Prescribing Safety Assessment (PSA) Practice Exam

What is the general guideline for stopping potassium-sparing diuretics before surgery?

1. 1 day before

2. 4 weeks before

3. The day before

4. They should not be discontinued

The correct answer is: The day before

The guideline for discontinuing potassium-sparing diuretics before surgery centers on the potential risks associated with hyperkalemia, especially during procedures that may affect renal function or fluid balance. Discontinuing these medications the day before surgery allows enough time for their effects to diminish while still minimizing the risk of rebound fluid retention or hypertension that could occur if they are stopped too far in advance. Potassium-sparing diuretics work by preventing the loss of potassium in the urine, which can lead to elevated potassium levels in the blood. If these diuretics are stopped too abruptly or too far in advance of surgery, it can result in fluid overload or uncontrolled blood pressure due to the quick rebound effects of other diuretics that might be in use. Thus, stopping them the day before provides a good compromise between minimizing risks while ensuring the patient remains stable leading up to the surgery. Other timelines suggested, such as stopping them 1 day before or 4 weeks prior, may either not allow sufficient time for the medication to clear or lead to complications surrounding the patient's overall management leading to the surgery. Maintaining a careful balance of these medications is crucial in perioperative care.