Perioperative Medication Management


Summary

Although general internists and subspecialists are familiar with prescribing and managing medications in typical outpatient and inpatient venues, the perioperative period represents a challenging and often unfamiliar setting. This module will outline the principles, available evidence, and expert opinion to be considered when making perioperative management recommendations for some of the most commonly prescribed medications.

Goal
To provide hospitalists/consultants with the information necessary to appropriately manage a patient’s medications in the perioperative period.
Target Audience
This activity is designed for hospitalists and other physicians serving as consultants to patients undergoing surgery. No prerequisites required.
Learning Objectives

After completing the module, the participant should be able to:

  1. Analyze the risks and benefits underlying perioperative management of antiplatelet and anticoagulant medications.
  2. Recognize the importance of continuing most cardiovascular medications perioperatively.
  3. Recognize the importance of continuing most pulmonary medications perioperatively.
  4. Assess when stress dose steroids are indicated and manage other endocrine medications in the perioperative period.
  5. List the theoretical risks of continuing neuropsychiatric medications and decide whether or not to discontinue them.
  6. Identify and discontinue herbal medications that may adversely impact perioperative outcomes.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CME Information
Accreditation Statement: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement: The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: October 15, 2009. Expiration date: October 15, 2011.

Estimated time to complete activity: 2 hours
Faculty & Faculty Disclosures
Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

*Director–Medical Consultation Service, Kings County Hospital Center, Clinical Professor of Medicine, SUNY Downstate, Brooklyn, New York.

Conflict of Interest: Dr Cohn reports holding stock in AstraZeneca, GlaxoSmithKline, Merck & Co, Inc, and Pfizer Inc; and serving on the speakers’ bureau for Sanofi-Aventis.

Off-Label Product Discussion: All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

Disclaimer: The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Address correspondence to: Steven L. Cohn, MD, FACP, Director–Medical Consultation Service, Kings County Hospital Center, Clinical Professor of Medicine, SUNY Downstate, 470 Clarkson Avenue–Box 68, Brooklyn, NY 11203. E-mail: steven.cohn@downstate.edu.
References
Click here to download the references for this educational activity.
Instructions
The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study activity, and a CME post-test. All 3 sections must be completed to receive CME credit.


Supported by an educational grant from Merck & Co., Inc.