Common Surgical Medications Flashcards
Which antibiotics are commonly used for anaerobic infections?
Metronidazole, clindamycin, cefoxitin, cefotetan, imipenem, ticarcillin-clavulanic acid, Unasyn, Augmentin
Which antibiotics are commonly used for gram-negative infections?
Gentamicin and other aminoglycosides, ciprofloxacin, aztreonam, 3rd-generation cephalosporins, sulfamethoxazole-trimethoprim
Which antibiotic, if taken with alcohol, will produce a disulfiram-like reaction?
Metronidazole (Flagyl)
What is the drug of choice for treating amoebic infections?
Metronidazole (Flagyl)
Which antibiotic is associated with cholestasis?
Ceftriaxone (Rocephin)
Which antibiotic cannot be given to children or pregnant women?
Ciprofloxacin (interferes with growth plate)
With which common antibiotics must serum levels be determined?
Aminoglycosides and vancomycin
Is rash (only) in response to penicillins a contraindication to cephalosporins?
No, but breathing problems, urticaria, and edema in response to penicillins are contraindications to the cephalosporins
What is Augmentin?
Amoxicillin and clavulanic acid
What is Unasyn?
Ampicillin and sulbactam
What is cefazolin (Ancef)?
1st-generation cephalosporin.
Surgical prophylaxis for skin flora.
What is cefoxitin (Mefoxin)?
2nd-generation cephalosporin.
Used for mixed aerobic/anaerobic infections.
Effective against Bacteroides fragilis and anaerobic bacteria.
What is ceftazidime (Ceftaz)?
3rd-generation cephalosporin.
Strong activity against Pseudomonas.
What is clindamycin?
Strong activity agains gram-negative anaerobes such as B. fragilis.
Adequate gram-positive activity.
What is gentamicin?
Aminoglycoside used to treat gram-negative bacteria.
Nephrotoxic, ototoxic.
Bblood teak/trough levels should be monitored.
What is imipenem and cilastatin (Primaxin)?
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.
What is metronidazole (Flagyl)?
Used for serious anaerobic infections.
Also used to treat amebiasis.
Patient must abstain from alcohol use during therapy.
What is nafcillin (Nafcil)?
Anti-staphylococcal penicillin commonly used for cellulitis
What is vancomycin?
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.
What is ciprofloxacin (Cipro)?
Quinoline antibiotic with broad-spectrum activity, especially against gram-negative bacteria, including Pseudomonas
What is aztreonam (Azactam)?
Monobactam with gram-negative spectrum
What is amphotericin?
IV antifungal antibiotic associated with renal toxicity, hypokalemia
What is fluconazole (Diflucan)?
Antifungal agent (IV or PO) not associated with renal toxicity
What is nystatin?
PO and topical antifungal
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
What are the uses of steroids?
Immunosuppression (transplant), autoimmune diseases, hormone replacement, spinal cord trauma, COPD
Can steroids be abruptly stopped?
No, steroids should always be tapered
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
What is the stress dose for steroids?
100 mg of hydrocortisone IV q8h and then taper
Which vitamin helps counteract the deleterious effects of steroids on wound healing?
Vitamin A
What is the mechanism of action of heparin?
Heparin binds with and activates antithrombin III
What are the uses of heparin?
Prophylaxis and treatment of DVT, PE, stoke, atrial fibrillation, acute arterial occlusion, cardiopulmonary bypass
What are the side effects of heparin?
Bleeding complications, can cause thrombocytopenia
What reverses the effects of heparin?
Protamine IV
What lab test should be used to follow the effect of heparin?
aPTT (activated PTT)
What is the standard lab target for therapeutic heparinization?
1.5-2.5 times control or measured anti-factor X level
Who is at risk for a protamine anaphylactic reaction?
Patients with type I diabetes mellitus, s/p prostate surgery
What is the half-life of heparin?
90 minutes
How long before surgery should heparin be discontinued?
From 4-6 hours preoperatively
Does heparin dissolve clots?
