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PMPR 430 > Perioperative Care > Flashcards

Perioperative Care Flashcards

1
Q

What is the goal of antibiotic prophylaxis for a surgery

A

Adequate antibiotic serum and tissue levels for the time during which surgical site is open

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2
Q

What are the three key measures for antibiotic prophylaxis

A

1) Antibiotic is appropriate for type of surgery
2) Antibiotic is given within one hour prior to surgical incision to optimize adequate tissue levels at time of surgical incision
3) Antibiotic is discontinued within 24 hours after surgery

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3
Q

Which antibiotics should be given two hours before surgical incision

A

Vancomycin, metronidazole, levofloxacin, and ciprofloxacin

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4
Q

Which surgery is antibiotics discontinued greater than 24 hours later, how much later

A

Cardiac surgery, 48 hours

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5
Q

What are the types of surgical wounds, top two

A

Clean, clean-contaminated, contaminated, dirty-infected/ clean and clean-contaminated

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6
Q

What is a viscus

A

An internal organ of the body, specifically one in the chest (heart or lungs) or abodmen (liver, pancreas, or intestines)

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7
Q

What is the difference between a clean surgical wound and clean-contaminated surgical wound

A

Clean: a viscus is not entered and no inflammation is encountered
Clean-contaminiated: a viscus is entered and no unusual contamination

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8
Q

T/F: A goal for the choice of antibiotics for surgery is the most narrow spectrum of activity that targets the most common organisms for anatomic region being operated on

A

True

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9
Q

What is the antibiotic of choice for most surgical procedures

A

Cefazolin

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10
Q

What are alternatives when cefazolin alone is appropriate

A

Clindaymcin (less efficacious, may add gentamicin) and vancomycin (select patients, high risk or currently MRSA positive)

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11
Q

When is cefazolin alone not sufficient, what is added

A

When a viscus is entered (clean contaminated), cefazolin and metronidazole OR cefatoxin

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12
Q

Howl long the antibiotic be in the system

A

During the entire the surgical site is open

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13
Q

What is the cefazolin dose for preoperative use, when and how should redosing occur

A

2 grams IV for patients greater than 80 kg OR 3 grams IV for patients greater than 120 kg/ redose after 4 hours (two half-lives) or excessive blood loss (greater than 1500 ml)

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14
Q

T/F: Most patients who have a penicillin allergy have a hypersensitivity reaction

A

False: Up 10% of hospitalized patients report a PCN allergy but as many as 80-90% of those DO NOT have a Type 1 IgE-mediated hypersensitivity reaction (80% of those with penicillin allergy lose it over time)

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15
Q

T/F: Patients with low or moderate risk of a PCN hypersensitivity reaction will still receive cefazolin

A

True

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16
Q

What drugs are given for induction/intubation

A

Propofol (produce unconsciousness) and Neuromuscluar blocking agent/NMBA ( facilitate intubation)

17
Q

What drugs are given for maintenance

A

Inhaled anesthetic agent and NMBA (maintain paralysis)

18
Q

What drugs are stopped and reversed

A

Inhaled anesthetic agent is turned off and NMBA is reversed

19
Q

What is given and how is it to induce rapid onset of unconsciousness

A

Propofol. single bolus induction dose

20
Q

`What are the kinetics of propofol

A

Rapid onset due to high lipid solubility with a short duration of action due to rapid redistribution into muscle then fat

21
Q

What are the doses for sedation, induction of general anesthesia, and maintenace of general anesthesia

A

Sedation: 25-75 mcg/kg/min continuous infusion
Induction of general anesthesia (unconsciousness): 1-2.5 mg/kg IV bolus dose
Maintenance of general anesthesia: 50-200 mcg/kg/min continuous infusion

22
Q

T/F: The dose for propofol should be adjusted with severe hepatic and renal disease

A

False: Presence of hepatic or renal disease causes no significant effect

23
Q

What are the adverse effects of propofol

A

Hypotension, respiratory depression, and pain on injection

24
Q

What are the 3 clinical uses for NMBAs

A

Facilitate intubation, maintain paralysis during surgery, paralysis in the ICU for mechanically ventilated patients

25
Q

T/F: NMBAs only produce muscle paralysis and THEY DO NOT produce sedation or analgesia

A

True

26
Q

How does nueromuscular transmission usually work

A

Acetycholine is released, activates nicotinic receptors on motor end plate, channel opens leading to depolarization with an action potential generated along entire muscle fiber for a muscle contraction

27
Q

What removes acetylcholine and allows for repolarization

A

Diffusion and acetylcholine destruction by acetylchlolinesterase/AChE)

28
Q

What are the non-depolarizing NMBAs

A

Rocuronium, cisatracurium Vecuronium, Atracurium

29
Q

What is the difference in MOA between depolarizing and non-depolarizing NMBAs

A

Succinycholine (depolarizing) binds to nicotinic receptors at motor end plate generating an action potential and is slower to dfffuse away for prolonged depolorization WHILE nondepolarizing bind to nicotinic receptors and PHYSICALLY BLOCK Ach from binding causing NO ACTION POTENTIAL AND NO DEPOLARIZATION

30
Q

When is succinlycholine indication, why

A

Endotracheal inutation, fastest onset and shortest duration

31
Q

What are the severe adverse effects of succinlycholine

A

anaphylaxis bradycardia (children), hyperkalemia, trigger malignant hyperthermia

32
Q

Which NMBA is the most commonly used, why, 2nd line

A

Rocuronium (fastest onset: 60-90 sec)/ cisatracurium (doesn’t need hepatic or renal elimination while rocuronium does)

33
Q

What two drugs are most used to reverse paralysis caused by NMBA, how does each work

A

Neostigme: inhibits AChE allowing for Ach to displace residual NMBAa from noicotinic receptors/ Sugammadex: gamma cyclodextrin that binds rocuronium rendering rocuronium inactive

34
Q

What are the adverse effects of neostigmine, what is the caveat of using this drug

A

Bradycardia, hypotension, N/V, salivation/ always combined with anticholinergic since neostigmine is not specific to just nicotonic receptors)

35
Q

What anticholinergics ARE ALWAYS GIVEN with neostigmine

A

Glycopyrrolate and atropine (block cholinergic effects at muscarinic receptors)

36
Q

What are the inhaled anesthetic agents

A

Isoflurance, Desflurane, sevoflurane

37
Q

What is the order of inhaled anesthetic agents for onset

A

desflurane (fast onset and fast offset), sevoflurane, and isoflurane

38
Q

Which inhaled anesthetic agent should be used for induction of general anesthesia, which should not

A

Sevoflurane, desflurane

PMPR 430 (21 decks)

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