Pre-op medication changes

Question 1

Which medications must be given pre-operatively?

Answer 1

• Anti-epileptics
• Anti-parkinsonian drugs
• Antipsychotics
• Anxiolytics
• Bronchodilators
• Cardiovascular drugs: except spironolactone; ARBs; ACEis
• PPIs; H₂RA
• Glaucoma drugs
• Immunosuppressants; steroids
• Drugs of dependence
• Thyroid anti-thyroid drugs

Question 2

Which drugs should be stopped prior to surgery?

Answer 2

• COCP
• MAOIs
• TCAs: risk of arrhythmias and hypotension
• Lithium: risk of toxicity
• Spironolactone; diuretics: risk of hyperkalaemia
• ACEi/ARBs: stop 24h prior; risk of severe hypotension
• Herbal medicines: potential interaction with anaesthetic