Gynecology and Obstetrics (2008 Edition) (Current Clinical by Paul D. Chan

By Paul D. Chan

Gynecology and Obstetrics summarizes analysis and administration of universal issues that take place in ladies. this article reports licensed remedy guidance for either inpatients and outpatients.

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2. 25 mg IVP (over 2-5 min) q6h, then increase up to 5 mg q6h. Reduce dose in azotemic patients. Contraindicated in bilateral renal artery stenosis. E. Esmolol (Brevibloc) is a non-selective beta-blocker with a 1-2 min onset of action and short duration of 10 min. The dose is 500 mcg/kg/min x 1 min, then 50 mcg/kg/min; max 300 mcg/kg/min IV infusion. F. Hydralazine is a preload and afterload reducing agent. It is ideal in hypertension due to eclampsia. Reflex tachycardia is common. The dose is 20 mg IV/IM q46h.

Physiologic maneuvers. Changes in an outflow murmur with the Valsalva maneuver may help diagnose hypertrophic cardiomyopathy. E. Abnormal neurologic findings. Unilateral abnormalities found upon neurologic examination may reflect a cerebral vascular accident. F. Gastrointestinal bleeding. A positive stool guaiac indicates gastrointestinal blood loss, which can result sequentially in anemia, hypovolemia, and syncope. G. Carotid sinus massage. Carotid sinus hypersensitivity, which is responsible for the carotid sinus syndrome, can be demonstrated by careful carotid sinus massage, preferably with simultaneous electrocardiographic monitoring.

G. Drug therapy 1. Statins are commonly used in the treatment of hypercholesterolemia. They are the most powerful drugs for lowering LDL cholesterol, with reductions of 20 to 60%. Fluvastatin (Lescol) is somewhat less potent, decreasing LDL by 20-25%. Atorvastatin is the most potent, reducing LDL by 29-61%. An additional benefit of atorvastatin is more effective triglyceride lowering (14 to 33%). Adverse reactions occur less frequently with the statins than with other lipid-lowering agents. 2. Cholesterol absorption inhibitors - Ezetimibe (Zetia) modestly lowers the LDL cholesterol when used alone, but may have its greatest use in combination with statins.

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