Perioperative Medication Management Flashcards
What pre-op blood sugar in diabetics is associated with surgical complications?
> 200
How long can you take oral agents for DM?
Until the night before surgery
Insulin
Decrease dose of intermediate-acting insulin morning of
Hold short-acting
Beta-blockers & Surgery
Keep on board
Helps to reduce ischemia, control/prevent arrhythmias, and decrease angina
ACEIs/ARBs & Surgery
Increased risk of preoperative hypotension
Stop prior to surgery: hard on kidneys
Cardiovascular drug that has limited data & appears to be safe with surgery
CCBs
Alpha-s Agonists & Surgery
Potentially beneficial
Possible rebound HTN if removed
Switch to transdermal
Diuretics & Surgery
D/C 48 hours prior to surgery
What risks are associated with diuretics & surgery?
Hypotension
Hypokalemia
H2 Blockers & PPIs & Surgery
Potentially beneficial due to increased mucus production
Take night prior to surgery
Inhaled Beta-Agonists & Anti-Cholinergics & Surgery
Beneficial post-op pulmonary effects
Administer morning of surgery
Leukotriene Inhibitors & Surgery
Used through morning of surgery
Corticosteroids & Surgery
Continue
Increase dose 2-3 days due to stress of surgery
Theophylline & Surgery
D/C night before
Niacin/Fibric Acid & Surgery
D/C in perioperative period
Atorvastin/Pravastatin & Surgery
Risk of myopathy
Studies ongoing: leaning towards continuation
Thyroxine & Surgery
Safely withheld for 5-7 days
IV if necessary at 80%
Aspirin & Surgery
Increased risk of bleeding if continued
Increased risk of thrombosis if discontinued
Usually discontinued: low molecular weight heparin
Warfarin & Surgery
D/C 2-4 days prior to surgery due to increased risk of bleeding
Antidepressants & Surgery
Take morning of & resume post op
NSAIDs & Surgery
D/C 7-10 days prior
Pre-Operative Medications
Antibiotics
Midazolam (Versed)
Benefits of Midazolam (Versed)
Anxiolytic
Sedative
Induction of preoperative anesthesia
Medications to Keep on Board with Surgery
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?
Medications to Caution with Surgery
Calcium channel blockers
Medications to Hold the Morning of Surgery
Oral diabetic agents
ACEI/ARBs
H2 blockers/PPI
Medications to Take off of Prior to Surgery
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
