The Hip book

NALBUPHINE/NUBAIN

for moderate to severe pain;  Synthetic partial opiate agonist/antagonist;  Adult: 10-20mg IM, IV, SQ;  q4-6hr prn;  Causes CNS depression and drowsiness;  use with caution in patients receiving opiate drugs;  KEY PAIN OPIOID

Mydazolam/Versed

– Discussion:     – for preoperative sedation; impairment of memory of perioperative events;     – sedation for procedures, short acting benzodiazepine:     – versed is 3 to 4 times more powerful per mg. than valium     – may dilute injection in D5W, NS, or LR; – Conscious Sedation:     – … Read more

Myelodysplasia

– Discussion:     – disorder of spinal cord development/closure or secondary rupture of developing cord secondary to hydrocephalus;     – term myelodysplasia includes:           – spina bifida occulta           – meningocele: sac without neural elements protruding through defect;           – myelomeningocele; … Read more

Myasthenia Gravis

– Discussion:     – most common neuromuscular junction defect;     – results from damage to postsynaptic acetylcholine receptor sites;     – more common in young women & older adults of both sexes;     – diff dx:           – myathenic syndrome:           – ALS … Read more

Metoclopramide/Reglan/ Clopra

– Diabetic Gastroparesis:   – 10mg PO 30min AC and HS for2-8 weeks prn;   – GI Reflux:  – 10-15mg PO 30min AC and HS; maximum duration of therapy is 12 weeks;  – Prophylaxis of N/V in Cancer Chemotherapy;  – IV infusion 1-2mg/kg diluted in 0.9% saline and given slowly (over 15min) 30 min before … Read more

Metronidazole / Flagyl

– Discussion and Dosage:     – type of reducing compound that leads to the formation of oxygen free radicals which are toxic to anaerobic bacteria;     – for amebiasis, trichomoniasis, B.fragilis, C. difficile;     – is effective for B.fragilis which is resistant to clindamycin, chloramphenicol, penicillin G;     – amebic: 750mg … Read more

Mezlocillin/Mezlin

– See:        – Penicillin Family        – AntiPseudo – Adult: 2-4gm q4-6hr Injection; or 200-300 mg/kg/24hr; 1.85mEq Na/gm; – More active than Ticarcillin against Enterobacteriacae, same activity against P.aeruginosa;  good activity against B.fragilis; – Diffusion from blood into CSF adequate w/ or w/o Inflammation; Ratio of CSF to Blood Level … Read more

Miconazole/Monistat

– For severe fungal infections including coccidioidomycosis, candidiasis, Cryptococcus, and others; various tinea forms; cutaneous candidiasis; vulvovaginal candidiasis; tinea versicolor; – Adult: systemic: dosage range from 200-3,600 mg/24hr IV based on diagnosis; to be administered diluted to minimum volume of 200 ml NSS; – Topical apply to affected area twice daily for 2-4 weeks; – … Read more

Methods to Prevent Infection

– See: Orthopaedic Infection Menu: and risk factors for TJR infection – Pre-Admission Considerations:         – removal of hardware prior to joint arthroplasty:                 – High incidence of early periprosthetic joint infection following THA with concomitant or previous hardware removal – Hospital and OR Considerations:          – perioperative oxygen          – normothermia:                  – Perioperative normothermia to … Read more