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.
Posts
2 comments:
naltrexone- should have been dc'ed sooner
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.
Post a Comment