Flashcards in Perioperative Medication Management Deck (7)
DM perio-op medication management;
-continue oral hypoglycemia agents until _____.
-how do we manage insulin in short simple procedures? long/complex?
-how do we manage insulin post-op?
-why do we worry about taking metoformin the day or surgery?
the morning of surgery, no oral agents the AM of surgery.
-decrease dose of intermediate acting insulin and hold short acting insulin the AM of surgery.
-switch to IV insulin w/ dextrose & K+
Post op sliding scale.
Metformin: dont give day of surgery or 72hrs post op b/c we worry about renal hypoperfusion and hypoglycemia
-do we continue these perioperativelY?
-do we continue ACEI/ARBs/Ca channel blockers perioperatively?
-do we continue alpha-s agonists (clonidine)/Diuretics perioperatively?
YES, keep the beta blocker on board.
ACEI/ARB: take these off the day of surgery and use other form of HTN agent. increased risk of perioperative hypotension.
CCB: we think these are cardioprotective, continue to take.
Clonidine: keep this on board, potential adverse withdrawal (rebound HTN)
Diuretics: d/c 48hrs before, risk of hypotension and hypokalemia
*loop diuretics are very high risk d/t the electrolyte imbalances.
-do we continue H2blocker/PPI perioperatively?
-do we continue inhaled beta agonists/anticholinergics/ leukotriene inhibitors perioperatively?
-do we continue corticoteroids perioperatively?
-do we continue theophylline perioperatively?
--do we continue Niacin/statins perioperatively?
H2blocker/PPI: continue through perioperative period. they reduce gastric volume and gastric pH.
Inhaled beta agonists/anticholinegics:
-administer morning of surgery and continue through perioperative period. reduced pulmonary complications.
-use AM of surgery and resume when pt tolerates PO meds.
-chronic use; continue during perioperative period, may need to give increased dose for 2-3days b/c of stress of surgery
Theophylline: d/c night before surgery.
Niacin: d/c perioperativ period
-continuation of statins, have antiinflamm effects.
-do we continue thyroxine perioperatively?
-do we continue aspirin perioperatively?
-do we continue plavix perioperatively?
Thyroxine: hold 5-7days prior, resume when pt taking PO.
-increased risk of bleeding if continued and increased risk of thrombosis if d/c. usually d/c and pt started on LMWH.
**any vascular surgery or known vascular dz we keep this on board, but for other specialties like neurosurgery you need to have a discussion about this.
-if anti-platelet effect is not desired d/c 5 days before surgery
How does aspirin work?
Aspirin works by irreversibly inhibiting cyclooxygenase which converts arachodonic acid to thromboxane A2
Thromboxane A2 is what signals platelet aggregation.
-do we continue warfarin perioperatively?
-do we continue antidepressants perioperatively?
-do we continue NSAIDS perioperatively?
Warfarin: d/c 2-4days before surgery to bring INR less than 2.0-1.5.
-should be taken the morning of surgery and resumed post-op within 2-3days... but heather says keep on board unless CNS surgery.
*Serotonin increases bleeding.
d/c 7-10days prior to surgery