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SCRIPT 4 > Perioperation > Flashcards

Perioperation Flashcards

1
Q

in general should medicines (that cause withdrawal syndromes perioperatively) be continued or stopped

A

continued

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2
Q

generally should non essential medicines that increase surgical risk before surgery be continued or stopped

A

stopped

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3
Q

antiplatelets for primary prevention should be stopped X days before surgery and why

A

7, to reduce bleeding complications

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4
Q

in most adult elective surgery without GI disease it is usual to restrict oral solids for x hrs before surgery

A

6

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5
Q

clear fluids can be given until x hrs before surgery

A

2

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6
Q

how many hrs before surgery should oral solids be stopped

A

6

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7
Q

why might some surgical procedures require the use of a single full dose of prophylactic antimicrobial prior

A

prevent surgical site infection

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8
Q

true or false there is an increased risk of DDIs in the perioperative period

A

true

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9
Q

would you consider stopping acei and aspirin prior to surgery yes or no

A

yes

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10
Q

what are acei associated with following the induction of anasthesia

A

marked hypotension

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11
Q

abrupt withdrawal of beta blockers can have adverse consequences especially in patients with concurrent x

A

angina

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12
Q

any oral dosage forms to be continued can be given with clear fluids until x hrs before surgery

A

2

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13
Q

when taking a history relating to surgery the anagram CASES is useful, what does it stand for

A

contraception
anticoagulation
steroids
ethanol
smoking

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14
Q

surgical relevance of contraception

A

pregnancy and vte risk

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15
Q

surgical relevance of anticoagulation

A

bleeding risk and consider continuation

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16
Q

what is the surgical relevance of steroids

A

requirement for steroids in surgery to prevent addisonion crisis

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17
Q

what is the surgical relevance of ethanol

A

risk of alcohol withdrawal and interaction with anaesthetic

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18
Q

what is the surgical relevance of smoking

A

lung disease

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19
Q

antiplatelets should be stopped x days before surgery to reduce the risk of bleeding

A

7 ideally

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20
Q

coc pill should be discontinued at least x weeks before major elective surgery lasting more than 30 mins

A

4

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21
Q

t/f coc may be continued in the case of minor surgery where the potential for prolonged immobilisation is low

A

true

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22
Q

give an alternative that would be suitable to the combined oral contraceptive pill in the interim

A

progestogen only contraception

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23
Q

herbal medicines should be stopped x days prior to surgery due to uncertainty of their contents and their effects

A

7

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24
Q

does a clear fluid include tea and coffee

A

only if its without milk

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25
Q

if a patient has gi problems or will be starved perioperatively will be oral route of drug admin be available, if not suggest an alternative route

A

no parenteral

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26
Q

what advice can you give someone about their long acting insulin such as insulin determir dose prior to surgery

A

reduce night dose by 20% day before surgery

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27
Q

can metformin be administered as normal the day prior to surgery

A

y

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28
Q

under what 3 circumstances should metformin be omitted the day before surgery and the following 48hrs after

A

egfr below 60
using radiocontrast media
vriii

29
Q

metformin should be stopped once a variable rate intravenous insulin infusion is started and should only be restarted at what point

A

when patient is eating and drinking normally

30
Q

what dose reduction would be required to a patients long acting insulin if they are started on a vriii

A

20%

31
Q

what insulin regimens must be stopped if vriii is being started

A

twice daily
short acting

32
Q

vriii should not be discontinued without ensuring patients regular insulin has been restarted and admin with last x mins

A

30

33
Q

why would vriii be required in t1dm patients undergoing surgery

A

dependent on exogenous insulin
if starved and insulin withheld
hyperglycaemia
ketoacidosis
diuresis
dehydration

34
Q

dependent on exogenous insulin
if starved and insulin withheld
hyperglycaemia
ketoacidosis
diuresis
dehydration

A

blood glucose levels poorly controlled or major or emergency surgery

35
Q

what should happen to sulphonylureas like gliclazide on the morning of surgery

A

omit

36
Q

can pioglitazone be taken as normal on the day of surgery

A

y

37
Q

what actions should be made towards dpp4 inhibitors such as sitagliptin on the day of surgery

