My patient is scheduled for PCI this morning. His meds include: ASA 360mg PO; Metoprolol 50mg PO, Metformin and Bumex 2mg IV. Which if any of these meds should I hold and more specifically why? I am pretty sure that I should give the ASA but not sure what to give as rationale for it. I am also sure that metformin should be held possibly because of its interaction with contrast dye? Please help me understand this
Just some rationale behind holding/giving the meds listed.
ASA: give. They will be on ASA for a time after procedure, risks associated with bleeding are less than the benefits.
Metroprolol: give (as long as HR >60, or per protocol). Beta Blockers help control heart rate, which in turn helps to decrease oxygen consumption of the heart. Pretty helpful in controlling chest pain while ballooning (blood flow is temporarily cut off distally)
Metformin: hold. If possible hold 24-48hr pre-procedure. This is to help prevent nephropathy.
Bumex: hold. 3 reasons... no one wants to put a pt on a bed pan/get them a urinal mid-cath (if the pt has no foley that is, lol) Bumex and other diuretics increase the chance of Contrast Induced Nephropathy post cath. In addition, a full bladder can cause oozing through the puncture site. If your pt is on a IIb-IIIa, you want to limit your ooz as much as possible.
Southern_RN
7 Posts
Just some rationale behind holding/giving the meds listed.
ASA: give. They will be on ASA for a time after procedure, risks associated with bleeding are less than the benefits.
Metroprolol: give (as long as HR >60, or per protocol). Beta Blockers help control heart rate, which in turn helps to decrease oxygen consumption of the heart. Pretty helpful in controlling chest pain while ballooning (blood flow is temporarily cut off distally)
Metformin: hold. If possible hold 24-48hr pre-procedure. This is to help prevent nephropathy.
Bumex: hold. 3 reasons... no one wants to put a pt on a bed pan/get them a urinal mid-cath (if the pt has no foley that is, lol) Bumex and other diuretics increase the chance of Contrast Induced Nephropathy post cath. In addition, a full bladder can cause oozing through the puncture site. If your pt is on a IIb-IIIa, you want to limit your ooz as much as possible.