Perioperative Medication Management

Steven L. Cohn, MD, FACP, SFHM

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. 

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.
CME INFORMATION

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of University of Virginia School of Medicine, ASiM, and the Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement:
The University of Virginia School of Medicine designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: February 23, 2015.                Expiration date: February 23, 2018.

Estimated time to complete activity: 2 hours

FACULTY AND FACULTY DISCLOSURES
Full Disclosure Policy Affecting CME Activities:
The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.

The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.

All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.

The faculty and staff of the University of Virginia Office of Continuing Medical Education have no financial affiliations to disclose.

The following relationships have been reported for this activity:

Leonard Feldman, MD, FACP, SFHM (Chair)
Associate Professor of Medicine
Johns Hopkins University School of Medicine
Med-Peds Urban Health Residency Program Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Consultative, and Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Steven L. Cohn, MD, FACP, SFHM
Medical Director – UHealth Preoperative Assessment Center
Director–UMH Medical Consultation Service
Professor of Clinical Medicine
University of Miami – Miller School of Medicine
Miami, Florida
Dr Cohn reports having minor stock holdings in AstraZeneca, GlaxoSmithKline, Merck & Co, Inc, and Pfizer Inc; and serving on the Advisory Boards for Janssen and Bristol Myers Squibb..
 
Bartho Caponi, MD (Peer Reviewer)
Clinical Assistant Professor
Division of Hospital Medicine
University of Wisconsin Hospital and Clinics
Madison, Wisconsin
Dr Caponi reports having no significant financial or advisory relationships with corporate organizations related to this activity.
 

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 Blackwell Futura Media Services 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.

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 program, and a CME post-test. All 3 sections must be completed to receive CME credit.

Click here to download the references for this educational activity.

Please note, there is an ongoing inquiry into publications involving Dr Poldermans and his colleagues. The results of this inquiry may affect recommendations regarding perioperative use of β blockers and statins.

This activity is supported by independent educational grants from Boehringer Ingelheim Pharmaceuticals, Inc, Bristol-Myers Squibb Company, and Pfizer Inc.

Course summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 Equivalent Credit
Course opens: 
02/23/2015
Course expires: 
02/23/2018
Cost:
$0.00
Parent activity set: 
Rating: 
0

Available Credit

  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 Equivalent Credit

Accreditation Period

Course opens: 
02/23/2015
Course expires: 
02/23/2018

Price

Cost:
$0.00
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