General

Question 1

HPT rx peri op

Answer 1

Diuretics and ACE I not on day of surgery
All others continue

BB started within a day of op prevent no fatal MI but increase risk of stroke, death, hypotension, bradycardia

Question 2

Corticosteroids peri op

Answer 2

= 5mg prednisone - nil
Minor op - normal dose and 25mg hydrocortisone intra op
Mod op - normal dose and 25mg hydrocortisone q6h for 24h
High risk op - normal dose and 25mg hydrocortisone q6h for 48-72h

Prevents addisonian crisis

Question 3

DM peri-op rx

Answer 3

Metformin - stop 24h before, start 48h after
Sulfonylureas - stop 24h before
Insulin - 2/3 usual dose long-acting pre-op, restart when eating post op. Major procedure: continuous insulin start 2-3h pre op

Question 4

Anti-coagulants

Answer 4

Aspirin/clopidogrel - stop 5d prior
Warfarin - stop 4d prior, target INR >1.5. Can give vit K if >12h pre-op, otherwise FFPs
Clexane - 12h before, 24h if therapeutic

Question 5

Bisphosphonates

Answer 5

Etanercept - stop 1.5w prior
Influximab - stop 3w prior
Tociluzimab - stop 1m prior
Rutuximab - stop 2m prior

Question 6

HRT peri-op

Answer 6

1/12 before

Question 7

Thyroid rx peri op

Answer 7

1/12 before