Perioperative Medication Management

Question 1

What pre-op blood sugar in diabetics is associated with surgical complications?

Answer 1

> 200

Question 2

How long can you take oral agents for DM?

Answer 2

Until the night before surgery

Question 3

Insulin

Answer 3

Decrease dose of intermediate-acting insulin morning of

Hold short-acting

Question 4

Beta-blockers & Surgery

Answer 4

Keep on board

Helps to reduce ischemia, control/prevent arrhythmias, and decrease angina

Question 5

ACEIs/ARBs & Surgery

Answer 5

Increased risk of preoperative hypotension

Stop prior to surgery: hard on kidneys

Question 6

Cardiovascular drug that has limited data & appears to be safe with surgery

Answer 6

CCBs

Question 7

Alpha-s Agonists & Surgery

Answer 7

Potentially beneficial
Possible rebound HTN if removed
Switch to transdermal

Question 8

Diuretics & Surgery

Answer 8

D/C 48 hours prior to surgery

Question 9

What risks are associated with diuretics & surgery?

Answer 9

Hypotension

Hypokalemia

Question 10

H2 Blockers & PPIs & Surgery

Answer 10

Potentially beneficial due to increased mucus production

Take night prior to surgery

Question 11

Inhaled Beta-Agonists & Anti-Cholinergics & Surgery

Answer 11

Beneficial post-op pulmonary effects

Administer morning of surgery

Question 12

Leukotriene Inhibitors & Surgery

Answer 12

Used through morning of surgery

Question 13

Corticosteroids & Surgery

Answer 13

Continue

Increase dose 2-3 days due to stress of surgery

Question 14

Theophylline & Surgery

Answer 14

D/C night before

Question 15

Niacin/Fibric Acid & Surgery

Answer 15

D/C in perioperative period

Question 16

Atorvastin/Pravastatin & Surgery

Answer 16

Risk of myopathy

Studies ongoing: leaning towards continuation

Question 17

Thyroxine & Surgery

Answer 17

Safely withheld for 5-7 days

IV if necessary at 80%

Question 18

Aspirin & Surgery

Answer 18

Increased risk of bleeding if continued
Increased risk of thrombosis if discontinued
Usually discontinued: low molecular weight heparin

Question 19

Warfarin & Surgery

Answer 19

D/C 2-4 days prior to surgery due to increased risk of bleeding

Question 20

Antidepressants & Surgery

Answer 20

Take morning of & resume post op

Question 21

NSAIDs & Surgery

Answer 21

D/C 7-10 days prior

Question 22

Pre-Operative Medications

Answer 22

Antibiotics

Midazolam (Versed)

Question 23

Benefits of Midazolam (Versed)

Answer 23

Anxiolytic
Sedative
Induction of preoperative anesthesia

Question 24

Medications to Keep on Board with Surgery

Answer 24

Insulin: decrease morning dose
Beta-blockers
Alpha-s agonists: transdermal
Inhaled beta-agonist & anti-cholinergic
Leukotriene inhibitors
Corticosteroids
Atorvastin/Pravastatin
Antidepressants: unless CNS surgery
Aspirin?

Question 25

Medications to Caution with Surgery

Answer 25

Calcium channel blockers

Question 26

Medications to Hold the Morning of Surgery

Answer 26

Oral diabetic agents
ACEI/ARBs
H2 blockers/PPI

Question 27

Medications to Take off of Prior to Surgery

Answer 27

Diuretics: 48 hours prior
Theophylline: night before
Niacin/fibric acid derivatives
Thyroxine: 5-7 days prior
Aspirin: low molecular weight heparin instead
Clopidogrel/ticlodipine: 5 days prior
Warfarin: 2-4 days prior
NSAIDs: 7-10 days prior