Surgery And Long-term Medication Flashcards
(26 cards)
The risk of ______________ on stopping long-term medication before surgery is often greater than the risk posed by _____________ during surgery. It is vital that the anaesthetist knows about all drugs that a patient is (or has been) taking.
losing disease control
continuing it
The risk of losing disease control on __________________ before surgery is often greater than the risk posed by ________________. It is vital that the anaesthetist knows about all drugs that a patient is (or has been) taking.
stopping long-term medication
continuing it during surgery
Patients with ______________ resulting from long-term ______________ use may suffer a precipitous fall in blood pressure unless _____________ cover is provided during anaesthesia and in the immediate postoperative period.
adrenal atrophy
corticosteroid
corticosteroid
Patients with adrenal atrophy resulting from long-term corticosteroid use may suffer a precipitous fall in ________________ unless corticosteroid cover is provided during anaesthesia and in the immediate postoperative period.
blood pressure
Patients with adrenal atrophy resulting from long-term corticosteroid use may suffer a precipitous fall in blood pressure unless corticosteroid cover is provided _____________ and in the _________________ period.
during anaesthesia
immediate postoperative
Other than steroids, drugs that should normally NOT be stopped before surgery include…? (10)
- antiepileptics
- antiparkinsonian drugs
- antipsychotics
- anxiolytics
- bronchodilators
- cardiovascular drugs (but see potassium-sparing diuretics, angiotensin-converting enzyme inhibitors, and angiotensin-II receptor antagonists)
- glaucoma drugs
- immunosuppressants
- drugs of dependence
- thyroid or antithyroid drugs
Patients taking ______________ medication or a(n) ______________ present an increased risk for surgery.
antiplatelet
oral anticoagulant
In patients taking antiplatelet medication or oral anticoagulants , the anaesthetist and surgeon should assess the relative risks and decide jointly whether the antiplatelet or the anticoagulant drug should be stopped or replaced with ______________________.
heparin (unfractionated) or low molecular weight heparin therapy
In patients with stable angina, perioperative ____________ should be only continued where there is a high thrombotic risk (e.g. patients with a recent acute coronary syndrome, coronary artery stents, or an ischaemic stroke).
aspirin
In patients with _____________, perioperative aspirin should be only continued where there is a high thrombotic risk (e.g. patients with a recent acute coronary syndrome, coronary artery stents, or an ischaemic stroke).
stable angina
In patients with stable angina, perioperative aspirin should be only continued where there is a high ____________________.
thrombotic risk (e.g. patients with a recent acute coronary syndrome, coronary artery stents, or an ischaemic stroke)
In patients with stable angina, perioperative aspirin should be only continued where there is a high thrombotic risk (e.g. patients with a _________________, _________________, or ________________).
recent acute coronary syndrome
coronary artery stents
an ischaemic stroke
Should combined hormonal contraceptives be stopped before surgery?
Yes; discontinued at least 4 weeks prior to major elective surgery, any surgery to the legs or pelvis, or surgery that prolongs immobilization of the lower limbs. May be recommenced 2 weeks after full remobilization
- When discontinuation is not possible, e.g. after trauma or if a patient admitted for an elective procedure is still on CHC, thromboprophylaxis should be considered
Can MAOIs be continued during surgery?
May have important interactions with some drugs used during surgery, ie pethidine
Can TCAs be continued during surgery?
Yes, HOWEVER, there may be an increased risk of arrhythmias and hypotension (and dangerous interactions with vasopressin drugs); therefore anesthetists should be informed if they are not stopped
Can lithium be continued during surgery?
Should be stopped 24 hours before major surgery
normal dose can be continued for minor surgery (with careful monitoring of fluids and electrolytes)
Lithium should be stopped ________ before major surgery
24 hours
_________________ may need to be withheld on the morning of surgery because hyperkalaemia may develop if renal perfusion is impaired or if there is tissue damage.
Potassium-sparing diuretics
Potassium-sparing diuretics may need to be withheld _________________ because hyperkalaemia may develop if renal perfusion is impaired or if there is tissue damage.
on the morning of surgery
Potassium-sparing diuretics may need to be withheld on the morning of surgery because ________________ may develop if renal perfusion is impaired or if there is tissue damage.
hyperkalaemia
_________________ and _______________ can be associated with severe hypotension after induction of anaesthesia
Angiotensin-converting enzyme (ACE) inhibitors
angiotensin-II receptor antagonists
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists can be associated with severe ____________ after induction of anaesthesia
hypotension
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists can be associated with severe hypotension after ________________
induction of anaesthesia
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists can be associated with severe hypotension after induction of anaesthesia; these drugs may need to be discontinued ___________ before surgery.
24 hours
