Thank you for selecting Markham Stouffville hospital for your hip or knee
replacement surgery. My name is Karen and I'm David
we're both pharmacists here and we'll be going through some medications you may
be taking when you go home including blood thinners, pain medications,
constipation medications, and iron supplements. All the information in this
video is also written in your hip and knee package. Patients like you who
undergo hip and knee replacement surgeries are at higher risk of
developing a blood clot so everyone is prescribed a blood thinner. If you're
already on a blood thinner at home the pharmacist will let you know when to
restart your usual blood thinner and after your surgery. Let's talk about
blood thinners a bit more in depth there are different kinds of blood thinners
the choice of blood thinners depend on your surgeon, type of surgery, and your
other health conditions and may include one Enoxaparin, two rivaroxaban, or
three baby aspirin. The usual duration of taking these drugs are between 14 to 35
days during this time it is important to remember to take your blood thinning
medications daily before you leave the hospital you'll be provided with a
medication list which contains a specific days you should take your
medications. In Enoxaparin also known as lovenox it's an injection that's given
once daily under the skin. Before discharge a nurse will teach you how to
inject a medication do not throw these needle out in your usual garbage you
will be given a special needle disposal bin which you can return to your local
pharmacy following your treatment.
Rivaroxaban also known as Xarelto it's an oral medication that should be taken
once daily with or without food.
Baby aspirin also known as low-dose aspirin is an oral medication usually
taken once daily in the morning this medication can be taken with food if you
experience stomach upset while on it. It is important to take your blood thinner
regularly as prescribed however if you forget to take a dose but it's still
close to the time you usually take it then you may take that day's dose if you
forget to take your dose and it's now the next day please do not double your
dose you can continue to take your blood thinner once a day until you complete
your entire supply. You will not need any further blood tests to monitor these
medications once you're at home. If you need to see any other healthcare
providers it's important to tell them then you are taking a blood thinner.
While you're on a blood thinner check with your pharmacist before starting any
other new medications including the ones who can purchase over-the-counter.
Although you are on this medication there's still a slight chance that you
could get a clot let's learn more about blood clots. An unwanted blood clot
occurring in the leg is also called a deep vein thrombosis or DVT. This
condition can cause swelling, pain, warmth, or a change in color to one or both of
your legs. It does not improve even when your leg
is elevated. Clots can break away and travel to your lungs causing a pulmonary
embolism also known as a PE. Symptoms include chest pain, shortness of breath,
difficulty breathing, coughing up blood, or excessive sweating. If you feel any of
these signs and symptoms of a DVT or PE please go to your nearest emergency room
so you can be treated immediately. New clots can also travel to your brain
causing a stroke if any of the following warning signs appear please call 911.
These warning signs include sudden numbness or weakness especially on one side of the
body, sudden confusion, trouble speaking or understanding, sudden trouble seeing
from one or both eyes, dizziness, loss of coordination or a sudden severe headache.
The acronym FAST is an easy way to remember sudden signs and symptoms of a
stroke. This stands for face drooping, arm weakness, speech difficulty, and time to
call 9-1-1. Monitoring yourself or bleeding is important common side
effects of blood thinners are cuts and bruises taking longer to heal bleeding gums or
to spontaneous nosebleeds. Speak to your doctor right away if you have a
nosebleed that won't stop bleeding or if you start experiencing vomiting up
coffee brown material or bright red blood, red or dark urine or red or black
stools. If you fall or hurt yourself or if you
hit your head you should visit your doctor promptly. You may also wish to use
only electric razors and soft toothbrushes to limit minor bleeding.
Please avoid taking herbals, other over-the-counter medications, and
vitamins while you're on blood thinners. Examples include gingko, garlic,
ginseng, ginger, and vitamin E. It is safe to continue taking vitamin D, calcium, and
multivitamin. Check with your pharmacist if you need to start any new
over-the-counter medications or prescription medications while you're on
a blood thinners so they can check for potential interactions.
Your doctor will prescribe different pain medications to help manage your
pain after your surgery this may include opioid and non-opioid
pain medications. It is important to take these non-opioid medications regularly
even if you don't have pain. These can help control your baseline pain and
decrease the amount of stronger pain medications that you may need such as
opioids. Acetaminophen, for the first two weeks you should take Acetaminophen or
better known as Tylenol four times a day please remember to stay within the daily
limit of four grams per day from all sources.
Celebrex is an anti-inflammatory medication. Monitor for signs of bleeding
previously discussed while on this medication, please complete the course as
prescribed. This medication can be taken with food if you experience any stomach
upset. Gabapentin or pregabalin are neuropathic pain medications that reduce
nerve pain such as shooting or numbing pain, please complete the course as
prescribed. Opioids that you may go home with come in two different formulations
immediate release and controlled release.
Hydromorphone immediate release or IR for short should only be taken on an
as-needed basis. Always start with the lowest dose and adjust up if your pain
is not well controlled these tablets can take up to 30 minutes to work a good
time to use them is 30 minutes prior to physiotherapy or exercise. Take this
medication for the shortest duration possible hydromorphone controlled relief
or CR for short is a long-acting hydromorphone that may be considered for
more severe pain. This medication starts to work in an hour and lasts up to 12
hours take this medication for the shortest time possible.
It is very important to follow the discharge instructions on how to take
these medications at home. Ask your healthcare team members about other
methods of reducing pain such as ice, stretching, or physiotherapy. Side effects
of these pain medications include constipation, nausea, drowsiness, and
sedation. You should avoid alcohol and sleeping pills while taking these pain
medications you should also avoid driving or operating heavy machinery
while you're on these opioids, gabapentin, or pre goblin. Please store
your medications in a safe location away from pets, children, and teenagers. If you
have leftover pain medications remember to bring them back to your pharmacy for
safe disposal and never share your medications with anyone else. During
surgery some blood loss is expected if your hemoglobin drops below a certain
point we will start you on iron supplementation.
If iron is on your prescription please take it at bedtime we suggest taking it
with vitamin C or orange juice to help improve absorption. Side effects
include stomach cramping, constipation, and they may also turn your stools dark.
If you're constipated common over-the-counter medications that are
available at your local pharmacy include Senokot, Lax-a-day, or Restoralax. You may
wish to take laxatives while on opioids to reduce the chances of being
constipated. Thank you very much for watching this video the pharmacists will
be with you shortly to review your pain and blood thinner medications as well as
answered any questions you may have. Have a great day.