Allergies and Surgery (Random)

Question 1

Which antihistamines can help with nausea and vomiting?

Answer 1

Cinnarizine
Cyclizine
Promethazine teoclate

Question 2

What is anaphylaxis?

Answer 2

A severe, life-threatening hypersensitivity reaction

Question 3

What are the most common allergens that can cause anaphylaxis?

Answer 3

Food (peanuts, sesame, tree nuts, soy)

Drugs (antibacterials, aspirin and other NSAIDS, neuromuscular blocking drugs, chlorhexidine, vaccines)

Venom (insect stings)

Latex

Question 4

What is the first-line treatment for anaphylaxis?

Answer 4

Intramuscular adrenaline/epinephrine

Question 5

What is refractory anaphylaxis?

Answer 5

Anaphylaxis that requires ongoing treatment due to persisting respiratory and/or cardiovascular problems despite two appropriate doses of intramuscular adrenaline/epinephrine

Question 6

What is allergic angioedemia?

Answer 6

Angioedema can be caused by an allergic reaction. It involves the swelling of deeper tissues, most commonly in the eyelids and lips, and sometimes the tongue and throat. Allergic angioedema that occurs with life-threatening airway and/or breathing and/or circulatory problems should be managed as anaphylaxis.

Question 7

What is a food allergy?

Answer 7

An adverse immune response to food, commonly associated with cutaneous and gastro-intestinal reactions, and less frequently associated with respiratory reactions and anaphylaxis.

Question 8

What are some of the most common food allergies?

Answer 8

Cow’s milk
Hen’s eggs
Soy
Wheat
Peanuts
Tree nuts
Fish
Shellfish

Question 9

Drugs Usually NOT Stopped Before Surgery

-Antiepileptics
-Antiparkinsonian drugs
-Antipsychotics
-Anxiolytics
-Bronchodilators
-CV drugs
-Glaucoma drugs
-Immunosuppressants
-Drugs of dependence
-Thyroid/antithyroid drugs

Answer 9

.

Question 10

Drugs Usually STOPPED Before Surgery

-Hormonal contraceptives
-MAOIs: can have interactions with drugs used during surgery
-Lithium (24h before major surgery)
-Potassium-sparing diuretics: hyperkalaemia may develop if renal perfusion is impaired.
-ACEi and ARBs (stop 24h before surgery): associated with severe hypotension after anaethesia induction
-TCA’s (depends: can increase hypotension and arrhythmia risk).
-Antiplatelets and Anticoagulants: joint decision to be made by surgery team whether to stop or replace with unfractionated heparin or LMWH.
-Herbal remedies

Question 11

Vaccination Timeline

-8 weeks: *6-in-1, Rotavirus, MenB
-12 weeks: *6-in-1 (second dose), pneumococcal vaccine, Rotavirus (second dose)
-16 weeks: *6-in-1 (3rd dose), MenB (second dose)
-One year: Hib/MenC (1st dose), MMR (1st dose), pneumococcal (second dose), MenB (third dose)

-3 years and 4 months: MMR (2nd dose), 4-in-1 pre-school booster

-65 years: pneumococcal vaccine, flu vaccine (and every year after)

70 years: Shingles

The 6-in-1 vaccine: diphtheria, hepatitis B, Hib (haemophilus influenza type b), polio, tetanus, whooping cough.

Answer 11

.

Question 12

For multiple daily dose regimens, blood samples should be taken one hour after administration (peak) and just before the next dose (trough). If the pre-dose (trough) is high, the dosing interval must be increased. If the post dose (peak) is high, the dose must be _.

Answer 12

Decreased

Question 13

Anaphylaxis Adrenaline: 300mcg is the standard dose for children, and between 300-500mcg is the standard dose for adults, depending on weight.

Question 14

How long before surgery should sulfonylureas be stopped?

Answer 14

The day of surgery

Question 15

Why do TCAs need to be stopped prior to surgery?

Answer 15

Can cause fatal arrhythmias whilst under anaesthesia