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