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Section I, Surgical Recall Sixth Edition > Common Surgical Medications, Chapter21 P130-138 > Flashcards

Common Surgical Medications, Chapter21 P130-138 Flashcards

1
Q

ANTIBIOTICS
Which antibiotics are commonly used for anaerobic infections?
P130

A

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

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2
Q

ANTIBIOTICS
Which antibiotics are commonly used for gram-negative infections?
P131

A

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

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3
Q

ANTIBIOTICS
Which antibiotic, if taken with alcohol, will produce a
disulfiram-like reaction?
P131

A

Metronidazole (Flagyl®) (disulfiram is Antabuse®)

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4
Q

ANTIBIOTICS
What is the drug of choice for treating amoebic infections?
P131

A

Metronidazole (Flagyl®)

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5
Q

ANTIBIOTICS
Which antibiotic is associated with cholestasis?
P131

A

Ceftriaxone (Rocephin®)

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6
Q

ANTIBIOTICS
Which antibiotic cannot be given to children or pregnant
women?
P131

A

Ciprofloxacin (interferes with the growth plate)

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7
Q

ANTIBIOTICS
With which common antibiotics must serum levels be determined?
P131

A

Aminoglycosides and vancomycin

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8
Q

ANTIBIOTICS
Is rash (only) in response to penicillins a contraindication to cephalosporins?
P131

A

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

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9
Q

ANTIBIOTICS
Describe the following medications:
Augmentin®
P131

A

Amoxicillin and clavulanic acid

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10
Q

ANTIBIOTICS
Describe the following medications:
Unasyn®
P131

A

Ampicillin and sulbactam

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11
Q

ANTIBIOTICS
Describe the following medications:
Cefazolin (Ancef ®)
P131

A

First-generation cephalosporin; surgical prophylaxis for skin flora

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12
Q

ANTIBIOTICS
Describe the following medications:
Cefoxitin (Mefoxin®)
P131

A

Second-generation cephalosporin; used for mixed aerobic/anaerobic infections; effective against Bacteroides fragilis and anaerobic bacteria

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13
Q

ANTIBIOTICS
Describe the following medications:
Ceftazidime (Ceftaz®)
P131

A

Third-generation cephalosporin; strong activity against Pseudomonas

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14
Q

ANTIBIOTICS
Describe the following medications:
Clindamycin
P131

A

Strong activity against gram-negative anaerobes such as B. fragilis; adequate gram-positive activity

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15
Q

ANTIBIOTICS
Describe the following medications:
Gentamicin
P132

A

Aminoglycoside used to treat gramnegative bacteria; nephrotoxic, ototoxic; blood peak/trough levels should be
monitored

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16
Q

ANTIBIOTICS
Describe the following medications:
Imipenem and cilastatin (Primaxin®)
P132

A
  • Often used as a last resort against serious, multiresistant organisms
  • Usually combined with cilastin, which inhibits renal excretion of imipenem
  • Has a very wide spectrum
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17
Q

ANTIBIOTICS
Describe the following medications:
Metronidazole (Flagyl®)
P132

A

Used for serious anaerobic infections (e.g., diverticulitis); also used to treat amebiasis; patient must abstain from
alcohol use during therapy

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18
Q

ANTIBIOTICS
Describe the following medications:
Nafcillin (Nafcil®)
P132

A

Antistaphylococcal penicillin commonly used for cellulitis

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19
Q

ANTIBIOTICS
Describe the following medications:
Vancomycin
P132

A

Used to treat methicillin-resistant Staphylococcus aureus (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

ANTIBIOTICS
Describe the following medications:
Ciprofloxacin (Cipro®)
P132

A

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

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21
Q

ANTIBIOTICS
Describe the following medications:
Aztreonam (Azactam®)
P132

A

Monobactam with gram-negative spectrum

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22
Q

ANTIBIOTICS
Describe the following medications:
Amphotericin
P132

A

IV antifungal antibiotic associated with renal toxicity, hypokalemia

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23
Q

ANTIBIOTICS
Describe the following medications:
Fluconazole (Diflucan®)
P132

A

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

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24
Q

ANTIBIOTICS
Describe the following medications:
Nystatin
P132

A

PO and topical antifungal

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25
Q

STEROIDS
What are the side effects?
P133

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 (avascular necrosis of the hip), GI perforations

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26
Q

STEROIDS
What are its uses?
P133

A

Immunosuppression (transplant), autoimmune diseases, hormone replacement (Addison’s disease), spinal cord trauma, COPD

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27
Q

STEROIDS
Can steroids be stopped
abruptly?
P133

A

No, steroids should never be stopped abruptly; always taper

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28
Q

STEROIDS
Which patients need stress-dose steroids before surgery?
P133

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

STEROIDS
What is the “stress dose” for steroids?
P133

A

100 mg of hydrocortisone IV every 8 hours and then taper (adults)

