Perioperative Medications Management Flashcards
Elevated pre-op BS associated w/ surgical complications
> 200… associated with deep wound infection
Beta-blockers
Take the morning of the procedure
ACEIs/ARBs
Increased risk perioperative hypotension if used the day of surgery
Decreased post-op hypertension
No clear consensus/recommendations
Alpha-s agonists (Clonidine)
Potentially beneficial
Potential adverse withdrawal (rebound HTN)
Switch to transdermal administration
Diuretics
If possible D/C 48 hrs before surgery
Risks of hypotension and hypokalemia
H2 blockers/PPIs
beneficial—because ulcer protection
Take night before surgery
Continue through perioperative period
Switch to IV as indicated
Pulmonary Agents
Inhaled beta-agonists and anti-cholinergics: Beneficial post-op pulmonary effects Administer morning of surgery Continue through perioperative period Leukotriene inhibitors: May be used through morning of surgery Resume when patient tolerates PO meds
Corticosteroids
Chronic use—continue during perioperative period, may need to give increased dose for 2-3 days because of stress of surgery
Atorvastin/pravastatin
D/C in perioperative period (per manufac-turers)
Risk of myopathy (rhabdomyalysis)
Statin safety studies underway
Thyroxine
May be safely withheld for 5-7 days
Resume PO when pt can take PO meds
If pt can’t take PO longer periods parenteral advised at 80% of the oral dose
Antiplatelet Agents
Aspirin:
Increased risk of bleeding if continued
Increased risk of thrombosis if discontinued
Usually discontinued and pt started on low molecular weight heparin
Clopidogrel/Ticlodipine:
If an antiplatelet effect is not desired D/C 5 days before surgery
Warfarin
Increased risk of bleeding with INR > 2.0
D/C 2-4 days before surgery to bring INR to
NSAID’s
These should be D/C 7-10 days prior to surgery
