'm a tad confused since the logic can seem to go either way. why doesn't a decrease in contractility directly decrease SV? Thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - December 4, 2017 Category: Universities & Medical Training Authors: dorian24 Source Type: forums
PSVT in mechanically ventilated patient
I had a patient the other day, mechanically ventilated, on weaning protocol who abruptly went into narrow, stable ST for 2 hours plus -- on metoprolol and dig daily, given additional metoprolol with seemingly minimal effect, who abruptly went in to NSR at 65 after a bowel movement.
If, after a delivered breath, her ET tube was fully occluded for 20-30 seconds, would increased intrathoracic pressure have possibly been an effective 'vagal maneuver'? (Was on PRVC, and breathing 2-4 breaths...
PSVT in mechanically ventilated patient (Source: Student Doctor Network)
Source: Student Doctor Network - October 31, 2017 Category: Universities & Medical Training Authors: LakeSuperiorFishing Source Type: forums
So here comes the limbo period...
I took the Step 3 this past week, and now that I've had a good rest... all the mistakes I made on the exam naturally have come flooding to me. Absurd things like recognizing the answer as the ulnar nerve and choosing lateral epicondyle. What was I thinking? Stress leading to lack of sleep I imagine. Or stopping Verapamil on a diabetic patient for Metoprolol? WHY DIDN't I START HER ON LISINOPRIL.
I just can't believe how on every step, I always have this happen. Walk out of the Step, and...
So here comes the limbo period... (Source: Student Doctor Network)
Source: Student Doctor Network - October 25, 2017 Category: Universities & Medical Training Authors: Konda Source Type: forums
Verifying Medication Questions?
Hi, hospital staff pharmacist here and I want to ask you guys few questions!
I am seeing many curve balls as I am verifying the orders.
If the frequency is different that what it says on Micromedex, but still under max dose would you guys verify? I got a clonidine order that is 0.1mg tid for blood pressure. I checked Micromedex and it says it's usually given BID (but max is 2.4mg/day)
I have numerous order sets like these. clonidine tid(?) lopressor 12.5 bid, lasix 80mg bid IV ?! (Source: Student Doctor Network)
Source: Student Doctor Network - March 7, 2017 Category: Universities & Medical Training Authors: wsbkp08 Source Type: forums
What to dispense when you get a prescription for these drugs? (Different salts)
Doxycycline: Dispense monohydrate or hyclate?
Prednisolone liquid, could you dispense Prednisolone sodium phosphate?
Forms of erythromycin: I know there are differences in absorption, but which form do you dispense if prescription doesn't specify? Anyone have a good summary of the different forms and what's different about each?
Any other similar drug situations please feel free to post, such as metoprolol succinate being extended release and tartrate being immediate release is an...
What to dispense when you get a prescription for these drugs? (Different salts) (Source: Student Doctor Network)
Source: Student Doctor Network - March 5, 2017 Category: Universities & Medical Training Authors: gradintern Source Type: forums
step 2CK: digoxin hyperkalemia
This is a question i found on MTB step 2 ck, it said:
You have a patient with dilated cardiomyopathy secondary to MI in the past, that comes for routine evaluation, is asymptomatic, but with hyperkalemia. He is on lisinopril, furosemide, metoprolol, aspirin and digoxin.
What is the best management?
The answer was to change lisinopril (a IECA, so a possible cause of hyperKalemia) for hydralazine + nitroglycerin. This also lowers mortality, like IECAs, in CHF.
My question is... I remember...
step 2CK: digoxin hyperkalemia (Source: Student Doctor Network)
Source: Student Doctor Network - August 30, 2016 Category: Universities & Medical Training Authors: DrPettans Source Type: forums
Ivabradine and Myocardial Infarction
In patients with anterior myocardial infarction and early left ventricular systolic dysfunction addition of ivabradine to metoprolol, in comparison with uptitration of metoprolol was associated with improvement of systolic and diastolic left ventricular function and decrease of serum NT-pro-ANP by day 25.Does many hospitals guidelines utilize the benefit of this combination to speed patients recovery and minimize long hospital stay ? (Source: Doc2Doc BMJ Cardiology)
Source: Doc2Doc BMJ Cardiology - March 9, 2013 Category: Cardiology Authors: alaminium Source Type: forums
