Pre-Op Medication Reference Sheet This document is intended only for patients receiving an anesthetic for Instruct patient to take Day-of-Surgery dose (as scheduled) with a small sip of water. a surgical or diagnostic procedure.
Continue up to and including the Day of Take up to Day of Surgery, Consult prescribing Discontinue. prior to surgery: Surgery: Do NOT take on the Day of MD. Modifications may Surgery: be required: Alzheimer's Medications ACE inhibitors: Anything ending in –pril Antiplatelet: Clopidogrel, Lithium: Stop 24-48 hrs prior to Note: Patient may take their evening Prasugrel, Ticagrelor, procedure. Inform anesthesiologist if dose as prescribed. Ticlopidine patient is still taking medication. Anti-anxiety, Antidepressants and Angiotensin II receptor blockers: Aspirin: IF stents present Aspirin: If NO Cardiac or Carotid stents Anti-psychiatric Medications: (exception: Lithium) Anything ending in -artan present: stop 7 days prior Fluvoxamine, Paroxetine, Sertraline, Venlafaxine MAOIs: Direct Renin Inhibitors: Warfarin (Coumadin) NSAIDs: Stop 7 days prior. See reference chart #1 Aliskiren, Amturnide, Tekamlo, Tekturna Diclofenac, Ibuprofen, Piroxicam, Aleve, Naprosyn Anti-Parkinson Medications: Diuretics: Dyazide, Furosemide Dabigatran (Pradaxa) Herbal Supplements: Cabidopa, L-Dopa, Levodopa, Stop 7 days prior Anti-seizure medications: Barbiturates, Particulate antacids: Tums, Maalox Rivaroxaban (Xarelto) Vitamin E: Carbamazepine, Phenytoin, Sodium Valproate Stop 7 days prior Beta Blockers: Anything ending in -olol Iron supplements Apixaban (Eliquis) Erection Medications: Stop 48 hrs prior. Cialis, Levitra, Viagra Anti-arrhythmic: Amiodarone, Digoxin Oral Diabetic agents: Hold Metformin if Heparin, LMWH: contrast dye to be used for procedure. Dalteparin, Enoxaparin Other Anti-hypertensive and Cardiac Medications: Estrogen compounds not used for Insulin and Insulin pumps: (Alpha-antagonists, Calcium-channel blockers, Nitrates): birth control purposes See reference chart #2 Clonidine, Digoxin, Diltiazem, Hydralazine, Isosorbide, Suboxone, Subutex Methyldopa, Verapamil Statins: Fluvastatin, Lovastatin, Pitavastatin Rosuvastatin, Simvastatin References: Steroids: inhaled and/or systemic 1. Froedlert & Medical College of Wisconsin. Authors: Herodotos Ellinas, Kathryn Lauer, Ann-Marie Manley, Harvey Woehlck Immunosuppressant and Rheumatologic 2. Anesthesiology: Chapter 6. Overview of PreOperative Assessment and Management
Medications: 3. Clinical Pharmacology for Anesthesiologist, Chapter 19—Perioperative Assessment of Diabeties. Jennifer DeCou Hold if risk of renal failure and not a transplant patient
Adalimumab, Allopurinol, Azathioprine, Cyclosporine, AREA: Clinical Practice EFFECTIVE DATE: 08/04/2015 Etanercept, Infliximab, Methotrexate, Sirolimus, Tacrolimus POLICY NUMBER: CP-M-5.00 REVIEWED/UPDATED: 08/04/15, 12/15/15, 01/21/16, 03/22/16 Anti-virals/Antiretrovirals Birth control pills used for pregnancy prevention AUTHOR(S): Therese Stecher, RN APPROVED BY: Faisal Choudhry, MD TCAA-AAPA Medical Director Director of Clinical Systems HealthEast Surgical Clinical Council Thyroid Medications WEBSITE UPDATED: 03/29/2016 APPLIES TO: All Sites Medications to control chronic pain: Ex: Oxycontin, MS Contin, Fentanyl patch © TCAA 2015
REFERENCE CHART #1: MAOIs: Selected Herbal/Alternative Medicine Products – MAOI Medications -- Non-selective MAO-A and Selective MAO-A Inhibitors MAO-B Inhibitors Generic Name Comment Generic Name Brand Name Examples Resveratrol Found in skin of red grapes Isocarboxazid Marplan Berberine Found in many herbs (e.g. goldenseal) Isoniazid Generic only Selected Herbal/Alternative Medicine Products – Linezolid Zyvox Non-Selective MAO-A and MAO-B Inhibitors Phenelzine Nardil Generic Name Comment Procarbazine Matulane Curcumin Found in turmeric Tranylcypromine Parnate Found in tobacco, Syrian rue, passion flower, ayahausca, Harmala alkaloids MAOI Medications -- Selective MAO-B Inhibitors Tribulus terrestris Generic Name Brand Name Examples Rhodiola Rosea Active constituents unknown Selected Herbal/Alternative Medicine Products – Rasagiline Azilect Selective MAO-B Inhibitors Selegiline Eldepryl, Emsam (patch), Zelapar Generic Name Comment Catechin Found in tea plant, cocoa, cat's claw Desmethoxyyangonin Found in kava Epicatechin Found in tea plant, cocoa, cat's claw
Fo-Ti Active constituents unknown Hydroxytyrosol Found in olive oil Piperine Found in pepper Selected Herbal/Alternative Medicine Products – Selectivity Unknown Generic Name Comment Note: Various tryptamine and phenethylamine/amphetamine derivatives such as amphetamine and methamphetamine may Myristicin Found in nutmeg, parsley, dill also have weak to strong MAOI effects at high doses. Siberian ginseng Active constituents unknown
Yerba mate Active constituents unknown
Yohimbe Active constituents unknown
Reference Chart #2: Insulin. Note: This is not intended to be an all-inclusive list.
Insulins: Preoperative Management
Short and rapid-acting Hold dose on the morning of the procedure. Resume usual dose when eating. Aspart (NovoLog) Glulisine (Apidra) Lispro (Humalog, Humalog U200) Regular insulin (Humulin R, Novolin R) Powdered Human Insulin (Afrezza)
Intermediate-acting Take half of usual dose morning of the procedure. Resume usual dose when eating. Extended zinc insulin (Ultralente) NPH (Humulin N, Novolin N) Zinc insulin (Lente)
Long acting Decrease usual dose by 20% morning of surgery or night before Resume usual dose after the procedure. Detemir (Levemir) surgery. Glargine/Touejeo (Lantus) Mixed insulins Hold on the morning of the procedure. Resume usual schedule when eating.
Subcutaneous insulin infusion pumps Consider a discussion with patient and/or endocrinologist. In general, basal rate can be continued at usual dose, and mealtime corrections can be discontinued until the patient is eating.