A patient is on regular medication for medical illness. Which of the following drugs can be safely stopped with least adverse effects before an abdominal surgery
**Core Concept**
Medication management is crucial before elective surgeries to minimize perioperative risks. Certain medications can be safely discontinued or continued in a reduced dose to reduce the risk of adverse effects during and after surgery.
**Why the Correct Answer is Right**
Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors. Stopping warfarin before surgery can reduce the risk of bleeding complications. However, it should be discontinued 5 days before surgery to allow INR levels to normalize. This allows for the safe administration of low molecular weight heparin (LMWH) or unfractionated heparin to maintain anticoagulation during the perioperative period.
**Why Each Wrong Option is Incorrect**
* **Option A:** Beta-blockers are commonly continued in a reduced dose before surgery to reduce the risk of cardiac complications. However, stopping beta-blockers abruptly can lead to rebound hypertension and tachycardia.
* **Option B:** Anti-epileptic medications like phenytoin and carbamazepine cannot be safely stopped before surgery, as they can increase the risk of seizures during the perioperative period.
* **Option C:** Corticosteroids like prednisolone are often continued in a reduced dose before surgery to prevent adrenal insufficiency. Stopping corticosteroids abruptly can lead to acute adrenal crisis.
**Clinical Pearl / High-Yield Fact**
Always review a patient's medication list before surgery and adjust or discontinue medications as necessary to minimize perioperative risks.
**Correct Answer: D. Warfarin**