|Refrigerator Magnets of Heavily Promoted Drugs|
- All psychotropic medications, antidepressants, narcotics, muscle relaxants, benzodiazepines (I've gotten away from those drugs entirely in the ICU except in alcohol withdrawal). The caveat here is some medications have associated withdrawal syndromes, such as gabapentin/Neurontin. Remarkably, I have yet to see opioid withdrawal, in spite of having large numbers of patients on high doses.
- All medications used for chronic disease management and prevention such as statins (and the loathesome Vytorin), oral hypoglycemics, anti-hypertensives. I usually continue aspirin and plavix. Mostly I stop Coumadin but it's a judgment call.
- All nonsensical PRN "bowel elixirs" such as magnesium, aluminum, Mylanta, this, that and the other thing. These things just clutter the medication list and make it harder for me to focus on the essentials. In patients whose disease is likely to include nausea, I will leave Zofran or phenergan or both.
- Tylenol. I hate this drug for fever. If patients are having fever I want to know about it, not have it masked. But, if you have a headache you're not getting dilaudid, you're getting two extra strength tylenol. So don't ask.
- Often I find myself stopping Albuterol and Atrovent. It's a great irony - as the pulmonologist on duty I have a net negative effect on the use of these drugs in the hospitals I staff. (Another irony is that I cancel more ABGs and CTPAs and PRBCs than I order.) Most patients aren't wheezing, just because you're on the vent doesn't mean you need bronchodilators, Albuterol may be harmful in ALI and ARDS, the drugs have no disease modifying ability in COPD and are for symptom relief alone (asthma is different), and Respiratory Therapy loves me for stopping them and/or making them PRN. I also find myself drastically reducing steroid doses in COPD patients - like from 125 mg solumedrol several times a day to 60 mg once a day, usually as oral prednisone.