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For fried rice made by mom
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For more tourist attractions
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Guide To Stacking, Dosages, And Side Effects
**Anabolic‑steroid pharmacology – “Weight‑gain” formulations**
| Drug (generic) | Typical formulation & dose range in adults |
Mechanism of action | Key indications (weight gain) | Common monitoring |
|—————-|——————————————–|———————|——————————–|——————-|
| **Oxandrolone** (Anavar, Oxandrin) | Oral 5–20 mg/day (often split into 2 doses);
max 40 mg/day | Non‑steroidal androgen; weakly aromatizable → ↑protein synthesis, ↓catabolism, ↑mTOR activity | • Refeeding after severe caloric deficit
• Chronic illness / burns | • LFTs every
3–6 mo
• Weight & lean mass (DXA) |
| **Testosterone cypionate** (Depot) | IM 200 mg q2‑wks; may increase to 400 mg q2‑wks |
Classic androgen → ↑satellite cell activation, ↓muscle protein breakdown, ↑IGF‑1 | • Hypogonadal patients
• Post‑surgery catabolic states | • Serum testosterone 1–3 mo after start
• CBC, LFTs |
| **Estradiol valerate** (oral) | 2 mg qd | Estrogenic effect on bone
density and muscle repair | • Women with low estrogen | •
Estradiol levels 3–6 wk after initiation |
—
## 4. Practical Recommendations
| Situation | Recommended Intervention | Timing & Dosage | Monitoring |
|———–|————————–|—————–|————|
| **Post‑surgery catabolic phase (1–2 weeks)** | 1.
**Glucocorticoid**: Prednisone 10–20 mg/d, taper over 4 wk.
2. **Anabolic steroid**: Testosterone enanthate 100 mg/8 wk or nandrolone 50 mg/8 wk if no contraindication. | Begin within 24 h after surgery; continue for 3–4 weeks.
| CBC, CMP, liver enzymes, lipids; watch for hypertension, glucose intolerance.
|
| **Chronic low‑grade inflammation (≥3 mo)** | 1.
**Low‑dose glucocorticoid**: Prednisone 5 mg/d or
budesonide 6–12 mg/d.
2. **Anabolic steroid**: Testosterone enanthate 100 mg/8 wk; consider adjunctive anabolic agents (e.g., oxandrolone 5–10 mg/d) if
needed. | Administer for 3–6 months, with periodic reassessment every 1–2 mo.
| Monitor CBC, liver enzymes, lipid panel; watch for adrenal suppression. |
| **Monitoring and Adjustment** | • Baseline labs:
CBC, CMP, lipid profile, fasting glucose/HbA1c.
• Follow-up labs at 4‑6 weeks after initiation and then every 3 months.
• Clinical assessment of wound healing, pain levels, functional status, and side effects.
• Adjust dosage based on efficacy and tolerability; consider
tapering steroids once inflammation subsides or if
adverse events occur. | • Use of topical NSAIDs or systemic NSAIDs may be added for pain control but monitor renal function in CKD
patients.
• In case of steroid‑induced hyperglycemia, refer to
endocrinology for glucose‑control strategies; consider insulin or oral
hypoglycemics. |
| **C. Other Pharmacologic Interventions** |
• **Antibiotics:** Only if there is clinical evidence of infection (purulent drainage, fever, leukocytosis).
Empiric coverage may include amoxicillin‑clavulanate for mild infections or clindamycin/vancomycin for MRSA risk.
• **Pain Management:** NSAIDs are contraindicated in CKD;
acetaminophen is safe up to 4 g/day. Consider opioids (e.g., oxycodone) for breakthrough pain, titrated carefully due to renal clearance and potential respiratory
depression.
• **Antibiotic Prophylaxis during Surgery:** A single dose of
cefazolin (or vancomycin if β‑lactam allergy) prior to incision. No need for postoperative antibiotics unless infection develops.
|
| 4 | **Potential Complications**
– **Infection**: Superficial wound breakdown, cellulitis,
abscess formation.
– **Recurrent Vascular Pseudoaneurysm** if the
underlying aneurysm is not fully excluded or new lesions develop.
– **Bleeding / Hemorrhage** from pseudoaneurysm rupture.
– **Ischemic Complications**: Due to inadvertent embolization of branch vessels, leading to skin necrosis
or digital ischemia.
– **Adverse Reactions**: Contrast nephropathy (though patient is likely at low risk given normal renal function), allergic reaction to contrast.
– **Radiation Exposure** and cumulative dose concerns. | 1) **Early Mobilization & Wound Care** – Encourage ambulation as
tolerated, but monitor incision for signs of infection;
maintain dressing integrity.
2) **Pain Management** – Use multimodal analgesia (NSAIDs if not contraindicated, acetaminophen, opioids as needed).
3) **Monitoring for Complications** – Check vital signs, wound appearance, and neurovascular status of the limb twice
daily; document pain scores.
4) **Educate on Activity Limits** – Advise patient to avoid
heavy lifting or strenuous activity for at least 2 weeks; use assistive devices if needed.
5) **Rehabilitation Referral** – Consider early physiotherapy/occupational therapy once stable (after
day 3–4) to aid in regaining function and prevent stiffness.
|
**Key Points for Nursing Care**
– The operative site is a complex, high‑risk wound: it is near the femoral vessels,
involves bone fixation, and will be exposed to a joint
environment; thus infection or dehiscence can be catastrophic.
– Early identification of subtle signs (e.g., slight erythema,
warmth, drainage) and prompt escalation of care are vital.
– Patient education on wound care, signs of infection,
and the importance of follow‑up visits is essential for early detection and management.
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