SR 21 - Common Surgical Medications Flashcards
Which antibiotics are commonly used for anaerobic infections?
Metronidazole Clindamycin Cefoxitin Cefotetan Imipenem Ticarcillin-clavulanic acid Unasyn Augmentin
Which antibiotics are commonly used for gram-negative infections?
Gentamicin and other aminoglycosides Ciprofloxacin Aztreonam Thrid-generation cephalosporins Sulfamethoxazole-trimethoprim
Which antibiotic, if taken with alcohol, will produce a disulfiram-like reaction?
Metronidazole
What is the drug of choice for treating amoebic infection?
Metronidazole (Flagyl)
Which antibiotic is associated with cholestasis?
Ceftriaxone (Rocephin)
Which antibiotic cannot be given to children or pregnant women?
Ciprofloxacin - interferes with the growth plate
With which common antibiotics must serum levels be determined?
Aminoglycosides
Vancomycin
Is rash only in response to penicillin a CI to cephalosporins?
No, but breathing problems, urticaria and edema in response to penicillins are a CI to cephalosporins
Define - Augmentin
Amoxicillin and clavulanic acid
Define - Unasyn
Ampicillin and sulbactum
Define - Cefazolin (Ancef)
First-generation cephalosporin
Surgical prophylaxis for skin flora
Define - Cefoxitin (Mefoxin)
Second-generation cephalosporin
Used for mixed aerobic/anarobic infections - effective against Bacteroides fragilis
Define - Ceftazidime (Ceftaz)
Third-generation cephalosporin
Active against Pseudomonas
Define - Clindamycin
Strong activity against gram-negative anaerobes (including B. fragilis) (above diaphragm)
Adequate gram-positive activity
Define - Gentamicin
Aminoglycoside used to treat gram-negative bacteria
AE - nephrotoxic, ototoxic
Monitor blood peak/trough levels
Define - Imipenem and cilastatin (primaxin)
Last resort drug against serious, multiresistant organisms
Cilastatin inhibits renal excretion of imipenem
Has a very wide spectrum
Define - Metronidazole (Flagyl)
Serious anaerobic infections
Treats amebiasis
No alcohol
Define - Naficillin (Nafcil)
Antistaphylococcal penicillin commonly used for cellulitis
Define - Vancomycin
Treat MRSA
Orally for C. difficle
Peak-trough levels for IV administration
Define - Ciprofloxacin (Cipro)
Quinoline antibiotic with broad-spectrum acitivty
Gram-negative bacteria, including Pseudomonas
Define - Aztreonam (Azactam)
Monobactam with gram-negative spectrum
Define - Amphotericin
IV antifungal
AE - renal toxicity, hypokalemia
Define - Fluconazole (Diflucan)
Antifungal (IV or PO)
NO renal toxicity
Define - Nystatin
PO and topical antifungal
What are the AE of steroids?
Adrenal suppression Immunosuppression Weight gain with central obesity Cushingoid facies Acne Hirsutism Purple striae HYPERglycemia Sodium retention/HYPOkalemia HYPTERtension Osteopenia Myopathy Ischemic bone necrosis (avascular necrosis of the hip) GI perforations
What are the uses of steroids?
Immunosuppression (transplant) Autoimmune disease Hormone replacement (Addison's disease) Spinal cord trauma COPD
Can steroids be stopped abruptly?
NO - you will have an adrenal crisis
Always taper
Which patients need stress-dose steroid before surgery?
Those who are on steroids
Those who were on steroids in the past year
Suspected hypoadrenalism
About to undergo andrealectomy
What is the stress dose for steroids?
100mg of hydrocortisone IV every 8 hours, then taper
Which vitamin helps counteract the deleterious effects of steroids on wound healing?
Vitamin A
What is the action of Heparin?
Binds with and activates antithrombin III
What are the uses of Heparin?
Prophylaxis/treatment - DVT, PE, stroke, a.fib, acute arterial occlusion, cardiopulmonary bypass
AE of Heparin
Bleeding complications
Heparin associated thrombocytopenia
What reverses the effects of Heparin?
Protamine sulfate IV
1:100 - 1mg of protamine for every 100 unites of heparin
Lab test to follow effect of Heparin?
aPTT
Standard lab target for therapeutic heparinization?
1.5-2.5 times control or measured antifactor X levels
Who is at risk for a protamine anaphylactic reaction?
Patient with type 1 DM
S/P prostate surgery
What is the half-life of heparin?
~90 minutes
How long before surgery should Heparin be discontinued?
4-6 hours preoperatively
Does Heparin dissolve clots?
No
It stops the progression of clot formation and allows the body’s own fibrinolytic systems to dissolve the clot
What laboratory tests do you follow LMWH?
None
Exceptions - children, obese patients, renal failure - check factor X levels
ACRONYM basis for Warfarin name?
