Common Surgical Medications, Chapter21 P130-138 Flashcards by Bea Eus

ANTIBIOTICS
Which antibiotics are commonly used for anaerobic infections?
P130

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

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

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

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

Metronidazole (Flagyl®) (disulfiram is Antabuse®)

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

Metronidazole (Flagyl®)

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ANTIBIOTICS
Which antibiotic is associated with cholestasis?
P131

Ceftriaxone (Rocephin®)

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

Ciprofloxacin (interferes with the growth plate)

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

Aminoglycosides and vancomycin

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

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

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ANTIBIOTICS
Describe the following medications:
Augmentin®
P131

Amoxicillin and clavulanic acid

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ANTIBIOTICS
Describe the following medications:
Unasyn®
P131

Ampicillin and sulbactam

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

First-generation cephalosporin; surgical prophylaxis for skin flora

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

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

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

Third-generation cephalosporin; strong activity against Pseudomonas

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ANTIBIOTICS
Describe the following medications:
Clindamycin
P131

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

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ANTIBIOTICS
Describe the following medications:
Gentamicin
P132

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

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

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

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

Antistaphylococcal penicillin commonly used for cellulitis

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ANTIBIOTICS
Describe the following medications:
Vancomycin
P132

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

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

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

Monobactam with gram-negative spectrum

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ANTIBIOTICS
Describe the following medications:
Amphotericin
P132

IV antifungal antibiotic associated with renal toxicity, hypokalemia

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

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

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ANTIBIOTICS
Describe the following medications:
Nystatin
P132

PO and topical antifungal

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STEROIDS What are the side effects? P133

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

STEROIDS What are its uses? P133

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

STEROIDS Can steroids be stopped abruptly? P133

No, steroids should never be stopped abruptly; always taper

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

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

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

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

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

Vitamin A

HEPARIN Describe the action. P133

Heparin binds with and activates antithrombin III

HEPARIN What are its uses? P133

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

HEPARIN What are the side effects? P133

Bleeding complications; can cause thrombocytopenia

HEPARIN What reverses the effects? P133

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

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

aPTT—activated partial thromboplastin time

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

1.5–2.5 times control or measured antifactor X level

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

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

HEPARIN What is the half-life of heparin? P134

≈90 minutes (1–2 hours)

HEPARIN How long before surgery should it be discontinued? P134

From 4 to 6 hours preoperatively

HEPARIN Does heparin dissolve clots? P134

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

HEPARIN What is LMWH? P134

Low Molecular Weight Heparin

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

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

WARFARIN (COUMADIN®) ACRONYM basis for name? P134

Wisconsin Alumni Research Foundation

WARFARIN (COUMADIN®) Describe its action. P134

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

WARFARIN (COUMADIN®) What are its uses? P134

Long-term anticoagulation (PO)

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

Bleeding complications, teratogenic in pregnancy, skin necrosis, dermatitis

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

PT (prothrombin time) as reported as INR

WARFARIN (COUMADIN®) What is INR? P134

International Normalized Ratio

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

INR of 2–3

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

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

WARFARIN (COUMADIN®) What reverses the action? P135

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

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

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

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

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

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

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

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

H(2) blocker (ulcers/gastritis)

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

H(2) blocker (ulcers/gastritis)

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

Antinausea | Anti-emetic

MISCELLANEOUS AGENTS Describe the following drugs: PPI P135

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

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

Acute antinausea agent; used postoperatively

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

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

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

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

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

Anti-emetic/serotonin receptor blocker

MISCELLANEOUS AGENTS Describe the following drugs: Albumin P136

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

MISCELLANEOUS AGENTS Describe the following drugs: Albuterol P136

Inhaled ℬ(2) agonist (bronchodilator)

MISCELLANEOUS AGENTS Describe the following drugs: Octreotide P136

Somatostatin analog

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

H(2) blocker

MISCELLANEOUS AGENTS Describe the following drugs: Aspirin P136

Irreversibly inhibits platelets by irreversibly inhibiting cyclooxygenase

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

Loop diuretic (watch for hypokalemia)

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

Medication used to treat malignant hyperthermia

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

``` Prostaglandin E(1 )analog Gastroduodenal mucosal protection ```

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

1. IV ciprofloxacin (Cipro) AND | 2. IV clindamycin or IV Flagyl

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

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

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

Diphenhydramine hydrochloride IV (Benadryl®)

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

Digitalis

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

ACE inhibitors

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

MISCELLANEOUS AGENTS What medications are used to stop seizures? P137

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

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

Ancef ® (gram-positive coverage)

MISCELLANEOUS AGENTS List examples of preop antibiotics for: Appendectomy P137

Cefoxitin, Unasyn® (anaerobic coverage)

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

Cefoxitin, Unasyn® (anaerobic coverage)

NARCOTICS What are common postoperative IV narcotics? P137

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

NARCOTICS What is Percocet® P137

PO narcotic pain reliever with acetaminophen and oxycodone

NARCOTICS What is Demerol’s claim to fame? P137

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

NARCOTICS What are side effects of narcotics? P137

Respiratory depression, hypotension, itching, bradycardia, nausea

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

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

NARCOTICS What medication reverses the effects of narcotic overdose? P138

Naloxone (Narcan®), 0.4 mg IV

NARCOTICS Narcotic used to decrease postoperative shivering? P138

Demerol®

MISCELLANEOUS What reverses the effects of benzodiazepines? P138

Flumazenil (Romazicon®), 0.2 mg IV

MISCELLANEOUS What is Toradol®? P138

Ketorolac = IV NSAID

MISCELLANEOUS What are the risks of Toradol®? P138

GI bleed, renal injury, platelet dysfunction

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

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

MISCELLANEOUS What is clonidine “rebound”? P138

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