Perioperative Meds

Question 1

ABRUPT w/d of benzodiazepines may result in…

Answer 1

HTN, delirium, seizures

Question 2

For pts with Parkinson’s, meds..

Answer 2

can be taken day before, but not morning of

Question 3

TCAs may result in

Answer 3

hypotension, change in sympathomimetic response (dopamine, NE)

Question 4

MAOIs need to be..

Answer 4

held 2 weeks before surgery

Question 5

Beta blockers must

Answer 5

always be continued, or risk MI

Question 6

ACEI

Answer 6

intra-op hypotension, but can be continued

Question 7

CCBs

Answer 7

must be stopped with LV dysfunction!

Question 8

Aspirin can lead to

Answer 8

internal bleeding, paralysis

Question 9

LMWH (lovenox, fragmin)

Answer 9

stopped 1-2 days before

Question 10

Coumadin

Answer 10

4-5 days before

risk of VTE

Question 11

Anti-platelet therapy (aspirin, plavix)…

Answer 11

stop 7-10 days before

Question 12

insulin

Answer 12

hold AM dose, or ½ AM dose

Question 13

metformin

Answer 13

hold 1-2 days before, renal problems > lactic acidosis

Question 14

Vitamin E

Answer 14

hold 7-10 before, bleeding!

Question 15

use this at end of procedure to prevent PONV

Answer 15

droperidol

Question 16

CNS toxicity is reversed with

Answer 16

Physostigmine

Question 17

Ranitidine use

Answer 17

elevate gastric pH, does not alter hepatic fx

Question 18

Lorazipam use

Answer 18

amoxylitic, sedative, amnesiac, no pain or phlebitis w/ injection

Question 19

2 first steps of anaphylaxis

Answer 19

remove offending agent, give oxygen

Question 20

for A-fib use

Answer 20

verapamil or digoxin (anti-arrythmics)

Question 21

verapamil or digoxin risk

Answer 21

ventricular clot

Question 22

for HTN use

Answer 22

hydralazine

propranolol

Question 23

for hypotension use

Answer 23

fluid bolus

vasopressors (ephedrine)

Question 24

clonidine use

Answer 24

produces sedation
prevents HTN, bradycardia
less total amnesia needed

Question 25

3 drugs pulmonary system cannot be used before sugery

Answer 25

theophylline
inhaled steroids
sildenafil!

Question 26

sulfonylureas

Answer 26

type of oral hypoglyemic
discontinue before surgery
increase MI risk

Question 27

oral contraceptives must be

Answer 27

discontinued after for 4 weeks > risk DVT/PE

Question 28

given in emergency surgery, pt has already eaten

Answer 28

metoclopramide/reglan

Question 29

Emergency surgery, coumadin pt use

Answer 29

Vitamin K IV/PO

Question 30

Emergency surgery, plavix

Answer 30

Transfuse platelets + pro-hemostatic agent

Question 31

Tramadol

Answer 31

no AM dose, seizures

Question 32

NSAIDs

Answer 32

stop 3-5 days before

Question 33

Celebrex

Answer 33

ok to continue

Question 34

2nd response anaphylaxis

Answer 34

1. epinephrine
2. benadryl
3. H2 blockers
4. Corticosteroids

Question 35

Versed

Answer 35

rapid-onset benzodiazepam

Question 36

droperidol side effects

Answer 36

dysphoria, fear of death

don’t use on psych