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Perioperative Medication (CVS (B-blockers
Continue dont start (Benefits
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Perioperative Medication
CVS
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ACEi
Controversial
Adverse
- Blunt RAS activation --> hypotension
Withdrawal
Observational 14k pt
- Reduced 30d mortality
- Reduced stroke/MI
- Reduced intraop hypotension
Increased post-op hypertension
Diuretics
Stop
Adverse
- Hypokalaemia & arrhythmia
- Hypotension due to volume
- Exacerbate bleeding hypotension
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Digoxin
Continue
Benefit
- Decreased periop arrhythmia
Statins
Continue
Benefit
- Prevent vascular events periop
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Others
OCP
Balanced Risk
Adverse
- VTE risk due to oestrogen dose
Discontinue 4/52 prior
- High risk surgery - balance risks
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Blood
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Clopidogrel
Withdrawal
- Increased stent thrombosis
Psychotropics
TCA
Balanced but continue
Adverse
- Delay gastric emptying
- QTc prolongation
- Arrhythmias
Withdrawal
- insomnia
- Headache
- Salivation/sweating
Interactions
- Sympathomimetics
- Atropine; confusion
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Lithium
Continue
Adverse
- Decrease NT release
- Prolong NDMR
- Toxic in renal impairment
- Interacts: NSAID, ACEi, Serotonergics, Diurectic
- Nephrogenic DI in 20% -> dehydration when water access impaired
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Benzodiazepines
Continue
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Adverse
- Increased sedation
- Tolerance
Psychostimulants
Stop DOS
Adverse
- Hypertension
- Arrhythmia
- Lower seizure threshold
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Steroids
Continue
Adverse
- Wound healing
- Skin/vessel friability
- Fracture risk
- GIT ulcer
Acute:
- Hyperglycaemia
- Hypertension
- Fluid retention
- Increased infection
No stress dosing
- Less than 5mg/day Prednisolone mane
- Glucocorticoid for <3 weeks
Intermediate: HPA axis unknown
- 5-20mg Prednisolone/day for >3weeks
Give Stress Dosing (Suppressed HPA Axis)
- Over 20mg/day prednisolone
- Over 3 weeks
- Cushingoid
Steroids in last year
- No evidence to support stress dosing