Why these meds... please help me figure this out.

CuriousMe · Mar 26, 2011

You gave his Hx, but what is he in the hospital for?

Ok. I had a patient this week in rotations and here is his Dx:
HIV
Hep B
Diplopia
GERD.
Can someone please explain to me why
1. Dr.s put everyone on Heparin. He has NO hx of DVT or Pulmonary Embolus. No abd surgery. Nothing.
2. my pt is on Vancomycin and Maxipime. No bacterial infections at all, only viral. In case people don't know: Antibiotics don't treat viruses. Is there some reason that Im missing? And he doesn't have diarrhea... so no C. Diff.
I can't go back to the hospital and ask the doctor for his rationale. Im hoping there's someone more intelligent than me that might could explain this.
Let me know if you have any other questions, I have all his lab tests and the rest of his chart and MAR in front of me.

dudette10, MSN, RN · Mar 26, 2011

HIV patients are highly susceptible to bacterial infections, so the antibiotics were probably ordered prophylactically.

You'll have to do more research, but a search of HIV and heparin indicates that it might have an inhibitory effect on HIV. There have also been studies on the effect of heparin as a treatment for chronic hep B. Like I said, you'll have to do more research on that one.

NCRNMDM, ASN, RN · Mar 26, 2011

I agree, HIV puts you at risk for a number of infections because you are immunocompromised. The antibiotics were probably started prophylactically to avoid any infections that he might pick up while in the hospital. Remember, some bacteria are opportunistic by nature and will invade the weakest host they can find, and obviously your HIV positive patient is going to be pretty weak. As far as the heparin goes, I think that dudette10 is right. You will have to do some more research, but this sounds like a plausible reasoning for the heparin.

turnforthenurse, MSN, NP · Mar 27, 2011

like the others said, HIV patients are immunocompromised - infections will kill these patients. Therefore, the antibiotics are prescribed prophylactically. As for heparin, I also agree with what dudette10 mentioned. Patients are also on heparin prophylactically to prevent clots in patients who are immobile. I don't know your patient's entire history but there are a lot of patients on heparin for this reason, surgery or not.

LaurenMarie · Mar 27, 2011

thanks for your replies... this is the interesting part:

I was just doing research on my patients drugs as part of an assignment and found out that Heparin is made from pig and cow parts. My patient is Muslim. He doesn't eat cow pig or a bunch of other things that aren't Hallal. Does the average nurse/doctor not know that it is make from pig intestines? I emailed my instructor and we are going to speak with the ethical committee tomorrow at the hospital to tell them what happened. I didn't give the injection, I only came across the information as research for my project. Does anyone know what will happen?

It has been a very interesting night to say the least...

Point of story: Don't give Heparin or Lovenox to your patients if you know they are Muslim.

NCRNMDM, ASN, RN · Mar 27, 2011

I did some research online, and found that Refludan (or Lepirudin) can be used as an alternative to heparin and Lovenox. Refludan is a DTI (direct thrombin inhibitor) and I'm not sure if it would function the same as the heparin prescribed by the physician. Refludan is usually only used in patients with HIT (heparin induced thrombocytopenia) so I'm not sure that it would be indicated in this situation.

dudette10, MSN, RN · Mar 27, 2011

thanks for your replies... this is the interesting part:
I was just doing research on my patients drugs as part of an assignment and found out that Heparin is made from pig and cow parts. My patient is Muslim. He doesn't eat cow pig or a bunch of other things that aren't Hallal. Does the average nurse/doctor not know that it is make from pig intestines? I emailed my instructor and we are going to speak with the ethical committee tomorrow at the hospital to tell them what happened. I didn't give the injection, I only came across the information as research for my project. Does anyone know what will happen?
It has been a very interesting night to say the least...
Point of story: Don't give Heparin or Lovenox to your patients if you know they are Muslim.

