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A Guide to the Administration of Medicines in the Perioperative

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A Guide to the Administration of Medicines in the Perioperative ......„„.....NHS Grampian Guideline For The Administration Of Medicines In The Pen-Operative Period Co-ordinators: Consultation Group: Approver: Pre-Operative Assessment See Consultation list Medicine Guidelines and Pharmacist Policies Group Signature: Signature: ...i 0 0 a Identifier: Review Date: Date Approved: NHSG/Guid/Peri0p/ May 2022 May 2019 MGPG1026 Uncontrolled when printed Version 3 Executive Sign-Off This document has been endorsed by the Director of Pharmacy and Medicines Management Signature: Title: Guideline for the Administration of Medicines in the Peri- Operative Period Unique Identifier: NHSG/Guid/PeriOp/MGPG1026 Replaces: NHSG/Guid/PeriOp/MGPG697, Version 2 Across NHS Organisation Directorate Clinical Service Sub Boards Wide Department Area This controlled document shall not be copied in part or whole without the express permission of the author or the author’s representative. Lead Author/Co-ordinator: Pre-Operative Assessment Pharmacist Subject (as per document Clinical Guidance registration categories): Key word(s): Peri-operative medication guidance, gastro intestinal system, cardiovascular system, respiratory, central nervous, infections, endocrine, obstetrics, gynaecology, urinary tract, malignant, nutrition, blood, musculoskeletal, joint, corticosteroid treatment, alternative routes, antiepileptic Process Document: Policy, Guideline Protocol, Procedure or Guideline Document application: NHS Grampian Purpose/description: This policy is designed to be used by pharmacy, nursing and medical staff at pre-assessment clinics in NHSG, to provide advice on stopping or changing regular medication prior to admission for a surgical procedure or investigation. The advice can also be used to guide medical, pharmacy and nursing staff on surgical wards. Responsibilities for implementation: Organisational: Chief Executive and Management Teams Corporate: Senior Managers Departmental: Heads of Service/Clinical Leads Area: Line Managers Hospital/Interface services: Divisional General Managers and Group Clinical Directors Operational Management Unit Operational Managers Unit: Policy statement: It is the responsibility of all staff to ensure that they are working to the most up to date and relevant policies, protocols procedures. Review: This policy will be reviewed in three years or sooner if current treatment recommendations change UNCONTROLLED WHEN PRINTED Review Date: May 2022 Identifier: NHSG/Guid/PeriOp/MGPG1026 - i - A Guide to The Administration Of Medicines in the Peri-Operative Period – Version 3 Responsibilities for review of this document: Pre-Operative Assessment Pharmacist Responsibilities for ensuring registration of Pharmacist, Pharmacy and Medicines this document on the NHS Grampian Directorate Information/ Document Silo: Physical location of the original of this Pharmacy Department, Aberdeen Royal document: Infirmary Job/group title of those who have control Medicines Guidelines and Policies Group over this document: Responsibilities for disseminating document Pre-Operative Assessment Pharmacist as per distribution list: Revision History: Revision Previous Summary of Changes Changes Marked* Date Revision (Descriptive summary of (Identify page Date the changes made) numbers and section heading ) Jan 2019 May 2014 Review of Introduction. Page 4 Jan 2019 May 2014 Addition of supporting Multiple sections evidence from UKCPA throughout guideline. Handbook of Peri-Operative Medicines. Jan 2019 May 2014 Consider commencing PPI or 1.1 and 1.2 H2-receptor antagonist in patients who are using antacids regularly. Jan 2019 May 2014 Review of Drugs Affecting the 1.9 Immune Response advice. Jan 2019 May 2014 Addition of Movicol. 1.10 Jan 2019 May 2014 Linaclotide – Avoid in bowel 1.11 surgery. Jan 2019 May 2014 Colestyramine – Avoid on day 1.13 of surgery. Jan 2019 May 2014 Addition of Minoxidil. 2.8 Jan 2019 May 2014 Hydralazine and adrenaline 2.8 interaction. Jan 2019 May 2014 Addition of Alfuzosin. 2.10 Jan 2019 May 2014 Update to alpha blocker 2.10 advice in cataract surgery after local discussion with Ophthalmology. UNCONTROLLED WHEN PRINTED Review Date: May 2022 Identifier: NHSG/Guid/PeriOp/MGPG1026 - ii - A Guide to The Administration Of Medicines in the Peri-Operative Period – Version 3 Revision Previous Summary of Changes Changes Marked* Date Revision (Descriptive summary of (Identify page Date the changes made) numbers and section heading ) Jan 2019 May 2014 Phenoxybenzamine – 2.10 Discuss pre-operative management with anaesthetist/surgeon. Jan 2019 May 2014 Addition of Lacidipine, 2.14 Lercanidipine and Nicardipine. Jan 2019 May 2014 Swallowing difficulties/enteral 2.14 feeding considerations with modified release preparations. Jan 2019 May 2014 Removal of section. 