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Surgical Recall > SR 21 - Common Surgical Medications > Flashcards

SR 21 - Common Surgical Medications Flashcards

1
Q

Which antibiotics are commonly used for anaerobic infections?

A 
Metronidazole
Clindamycin
Cefoxitin
Cefotetan
Imipenem
Ticarcillin-clavulanic acid
Unasyn
Augmentin
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2
Q

Which antibiotics are commonly used for gram-negative infections?

A 
Gentamicin and other aminoglycosides
Ciprofloxacin
Aztreonam
Thrid-generation cephalosporins
Sulfamethoxazole-trimethoprim
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3
Q

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

A

Metronidazole

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4
Q

What is the drug of choice for treating amoebic infection?

A

Metronidazole (Flagyl)

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5
Q

Which antibiotic is associated with cholestasis?

A

Ceftriaxone (Rocephin)

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6
Q

Which antibiotic cannot be given to children or pregnant women?

A

Ciprofloxacin - interferes with the growth plate

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7
Q

With which common antibiotics must serum levels be determined?

A

Aminoglycosides

Vancomycin

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8
Q

Is rash only in response to penicillin a CI to cephalosporins?

A

No, but breathing problems, urticaria and edema in response to penicillins are a CI to cephalosporins

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9
Q

Define - Augmentin

A

Amoxicillin and clavulanic acid

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10
Q

Define - Unasyn

A

Ampicillin and sulbactum

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11
Q

Define - Cefazolin (Ancef)

A

First-generation cephalosporin

Surgical prophylaxis for skin flora

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12
Q

Define - Cefoxitin (Mefoxin)

A

Second-generation cephalosporin

Used for mixed aerobic/anarobic infections - effective against Bacteroides fragilis

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13
Q

Define - Ceftazidime (Ceftaz)

A

Third-generation cephalosporin

Active against Pseudomonas

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14
Q

Define - Clindamycin

A

Strong activity against gram-negative anaerobes (including B. fragilis) (above diaphragm)
Adequate gram-positive activity

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15
Q

Define - Gentamicin

A

Aminoglycoside used to treat gram-negative bacteria
AE - nephrotoxic, ototoxic
Monitor blood peak/trough levels

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16
Q

Define - Imipenem and cilastatin (primaxin)

A

Last resort drug against serious, multiresistant organisms
Cilastatin inhibits renal excretion of imipenem
Has a very wide spectrum

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17
Q

Define - Metronidazole (Flagyl)

A

Serious anaerobic infections
Treats amebiasis
No alcohol

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18
Q

Define - Naficillin (Nafcil)

A

Antistaphylococcal penicillin commonly used for cellulitis

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19
Q

Define - Vancomycin

A

Treat MRSA
Orally for C. difficle
Peak-trough levels for IV administration

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20
Q

Define - Ciprofloxacin (Cipro)

A

Quinoline antibiotic with broad-spectrum acitivty

Gram-negative bacteria, including Pseudomonas

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21
Q

Define - Aztreonam (Azactam)

A

Monobactam with gram-negative spectrum

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22
Q

Define - Amphotericin

A

IV antifungal

AE - renal toxicity, hypokalemia

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23
Q

Define - Fluconazole (Diflucan)

A

Antifungal (IV or PO)

NO renal toxicity

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24
Q

Define - Nystatin

A

PO and topical antifungal

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25
Q

What are the AE of steroids?

A 
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
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26
Q

What are the uses of steroids?

A 
Immunosuppression (transplant)
Autoimmune disease
Hormone replacement (Addison's disease)
Spinal cord trauma
COPD
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27
Q

Can steroids be stopped abruptly?

A

NO - you will have an adrenal crisis

Always taper

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28
Q

Which patients need stress-dose steroid before surgery?

A

Those who are on steroids
Those who were on steroids in the past year
Suspected hypoadrenalism
About to undergo andrealectomy

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29
Q

What is the stress dose for steroids?

A

100mg of hydrocortisone IV every 8 hours, then taper

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30
Q

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

A

Vitamin A

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31
Q

What is the action of Heparin?

A

Binds with and activates antithrombin III

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32
Q

What are the uses of Heparin?

A

Prophylaxis/treatment - DVT, PE, stroke, a.fib, acute arterial occlusion, cardiopulmonary bypass

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33
Q

AE of Heparin

A

Bleeding complications

Heparin associated thrombocytopenia

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34
Q

What reverses the effects of Heparin?

A

Protamine sulfate IV

1:100 - 1mg of protamine for every 100 unites of heparin

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35
Q

Lab test to follow effect of Heparin?

A

aPTT

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36
Q

Standard lab target for therapeutic heparinization?

A

1.5-2.5 times control or measured antifactor X levels

37
Q

Who is at risk for a protamine anaphylactic reaction?

A

Patient with type 1 DM

S/P prostate surgery

38
Q

What is the half-life of heparin?

A

~90 minutes

39
Q

How long before surgery should Heparin be discontinued?

A

4-6 hours preoperatively

40
Q

Does Heparin dissolve clots?

A

No

It stops the progression of clot formation and allows the body’s own fibrinolytic systems to dissolve the clot

41
Q

What laboratory tests do you follow LMWH?

A

None

Exceptions - children, obese patients, renal failure - check factor X levels

42
Q

ACRONYM basis for Warfarin name?