Wisconsin Alumni Research Foundation
What is the action of Warfarin?
Inhibits vitamin K-dependent clotting factors - II, VII, IX, X (produced in liver)
What are the uses for Warfarin?
Long-term anticoagulation - PO
What are the risks of Warfarin?
Bleeding complications
Teratogenic in pregnancy
Skin necrosis
Dermatitis
What lab test do you follow with Warfarin?
PT, reported as INR
What does INR stand for?
International Normalized Ratio
What is the classic therapeutic INR?
INR 2-3
What is the half-life of Warfarin?
40 hours
About 2 days to observe a change in the PT
What reverses the action of Warfarin?
Cessation
Vitamin K
Fresh-frozen plasma (in emergencies)
How long before surgery should it be dicontinued?
From 3-5 days preoperatively - start IV Heparin
Stop IV heparin 4-6 hours before surgery
Post-op restart IV Heparin - then Warfarin a few days later
How can Warfarin cause skin necrosis with first started?
Protein C and S have shortest half-life - so initial impact is hypercoagulable state
Avoid this by using Heparin when starting
Define - Sucralfate (Carafate)
Treats peptic ulcers by forming an acid-resistant barrier
Binds to ulcer craters
Needs acid to activate and should not be used with H2 blockers
Define - Cimetidine (Tagaet), Ranitidine (Zantac)
H2 blocker (ulcers/gastritis)
Define - Ondansetron (Zofran)
Antinausea and anti-emetic
Serotonin receptor blocker
Define - PPI
Proton-pump inhibitors
Gastric acid secretion inhibitors
Inhibit the K/H-ATPase
Define - Promethazine (Phenergan)
Acute antinausea agent
Used postoperatively
Define - Metoclopramide (Reglan)
Increases gastric emptying with increase in LES pressure
Dopamine antagonists
Used in diabetic gastroparesis and to help move feeding tubes past the pylorus
Define - Haloperidol (Haldol)
Sedative/antipsychotic
AE - extrapyramidal symptoms, QT prolongation
Define - Albumin
Draws extravascular fluid into intravascular space by oncotic pressure
Type of colloid
Define - Albuterol
Inhaled B2 agonist
Bronchodilator
Define - Octreotide
Somatostatin analog
Define - Famotidine (Pepcid)
H2 blocker
Define -ASA
Irreversibly inhibits platelts by irreversibly inhibiting Cyclooxygenase
Furosemide (Lasix)
Loop diuretic
Monitor for hypokalemia
Dantrolene (Dantrium)
Medication used to treat malignant hyperthermia
Misoprostol (Cytotec)
PGE1 analog
Gastroduodenal mucosal protection
Antibiotic option for colon/appendectomy coverage if the patient is allergic to penicillin?
IV Ciprofloxacin AND
IV Clindamycin OR IV Flagyl
If the patient does not respond to a dose of Furosemide - what do you do?
Double the dose
Medication to treat promethazine-induced dystonia?
Benadryl (Diphenhydramine hydrochloride) IV
Which medication is classically associated with mesenteric ischemia?
Digitalis
What type of antihypertensive medication is contraindicated in patients with renal artery stenosis?
ACE inhibitors
Does acetaminophen (Tylenol) inhibit platelets?
NO
What medications are used to stop seizures?
Benzos (lorazepam/ativan)
Phenytoin (Dilantin)
Pre-op antibiotics for vascular prosthetic graft?
Ancef (Gram-positive coverage)
Pre-op antibiotics for appendectomy?
Cefoxitin, Unasyn (anaerobic coverage)
Pre-op antibiotics for colon surgery?
Cefoxitin, Unasyn (anaerobic coverage)
Common post-op IV narcotics?
Morphine Meperidine (Demerol) Fentanyl Percocet Dilaudid
What is Percocet?
PO narcotic pain reliever
Acetaminophen and oxycodone
What is Demerol’s claim to fame?
Used with acute pancreatitis/biliary pathology
Morphine classically causes sphincter of oddi spasm/constriction
What are AE of narcotics?
Respiratory depression Hypotension Itching Bradycardia Nausea
Danger of prolonged use of Demerol?
Accumulation of metabolite normeperidine (especially with renal/hepatic dysfunction)
AE - oversedation, hallucinations, seizures
What medication reverses the effect of narcotic overdose?
Naloxone (Narcan)
0.4mg IV
Narcotic used to decrease post-op shivering?
Demerol
What reverses the effects of benzos?
Flumazenil (Romazicon)
0.2mg IV
What is Toradol?
Ketorolac
IV NSAID
What are the risks of Toradol?
GI bleed
Renal injury
Platelet dysfunction
Why give patient IV Cipro if they are eating a regular diet?
You shouldn’t
500mg PO = 300mg IV
And, PO is much cheaper
