Friday July 2, 2010
Q: You confirmed propofol infusion syndrome in a patient on prolong high concentration infusion. Once you stop propofol how long does it take to recover from propofol associated lactic acidosis?
Answer: About 6 hours
Propofol infusion syndrome (PRIS) has been observed in patients receiving propofol at high dosages and for prolonged periods though reported with lower doses as well as short infusion time. It is said to be synergestic when given concomitantly with catecholamines or steroids in the setting of acute neurologic or inflammatory diseases.
Propofol infusion syndrome is said to occur in patients with genetic mitochondrial abnormalities.
MCQ on PRIS here (posted here earlier)
Friday, July 2, 2010
Thursday, July 1, 2010
Thursday July 1, 2010
Q: 34 year old male with previous history of lung transplant is admitted to ICU with sepsis. Patient is recovering well but continue to have persistent ileus. Junior resident wrote for erythromycin to increase GI motility. What need to be watch in this patient?
Answer: Tacrolimus level
Tacrolimus has clinically major drug interactions with erythromycin, dilantin and rifampin. Erythromycin may increase Tacrolimus to toxic level. It is recommended that concurrent administration of erythromycin and tacrolimus be avoided. However, if concomitant therapy is necessary, tacrolimus concentrations should be monitored.
Other significant interactions Tacrolimus may have is with amphotericin, barbiturates, calcium channel blockers, itraconazole, ketoconazole, fluconazole, cyclosporine, and cimetidine.
Q: 34 year old male with previous history of lung transplant is admitted to ICU with sepsis. Patient is recovering well but continue to have persistent ileus. Junior resident wrote for erythromycin to increase GI motility. What need to be watch in this patient?
Answer: Tacrolimus level
Tacrolimus has clinically major drug interactions with erythromycin, dilantin and rifampin. Erythromycin may increase Tacrolimus to toxic level. It is recommended that concurrent administration of erythromycin and tacrolimus be avoided. However, if concomitant therapy is necessary, tacrolimus concentrations should be monitored.
Other significant interactions Tacrolimus may have is with amphotericin, barbiturates, calcium channel blockers, itraconazole, ketoconazole, fluconazole, cyclosporine, and cimetidine.
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