Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
A 61-year-old man arrives in the emergency department complaining of severe abdominal pain and bloating. He reports being unable to have a bowel movement for the last 3 days and he is unsure if he is still passing gas. His past medical history includes multiple abdominal operations, including exploratory laparotomy after a gunshot wound and an appendectomy at age 23, as well as diabetes, coronary artery disease, benign prostatic hyperplasia, and depression. Current medications include metformin, insulin, metoprolol, aspirin, fosinopril, terazosin, and sertraline. The patient is evaluated in the emergency room and the surgical service is consulted for a likely admission. Which of the following outpatient medications needs to be held during this patient™s hospital stay?
A. Insulin
B. Metformin
C. Metoprolol
D. Sertraline
E. Terazosin
Posts: 3,675,937
Threads: 734,344
Joined:
Sep 2021
Reputation:
5
The correct answer is B. Metformin should not be given during states of acute illness, or when a radiographic procedure involving iodinated dye is likely, because the risk for metformin-induced lactic acidosis is significantly increased.
Insulin (choice A) should be continued during this patient™s hospital stay. Glycemic control is proven to correlate with improved wound healing, better surgical outcomes, shortened hospital stays, and reduced risk of infection.
Beta-blockers, such as metoprolol (choice C), should be given perioperatively, inasmuch as they reduce the risk of cardiac events related to surgery. Unless this patient becomes hemodynamically unstable, metoprolol does not need to be withheld during his hospital stay.
Sertraline (choice D) is a relatively benign selective serotonin reuptake inhibitor and does not need to be held during acute illness.
Terazosin (choice E) is an alpha-1 antagonist with mild to minimal antihypertensive effects, used mainly to treat benign prostatic hyperplasia. It does not need to be held in acute illness unless the patient is hemodynamically unstable.
