Thursday, September 15, 2011

You're in Court... II

A 50 year old gentleman with CAD, HTN, hyperlipidemia, DM, diverticulosis, hypothyroidism, and opiate dependence in remission is scheduled for a 3 vessel coronary artery bypass graft tomorrow. His medications include metoprolol, lisinopril, atorvastatin, levothyroxine, naltrexone, and aspirin. He has a two flight of stairs exercise tolerance. His exam and labs are unremarkable. The patient stopped his aspirin 7 days ago. You tell him to hold his lisinopril and naltrexone tonight. He takes his metoprolol on the day of surgery.

Challenge: You're in court... Why?

Image is in the public domain, from Wikipedia.


jimmy said...

naltrexone- should have been dc'ed sooner

Craig Chen said...

yes! very good
You’re in Court... II

Naltrexone’s half-life is several days and so it is still in the patient’s system on the day of surgery. As it is a pure opioid antagonist, the patient will get no perioperative pain relief.

Source: UpToDate.