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Managing medication before surgery

by Professor Lynn Basford

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There seems to be an endless list of things to do before having your elective Hysterectomy or other surgery, and feeling quite stressed about the whole situation may at times seem overwhelming. During this period it is easy to forget your prescribed medication or indeed remember to ask if you should stop taking it before surgery and, if so, WHEN?

 ESSENTIALLY  IT IS YOUR DOCTOR AND HEALTH PROFESSIONAL TEAM WHO ARE THE PEOPLE TO ASK AND TAKE APPROPRIATE ADVICE FROM.

 

The following is general advice given from the medical communities as part of any planned surgical intervention:

1. Recreational drugs

Heroin, marijuana, cocaine etc. should be stopped prior to surgery. If you have a drug dependency then this MUST be discussed with your profession health team so that they can accommodate for your personal issues. If time permits you may be asked to undergo an addictions programme that best suits your need.

 2. Blood thinning drugs 

The nature of these drugs are that they thin the blood which means the blood clotting time is reduced.  Of course that is what it is supposed to do, but there can be complications during surgical procedures in that you can bleed more easily. Unless your doctor tells you to continue taking your prescribed blood thinning medications, then it is common practice to ask you to stop taking them 7 days prior to surgery.

Most of these drugs contain aspirin but what is not commonly known is that there are a lot of over-the-counter drugs that contain aspirin. For example, Alka-Seltzer; Bufferin, advil ( ibuprofen); diclofenac; OR, some weight loss products  and some herbs. If by chance you are taking Warfarin your health professional team will discuss with you how your warfarin needs will be addressed.

3. Oral Contraception

Given the nature of your surgery you will no longer need to take oral contraception after surgery to prevent pregnancy nor will you need to take any other form of contraception. However, there may be other reasons why you were prescribed oral contraception and therefore it must be discussed with the health professional team. Usually for pregnancy prevention you can be told to stop taking them after your last packet prior to surgery, or if you take them for other reasons you can be advised to continue taking them up to 24 hours prior to surgery.

4. ACE inhibitors

These are medicines that are used mainly in the treatment of hypertension (high blood pressure) and heart failure.  They can also be used in cases of diabetes, for some forms of kidney disease, and after a heart attack to help protect the heart. They include: captopril, cilazapril, enalapril, fosinopril, imidapril, lisinopril, moexipril, perindopril, quinapril, ramipril and trandolapril. Each of these medicines also has various different brand names. Some ACE inhibitor medicines are also part of a combined tablet with a calcium-channel blocker medicine or diuretic medicine (water tablet). It is usually the anaesthetic team who  will need to understand the nature of you taking ACE inhibitors . Again your team will advice you when they would like you to stop taking them, but it is common to continue taking them until 18 hours prior to surgery.

5. Diuretics- Water pills.

For example, Lasix and Thalitone are designed to prevent oedema of your cellular tissue, i.e. water retention. Again your professional team will advice you when and if to stop taking these tablets. As a rule, it is usual for you to keep taking them until 24 hours prior to surgery.

6. Insulin

Your health professional team will discuss any changes required re dose etc prior to and post surgery. On no account do you stop taking your normal dose.

7. Anti-platelet medication

If you are on anti-platelet medication it is because you are at high risk of heart attack or stroke. they are designed to stop your platelets (that circulate your blood) from sticking together and forming clots. For example, aspirin,dipyridamole, clopidogrel. Your health professional team will advice you.

8 Comorbidity

If you are an individual who has multiple health problems it is likely that you will have several medications to take on a daily basis. This is not problematic if your health professional team knows your prescription plan. There will be communication from your doctor to the hospital, and on your admission there will be a planned approach made and discussed with you regarding your medication.

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9. Complementary therapies/herbal medicines

Please ensure you discuss any complementary/herbal medication that you may be taking. In some instances drugs can interact with each other and be detrimental to you health.

10. Hypothyroidism and Hyperthyroidism

Hypothyroidism means you have an under active thyroid that affects your metabolic behaviour, conversely if you have Hyperthyroidism it mean you have an overactive thyroid which in effect speeds up all the other bodily functions.

If you suffer from the former (hypothyroidism) you may be on daily oral drugs such as levothyroxine that are designed to replace the deficit hormone from your under active thyroid. You will have blood tests prior to surgery to confirm the levels of your thyroid hormones. Indeed it is well noted that stress can have an affect therefore don’t be surprised that there may be some adjustment needed to your dosage. On no account stop taking your tablets prior to surgery unless advised to do so by your professional team. 

If, on the other hand, you have an hyperactive thyroid it means your body is receiving too much thyroid hormones. The reasons for this are varied from a condition known as Graves disease, Thyroid nodules ( usually benign tumour ), or, cancer.

Treatment regimes usually consist of drugs to reduce the level of thyroid hormones such as, carbimazole, or, you may be on a regime of Thyroid Replacement Therapy until your doctors have determined the right therapeutic dose you require, or, you may be on a waiting list to have a thyroidectomy ( removal of your thyroid).

Please understand that your condition before your Hysterectomy will be monitored very carefully, and ideally you should be in a condition known as euthyroid ( simply means your thyroid functioning is within normal levels). Whatever your treatment regime is you must not stop it prior to surgery. Instead your health professional team will advice you.

11. Antidepressants

Antidepressants, as the name infers, means you are taking these drugs to alleviate some form of depression. This may be a mild (temporary) depression attack, perhaps after you have suffered from acute trauma or grief, or , be more sever form requiring long term therapeutic intervention.

Because of the variety of  diagnostic forms of  clinical depression it is clear there are a plethora of drugs  that can be prescribed. Notwithstanding,  a host of natural products including the herb St Johns Wort. Examples of prescribed antidepressant drugs are Prozac, Paxil, Zoloft ….etc. Whilst these drugs help you through your clinical depression there are emerging studies that suggest they may increase bleeding during surgery.* Therefore your health professional team may advice you to discontinue taking these drugs two weeks prior to surgery , or, you could be told to continue up to 24 hrs prior to surgery. AS always discuss both prescribed and natural products that you may be taking with your health professional team.

 

REMEMBER YOU ARE AN INDIVIDUAL WITH INDIVIDUAL NEEDS AND YOUR PROFESSIONAL TEAM IS THERE TO HELP AND ADVISE

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Click the box below to see all our articles on Preparing for Hysterectomy, and even if your surgery is for another condition much of the information in these articles will also apply.

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*Additional sources:

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