Peri-operative Medication

[Emmz]

I'm currently trying to revise for my exams and one of the questions that crops up frequently in the past papers is about a surgical patient who will be NBM for x amount of days and is on a, b, c and d etc meds and we have to advise the doctor on how to manage the medication.

We're allowed our BNFs in this exam so I've found the part on surgery at the back at it says things like anti-epileptics etc shouldn't be stopped, contraceptive pill should and how to manage diabetics. But I'm struggling a bit to find out whether to stop other meds. One that's on 2 is levothyroxine and I've got written in my notes on surgery that it can be stopped for up to 7 days but you need to monitor the patient ... but I can't find where it says this anywhere in the BNF? So I'm a bit worried that in the exam some of the meds may be like this and there be no reference to what to do in surgery with in the BNF.

I mean generally unless it was in the list that shouldn't be stopped and it's not got a warning label of 'do not stop taking this medicine unless on your doctors advice' would I suggest stopping it until the patient is no longer nil by mouth? Also what do I with meds that can't be stopped but there's not an alternative route of delivery? Still give them but with the minimal amount of water?

Any views would be greatly appreciated!!
Thanks

[pharmatron]

See this article on 'Medication in the peri-operative period' from the PJ a couple of years ago. I found it useful when revising for my exams.

http://www.pharmj.com/pdf/cpd/pj_200...perative01.pdf

Hope it helps!

[johnep]

Warfarin has to be stopped. In past meant pt had to be admitted and put on IV heparin. now can use LM heparin such as Innohep as out pt.
johnep