Perioperative Medical Management

Question 1

Anticoagulant + qx What to do?

Answer 1

Discontinue before
major surgery.

Very high-risk patients may
require heparin bridge

Question 2

Antiplatelet + qx What to do?

Answer 2

Noncardiac patients:
discontinue before
major surgery.

Question 3

Antiplatelet: Discontinuation in patients with cardiac stents T/F

Answer 3

it is controversial.

Question 4

Aspirin should be started

before

Answer 4

CABG.

Question 5

beta blockers and CCBs + qx. What to do?

Answer 5

continue

Question 6

diuretics + qx. What to do?

Answer 6

Discontinue
diuretics on day of
surgery

Question 7

Lipid-lowering

medications + qx. What to do?

Answer 7

Withhold on the day of

the surgery

Question 8

inhalers and glucocorticoids + qx. What to do?

Answer 8

continue

Question 9

H2 and PPI

meds + qx. What to do?

Answer 9

Continue

Question 10

Oral hypoglycemics:+ qx. What to do?

Answer 10

stop 3 days before

surgery

Question 11

Short-acting insulin::+ qx. What to do?

Answer 11

withhold on the

morning of surgery

Question 12

Long-acting insulin:+ qx. What to do?

Answer 12

continue at halfdose

Question 13

Thyroid medications

Answer 13

Continue

Question 14

Glucocorticoids

Answer 14

Continue steroids

Stress dose steroids for patients on chronic steroids >3 weeks

Question 15

Estrogen

Answer 15

Discontinue several
weeks before surgery
due to increased risk
of DVT

Question 16

antiepileptic

medication

Answer 16

Continue

Question 17

dementia drugs

Answer 17

Discontinue
dementia drugs
before surgery

Question 18

Herbal medications

Answer 18

Stop 1 week before

surgery

Question 19

NSAIDs and COX-2

inhibitors

Answer 19

stopped 7

days before surgery

Question 20

Narcotics

Answer 20

should be
tapered on a caseby-
case basis if
possible.

Question 21

Immunomodulators Nontransplant:

Answer 21

discontinue 2
weeks before
surgery

Question 22

Immunomodulators Transplant:

Answer 22

continue all except
sirolimus cuz
may lead to poor
wound healing or dehiscence
and should be discontinued
before surgery.