Pre-op Medicine withdraw - april17

[ArchivalUser]

Hi, i saw She posted somes good post-op Q . Now pls try this preop Q, She.
A 64yo woman with diabetes, HTN, and depression presents for preop evaluation. She is to undergo excision of a lung mass. Current medications are Glyburide, Metformin , lisinopril , hydrochlorothiazide , and sertraline daily.What should the patient be instructed to do with these medications b4 surgery?
A. Hold all medications on the morning of surgery
B. Hold Metformin, HCTZ, sertraline on the morning of surgery
C. Take only the lisinopril on the morning of surgery
D. Take only the HCTZ on the morning of surgery
E.Take all of your medications, but take only 1/2 of the glyburide dose
F. Take all of your medications except the HCTZ, which should be held

[ArchivalUser]

B. Hold Metformin, HCTZ, sertraline on the morning of surgery?

[ArchivalUser]

April 17 very trick q,a real good one...I think it is C as most of the patients need insulin and hence metformin and glyburide is not given in the morning ofthe surgery,serrtaline causes mild platelet dysfunction which is rare so we could eliminate that, the antihypertensive should not be discontinued especially beta blocker i hope that holds good for ACE inhibitors tooo...so my ans is C...i have never felt so tense to ans any q till today,,,,though i keep making mistakes..

[ArchivalUser]

I agree C .. so what is the answer April17 ?

[ArchivalUser]

I also think it is C.The hypoglycemic drugs per os have to be cut off on the day of surgery,drugs for HTN(lisinopril) have to be mainained due to risk of post-OP rebound HTN and diuretics have to be set up again on the day after surgery to prevent complications of CHF.

[ArchivalUser]

C is the right ans. For this pt, all antihypertensive drugs should be continue as usual, except diuretics. So,the only medication she should take on the morning of surgery is lisinopril.
Other drug are held on the morning of surgery (and metformin is held 2 days preoperatively-
http://www.medsafe.govt.nz/profs/PUarticles/5.htm#Not)

[ArchivalUser]

excellent q