Differences

This shows you the differences between two versions of the page.

Link to this comparison view

Both sides previous revision Previous revision
Next revision		 Previous revision
peri_operative_medication_management [2026/04/09 03:22] – Scott Larsonperi_operative_medication_management [2026/04/09 03:30] (current) – Scott Larson
Line 1: Line 1:
 ====== Peri-Operative Medication Management ====== ====== Peri-Operative Medication Management ======
-FIXME+
 ====Cardiovascular and Hypertensive Medication==== ====Cardiovascular and Hypertensive Medication====
   * Beta Blockers- continue through surgery    * Beta Blockers- continue through surgery 
Line 135: Line 135:
   * Hold for 2-3 half-lives before surgery—restart with wound closure ~ 2 weeks after surgery. Consult with rheumatology if any questions about medication management.   * Hold for 2-3 half-lives before surgery—restart with wound closure ~ 2 weeks after surgery. Consult with rheumatology if any questions about medication management.
  
-==TNF Blockers==+===TNF Blockers===
  
   * Etanercept (Enbrel)—t ½ 3.5-5.5d, hold 7-10 days prior to surgery   * Etanercept (Enbrel)—t ½ 3.5-5.5d, hold 7-10 days prior to surgery
Line 144: Line 144:
   * Golimumab (Simponi)—t ½ 14d, hold 4 weeks prior to surgery   * Golimumab (Simponi)—t ½ 14d, hold 4 weeks prior to surgery
  
-==PDE-4 Inhibitor==+===PDE-4 Inhibitor===
  
   * Apremilast (Otezla) - t ½ 6-9 hrs, hold 3 days prior and resume when stitches are out   * Apremilast (Otezla) - t ½ 6-9 hrs, hold 3 days prior and resume when stitches are out
  
-==T cell costimulator==+===T cell costimulator===
  
   * Abatacept (Orencia)—t ½ 13d, hold 4 weeks prior to surgery   * Abatacept (Orencia)—t ½ 13d, hold 4 weeks prior to surgery
  
-==Interleukins antagonist==+===Interleukins antagonist===
  
   * Tocilizumab (Actemra)—t ½ 11-13d, hold 3 weeks prior to surgery   * Tocilizumab (Actemra)—t ½ 11-13d, hold 3 weeks prior to surgery
   * Anakinra (Kineret)—t ½ 4-6 hrs, hold 1 day prior to surgery   * Anakinra (Kineret)—t ½ 4-6 hrs, hold 1 day prior to surgery
  
-==B cell depleting agent and other biological modifiers==+===B cell depleting agent and other biological modifiers===
  
   * Rituximab (Rituxan)—t ½ 18 d, hold 4 weeks prior to surgery   * Rituximab (Rituxan)—t ½ 18 d, hold 4 weeks prior to surgery
Line 166: Line 166:
   * Upadacitinib (Rinvoq)- t ½ 8-14hrs, ok to continue through surgery for low-risk procedure (per Dr. Knibbe)   * Upadacitinib (Rinvoq)- t ½ 8-14hrs, ok to continue through surgery for low-risk procedure (per Dr. Knibbe)
  
-===Gout Medications===+====Gout Medications====
  
   * Hold colchicine, allopurinol and probenecid on day of surgery   * Hold colchicine, allopurinol and probenecid on day of surgery
Line 175: Line 175:
   * If patient is on an mTOR inhibitor (sirolimus or everolimus), recommend discussion with nephrology prior to surgery as these can cause post-op wound healing issues, seromas and lymphoceles.   * If patient is on an mTOR inhibitor (sirolimus or everolimus), recommend discussion with nephrology prior to surgery as these can cause post-op wound healing issues, seromas and lymphoceles.
  
-11.  Hematology/Oncology Medication-Best to discuss IN ADVANCE OF SURGERY with Hematologist and surgeon for guidance during perioperative period. +====Hematology and Oncology Medications==== 
 +  * Best to discuss IN ADVANCE OF SURGERY with Hematologist and surgeon for guidance during perioperative period.
   * Palbociclib (Ibrance)-- can cause neutropenia, dosed 3 weeks on/1 week off to allow ANC to recover. May need to be held before surgery and up to 1 week after to allow for healing but needs to be discussed with oncologist MUCH PRIOR to surgery to coordinate   * Palbociclib (Ibrance)-- can cause neutropenia, dosed 3 weeks on/1 week off to allow ANC to recover. May need to be held before surgery and up to 1 week after to allow for healing but needs to be discussed with oncologist MUCH PRIOR to surgery to coordinate
   * Anastrozole (Arimidex), tamoxifen, letrozole, exemestane (Aromasin)-- hold 1 day prior to surgery and day of surgery due to risk for clotting. Should be held up to 1 week after surgery depending on mobility   * Anastrozole (Arimidex), tamoxifen, letrozole, exemestane (Aromasin)-- hold 1 day prior to surgery and day of surgery due to risk for clotting. Should be held up to 1 week after surgery depending on mobility
  
-12.  Parathyroid Hormone Analogs+====Parathyroid Hormone Analogs====
  
   * Teriparatide (Forteo) and other similar osteoporosis agents are ok to continue through surgery.   * Teriparatide (Forteo) and other similar osteoporosis agents are ok to continue through surgery.
  
-13.  PDE Inhibitors (i.e. sildenafil)+====PDE Inhibitors (i.e. sildenafil)====
  
   * If for ED, hold for 24 hrs prior to surgery. Continue if for pulmonary HTN.   * If for ED, hold for 24 hrs prior to surgery. Continue if for pulmonary HTN.
  
-14. Herbal Medications+====Herbal Medications====
   * CBD oil should also be held for 1 week prior to surgery.    * CBD oil should also be held for 1 week prior to surgery. 
   * Stop ALL herbal supplements for 1 week prior to surgery.   * Stop ALL herbal supplements for 1 week prior to surgery.