Nokea
Ms. OReilly is a 69-year-old patient who is having a bowel resection for a malignant tumor of the right colon. She has several chronic medical conditions and takes numerous daily medications, including metoprolol 100 mg daily, warfarin 5 mg daily, vitamin E 200 units daily, and metformin 1000 mg bid. Which of the following regimens is the most appropriate approach to managing her medications preoperatively?
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. Metformin should be held if the morning blood sugar is < 200 mg/dL to reduce the risk of lactic acidosis postoperatively.
2. Warfarin should be held 5 days before surgery to prevent excessive bleeding during the procedure.
3. Beta blocker (metoprolol) can be continued on the day of surgery to prevent rebound hypertension.
4. Vitamin E can be continued as it does not have significant interactions or adverse effects in this scenario.
Summary:
- Choice A is incorrect as it does not address the need to hold metformin and warfarin appropriately.
- Choice B is incorrect as it discontinues medications too early and does not address metformin management.
- Choice C is incorrect as it only addresses warfarin and does not consider metformin or other medications.
- Choice D is the most appropriate approach as it addresses the specific considerations for each medication based on their effects and interactions.