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Flashcards in Perioperative Medications Management Deck (20):
1

1. Medications associated w/ known morbidity if withdrawn abruptly should be what?

2. Medications thought to increase risk of what should be held? 2

1. continued

2.
-surgical complications AND
-not essential for short-term

2

Insulin Treatment
1. For short simple procedures?
2

2. Long/complex procedures?
2

3. Post op?

1. Short simple procedures
-Decrease dose of intermediate-acting insulin morning of procedure proportional to anticipated delay in next oral meal
-Hold short-acting insulin

2. Long/complex procedures
-Switch to IV insulin w/ dextrose (+ K+) infusion
-Monitor BS/electrolytes closely

3. Post-op sliding scale

3

Diabetes Medications
1. Anticipate glycemic control problems in perioperative period? 2

2. Continue routine oral hypoglycemic agents until when?

3. No what the morning of surgery?

4. Switch to what?

5. High risk of what?

1.
-Elevated pre-op BS (>200) associated w/ surgical complications (deep wound infection)‏
-Increased BS normal physiologic response to the surgery/anesthesia

2. morning of

3. No oral agents morning of surgery
4. Switch to sliding-scale SQ insulin

5.
-hypoglycemia episodes
-DKA

4

Cardiovascular Drugs
1. Which drugs are potentially beneficial and you should take the morning of?

2. ACEIs/ARBs:
-disadvanatge?
-advanatge?
Hold dose?

3. CCB?

1. BB

2. ACEIs/ARBs:
-Increased risk perioperative hypotension if used the day of surgery
-Decreased post-op hypertension
Hold dose morning of surgery

No clear consensus/recommendations


3. CCBs: limited data/appear safe to take

5

1. Which drug is potentially beneficial but has potential adverse withdrawl affects (rebound HTN)?
2. Switch to what kind of administration?

3. Diuretics: Manage how?
4. Diuretic risk factors? 2

5. Which are the most concerning of the diuretics?

1. Alpha-s agonists (Clonidine)‏
(rebound HTN!)
2. Trandsermal administration

3. If possible D/C 48 hrs before surgery

4. Risks of
-hypotension and
-hypokalemia
They are going to lower volume and you may need that volume.

5. Loop

6

Gastrointestinal Agents
1. H2 blockers/PPIs potentially beneficial why?
2. Decreases insidence of what complication?

3. Take when?

4. Continue through what?

5. Switch to what as indicated?

1. Potentially beneficial—because there is a lot of stress related mucosal damage. Will be able to decrease acid and increase pH levels.
2. chemical pneumonitis

3. Take night before surgery

4. Continue through perioperative period

5. Switch to IV as indicated

7

BB advantages? 3

Risks? 2

1. reduced ischemia due to inflammation
2. prevents arrthrymias
3. Decreased angina

1. Rebound HTN
2. and tachycardia

8

Pulmonary Agents
1. Inhaled beta-agonists and anti-cholinergics beneficial for what?
2. Administer when?
3. Continue through?

1. Beneficial post-op pulmonary effects

2. Administer morning of surgery

3. Continue through perioperative period

9

Pulmonary agents
Leukotriene inhibitors
1. May be used until when?
2. Resume when?

1. May be used through morning of surgery

2. Resume when patient tolerates PO meds

10

Pulmonary agents:
Corticosteroids
Chronic use—continue during 1.___________ period, may need to give increased dose for ____ days because of stress of surgery

1. perioperative, 2-3

11

Pulmonary Agents:
Theophylline affects and recommendations?
2

1. Potential serious toxicity
2. Recommend D/C night before surgery

12

Antihyperlipidemic Agents
1. Niacin/fibric acid derivatives management?

2. Atorvastin/pravastatin
-risk of?

1. D/C in perioperative period

2. Risk of myopathy (rhabdomyalysis)‏

-Statin safety studies underway/leaning towards continuation

13

Thyroid Medications
Thyroxine
1. May be safely held for how long?
2. Resume when?
3. If pt can't take PO longer periods parenteral advised at what dose?

1. May be safely withheld for 5-7 days
2. Resume PO when pt can take PO meds


3. 80% of the oral dose

14

Antiplatelet Agents
Aspirin
1. Increased risk of what if continued?
2. Increased risk of what if D/Cd?

3. What usually happens?
4. When do you have to stop it if you do?

5. May want to keep it on for CV surg but DEFINITELY not for what?

1. Increased risk of bleeding if continued

2. Increased risk of thrombosis if discontinued

3. Usually discontinued and pt started on low molecular weight heparin
4. 7 to 10 days

5. Neuro surge

15

Antiplatelet Agents
1. Dipyridamole: No data but what do we know about it?

2. Clopidogrel/Ticlodipine
If an antiplatelet effect is not desired D/C how early?

1. Short half life


2. 5 days before surgery

16

Warfarin:
1. Increased risk?
2. D/C when and why?

1. Increased risk of bleeding with INR > 2.0

2. D/C 2-4 days before surgery to bring INR to less than 2.0

17

Antidepressants
1. Most antidepressants have a _____ half life and
2. can be held for how long?

3. They should be taken when and continued when?

4.

1. long
2. 2-3 days


3. morning of surgery and resumed post-op within 2-3 days

18

NSAID management for surgery?

These should be D/C 7-10 days prior to surgery

19

Pre-operative Medications
1. What to use an antibiotic: What should we use?

2. In who and what dose?

3. Benefits? 3

1. Midazolam (Versed)‏

2. Age

20

When should they get off their at home supplements and herbal medications?

2 weeks