Medications in Surgery Flashcards
Most drugs can be continued during surgery because of the risk of losing control of disease if stopped suddenly.
Which medications cannot be stopped?
Which medications have to be stopped?
CCBs, Beta blockers, and long term steroid must be continued
Stopped:
1) COCP/HRT
2) K-sparing diuretics
3) ACE inhibitors
4) Lithium
5) Anticoagulants
6) Oral hypoglycaemics
Long term steroids should be continued during surgery however they need to be modified. What modification needs to be applied?
What is the consequence if not?
Sick day rules need to be applied which is doubling the dose. (This is done to be able to mount a physiological stress response to surgery)
If not, Addisonian crisis
How far ahead of surgery does COCP or HRT need to be stopped?
4 weeks before surgery
K-sparing diuretics and ACE-inhibitors need to be stopped before surgery at the same time. What should they be stopped?
Day of surgery
When should lithium be stopped pre-op?
Day before surgery
Anticoagulants need to be stopped before surgery. When should they be stopped?
When should LMWH be started Post-op in general?
6-12 hours post-op
When should PO hypoglycemic drugs/ insulin be stopped pre-op? When is it restarted?
What is the target INR for warfarin in general and for valves?
What are some indications for warfarin use?
A patient with a metallic heart valve is currently on warfarin but is set to undergo surgery in the coming weeks. Outline how you would change her medication from pre-op to post-op.
A patient on warfarin has an INR of 5. What is your action plan?
Reduce dose (<6)
A patient on warfarin has an INR of 6. What is your action plan?
6-8 - reduce dose and omit warfarin for 2 days
A patient on warfarin has an INR of 8. What is your action plan?
8+ - give PO vitK and omit warfarin for 2 days
What agents are involved in the reversal of warfarin?
Which LMWH is used for PE?
tinzaparin
A patient is about to undergo a surgery. What are the options available for DVT prophylaxis. Are there any contraindications for your options?
What are some commonly prescribed antiemetic drugs? Will they be a regular prescription or PRN?
cyclizine
metoclopramide
ondansetron
What is the dosage and route of administration for Cyclizine. When should it not be used?
PO/IM/IV 50mg TDS
not in HF/ fluid retention
What is the dosage and route of administration for metoclopramide. When is it especially useful and when should it not be used?
What is the dosage and route of administration for ondansetron. When should it be used?
What drug should be co-prescribed with opioids?
Laxative (esp in elderly)
What are the signs of opioid OD? How is it managed?
What drug should be co-prescribed with NSAIDS?
PPI (omeprazole)
Outline the pain management ladder.
How would you define constipation?
How would you manage constipation conservatively?
What are some reversible causes of constipation?
What are the types of laxatives. Give examples
What patient group may require specialist referral for constipation? Why?
What stimulant laxatives are indicated for:
1. soft stools
2. hard stools
3. both
Outline the possible options for pharmacological management of constipation.
What drugs can be used for faecal impaction? What are the contraindications to these drugs?
What drug can be used to treat both fecal impaction and colonic atony?
What laxative should be used if the patient presents with an acute abdomen?
Give some examples of PPIs. What is the MOA of a PPI? WHat are the indications for use?
What are the SEs of PPIs?
What are the antibiotics of choice for:
1. intra abdominal infection
What are the antibiotics of choice for:
1. urosepsis
What are the antibiotics of choice for:
1.CAP
2. HAP
What are the antibiotics of choice for:
1. cellulitis
For the following types of diuretics, give examples and state the SEs.
1. loop
2. thiazide
3. K-sparing
Whe MOA and SEs of statins?
You are observing an open midline laparotomy. The surgeon asks you to outline what structures are being cut during the initial incision. What would you say?
The abdominal wall is composed of several layers, organized from superficial to deep:
1. Skin
* The outermost layer, consisting of epidermis and dermis.
2. Subcutaneous Tissue (Superficial Fascia)
* Camper’s fascia: A fatty superficial layer.
* Scarpa’s fascia: A deeper, membranous layer.
3. Muscles and Their Fasciae
* External Oblique Muscle: The most superficial muscle layer.
* Internal Oblique Muscle: Lies beneath the external oblique.
* Transversus Abdominis Muscle: The innermost muscle layer.
4. Transversalis Fascia
* A thin connective tissue layer deep to the transversus abdominis muscle.
5. Extraperitoneal Fat
* A layer of fat located between the transversalis fascia and the peritoneum.
6. Parietal Peritoneum
* The innermost layer, lining the abdominal cavity and forming the outermost layer of the peritoneal cavity.
