Download GBMC Peri-Operative Medication Reference 4.12.16

GBMC Peri-Operative Medication Reference
4.12.16
The following recommendations regarding perioperative medication management are based on:
1. The potential of withdrawal if the medication is discontinued
2. The potential of disease progression if therapy is interrupted
3. The potential for drug interactions/complications with the anesthetic and or surgical procedure 1
Class of Drug
Cardiovascular agents
Beta Blockers
Alpha 2 agonist
Calcium Channel Blockers
ACE Inhibitors/ ARB Blockers
Diuretics
Statins
Non Statin Lowering Agents
Gastrointestinal
H2 Blockers
Proton Pump Inhibitors
Pulmonary
Inhaled Bronchodilators
Theophylline
Leukotriene inhibitors
Endocrine
Oral Contraceptives
Clinical Considerations
Withdrawal Symptoms1
HTN, tachycardia, MI
Withdrawal Symptoms1
HTN, MI
Increased risk of bleeding7
Decreased morbidity and mortality
Exacerbated hypotension
Hypovolemia and hypotension
Increased risk of myopathy13
CV protection14
Rhabdomyolysis,
Interference with absorption of drugs
Continue up to and including day of Surgery2,3
Aspiration of gastric fluid
Aspiration of gastric fluid
Continue up to and including day of surgery16
Continue up to and including day of surgery17
Bronchoconstriction
Post-operative pulmonary
complications
Arrhythmia, Neurotoxicity
*Asthma maintenance
Continue up to and including day of surgery 18
Increase risk of VTE20
Pregnancy
Continue up to and including day of surgery for patients low risk for DVT
Discontinue in high risk patients and use alternative contraception unless
receiving appropriate antithrombotic prophylaxis21
Continue for low risk surgical procedures,
Discontinue 4-6 weeks prior to moderate to high risk surgical procedures22 23
Continue long acting insulin – dose should be reduced by 50% once the fasting
period begins, including the night before surgery
Continue short acting insulin based on finger stick readings24
Discontinue am of surgery24
DISCONTINUE FOR 24 HOURS BEFORE SURGERY (NO EVENING DOSE)
Continue treatment up to and including day of treatment 25
Hormone Replacement Therapy
Increase risk of VTE
Insulin
Hypo/hyperglycemia, surgical site
infection, Ketoacidosis, electrolyte
imbalance
Hypoglycemia
Oral hypoglycemic
METFORMIN
Corticosteroids
Glucocorticoids
Anticoagulants
Aspirin
Withdrawal Symptoms1
Adrenal insufficiency
Adrenal insufficiency
Increased risk of surgical bleeding
Increased risk of thromboembolic
event
Plavix
Vascular Thrombosis
Coumadin
Intraoperative bleeding
Thromboembolism
Psychotropic Drugs31
Antipsychotics
Benzodiazepines
Buspirone
Recommendations for NPO period
Occasionally may be associated with
QT prolongation, hypotension and
arrythmias
Withdraw can lead to hemodynamic
instability, agitation, seizures
Withdrawal Potential
Continue up to and including day of surgery4-6
Continue up to and including day of surgery8,9
Discontinue night before unless being using for heart failure10,11
Discontinue day of surgery12
Continue up to and including day of surgery15
Discontinue day before surgery
Discontinue day before of surgery
Continue up to and including day of surgery19
Continue Treatment up to and including day of surgery26
Discontinue 7 days prior to non cardiovascular surgery when being used for
primary prevention of stroke and ACS27
*Continue aspirin in patients undergoing carotid endarterectomy, recent
coronary stent (Bare Metal Stent <30 days, Drug-Eluting Stent < 1 year),
recent carotid stent (<30 days), acute coronary syndrome, MI, or stroke27
Consultation with cardiology, neurology or vascular surgery (whomever
prescribed the therapy) should be obtained when a question/concern exists
*elective surgery postponed until minimum period of therapy is completed 28
- Can be continued if procedure cannot be delayed until minimum period of
therapy is completed (symptomatic carotid disease, carotid stents, coronary
stents) 29
See Bridging Tool
Continue up to and including day of surgery for patients with high risk of
psychosis
Continue up to and including day of surgery
Continue up to and including day of surgery
Lithium
May prolong the effect of muscle
relaxants
Potential for severe hypertension
from ephedrine and serotonin
syndrome from meperidine
Generally believed safe, very rare
instances of serotonin syndrome
(citalopram and fentanyl together)
Withdrawal Potential1
Potentiation of norepinephrine and
epinephrine
MAOI
SSRI
TCA
Valproic Acid
Chronic Pain Medications
Opioids
No known adverse effects
NSAIDS
Phentermine
Withdrawal potential
Pain management
Increased bleeding risk
Heat intolerance, hypotension
Suboxone
Pain intolerance
Continue up to and including day of surgery
* For elective surgery, obtain Psychiatric Consult32
Continue up to and including the day of surgery
Discontinue in patients on low doses who are at increased risk of developing
an arrhythmia prior to elective surgery 31,33
Continue in patients on high doses
*Consult with patient’s psychiatrist regarding patient’s mental stability
Continue up to and including day of surgery
Continue up to and including day of surgery
Discontinue at least 3 days prior to surgery34,35
Discontinue 6 days prior to surgery. May be waived by individual
anesthesia provider
Contact prescribing physician for management prior to surgery
**DISCONTINUE ALL HERBAL MEDICATIONS 7 DAYS BEFORE SURGERY**
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