Dominate perioperative medication management with tips from Kashlak’s newly minted Chief of Perioperative Medicine, @aoglasser, Avital O’Glasser MD, FACP, FHM (OHSU). We cover perioperative anticoagulation, why “bridging is dead”, aspirin, dual antiplatelet therapy, DMARDS, diabetic medications, buprenorphine, and much more! Be sure to check out Dr. O’Glasser’s previous episode #135 Perioperative Medicine: Assess and Optimize Risk to get a full overview of perioperative medicine. ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Full show notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced by: Avital O’Glasser MD, FACP, FHM and Matthew Watto MD, FACP  CME Questions: Matthew Watto MD, FACP Infographic: Matthew Watto MD, FACP Cover Art: Kate Grant MBChB DipGUMed Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP  Editor: Matthew Watto MD, FACP Guest: Avital O’Glasser MD, FACP, FHM Time Stamps 00:00 Intro, disclaimer, guest bio 03:20 Guest one-liner 04:46 Picks of the Week*: A Moment of Lift (book) by Melinda Gates; Crawl (film); Rich Roll (podcast) episodes w/Valter Longo and David Sinclair 09:35 Avi’s mantras for perioperative management and other core tenants 14:40 NPO and The Consult Guys 17:23 Medical cannabis (marijuana) in perioperative medicine 19:24 Case #1 Ms. Bridge - perioperative anticoagulation: to bridge or not to bridge 25:00 Low bleeding risk surgeries and anticoagulation 27:25 Moderate to high bleeding risk surgeries and anticoagulation; What about the CHA2DS2 Vasc of 7? 28:42 Bridging for venous thromboembolism (VTE) 31:30 How to give instructions for holding warfarin 32:30 Bridging a DOAC 36:16 Recap on bridging VKAs and use of DOACs 37:48 Neuraxial anesthesia and anticoagulation 39:49 Biologic DMARDS; Nonbiologic DMARDS 43:48 Supplements and herbals 48:40 Case #1 wrap up 50:16 Case #2 -Mr. DAPT; Perioperative Aspirin; DAPT -dual antiplatelet therapy 57:20 Summary of perioperative antiplatelet therapy 63:18 Statins 64:45 Beta blockers 67:21 ACEI and ARB; Diuretics 69:17 Oral hypoglycemics and newer diabetes agents (SGLT2 inhibitors, GLP1 agonists); What about metformin? 72:04 Insulin 74:40 Case #2 wrap up 75:35 Case #3 Ms. GB Stone who takes lithium and buprenorphine 77:30 NSAIDS, Buprenorphine 81:45 ART, transplant meds, Lithium, MAOIs, Levothyroxine; Watch out for lithium 86:34 Case #3 wrap up 87:25 Take Home Points 88:45 Outro 90:15 Avi and Mr. Rogers  *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goals Listeners will develop a practical approach to perioperative medication management and review special considerations for the various drug classes. Learning objectives After listening to this episode listeners will... Frame perioperative medication management decisions as another type of patient-centered, surgery-specific perioperative “risk/benefit” decision Discuss guideline recommendations for the perioperative management of multiple classes of medications Examine more nuanced or challenging medications to manage in the perioperative setting Explore professional, patient-centered and multidisciplinary communication techniques when disagreements arise regarding best medication management recommendations Disclosures Dr O’Glasser reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation O’Glasser A, Williams PN, Watto MF. “#174 Perioperative Medication Management”. The Curbsiders Internal Medi