Surgery
How to manage ANTIplatelets around surgery
As a clinical pharmacist, you will be asked how to manage dual antiplatelet therapy (DAPT) around surgery in patients with a recent coronary stent. It’s a balancing act between risk of thrombosis and bleeding. American College of Cardiology guidelines still prefer at least 6 to 12 months of DAPT after most stent placements, but suggest shorter durations as an opti…
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Weight Loss
Adjusting medications after bariatric surgery
More patients will need help adjusting medications after bariatric surgery. More of these procedures are being done to help patients lose weight, control diabetes, and improve cardiovascular risk. Gastric banding (Lap-Band) and the Roux-en-Y gastric bypass are the most common procedures. Banding uses an inflatable ring to squeeze the neck of the stomach to reduce sto…
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Surgery
How to manage direct oral anticoagulants (DOACs) around surgery?!
As a clinical pharmacist, you'll face questions about how to manage direct oral anticoagulants ( Eliquis , etc) around an elective procedure or surgery. Direct oral anticoagulants (DOACs) kick in and wear off faster than warfarin, so they need to be managed differently around procedures. Explain it's okay to continue DOACs for many low-bleeding-risk proced…
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Surgery
Management of minor bleeding from antithrombotics
Patients using an antithrombotic may be alarmed by "nuisance bleeding" OR nosebleeds, prolonged bleeding from a small cut, etc. This isn't typically serious or a reason to stop therapy. Share tips to prevent bleeding, such as using a saline spray to keep the nasal passages moist, an electric razor to avoid nicks while shaving and a soft toothbrush to pr…
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Surgery
Stopping medications preoperatively in some patients
One of the most important questions, when to temporarily stop chronic medications before NONcardiac surgery?.. Consider these tips to manage common home medications before surgery... Diabetes medications. Stop most non-insulin drugs the morning of surgery. But consider stopping metformin 24 hours pre-operative and SGLT2 inhibit…
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Surgery
When to hold medications before colonoscopy?
Patients will ask pharmacist which medications need to be held before colonoscopy. Most medications can be taken with a sip of water about 3 hours before the procedure including low-dose aspirin or NSAIDs. For others, work with prescribers and consider some rules of thumb... Anticoagulants In general, suggest holding warfarin 5 days before the procedure or dire…
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Surgery
Preop mgmt of diabetes meds in pts undergoing surgery
Overview ㅡ The goal is to help prevent the blood glucose seesaw. Consider these strategies, but be aware, evidence is lacking for the best preoperative glucose targets or protocols for diabetes medications. Continue to recommend avoiding tight blood glucose control around surgery to limit hypoglycemia. Generally aim to keep glucose below 180 mg/dL or lean toward less…
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