Clinical questions...

[MdBrndPhrmcst]

Hi I'd appreciate any input on some clinical questions I've got...

- How do you taper clonidine patchs? (I think decrease .1mg per week right? correct me if im wrong) and what if a patient is on a 3mg patch? then what do you do?

-How do you taper oral clonidine? say a patient is taking .2mg TID

-How do you start an insulin sliding scale (dose, regimen etc?) are there any good articles or references you know of that talk about this?

- Do you deal wit prednisone tapers proactively or reactively with DM patients? (mean if a pateint is going to be tapering insulin do you automatically decrease insulin or wait to see what the numbers are?)

I know we got some smart people on this forum..please enlighten me.
Thanks!!

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[Epic]

Literature search. Then tell us. Then we can all be little smarter.

 

[bonvox]

Clonidine is usually tapered over 7-14 days to avoid rebound hypertension. 0.1-0.2mg every day or so usually does it, even for someone who's riding a 3mg patch.

Insulin... for Regular sliding scale its usually like 1 unit for every 50 mg/dl above 100 mg/dl... or 1-2 units for every 10-15 mg of carbs consumed, but that really varies from pt to pt (wt, activity level, etc) and is adjusted trial and error all the time. Hence the importance of glucose monitoring. As far as references, Google & Google Scholar is seriously all you should need.

Lastly, regarding insulin adjustments with steroids, it would make sense to just taper the insulin back down in the exact same fashion it was tapered up, but I'm still on rotations, and I haven't noticed any trends or protocols. Maybe someone with more experience can step in on that one.

 

[KUMoose]

This thread makes me QQ because ostensively this poster goes to my school and is being lazy.

 

[pharmboy30]

whatever the doctor writes for

 

[FixLittlePeople]

tell you what. i'm on 0.3mg clonidine patch, and not only does the patch suck (never get consistent delivery from it) if i tried decreasing it 0.1mg ony my own i had extreme anxiety come over me. this my doctor called "classical clonodine withdrawal", ye, didn't make me feel any better. anyways, with the patch my bp never really dropped below 140/90 most day, unless i doubled up two 0.2mg patches (my original subscription), and then i was unable to stay awake throughout the day. to get me off the patches, he finally switched me to atenolol, which i told him might also help me with my anxiety. this week, i'm supposed to be going down to 0.1mg clodinie w/50mg atenolol once daily, but i'm really feeling the anxiety kicking in. my bp has been 130ish/80ish and my pulse has decreased considereably as well...to wrap this up, rebound hypertension is only one of the side effects of clonodine withdrawal. anyone else, actually have simialr experience?