Prescribing Safety Assessment (PSA) Practice Exam

Which medications should generally be stopped prior to surgery?

1. Antihistamines and antipyretics

2. Insulin, Lithium, ARBs, ACE inhibitors, and Anticoagulants

3. Vitamins and herbal supplements

4. Analgesics and corticosteroids

The correct answer is: Insulin, Lithium, ARBs, ACE inhibitors, and Anticoagulants

The medications that should generally be stopped prior to surgery include insulin, lithium, angiotensin receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, and anticoagulants. This is because these drugs can pose significant risks during surgical procedures. Insulin needs special consideration due to the potential for hypoglycemia during fasting periods that often precede surgery. Managing blood glucose levels is crucial, so the timing of insulin administration may require adjustments. Lithium is used to treat mood disorders but can lead to complications during surgery, such as fluctuations in electrolyte balance and potential interactions with anesthetics. Both ARBs and ACE inhibitors can affect blood pressure regulation. Their continuation may lead to intraoperative hypotension or decreased renal perfusion, especially under anesthesia. Anticoagulants significantly increase the risk of bleeding during surgery, which is why they are typically stopped to minimize this risk. Careful management is required for patients on anticoagulation to ensure they are safely off the medication for an appropriate period prior to their procedure and to manage their anticoagulation thereafter. In contrast, although antihistamines, antipyretics, vitamins, herbal supplements, analgesics, and corticosteroids may require some attention, they do not universally pose the same