Neupogen IV

Just a reminder that Neupogen IV needs to be diluted in D5w.

stress dose steroids peri-op

I was asked about dosing steroids peri- op for a patient who has been on long term prednisone and was about to have a C-section. I was not very familiar with this so I thought I would share what I found out. Information is also in the Lexi Drug Handbook under Hydrocortisone and I put a folder with information in the drawer of knowledge. Thank you to Nick, Chanda, and Kevin for helping me find information.



Stress dose steroids should be given around surgery for patients who have been recieving an equivalent of prednisone 5 mg /day. The stress dose should be given no more than 1-3 days peri-op and the dose is proportionate to the severity of the surgery. After the stress dosing period patients can resume their normal dosage of whatever steroid they are on.



The rationale behind this is that patients on long term steroids have suppression of the HPA axis so they may be unable to produce this physiologic response to stress such as surgery. In patients not on steroids, the HPA axis is activated during surgery.



Stress dose steroids are also recommended in patients who have recently stopped taking steroids if they had been on them long term. The HPA axis may take up to a year to recover after stopping long-term steroids. Short bursts of steroids would not fall under this category (pts taking steroids <1>

Here is a sample dosing schedule:

Surgery Type:

Minor (outpatient): Hydrocortisone 25 mg x1

Moderate (total joint): Hydrocortisone 25mg q12h x1 day

Hydrocortisone 25mg x1 the next day

Major (CABG): Hydrocortisone 50mg IV q8h x1day

Hydrocortisone 50mg IV q12h x1day

Hydrocortisone 25mg IV q12h x1day

Rx Tidbits from Nick

If somebody is not getting adequate relief from morphine they can take dextromethorphan OTC and that will increase morphine levels by inhibiting the metabolism of morphine by 2D6.

Quinolones can increase your risk for seizure by enhancing the release of glutamine, a neurotransmitter involved with seizures.

Nick -- what did you say about lasix? Was it that Lasix is bid 6 hrs apart and that is how it got part of it's name -- lasix? Please correct me if I am wrong.