2.8.1 2.8.1 Parenteral anticoagulant drugs. Jan 2019 May 2014 Removal of section. 2.8.2 2.8.2 Oral anticoagulant drugs. Jan 2019 May 2014 Removal of section. 2.9 2.9 Antiplatelet drugs. Jan 2019 May 2014 Addition of Fluvastatin, 2.17 Pravastatin and Rosuvastatin. Jan 2019 May 2014 Addition of Ezetimibe. 2.17 Jan 2019 May 2014 Addition of Midodrine. 2.18 Jan 2019 May 2014 Addition of Zaleplon and 4.1 Zolpidem. Jan 2019 May 2014 Addition of Alprazolam, 4.2 Clobazam, Clonazepam, Flurazepam, Loprazolam, Lormetazepam, Midazolam and Oxazepam. Jan 2019 May 2014 Diazepam and Ketamine 4.2 interaction. Jan 2019 May 2014 Diazepam and Bupivacaine 4.2 interaction. Jan 2019 May 2014 Midazolam and Fentanyl 4.2 interaction. Jan 2019 May 2014 Review of Lithium advice. 4.4 UNCONTROLLED WHEN PRINTED Review Date: May 2022 Identifier: NHSG/Guid/PeriOp/MGPG1026 - iii - A Guide to The Administration Of Medicines in the Peri-Operative Period – Version 3 Revision Previous Summary of Changes Changes Marked* Date Revision (Descriptive summary of (Identify page Date the changes made) numbers and section heading ) Jan 2019 May 2014 Addition of Clomipramine and 4.5 Imipramine. Jan 2019 May 2014 Review of Monoamine- 4.6 Oxidase Inhibitors (MAOIs) advice. Jan 2019 May 2014 Addition of Escitalopram, 4.7 Fluvoxamine and Paroxetine. Jan 2019 May 2014 SSRIs and Methylthioninium 4.7 Chloride (Methylene Blue) interaction. Jan 2019 May 2014 Addition of Madopar®, 4.17 Madopar CR®, Sinemet®, Sinemet CR®, Half-Sinemet CR® and Stalevo®. Jan 2019 May 2014 Removal of Ropinirole. 4.17 Jan 2019 May 2014 Levodopa and 4.17 Metoclopramide and Prochlorperazine interaction. Jan 2019 May 2014 Considerations to reduce risk 4.17 from a NBM period. Jan 2019 May 2014 Creation of new section. 4.18 4.18 Dopaminergic drugs – Dopamine agonists Jan 2019 May 2014 Addition of Pramipexole, 4.18 Ropinirole and Rotigotine. Jan 2019 May 2014 Addition of Stalevo®. 4.20 Jan 2019 May 2014 Considerations to reduce risk 4.20 from a NBM period. Jan 2019 May 2014 Removal of section. 6.1.1.1 6.1.1.1 Insulins (Short acting). Jan 2019 May 2014 Removal of section. 6.1.1.2 6.1.1.2 Insulins (Twice daily dosing). Jan 2019 May 2014 Removal of section. 6.1.1.2 6.1.1.2 Insulins (Long acting). Jan 2019 May 2014 Removal of section. 6.1.2.1 6.1.2.1 Sulfonylureas. UNCONTROLLED WHEN PRINTED Review Date: May 2022 Identifier: NHSG/Guid/PeriOp/MGPG1026 - iv - A Guide to The Administration Of Medicines in the Peri-Operative Period – Version 3 Revision Previous Summary of Changes Changes Marked* Date Revision (Descriptive summary of (Identify page Date the changes made) numbers and section heading ) Jan 2019 May 2014 Removal of section. 6.1.2.2 6.1.2.2 Biguanides. Jan 2019 May 2014 Removal of section. 6.1.2.3 6.1.2.3 Other diabetic drugs. Jan 2019 May 2014 Review of Bisphosphonates 6.6 advice. Jan 2019 May 2014 Addition of Indoramin, 7.3 Prazosin and Terazosin. Jan 2019 May 2014 Update to alpha blocker 7.3 advice in cataract surgery after local discussion with Ophthalmology. Jan 2019 May 2014 Addition of Bethanechol. 7.3 Jan 2019 May 2014 Addition of Fesoterodine. 7.4 Jan 2019 May 2014 Review of 8.2 Immunosuppressants advice. Jan 2019 May 2014 Review of Rituximab advice. 8.3 Jan 2019 May 2014 Review of Drugs Which 10.2 Suppress the Rheumatic Disease Process advice. Jan 2019 May 2014 Addition of Leflunomide. 10.2 *Changes marked should detail the section(s) of the document that have been amended, i.e. page number and section heading. UNCONTROLLED WHEN PRINTED Review Date: May 2022 Identifier: NHSG/Guid/PeriOp/MGPG1026 - v - A Guide to The Administration Of Medicines in the Peri-Operative Period – Version 3 Guideline for the Administration of Medicines in the Peri-Operative Period Contents Page No Introduction ................................................................................................................... 2 Objective of Guidance ................................................................................................... 3 Section 1: Gastrointestinal System ............................................................................... 4 Section 2: Cardiovascular System ................................................................................ 9 Section 3: Respiratory System .................................................................................... 16 Section 4: Central Nervous System............................................................................. 18 Section 5: Infections .................................................................................................... 36 Section 6: Endocrine System ...................................................................................... 38 Section 7: Obstetrics, Gynaecology & Urinary Tract ..................................................
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