Perioperative Medication Management

Question 1

Patient instructions for oral hypoglycemic agents prior to surgery

Answer 1

No oral agents morning of surgery.

Question 2

What are Type I diabetics at very high risk of developing during surgery?

Answer 2

ketoacidosis

Question 3

Patient instructions for insulin when DM patient is having a short simple procedure

Answer 3

Decrease dose of intermediate-acting insulin morning of procedure. Hold short-acting insulin

Question 4

Patient instructions for insulin when DM patient is having a long/complex procedure

Answer 4

Switch to IV insulin w/ dextrose (+ K) infusion

Question 5

Increased risk perioperative hypotension if used the day of surgery

Answer 5

ACEI/ARBs

Question 6

CV drug with potential adverse withdrawal (rebound HTN)‏. Switch to transdermal administration

Answer 6

Alpha-s agonists (Clonidine)‏

Question 7

Patient instructions for diuretics prior to surgery due to risk of hypotension and hypokalemia

Answer 7

If possible D/C 48 hrs before surgery

Question 8

Surgical recommendations for H2 blockers/PPIs

Answer 8

Take night before surgery. Continue through perioperative period. Switch to IV as indicated

Question 9

Pulmonary agents with beneficial post-op effects. Should be given morning of surgery and continued through surgery.

Answer 9

inhaled beta-agonists and anti-cholinergics

Question 10

Pulmonary agent with potential serious toxicity perioperatively. Recommended to discontinue the night before

Answer 10

theophylline

Question 11

Antihyperlipidemic agents that need to be discontinued in perioperative period

Answer 11

Niacin and fibric acid derivatives

Question 12

Found to be safe during surgery due to decreased risk of MI despite increased risk of rhabdo

Answer 12

statins

Question 13

When should you resume thyroxine post-operatively?

Answer 13

Resume PO when pt can take PO meds. If it’s been longer than 7 days can give IV

Question 14

Surgical recommendations for aspirin

Answer 14

Usually discontinued and pt started on low molecular weight heparin if it’s necessary for patient

Question 15

Possible complication of aspirin if continued during surgery

Answer 15

bleeding

Question 16

Possible complication of aspirin is discontinued during surgery

Answer 16

thrombosis

Question 17

Surgical recommendations for warfarin pre-operatively

Answer 17

D/C 2-4 days before surgery to bring INR to < 2.0

Question 18

Patient instructions for antidepressants prior to surgery

Answer 18

taken the morning of surgery and resumed post-op within 2-3 days

Question 19

How long prior to surgery shoud NSAIDs be discontinued?

Answer 19

7-10 days

Question 20

Can a patient scheduled for cataract surgery remain on aspirin therapy?

Answer 20

yes

Question 21

How long prior to surgery should you discontinue Plavix?

Answer 21

5 days

Question 22

How do you reverse warfarin (Coumadin)?

Answer 22

vitamin K (takes awhile) and FFP (works quickly)

Question 23

Bleeding pathway coumadin works through

Answer 23

extrinsic

Question 24

Bleeding pathway heparin works through

Answer 24

intrinsic

Question 25

Anxiolytic given 2.5-5.0 mg prior to surgery that is a sedative

Answer 25

midazolam (Versed)