No, it stops the progression of clot formation and allows the body’s own fibrinolytic systems to dissolve the clot
What is LMWH?
Low Molecular Weight Heparin
What lab test do you need to follow LMWH?
None, except in children, patients with obesity, and those with renal failure
What is the mechanism of action of warfarin?
Inhibits vitamin K-dependent clotting factors II, VII, IX, and X produced in the liver
What are the uses of warfarin?
Long-term anticoagulation
What are the associated risks of warfarin?
Bleeding complications, teratogenic in pregnancy, skin necrosis, dermatitis
What lab test should be used to follow its effect?
PT as reported in INR
What is the half-life of warfarin?
40 hours
What reverses the action of warfarin?
Cessation, vitamin K, FFP (in emergencies)
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.
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)
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.
What is cimetidine (Tagamet)?
H2 blocker
What is ranitidine (Zantac)?
H2 blocker
What is ondansetron (Zofran)?
Anti-nausea, anti-emetic.
Serotonin receptor blocker.
What is a PPI?
Proton-pump inhibitor:
Gastric acid-secretion inhibitor.
Works by inhibiting the K/H-ATPase
What is promethazine (Phenergan)?
Acute anti-nausea agent.
Used postoperatively.
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.
What is haloperidol (Haldol)?
Sedative/antipsychotic.
Side effects: extrapyramidal symptoms, QT prolongation.
What is albumin?
25% albumin: draws extravascular fluid into intravascular space by oncotic pressure
What is albuterol?
Inhaled B2 agonist (bronchodilator)
What is octreotide?
Somatostatin analog
What is famotidine (Pepcid)?
H2 blocker
What is aspirin?
Irreversibly inhibits platelets by irreversibly inhibiting cyclooxygenase
What is furosemide (Lasix)?
Loop diuretic (watch for hypokalemia)
What is dantrolene (Dantrium)?
Used to treat malignant hyperthermia
What is misoprostal (Cytotec)?
Prostaglandin E1 analog.
Gastroduodenal mucosal protection.
What is an antibiotic option for colon/appendectomy coverage if the patient is allergic to penicillin?
- IV ciprofloxacin and
2. IV clindamycin or metronidazole
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
What medication is used to treat promethazine-induced dystonia?
Diphenhydramine hydrochloride IV (Benadryl)
Which medication is classically associated with mesenteric ischemia?
Digitalis
What type of antihypertensive medication is contraindicated in patients with renal artery stenosis?
ACE inhibitors
Does acetaminophen (Tylenol) inhibit platelets?
No
What medications are used to stop seizures?
Benzodiazepines, phenytoin (Dilantin)
What preoperative antibiotics are given for vascular prosthetic graft?
Ancef (gram-positive coverage)
What preoperative antibiotics are given for appendectomy?
Cefoxitin, Unasyn (anaerobic coverage)
What preoperative antibiotics are given for colon surgery?
Cefoxitin, Unasyn (anaerobic coverage)
What are common postoperative IV narcotics?
Morphine (most common), meperidine (Demerol), fentanyl, Percocet, Dilaudid
What is Percocet?
PO narcotic pain reliever with acetaminophen and oxycodone
What narcotic is commonly used with acute pancreatitis or biliary pathology?
Demerol
Why is morphine contraindicated with acute pancreatitis or biliary pathology?
May cause spasm or constriction of the sphincter of Oddi
What are side effects of narcotics?
Respiratory depression, hypotension, itching, bradycardia, nausea
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
What medication reverses the effects of narcotic overdose?
Naloxone (Narcan), 0.4 mg IV
Which narcotic is used to decrease postoperative shivering?
Demerol
What reverses the effects of benzodiazepines?
Flumazenil (Romazicon), 0.2 mg IV
What is Toradol?
Ketorolac, an IV NSAID
What are the risks of Toradol?
GI bleed, renal injury, platelet dysfunction
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
What is clonidine rebound?
Abruptly stopping clonidine can cause the patient to have severe rebound hypertension