I did another search on heparin as it relates to Islam, and I came across this.

http://medicaleconomics.modernmedicine.com/memag/content/printContentPopup.jsp?id=158977

That was thought to cause a potential problem for Jewish, Muslim, and Seventh-day Adventist patients at this institution," says Doha Hamza, the coordinator of Muslim volunteers at the spiritual care service department at Stanford (CA) University Medical Center. "We investigated the issue with an imam and a Muslim doctor who concurred that the use of porcine heparin is lawful because of the chemical modification the product undergoes and the urgent need involved. Also the amount is so small, it doesn't fit the definition of consumption.

It's good that you and your instructor are bringing it up to the ethics committee so that possibly a policy could be created in collaboration with the Islamic religious leaders in the area. However, I do not think it wise to automatically do what you are suggesting in the bolded statement as an independent nursing action. Ask the patient first! He/she may already know the religious law and have already determined it's an acceptable treatment. Heparin is such a common drug in hospitals, Muslim patients may be aware of the issue already.

I'm interested to know if the answers that I and other posters provided to you re: antibiotics and heparin fit your patient.

dudette10, MSN, RN · Mar 27, 2011

I did some research online, and found that Refludan (or Lepirudin) can be used as an alternative to heparin and Lovenox. Refludan is a DTI (direct thrombin inhibitor) and I'm not sure if it would function the same as the heparin prescribed by the physician. Refludan is usually only used in patients with HIT (heparin induced thrombocytopenia) so I'm not sure that it would be indicated in this situation.

To add to matt's info: It seems that bovine heparin is no longer used because it was found to increase the risk of HIT, which is why porcine heparin is the only heparin form available. Another document I found indicated that a synthetic heparin made by GlaxoSmithKline is also available. I didn't search further for comparisons of indications, contraindications or efficacy of the synthetic heparin.

CuriousMe · Mar 27, 2011

thanks for your replies... this is the interesting part:
I was just doing research on my patients drugs as part of an assignment and found out that Heparin is made from pig and cow parts. My patient is Muslim. He doesn't eat cow pig or a bunch of other things that aren't Hallal. Does the average nurse/doctor not know that it is make from pig intestines? I emailed my instructor and we are going to speak with the ethical committee tomorrow at the hospital to tell them what happened. I didn't give the injection, I only came across the information as research for my project. Does anyone know what will happen?
It has been a very interesting night to say the least...
Point of story: Don't give Heparin or Lovenox to your patients if you know they are Muslim.

Evidently there's some discussion as to whether heparin is considered "consumption."

http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=158977&pageID=1&sk=&date=

Music in My Heart · Mar 27, 2011

Be very careful in your terminology. The patient is *NOT* on heparin, the patient is (from what you say) on enoxaparin which are not the same thing nor may the words be used interchangeably.

Does the patient have HIV or AIDS? What is the patient's viral load? It's a little hard to imagine that they're running a course of vanco just prophylactically. Are you certain that there were no indicators of an incipient infection (specifically, an elevated band count). Upon what data do you base your conclusion that the patient doesn't have a bacterial infection?

What is actually wrong with the patient? Is s/he there for acute Hep B?

Whenever you're reading up on a patient, be sure to read the H&P and - if you can read them - the physician's progress notes.

~Mi Vida Loca~RN, ASN, RN · Mar 27, 2011

Be very careful in your terminology. The patient is *NOT* on heparin, the patient is (from what you say) on enoxaparin which are not the same thing nor may the words be used interchangeably.
Does the patient have HIV or AIDS? What is the patient's viral load? It's a little hard to imagine that they're running a course of vanco just prophylactically. Are you certain that there were no indicators of an incipient infection (specifically, an elevated band count). Upon what data do you base your conclusion that the patient doesn't have a bacterial infection?
What is actually wrong with the patient? Is s/he there for acute Hep B?
Whenever you're reading up on a patient, be sure to read the H&P and - if you can read them - the physician's progress notes.

Exactly what I was thinking with the Vanco. It's a pretty hard core drug that is very hard on the body to use just in case.