TIPS ON PHARMACOLOGY

You don't have to know the dose and schedule of every drug in the PDR to seem well-informed about drug topics on the wards and clinics. Especially on inpatient wards, a relatively small set of drugs are used over and over, and you would do well to make yourself especially familiar with them. They are anticoagulants (warfarin, heparin, enoxaparin), pain meds (especially opiates), insulin, and bowel regimens (docusate, bisacodyl, Sennokot, and the like).

Bowel drugs. We didn't study them much in pharmacology, but they are handed out like candy on the wards. (For a decent overview, see Prather CM. Evaluation and treatment of constipation and fecal impaction in adults. Mayo Clin Proc. 1998;73:881–887.). Key point: If you write a scrip for opiates, your next act should be writing scrips for a bowel regimen. Anyone on opiates should have a standing order for the stool softener docusate (250 mg po bid, hold for loose stools), and a PRN order for a cathartic, either senna tabs (2 tabs po q12h PRN constipation) or bisacodyl. By the way, docusate alone is insufficient for opiate patients, since the problem is decreased peristalsis.

Bowel regimens are serious business. I had a patient who became obstipated despite aggressive management, including enemas, and wound up perforating her colon. She went into hypovolemic shock and almost died. Very, very bad. So treat this issue seriously.