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Flashcards in Perioperative Medication Management Deck (27):
1

What pre-op blood sugar in diabetics is associated with surgical complications?

>200

2

How long can you take oral agents for DM?

Until the night before surgery

3

Insulin

Decrease dose of intermediate-acting insulin morning of
Hold short-acting

4

Beta-blockers & Surgery

Keep on board
Helps to reduce ischemia, control/prevent arrhythmias, and decrease angina

5

ACEIs/ARBs & Surgery

Increased risk of preoperative hypotension
Stop prior to surgery: hard on kidneys

6

Cardiovascular drug that has limited data & appears to be safe with surgery

CCBs

7

Alpha-s Agonists & Surgery

Potentially beneficial
Possible rebound HTN if removed
Switch to transdermal

8

Diuretics & Surgery

D/C 48 hours prior to surgery

9

What risks are associated with diuretics & surgery?

Hypotension
Hypokalemia

10

H2 Blockers & PPIs & Surgery

Potentially beneficial due to increased mucus production
Take night prior to surgery

11

Inhaled Beta-Agonists & Anti-Cholinergics & Surgery

Beneficial post-op pulmonary effects
Administer morning of surgery

12

Leukotriene Inhibitors & Surgery

Used through morning of surgery

13

Corticosteroids & Surgery

Continue
Increase dose 2-3 days due to stress of surgery

14

Theophylline & Surgery

D/C night before

15

Niacin/Fibric Acid & Surgery

D/C in perioperative period

16

Atorvastin/Pravastatin & Surgery

Risk of myopathy
Studies ongoing: leaning towards continuation

17

Thyroxine & Surgery

Safely withheld for 5-7 days
IV if necessary at 80%

18

Aspirin & Surgery

Increased risk of bleeding if continued
Increased risk of thrombosis if discontinued
Usually discontinued: low molecular weight heparin

19

Warfarin & Surgery

D/C 2-4 days prior to surgery due to increased risk of bleeding

20

Antidepressants & Surgery

Take morning of & resume post op

21

NSAIDs & Surgery

D/C 7-10 days prior

22

Pre-Operative Medications

Antibiotics
Midazolam (Versed)

23

Benefits of Midazolam (Versed)

Anxiolytic
Sedative
Induction of preoperative anesthesia

24

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?

25

Medications to Caution with Surgery

Calcium channel blockers

26

Medications to Hold the Morning of Surgery

Oral diabetic agents
ACEI/ARBs
H2 blockers/PPI

27

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