Hold Meds for morning tests

    • Many tests require patients to be NPO.

    • Most orders are written: "NPO after midnight except meds"

    • Cardiac stress tests need you also hold BB, CCB the morning of tests.

    • D/C metformin 24 hours prior to studies involving IV iodinated contrast.

    • If test is cancelled, make sure to restart diet.

    • Drugs stopped preop for CTS

      • ASA: 3 - 7 days, though some surgeons continue. Decreased perioperative mortality.

      • Clopidogrel (Plavix): 5 - 7 days.

      • Abciximab (Reopro): 12 - 24 h

      • Eptifibatide (Integrilin): 2 - 4 h

      • Tirofiban (Aggrastat): 2 - 4 h

      • LMWH: 12 h

      • UFH: 4 - 8 h or not stopped.

      • Warfarin: 4 days

      • Thrombolytic Tx (tPA): surgery should be delayed at least 24 h.

      • NSAID, Omega-3-fatty acids (fish oils), garlic, vitamin E, gingko, flavanoids: stop ASAP before surgery.

      • Smoking: stop at least 4 weeks prior to surgery.

      • Hold cellcept for 10 days before and 2 weeks after surgery.

      • Hold Forteo (teriparatide) for 1 week before and 2 weeks after surgery.

      • Continue with steroids, use stress dose if patient has been on steroids for a long time.

      • D/c Metformin, switch Pt. to insulin