A

take as normal

38
Q

what actions should be made towards glp1 receptor antagonists such as liraglutide on the day of surgery

A

take as normal

39
Q

should sglt2 inhibitors like dapagliflozin be continued or omitted on the morning of surgery

A

omitted

40
Q

2 diabetic drug classes that must be omitted on the day of surgery

A

sulphonylureas and sglt2 inhibitors

41
Q

currently manufacturers advise stopping DOACs x hrs prior to surgery with low bleeding risk

A

24

42
Q

doacs should be stopped x hrs before surgery with high bleeding risk

A

48

43
Q

vitamin k antagonists should be stopped at least x days before surgery

A

4-5

44
Q

dabigatran omission is dependent on x function

A

renal

45
Q

what 2 parameters can be used to assess the level of anticoagulation of UFH

A

act or aptt

46
Q

what is often the anticoagulant drug of choice in high risk patients

A

UFH

47
Q

interim anticoag with LMWH must be stopped x hrs before surgery

A

24

48
Q

when can LWMH be restarted

A

when risk of bleeding has passed usually 48 hrs

49
Q

warfarin should be stopped X days before operative day

A

4-5

50
Q

why should patients that are maintained on long term corticosteroids not have their meds stopped peri operatively

A

underlying condition may flare up with withdrawal
patients HPA axis will be suppressed with maintenance doses of 10mg prednisolone or equivalent daily

51
Q

if a patient is taking prednisolone long term prior to surgery what induction dose of hydrocortisone iv should they recieve as part of their perioperative management plan

A

100mg

52
Q

if a px on prednisolone they should receive usual dose on morning of surgery t/f

A

true

53
Q

following an induction dose patients on hydrocortisone should receive a continous infusion at what rate

A

100mg
200mg over 24hrs

54
Q

when enteral nutrition is restablished what dose of oral prednisolone daily should be prescribed before tapering back down to the patients normal dose

A

10mg

55
Q

most abx can be given by bolus injection on arrival to theatre, it should be admin x mins before skin incision to minimise risk of infection

A

30-60

56
Q

what treatments exist for perioperative nausea and vomiting

A

antihistamines like cyclizine
5ht3 antagonists like ondansetron
phenothiazines like prochlorperazine
dexamethasone

57
Q

after spleenectomy patients will need the annual flu vaccine unless they are allergic to

A

egg

58
Q

why is long term abx therapy needed after speelnectomy

A

prevent pneumococcal infection

59
Q

Which ONE of the following medicines is MOST likely to be accidently omitted when taking a drug history?

Apixaban
Entresto®
Lansoprazole
Microgynon®
Ramipril

A

microgynon (oral contraceptives)

60
Q

microgynon (oc) should be stopped at least x weeks before surgery

A

4

61
Q

On the operative day, which ONE of the following medicines would you recommend was omitted?

Atorvastatin 20 mg
Calcichew D3 Forte
Hydrocortisone 20 mg
Metoprolol 50 mg
Perindopril 4 mg

A

not standard practice to omit medicines unless clinical reason; this avoids confusion and increases likelihood that important drugs are administered.

ACE inhibitors associated with hypotension following anaesthesia. omit

62
Q

drugs causing gi irritation can increase nausea and vom eg

A

ferrous sulphate

63
Q

what anasthesia may increase nausea vom risk

A

inhaled anaesthesis esp nitrous oxide

64
Q

t/f females more at risk of periop nausea and vom

A

true

65
Q

MAOIs eg phenelzine should be stopped X weeks before surgery, due to the risk of hypo- and hypertension.

A

2

66
Q

Which ONE of the following medicines is MOST likely to increase the risk of hypotension if co-prescribed with propofol?

Chlorphenamine
Digoxin
Haloperidol
Levothyroxine
Tamoxifen

A

haloperidol

Antipsychotics interact with anaesthetic agents and can cause hypotension. The BNF states ‘both propofol and haloperidol can increase the risk of hypotension’. Many other drug classes also interact with anaesthetic agents to cause hypotension, so always consult the BNF.

67
Q

Stopping rules for X are dependent on the risk of bleeding and the patient’s renal function as creatinine clearance.

A

dabigatran

68
Q
A

SCRIPT 4 (5 decks)

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