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Surgical Recall > Common Surgical Medications > Flashcards

Common Surgical Medications Flashcards

1
Q

Which antibiotics are commonly used for anaerobic infections?

A

Metronidazole, clindamycin, cefoxitin, cefotetan, imipenem, ticarcillin-clavulanic acid, Unasyn, Augmentin

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2
Q

Which antibiotics are commonly used for gram-negative infections?

A

Gentamicin and other aminoglycosides, ciprofloxacin, aztreonam, 3rd-generation cephalosporins, sulfamethoxazole-trimethoprim

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3
Q

Which antibiotic, if taken with alcohol, will produce a disulfiram-like reaction?

A

Metronidazole (Flagyl)

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4
Q

What is the drug of choice for treating amoebic infections?

A

Metronidazole (Flagyl)

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5
Q

Which antibiotic is associated with cholestasis?

A

Ceftriaxone (Rocephin)

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6
Q

Which antibiotic cannot be given to children or pregnant women?

A

Ciprofloxacin (interferes with growth plate)

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7
Q

With which common antibiotics must serum levels be determined?

A

Aminoglycosides and vancomycin

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8
Q

Is rash (only) in response to penicillins a contraindication to cephalosporins?

A

No, but breathing problems, urticaria, and edema in response to penicillins are contraindications to the cephalosporins

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9
Q

What is Augmentin?

A

Amoxicillin and clavulanic acid

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10
Q

What is Unasyn?

A

Ampicillin and sulbactam

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11
Q

What is cefazolin (Ancef)?

A

1st-generation cephalosporin.

Surgical prophylaxis for skin flora.

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12
Q

What is cefoxitin (Mefoxin)?

A

2nd-generation cephalosporin.
Used for mixed aerobic/anaerobic infections.
Effective against Bacteroides fragilis and anaerobic bacteria.

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13
Q

What is ceftazidime (Ceftaz)?

A

3rd-generation cephalosporin.

Strong activity against Pseudomonas.

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14
Q

What is clindamycin?

A

Strong activity agains gram-negative anaerobes such as B. fragilis.
Adequate gram-positive activity.

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15
Q

What is gentamicin?

A

Aminoglycoside used to treat gram-negative bacteria.
Nephrotoxic, ototoxic.
Bblood teak/trough levels should be monitored.

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16
Q

What is imipenem and cilastatin (Primaxin)?

A

Often used as a last resort against serious multiresistant organisms.
Usually combined with cilastatin, which inhibits renal excretion of imipenem.
Has a very wide spectrum.

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17
Q

What is metronidazole (Flagyl)?

A

Used for serious anaerobic infections.
Also used to treat amebiasis.
Patient must abstain from alcohol use during therapy.

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18
Q

What is nafcillin (Nafcil)?

A

Anti-staphylococcal penicillin commonly used for cellulitis

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19
Q

What is vancomycin?

A

Used to treat MRSA.
Used orally to treat C. difficile pseudomembranous colitis (poorly absorbed from the gut).
With IV administration, peak/trough levels should be monitored.

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20
Q

What is ciprofloxacin (Cipro)?

A

Quinoline antibiotic with broad-spectrum activity, especially against gram-negative bacteria, including Pseudomonas

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21
Q

What is aztreonam (Azactam)?

A

Monobactam with gram-negative spectrum

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22
Q

What is amphotericin?

A

IV antifungal antibiotic associated with renal toxicity, hypokalemia

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23
Q

What is fluconazole (Diflucan)?

A

Antifungal agent (IV or PO) not associated with renal toxicity

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24
Q

What is nystatin?