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30
Q

STEROIDS
Which vitamin helps counteract the deleterious effects of steroids on wound healing?
P133

A

Vitamin A

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31
Q

HEPARIN
Describe the action.
P133

A

Heparin binds with and activates antithrombin III

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32
Q

HEPARIN
What are its uses?
P133

A

Prophylaxis/treatment—DVT, pulmonary embolism, stroke, atrial fibrillation, acute arterial occlusion, cardiopulmonary bypass

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33
Q

HEPARIN
What are the side effects?
P133

A

Bleeding complications; can cause thrombocytopenia

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34
Q

HEPARIN
What reverses the effects?
P133

A

Protamine IV ( 1:100, 1 mg of protamine to every 100 units of heparin)

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35
Q

HEPARIN
What laboratory test should be used to follow effect?
P134

A

aPTT—activated partial thromboplastin time

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36
Q

HEPARIN
What is the standard lab target for therapeutic heparinization?
P134

A

1.5–2.5 times control or measured antifactor X level

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37
Q

HEPARIN
Who is at risk for a protamine anaphylactic reaction?
P134

A

Patients with type 1 diabetes mellitus, s/p prostate surgery

38
Q

HEPARIN
What is the half-life of heparin?
P134

A

≈90 minutes (1–2 hours)

39
Q

HEPARIN
How long before surgery should it be discontinued?
P134

A

From 4 to 6 hours preoperatively

40
Q

HEPARIN
Does heparin dissolve clots?
P134

A

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

41
Q

HEPARIN
What is LMWH?
P134

A

Low Molecular Weight Heparin

42
Q

HEPARIN
What laboratory test do you need to follow LMWH?
P134

A

None, except in children, patients with obesity, and those with renal failure, which is the major advantage of LMWH
(check factor X levels)

43
Q

WARFARIN (COUMADIN®)
ACRONYM basis for name?
P134

A

Wisconsin Alumni Research Foundation

44
Q

WARFARIN (COUMADIN®)
Describe its action.
P134

A

Inhibits vitamin K–dependent clotting factors II, VII, IX, and X, (i.e., 2, 7, 9 and 10 [Think: 2 + 7 = 9 and 10]), produced in the liver

45
Q

WARFARIN (COUMADIN®)
What are its uses?
P134

A

Long-term anticoagulation (PO)

46
Q

WARFARIN (COUMADIN®)
What are its associated risks?
P134

A

Bleeding complications, teratogenic in pregnancy, skin necrosis, dermatitis

47
Q

WARFARIN (COUMADIN®)
What laboratory test should be used to follow its effect?
P134

A

PT (prothrombin time) as reported as INR

48
Q

WARFARIN (COUMADIN®)
What is INR?
P134

A

International Normalized Ratio

49
Q

WARFARIN (COUMADIN®)
What is the classic therapeutic INR?
P135

A

INR of 2–3

50
Q

WARFARIN (COUMADIN®)
What is the half-life of effect?
P135

A

40 hours; thus, it takes about 2 days to observe a change in the PT

51
Q

WARFARIN (COUMADIN®)
What reverses the action?
P135

A

Cessation, vitamin K, fresh-frozen plasma (in emergencies)

52
Q

WARFARIN (COUMADIN®)
How long before surgery should it be discontinued?
P135

A

From 3 to 5 days preoperatively and IV heparin should be begun; heparin should be discontinued from 4 to 6 hours
preoperatively and can be restarted postoperatively; Coumadin® can be restarted in a few days

53
Q

WARFARIN (COUMADIN®)
How can warfarin cause skin necrosis when first started?
P135

A

Initially depressed protein C and S result in a HYPERcoagulable state! Avoid by using heparin concomitantly when starting

54
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Sucralfate (Carafate®)
P135

A

Treats peptic ulcers by forming an acidresistant barrier; binds to ulcer craters; needs acid to activate and thus should not be used with H(2) blockers

55
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Cimetidine (Tagamet®)
P135

A

H(2) blocker (ulcers/gastritis)

56
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Ranitidine (Zantac®)
P135

A

H(2) blocker (ulcers/gastritis)

57
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Ondansetron (Zofran®)
P135

A

Antinausea

Anti-emetic

58
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
PPI
P135

A

Proton-Pump Inhibitor:

Gastric acid–secretion inhibitor; works by inhibiting the K⁺/H⁺-ATPase (e.g., omeprazole [Prilosec®])

59
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Promethazine (Phenergan®)
P135

A

Acute antinausea agent; used postoperatively

60
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Metoclopramide (Reglan®)
P136

