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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
Q

What are the side effects of steroids?

A

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

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26
Q

What are the uses of steroids?

A

Immunosuppression (transplant), autoimmune diseases, hormone replacement, spinal cord trauma, COPD

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27
Q

Can steroids be abruptly stopped?

A

No, steroids should always be tapered

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28
Q

Which patients need stress-dose steroid before surgery?

A

Those who are on steroids, were on steroids in the past year, have suspected hypoadrenalism, or are about to undergo adrenalectomy

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29
Q

What is the stress dose for steroids?

A

100 mg of hydrocortisone IV q8h and then taper

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30
Q

Which vitamin helps counteract the deleterious effects of steroids on wound healing?

A

Vitamin A

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31
Q

What is the mechanism of action of heparin?

A

Heparin binds with and activates antithrombin III

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32
Q

What are the uses of heparin?

A

Prophylaxis and treatment of DVT, PE, stoke, atrial fibrillation, acute arterial occlusion, cardiopulmonary bypass

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33
Q

What are the side effects of heparin?

A

Bleeding complications, can cause thrombocytopenia

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34
Q

What reverses the effects of heparin?

A

Protamine IV

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35
Q

What lab test should be used to follow the effect of heparin?

A

aPTT (activated PTT)

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36
Q

What is the standard lab target for therapeutic heparinization?

A

1.5-2.5 times control or measured anti-factor X level

37
Q

Who is at risk for a protamine anaphylactic reaction?

A

Patients with type I diabetes mellitus, s/p prostate surgery

38
Q

What is the half-life of heparin?

A

90 minutes

39
Q

How long before surgery should heparin be discontinued?

A

From 4-6 hours preoperatively

40
Q

Does heparin dissolve clots?

A

No, it stops the progression of clot formation and allows the body’s own fibrinolytic systems to dissolve the clot

41
Q

What is LMWH?

A

Low Molecular Weight Heparin

42
Q

What lab test do you need to follow LMWH?

A

None, except in children, patients with obesity, and those with renal failure

43
Q

What is the mechanism of action of warfarin?

A

Inhibits vitamin K-dependent clotting factors II, VII, IX, and X produced in the liver

44
Q

What are the uses of warfarin?

A

Long-term anticoagulation

45
Q

What are the associated risks of warfarin?

A

Bleeding complications, teratogenic in pregnancy, skin necrosis, dermatitis

46
Q

What lab test should be used to follow its effect?

A

PT as reported in INR

47
Q

What is the half-life of warfarin?

A

40 hours

48
Q

What reverses the action of warfarin?

A

Cessation, vitamin K, FFP (in emergencies)

49
Q

How long before surgery should warfarin be discontinued?

A

From 3-5 days preoperatively and IV heparin should be begun.

Warfarin can be restarted a few days post-op.

50
Q

How can warfarin cause skin necrosis when first started?

A

Initially depressed protein C and S result in a hypercoagulable state (avoid by using heparin concomitantly when starting)

51
Q

What is sucralfate (Carafate)?

A

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
Q

What is cimetidine (Tagamet)?

A

H2 blocker

53
Q

What is ranitidine (Zantac)?

A

H2 blocker

54
Q

What is ondansetron (Zofran)?

A

Anti-nausea, anti-emetic.

Serotonin receptor blocker.

55
Q

What is a PPI?

A

Proton-pump inhibitor:
Gastric acid-secretion inhibitor.
Works by inhibiting the K/H-ATPase

56
Q

What is promethazine (Phenergan)?

A

Acute anti-nausea agent.

Used postoperatively.

57
Q

What is metoclopramide (Reglan)?

A

Increases gastric emptying with increase in LES pressure.

Dopamine antagonist used in diabetic gastroparesis and to help move feeding tubes past the pylorus.

58
Q

What is haloperidol (Haldol)?

A

Sedative/antipsychotic.

Side effects: extrapyramidal symptoms, QT prolongation.

59
Q

What is albumin?

A

25% albumin: draws extravascular fluid into intravascular space by oncotic pressure

60
Q

What is albuterol?

A

Inhaled B2 agonist (bronchodilator)

61
Q

What is octreotide?

A

Somatostatin analog

62
Q

What is famotidine (Pepcid)?

A

H2 blocker

63
Q

What is aspirin?

A

Irreversibly inhibits platelets by irreversibly inhibiting cyclooxygenase

64
Q

What is furosemide (Lasix)?

A

Loop diuretic (watch for hypokalemia)

65
Q

What is dantrolene (Dantrium)?

A

Used to treat malignant hyperthermia

66
Q

What is misoprostal (Cytotec)?

A

Prostaglandin E1 analog.

Gastroduodenal mucosal protection.

67
Q

What is an antibiotic option for colon/appendectomy coverage if the patient is allergic to penicillin?

A
  1. IV ciprofloxacin and

2. IV clindamycin or metronidazole

68
Q

If the patient does not respond to a dose of furosemide, should the dose be repeated, increased, or decreased?

A

Dose should be doubled if there is no response to the initial dose

69
Q

What medication is used to treat promethazine-induced dystonia?

A

Diphenhydramine hydrochloride IV (Benadryl)

70
Q

Which medication is classically associated with mesenteric ischemia?

A

Digitalis

71
Q

What type of antihypertensive medication is contraindicated in patients with renal artery stenosis?

A

ACE inhibitors

72
Q

Does acetaminophen (Tylenol) inhibit platelets?

A

No

73
Q

What medications are used to stop seizures?

A

Benzodiazepines, phenytoin (Dilantin)

74
Q

What preoperative antibiotics are given for vascular prosthetic graft?

A

Ancef (gram-positive coverage)

75
Q

What preoperative antibiotics are given for appendectomy?

A

Cefoxitin, Unasyn (anaerobic coverage)

76
Q

What preoperative antibiotics are given for colon surgery?

A

Cefoxitin, Unasyn (anaerobic coverage)

77
Q

What are common postoperative IV narcotics?

A

Morphine (most common), meperidine (Demerol), fentanyl, Percocet, Dilaudid

78
Q

What is Percocet?

A

PO narcotic pain reliever with acetaminophen and oxycodone

79
Q

What narcotic is commonly used with acute pancreatitis or biliary pathology?

A

Demerol

80
Q

Why is morphine contraindicated with acute pancreatitis or biliary pathology?

A

May cause spasm or constriction of the sphincter of Oddi

81
Q

What are side effects of narcotics?

A

Respiratory depression, hypotension, itching, bradycardia, nausea

82
Q

What is the danger of prolonged use of Demerol?

A

Accumulation of metabolite normeperidine (especially with renal/hepatic dysfunction), which may result in over-sedation, hallucinations, and seizures

83
Q

What medication reverses the effects of narcotic overdose?

A

Naloxone (Narcan), 0.4 mg IV

84
Q

Which narcotic is used to decrease postoperative shivering?

A

Demerol

85
Q

What reverses the effects of benzodiazepines?

A

Flumazenil (Romazicon), 0.2 mg IV

86
Q

What is Toradol?

A

Ketorolac, an IV NSAID

87
Q

What are the risks of Toradol?

A

GI bleed, renal injury, platelet dysfunction

88
Q

Why give patients IV Cipro if they are eating a regular diet?

A

No reason, 500 mg of Cipro PO gives the same serum level as 400 mg Cipro IV

89
Q

What is clonidine rebound?

A

Abruptly stopping clonidine can cause the patient to have severe rebound hypertension

Surgical Recall (68 decks)

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