Check Your INR!
Guidelines
Pre- and Post-Op
Playing Together
100
This fat based vitamin affects platelet function, may increase mortality at doses of >= 400 IU/day, and can decrease the effect of vitamin K/increase the risk of bleeding at doses of 800 IU/day.
What is Vitamin E?
100
One should stop all natural medicines _ days before surgery because further research is needed to more fully assess half-lives. One should stop NSAIDS _ half-lives before surgery. Stop Diclofenac, Ibuprofen and Ketoprofen _ days before surgery. Stop Celcoxib, Diflunisal Naproxen and Sulindac _ days before surgery. Stop Meloxicam, Nabumetone and Piroxicam _ days before surgery.
What is 14? What is 5 half-lives? What is 1, 2-3, 10 days?
100
For most post-op patients re-start antiplatelets _ hours after surgery or the morning after surgery if hemostatis is achieved.
What is 24?
100
Body builders and those using weight loss products have replaced ephedra with this supplement. The stimulant contains synephrine and has been linked to numerous reports of hypertension, tachycardia, stroke, MI and arrhythmias.
What is bitter orange?
200
1mg to 2mg of this vitamin can be given orally 1-2 days pre-op if the INR is higher than 1.5. For urgent surgeries, 2.5mg or 5mg of this vitamin can be given IV.
What is vitamin K?
200
Because of the long elimination half-life of this pharmaceutical (58 days) and its active metabolite, desethylamiodarone (36 days), it is unreasonable to discontinue therapy to achieve low serum drug concentrations before surgery. Therefore, this pharmaceutical may safely be continued for most surgical procedures, especially when therapy is indicated for the treatment of life-threatening arrhythmias
What is amiodarone?
200
Beta-blockers should be continued for at least this amount of time after surgery.
What is one month?
200
Name 5 supplements that affect platelet function and should be used with great caution when also using aspirin, clopidogrel, warfarin and ticlopidine.
What are Ginkgo biloba, coenzyme 10, green tea, garlic, guggul, fish oil (>3g day), vitamin E, horse chestnut, Cordyceps fungus and policosanol?
300
This herb is commonly used to improve memory. It has also been associated with case reports reporting excessive post-op bleeding requiring transfusion following laparoscopic surgery and total hip arthroplasty.
What is ginkgo biloba?
300
Beta-blocker use perioperatively is determined by risk. A high risk patient has more than one clinical risk factor and should continue/start beta-blockers titrated to heart rate and blood pressure for high risk surgery (vascular surgery) and intermediate risk surgery (prostate, orthopedic, head, neck, chest, carotid, intraperitoneal). There is no recommendation for starting a beta-blocker for low risk surgeries (ambulatory, superficial, endoscopic, cataract, breast surgery). The clinical risk factors are:
What are history of ischemic heart disease, heart failure, cerebrovascular disease, diabetes, serum creatinine 2mg dl or higher?
300
Beta blockers are used perioperatively to prevent increased heart rate triggered by this intra-operative cascade of events.
What is the release of epinephrine and norepinephrine in response to surgical stress? The release increases heart rate and contractility which can lead to ischemia and arrhythmias, if myocardial oxygen demand exceeds supply.
300
This root (Glycyrrhiza glabra) has mineralcorticoid actions resulting in potential problems wtih hypokalemia, edema and hypertension. Stop this root around surgery and with coronary artery disease.
What is Licorice root?
400
This fatty acid has significant positive effects on cardiovascular health. It has antithrombin and antiplatelet effects in addition to reducing blood pressure. It may also interact with warfarin.
What is omega 3?
400
Current research supports starting beta-blockers days to weeks before surgery for high risk patients titrating to a resting heart rate of 60 to 80 bpm with a systolic pressure of no less than 100 mm Hg. Do not use high dose beta blockers without titration. Though there is no definitive dosing regimen for preioperative beta-blockers these doses are suggested.
What are 1. Bisoprolol 2.5mg/day (DECREASE IV study) 2. Atonolol 50mg or 100mg qdaily 3. Metoprolol 25mg or 50 mg qdaily?
400
Risk of a perioperative cardiovascular event such as death caused by an MI is _% in the general population. In high risk patients the incidence is __%.
What is 1% to 5%? What is 11% to 34%?
400
In addition to smoking cessation, these four classes of pharmaceuticals lower the risk of future vascular events by about 25% each:
What are aspirin, beta blockers, Angiotension-converting enzyme inhibitors, statins (lipid lowering agents)?
500
Statins block the hepatic pathway that branches to this supplement. This supplement is needed for oxidative phosphorylation in the mitochondria for the production of ATP used in muscle contraction. Clinically, this supplement reduces ventricular arrhythmias and HTN. It also may have vitamin K-like procoagulant effects, which reduces the anticoagulation effects of warfarin.
What is co-enzyme Q10? Dosage 20-200mg/day in divided doses.
500
While the data regarding the perioperative use of ACE inhibitors and ARBs are somewhat conflicting, the current recommendation is to discontinue these medications at least ___ hours before anesthesia induction and surgery because of this potential side effect.
What are 24 hours and hypotension?
500
Provide FFP a few hours before surgery to ameliorate the effects of this blood thinner when the INR is above __.
What are Warfarin and 1.5?
500
This imagery CD was found highly effective in research at The Cleveland Clinic, UC Davis Medical Center, and Blue Shield of California in decreasing anxiety around surgery.
What are the Successful Surgery CDs by Belleruth Naparstek sold by Health Journeys?
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