A

Wisconsin Alumni Research Foundation

43
Q

What is the action of Warfarin?

A

Inhibits vitamin K-dependent clotting factors - II, VII, IX, X (produced in liver)

44
Q

What are the uses for Warfarin?

A

Long-term anticoagulation - PO

45
Q

What are the risks of Warfarin?

A

Bleeding complications
Teratogenic in pregnancy
Skin necrosis
Dermatitis

46
Q

What lab test do you follow with Warfarin?

A

PT, reported as INR

47
Q

What does INR stand for?

A

International Normalized Ratio

48
Q

What is the classic therapeutic INR?

A

INR 2-3

49
Q

What is the half-life of Warfarin?

A

40 hours

About 2 days to observe a change in the PT

50
Q

What reverses the action of Warfarin?

A

Cessation
Vitamin K
Fresh-frozen plasma (in emergencies)

51
Q

How long before surgery should it be dicontinued?

A

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

52
Q

How can Warfarin cause skin necrosis with first started?

A

Protein C and S have shortest half-life - so initial impact is hypercoagulable state
Avoid this by using Heparin when starting

53
Q

Define - Sucralfate (Carafate)

A

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

54
Q

Define - Cimetidine (Tagaet), Ranitidine (Zantac)

A

H2 blocker (ulcers/gastritis)

55
Q

Define - Ondansetron (Zofran)

A

Antinausea and anti-emetic

Serotonin receptor blocker

56
Q

Define - PPI

A

Proton-pump inhibitors
Gastric acid secretion inhibitors
Inhibit the K/H-ATPase

57
Q

Define - Promethazine (Phenergan)

A

Acute antinausea agent

Used postoperatively

58
Q

Define - Metoclopramide (Reglan)

A

Increases gastric emptying with increase in LES pressure
Dopamine antagonists
Used in diabetic gastroparesis and to help move feeding tubes past the pylorus

59
Q

Define - Haloperidol (Haldol)

A

Sedative/antipsychotic

AE - extrapyramidal symptoms, QT prolongation

60
Q

Define - Albumin

A

Draws extravascular fluid into intravascular space by oncotic pressure
Type of colloid

61
Q

Define - Albuterol

A

Inhaled B2 agonist

Bronchodilator

62
Q

Define - Octreotide

A

Somatostatin analog

63
Q

Define - Famotidine (Pepcid)

A

H2 blocker

64
Q

Define -ASA

A

Irreversibly inhibits platelts by irreversibly inhibiting Cyclooxygenase

65
Q

Furosemide (Lasix)

A

Loop diuretic

Monitor for hypokalemia

66
Q

Dantrolene (Dantrium)

A

Medication used to treat malignant hyperthermia

67
Q

Misoprostol (Cytotec)

A

PGE1 analog

Gastroduodenal mucosal protection

68
Q

Antibiotic option for colon/appendectomy coverage if the patient is allergic to penicillin?

A

IV Ciprofloxacin AND

IV Clindamycin OR IV Flagyl

69
Q

If the patient does not respond to a dose of Furosemide - what do you do?

A

Double the dose

70
Q

Medication to treat promethazine-induced dystonia?

A

Benadryl (Diphenhydramine hydrochloride) IV

71
Q

Which medication is classically associated with mesenteric ischemia?

A

Digitalis

72
Q

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

A

ACE inhibitors

73
Q

Does acetaminophen (Tylenol) inhibit platelets?

A

NO

74
Q

What medications are used to stop seizures?

A

Benzos (lorazepam/ativan)

Phenytoin (Dilantin)

75
Q

Pre-op antibiotics for vascular prosthetic graft?

A

Ancef (Gram-positive coverage)

76
Q

Pre-op antibiotics for appendectomy?

A

Cefoxitin, Unasyn (anaerobic coverage)

77
Q

Pre-op antibiotics for colon surgery?

A

Cefoxitin, Unasyn (anaerobic coverage)

78
Q

Common post-op IV narcotics?

A 
Morphine
Meperidine (Demerol)
Fentanyl
Percocet
Dilaudid
79
Q

What is Percocet?

A

PO narcotic pain reliever

Acetaminophen and oxycodone

80
Q

What is Demerol’s claim to fame?

A

Used with acute pancreatitis/biliary pathology

Morphine classically causes sphincter of oddi spasm/constriction

81
Q

What are AE of narcotics?

A 
Respiratory depression
Hypotension
Itching
Bradycardia
Nausea
82
Q

Danger of prolonged use of Demerol?

A

Accumulation of metabolite normeperidine (especially with renal/hepatic dysfunction)
AE - oversedation, hallucinations, seizures

83
Q

What medication reverses the effect of narcotic overdose?

A

Naloxone (Narcan)

0.4mg IV

84
Q

Narcotic used to decrease post-op shivering?

A

Demerol

85
Q

What reverses the effects of benzos?

A

Flumazenil (Romazicon)

0.2mg IV

86
Q

What is Toradol?

A

Ketorolac

IV NSAID

87
Q

What are the risks of Toradol?

A

GI bleed
Renal injury
Platelet dysfunction

88
Q

Why give patient IV Cipro if they are eating a regular diet?

A

You shouldn’t
500mg PO = 300mg IV
And, PO is much cheaper

Surgical Recall (32 decks)

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