[Part 5] Inquiry Problem <Surgery: Colorectal Cancer Edition>

Hello everyone. Today, I will introduce the content of an inquiry for a patient undergoing colorectal cancer resection surgery.
Surgery is synonymous with the surgical department. However, there are also medications that require caution during surgery. Let's check them out!

Question 5

Surgery, 72 years old, male, height 170 cm, weight 60 kg
Laboratory values: WBC: 7000, GOT: 50, GPT: 35, sCre: 0.65, CRP: 0.52
Allergy history: Metal
Past medical history: Cerebral infarction, colitis, diabetes

Present illness
Underwent detailed examination due to a positive fecal occult blood test during a health checkup. As a result of the detailed examination, diagnosed with colorectal cancer. The stage is early and surgery is possible. After consulting with the doctor, it was decided to be hospitalized for surgery. The patient receives several medications from their primary care physician, but since they forgot to bring them, it was decided that all medications would be prescribed at the hospital, and the following prescriptions were issued.
(*Admission date/Prescription date: 4/1. Surgery: 4/8)

Prescription
Rp1. Aspirin enteric-coated tablets 100 mg, 1 tablet, once daily after breakfast, 7-day supply
Rp2. Lansoprazole tablets 15 mg, 1 tablet, once daily after breakfast, 7-day supply
Rp3. Metformin tablets 250 mg, 6 tablets, 3 times daily after each meal, 7-day supply

Now, what would you do for an inquiry with this?

The hint is to think about which medications are okay to use during surgery and which are not.

There are two mistakes this time. Let's not be satisfied with just one.

Prescription
Rp1.Aspirin enteric-coated tablets 100 mg 1 tablet, once daily after breakfast, 3-day supply
Rp2. Lansoprazole tablets 15 mg, 1 tablet, once daily after breakfast, 3-day supply
Rp3.Metformin tablets 250 mg 6 tablets, 3 times daily after each meal, 3-day supply

The answer is here.
There are two points this time. First, what kind of medication is an aspirin enteric-coated tablet? It is an antiplatelet drug (a so-called blood-thinning medication). Therefore, if taken before surgery, the possibility of increased bleeding during surgery is high. For this reason, in the case of aspirin, the medication is discontinued 1 to 2 weeks before, and it is switched to intravenous heparin or similar.
By the way, although I won't explain in detail, even among blood-thinning medications, there are those that require 1 day of withdrawal and those that require 1 week. Let's discontinue them according to the specific medication.

Also, metformin. This needs to be discontinued for 2 days before and after surgery. This is because dehydration during surgery can make lactic acidosis more likely to occur.

How was it? Checking for medications to discontinue is also essential. Especially since doctors may sometimes prescribe medications as they are when they are busy, pharmacists should check thoroughly.

See you again!

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