A

PO and topical antifungal

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25
What are the side effects of steroids?
Adrenal suppression, immunosuppression, weight gain with central obesity, cushingoid facies, acne, hirsutism, purple striae, hyperglycemia, sodium retention, hypokalemia, hypertension, osteopenia, myopathy, ischemic bone necrosis, GI perforations
26
What are the uses of steroids?
Immunosuppression (transplant), autoimmune diseases, hormone replacement, spinal cord trauma, COPD
27
Can steroids be abruptly stopped?
No, steroids should always be tapered
28
Which patients need stress-dose steroid before surgery?
Those who are on steroids, were on steroids in the past year, have suspected hypoadrenalism, or are about to undergo adrenalectomy
29
What is the stress dose for steroids?
100 mg of hydrocortisone IV q8h and then taper
30
Which vitamin helps counteract the deleterious effects of steroids on wound healing?
Vitamin A
31
What is the mechanism of action of heparin?
Heparin binds with and activates antithrombin III
32
What are the uses of heparin?
Prophylaxis and treatment of DVT, PE, stoke, atrial fibrillation, acute arterial occlusion, cardiopulmonary bypass
33
What are the side effects of heparin?
Bleeding complications, can cause thrombocytopenia
34
What reverses the effects of heparin?
Protamine IV
35
What lab test should be used to follow the effect of heparin?
aPTT (activated PTT)
36
What is the standard lab target for therapeutic heparinization?
1.5-2.5 times control or measured anti-factor X level
37
Who is at risk for a protamine anaphylactic reaction?
Patients with type I diabetes mellitus, s/p prostate surgery
38
What is the half-life of heparin?
90 minutes
39
How long before surgery should heparin be discontinued?
From 4-6 hours preoperatively
40
Does heparin dissolve clots?
No, it stops the progression of clot formation and allows the body's own fibrinolytic systems to dissolve the clot
41
What is LMWH?
Low Molecular Weight Heparin
42
What lab test do you need to follow LMWH?
None, except in children, patients with obesity, and those with renal failure
43
What is the mechanism of action of warfarin?
Inhibits vitamin K-dependent clotting factors II, VII, IX, and X produced in the liver
44
What are the uses of warfarin?
Long-term anticoagulation
45
What are the associated risks of warfarin?
Bleeding complications, teratogenic in pregnancy, skin necrosis, dermatitis
46
What lab test should be used to follow its effect?
PT as reported in INR
47
What is the half-life of warfarin?
40 hours
48
What reverses the action of warfarin?
Cessation, vitamin K, FFP (in emergencies)
49
How long before surgery should warfarin be discontinued?
From 3-5 days preoperatively and IV heparin should be begun. | Warfarin can be restarted a few days post-op.
50
How can warfarin cause skin necrosis when first started?
Initially depressed protein C and S result in a hypercoagulable state (avoid by using heparin concomitantly when starting)
51
What is sucralfate (Carafate)?
Treats peptic ulcers by forming an acid-resistant barrier. Binds to ulcer craters. Needs acid to activate and thus should not be used with H2 blockers.
52
What is cimetidine (Tagamet)?
H2 blocker
53
What is ranitidine (Zantac)?
H2 blocker
54
What is ondansetron (Zofran)?
Anti-nausea, anti-emetic. | Serotonin receptor blocker.
55
What is a PPI?
Proton-pump inhibitor: Gastric acid-secretion inhibitor. Works by inhibiting the K/H-ATPase
56
What is promethazine (Phenergan)?
Acute anti-nausea agent. | Used postoperatively.
57
What is metoclopramide (Reglan)?
Increases gastric emptying with increase in LES pressure. | Dopamine antagonist used in diabetic gastroparesis and to help move feeding tubes past the pylorus.
58
What is haloperidol (Haldol)?
Sedative/antipsychotic. | Side effects: extrapyramidal symptoms, QT prolongation.
59
What is albumin?
25% albumin: draws extravascular fluid into intravascular space by oncotic pressure
60
What is albuterol?
Inhaled B2 agonist (bronchodilator)
61
What is octreotide?
Somatostatin analog
62
What is famotidine (Pepcid)?
H2 blocker
63
What is aspirin?
Irreversibly inhibits platelets by irreversibly inhibiting cyclooxygenase
64
What is furosemide (Lasix)?
Loop diuretic (watch for hypokalemia)
65
What is dantrolene (Dantrium)?
Used to treat malignant hyperthermia
66
What is misoprostal (Cytotec)?
Prostaglandin E1 analog. | Gastroduodenal mucosal protection.
67
What is an antibiotic option for colon/appendectomy coverage if the patient is allergic to penicillin?
1. IV ciprofloxacin and | 2. IV clindamycin or metronidazole
68
If the patient does not respond to a dose of furosemide, should the dose be repeated, increased, or decreased?
Dose should be doubled if there is no response to the initial dose
69
What medication is used to treat promethazine-induced dystonia?
Diphenhydramine hydrochloride IV (Benadryl)
70
Which medication is classically associated with mesenteric ischemia?
Digitalis
71
What type of antihypertensive medication is contraindicated in patients with renal artery stenosis?
ACE inhibitors
72
Does acetaminophen (Tylenol) inhibit platelets?
No
73
What medications are used to stop seizures?
Benzodiazepines, phenytoin (Dilantin)
74
What preoperative antibiotics are given for vascular prosthetic graft?
Ancef (gram-positive coverage)
75
What preoperative antibiotics are given for appendectomy?
Cefoxitin, Unasyn (anaerobic coverage)
76
What preoperative antibiotics are given for colon surgery?
Cefoxitin, Unasyn (anaerobic coverage)
77
What are common postoperative IV narcotics?
Morphine (most common), meperidine (Demerol), fentanyl, Percocet, Dilaudid
78
What is Percocet?
PO narcotic pain reliever with acetaminophen and oxycodone
79
What narcotic is commonly used with acute pancreatitis or biliary pathology?
Demerol
80
Why is morphine contraindicated with acute pancreatitis or biliary pathology?
May cause spasm or constriction of the sphincter of Oddi
81
What are side effects of narcotics?
Respiratory depression, hypotension, itching, bradycardia, nausea
82
What is the danger of prolonged use of Demerol?
Accumulation of metabolite normeperidine (especially with renal/hepatic dysfunction), which may result in over-sedation, hallucinations, and seizures
83
What medication reverses the effects of narcotic overdose?
Naloxone (Narcan), 0.4 mg IV
84
Which narcotic is used to decrease postoperative shivering?
Demerol
85
What reverses the effects of benzodiazepines?
Flumazenil (Romazicon), 0.2 mg IV
86
What is Toradol?
Ketorolac, an IV NSAID
87
What are the risks of Toradol?
GI bleed, renal injury, platelet dysfunction
88
Why give patients IV Cipro if they are eating a regular diet?
No reason, 500 mg of Cipro PO gives the same serum level as 400 mg Cipro IV
89
What is clonidine rebound?
Abruptly stopping clonidine can cause the patient to have severe rebound hypertension

Surgical Recall (68 decks)

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