Which Drugs Can/not Take The Morning Of Surgery

Question 1

ACE inhibitor

Answer 1

No special action is required if BP and U &E are ok but may prefer to omit the morning dose due to the risk of perioperative hypotension and kidney injury
Take the morning of surgery

Question 2

Beta blocker

Answer 2

Continue as it reduces the risk of a labile cardiovascular response
Take the morning of surgery

Question 3

Digoxin

Answer 3

Continue up to and including the morning of surgery
Check for toxicity and check plasma K+
As suxamenthonium inc serum k by approx 1 mmol/l and can lead to ventricular arrhythmia in the gully digitalised
Take the morning of surgery

Question 4

Statins

Answer 4

Should be continued especially in those at high risk of CV event but discontinue non statin hypolipidaemic drugs
Take the morning of surgery

Question 5

Bronchodilators

Answer 5

Continue and consider supplementing with nebulisers

Take the morning of surgery

Question 6

PPI

Answer 6

Continue

Take the morning of surgery

Question 7

Steroids

Answer 7

If the patient is on or has recently taken steroids at an equivalent of >10mg prednisolone per day give extra cover for the perioperative period
Take the morning of surgery

Question 8

Anti convulsants

Answer 8

Give usual dose up to an hour before surgery
Give drugs IV or NG until able to take oral
Take the morning of surgery

Question 9

Levodopa

Answer 9

Possible arrhythmias under GA

Take the morning of surgery

Question 10

Antibiotics

Answer 10

Take but be aware
Aminoglycosides, colistin, and tetracycline prolong the neuromuscular blockade even depolarising
Take the morning of surgery

Question 11

Anticoagulants

Answer 11

INR needs to be below 2 before surgery 
Check what it is indicated for 
Change to heparin if needed 
Admit early and discuss plan 
Avoid epidurals /spins blocks be aware of regional anaesthesia 
Should not take the morning of f surgery

Question 12

Aspirin

Answer 12

Controversial dependent on indication and the individual procedure

Patients are given aspirin prior to PCI but may be avoided in other surgery to negate bleeding risk
Mostly not taken the morning of surgery

Question 13

Clopidogrel
Ticagralor
Prasugrel

Answer 13

Do not take the morning of surgery

Stop 5-7 days before

Question 14

DAPT

Clopidogrel and aspirin

Answer 14

If after coronary stents
If the surgery is elective should wait the 1year till clopidogrel is stopped to minimise stent thrombosis
In love interventional radiology’s opinion and surgeons
If urgent non cardiac surgery is needed if possible defer surgery for 6 weeks after bare metal stents and 6 months after drug diluting stents

Question 15

NSAIDS

Answer 15

Should be discontinued due to renal and antiplatelet effects

Question 16

Diuretics

Answer 16

Beware hypokalaemia and hypovolaemia check u &e

Do not take morning of surgery

Question 17

Insulin

Answer 17

Continue long acting basal insulin

Omit oral hypoglycaemic agents on the morning of surgery

Question 18

Contraceptive oil and HRT

Answer 18

Stop 4 weeks before major surgery
Restart 2 weeks post op if mobile
Use heparin thromboprophylaxis and stocking

Question 19

SSRIs

Answer 19

Stop 3 weeks prior to certain high risk CNS procedures due to increased bleeding risk but in the majority they can be continued

Question 20

Ophthalmic drugs

Answer 20

Anticholinesterases used to treat glaucoma may cause sensitivity to and prolong the duration of drugs metabolised by cholinesterasee e.g. suxamethonium
Beta blocker eye drops may causes systemic symptoms of bronchospasm /hypotension. Stop alpha blockers as they can cause a floppy iris syndrome making cataract surgery challenging