A

Increases gastric emptying with increase in LES pressure; dopamine antagonist; used in diabetic gastroparesis and to help move feeding tubes past the pylorus

61
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Haloperidol (Haldol®)
P136

A

Sedative/antipsychotic (side effects extrapyramidal symptoms, QT prolongation)

62
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Ondansetron (Zofran®)
P136

A

Anti-emetic/serotonin receptor blocker

63
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Albumin
P136

A

5% albumin
25% albumin—draws extravascular fluid into intravascular
space by oncotic pressure

64
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Albuterol
P136

A

Inhaled ℬ(2) agonist (bronchodilator)

65
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Octreotide
P136

A

Somatostatin analog

66
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Famotidine (Pepcid®)
P136

A

H(2) blocker

67
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Aspirin
P136

A

Irreversibly inhibits platelets by irreversibly inhibiting cyclooxygenase

68
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Furosemide (Lasix®)
P136

A

Loop diuretic (watch for hypokalemia)

69
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Dantrolene (Dantrium®)
P136

A

Medication used to treat malignant hyperthermia

70
Q

MISCELLANEOUS AGENTS
Describe the following drugs:
Misoprostol (Cytotec®)
P136

A 
Prostaglandin E(1 )analog
Gastroduodenal mucosal protection
71
Q

MISCELLANEOUS AGENTS
What is an antibiotic option for colon/appendectomy
coverage if the patient is allergic to penicillin?
P136

A
  1. IV ciprofloxacin (Cipro) AND

2. IV clindamycin or IV Flagyl

72
Q

MISCELLANEOUS AGENTS
If the patient does not respond to a dose of furosemide, should the dose be repeated, increased, or decreased?
P136

A

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

73
Q

MISCELLANEOUS AGENTS
What medication is used to treat promethazine-induced
dystonia?
P137

A

Diphenhydramine hydrochloride IV (Benadryl®)

74
Q

MISCELLANEOUS AGENTS
Which medication is classically associated with mesenteric ischemia?
P137

75
Q

MISCELLANEOUS AGENTS
What type of antihypertensive medication is contraindicated
in patients with renal artery stenosis?
P137

A

ACE inhibitors

76
Q

MISCELLANEOUS AGENTS
Does acetaminophen (Tylenol®) inhibit platelets?
P137

77
Q

MISCELLANEOUS AGENTS
What medications are used to stop seizures?
P137

A

Benzodiazepines (e.g., lorazepam [Ativan®]); phenytoin (Dilantin®)

78
Q

MISCELLANEOUS AGENTS
List examples of preop antibiotics for:
Vascular prosthetic graft
P137

A

Ancef ® (gram-positive coverage)

79
Q

MISCELLANEOUS AGENTS
List examples of preop antibiotics for:
Appendectomy
P137

A

Cefoxitin, Unasyn® (anaerobic coverage)

80
Q

MISCELLANEOUS AGENTS
List examples of preop antibiotics for:
Colon surgery
P137

A

Cefoxitin, Unasyn® (anaerobic coverage)

81
Q

NARCOTICS
What are common postoperative IV narcotics?
P137

A

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

82
Q

NARCOTICS
What is Percocet®
P137

A

PO narcotic pain reliever with acetaminophen and oxycodone

83
Q

NARCOTICS
What is Demerol’s claim to fame?
P137

A

Used commonly with acute pancreatitis/biliary pathology because classically morphine may cause sphincter of Oddi
spasm/constriction

84
Q

NARCOTICS
What are side effects of narcotics?
P137

A

Respiratory depression, hypotension, itching, bradycardia, nausea

85
Q

NARCOTICS
What is the danger of prolonged use of Demerol?
P138

A

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

86
Q

NARCOTICS
What medication reverses the effects of narcotic overdose?
P138

A

Naloxone (Narcan®), 0.4 mg IV

87
Q

NARCOTICS
Narcotic used to decrease postoperative shivering?
P138

88
Q

MISCELLANEOUS
What reverses the effects of benzodiazepines?
P138

A

Flumazenil (Romazicon®), 0.2 mg IV

89
Q

MISCELLANEOUS
What is Toradol®?
P138

A

Ketorolac = IV NSAID

90
Q

MISCELLANEOUS
What are the risks of Toradol®?
P138

A

GI bleed, renal injury, platelet dysfunction

91
Q

MISCELLANEOUS
Why give patients IV Cipro if they are eating a regular diet?
P138

A

No reason—500 mg of Cipro PO gives the same serum level as 400 mg Cipro IV! And PO is much cheaper!

92
Q

MISCELLANEOUS
What is clonidine “rebound”?
P138

A

Abruptly stopping clonidine can cause
the patient to have severe “rebound”
hypertension (also seen with ℬ-blockers)

Section I, Surgical Recall Sixth Edition (33 decks)

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