From the Guidelines
For a patient on continuous BIPAP and NPO status, oral medications should be held temporarily, and essential medications should be converted to intravenous or alternative routes, while also initiating blood glucose monitoring with AccuChecks every 6 hours due to the patient's diabetes and steroid use. The patient's current medications, including Diltiazem 30mg, Doxycycline 100mg, and Atorvastatin 20mg, should be evaluated for IV formulations, and Atorvastatin can be safely held for a short period if necessary 1. Given the patient's hunger and diabetes, it is crucial to monitor blood glucose levels closely, especially since the patient is on Solumedrol 60mg IV q6h, which can significantly elevate blood glucose levels 1.
The patient's diabetes management should prioritize preventing hyperglycemia and hypoglycemia, with glucose targets of 7.8 to 10 mmol/L (140 to 180 mg/dL) recommended for most noncritical and critically ill patients 1. However, the most recent guidelines from 2022 emphasize the importance of blood glucose monitoring devices and access to blood glucose monitoring at all times for people with diabetes 1.
Key considerations for the patient's care include:
- Converting essential medications to IV or alternative routes
- Initiating blood glucose monitoring with AccuChecks every 6 hours
- Considering IV dextrose if glucose levels fall below 70 mg/dL
- Prioritizing diabetes management due to steroid use
- Reassessing NPO status once respiratory status improves and BIPAP can be interrupted, as strict NPO status is necessary to prevent aspiration risk while on BIPAP 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medication Administration
- The patient is due for several medications, including Diltiazem 30mg, Doxycycline 100, and Atorvastatin 20.
- According to the studies, Diltiazem can be administered to patients with various cardiovascular conditions, including angina and hypertension 2, 3.
- Atorvastatin is a commonly used statin for managing dyslipidemia, and its efficacy has been established in numerous studies 4.
- However, the patient's current condition, being on continuous BIPAP and keeping NPO (nil per os), may require careful consideration before administering any medications.
Patient's Condition and Needs
- The patient is expressing hunger and is a diabetic, which may require monitoring of their blood glucose levels.
- Accuchecks may be necessary to assess the patient's blood glucose levels, especially since they are diabetic and are being treated with medications that may affect their glucose levels.
- The patient is also on Solumedrol 60 IV q6, which is a corticosteroid that can affect blood glucose levels.
Potential Interactions and Considerations
- The concomitant use of Diltiazem and statins, such as Atorvastatin, may require careful monitoring due to potential interactions 5.
- The patient's medications and condition should be closely monitored to avoid any adverse events or interactions.
- It is essential to consider the patient's overall health status, including their diabetes and cardiovascular condition, when administering medications and making treatment decisions.