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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
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 ```
26
What are the uses of steroids?
``` Immunosuppression (transplant) Autoimmune disease Hormone replacement (Addison's disease) Spinal cord trauma COPD ```
27
Can steroids be stopped abruptly?
NO - you will have an adrenal crisis | Always taper
28
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
29
What is the stress dose for steroids?
100mg of hydrocortisone IV every 8 hours, then taper
30
Which vitamin helps counteract the deleterious effects of steroids on wound healing?
Vitamin A
31
What is the action of Heparin?
Binds with and activates antithrombin III
32
What are the uses of Heparin?
Prophylaxis/treatment - DVT, PE, stroke, a.fib, acute arterial occlusion, cardiopulmonary bypass
33
AE of Heparin
Bleeding complications | Heparin associated thrombocytopenia
34
What reverses the effects of Heparin?
Protamine sulfate IV | 1:100 - 1mg of protamine for every 100 unites of heparin
35
Lab test to follow effect of Heparin?
aPTT
36
Standard lab target for therapeutic heparinization?
1.5-2.5 times control or measured antifactor X levels
37
Who is at risk for a protamine anaphylactic reaction?
Patient with type 1 DM | S/P prostate surgery
38
What is the half-life of heparin?
~90 minutes
39
How long before surgery should Heparin be discontinued?
4-6 hours preoperatively
40
Does Heparin dissolve clots?
No | It stops the progression of clot formation and allows the body's own fibrinolytic systems to dissolve the clot
41
What laboratory tests do you follow LMWH?
None | Exceptions - children, obese patients, renal failure - check factor X levels
42
ACRONYM basis for Warfarin name?
Wisconsin Alumni Research Foundation
43
What is the action of Warfarin?
Inhibits vitamin K-dependent clotting factors - II, VII, IX, X (produced in liver)
44
What are the uses for Warfarin?
Long-term anticoagulation - PO
45
What are the risks of Warfarin?
Bleeding complications Teratogenic in pregnancy Skin necrosis Dermatitis
46
What lab test do you follow with Warfarin?
PT, reported as INR
47
What does INR stand for?
International Normalized Ratio
48
What is the classic therapeutic INR?
INR 2-3
49
What is the half-life of Warfarin?
40 hours | About 2 days to observe a change in the PT
50
What reverses the action of Warfarin?
Cessation Vitamin K Fresh-frozen plasma (in emergencies)
51
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
52
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
53
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
54
Define - Cimetidine (Tagaet), Ranitidine (Zantac)
H2 blocker (ulcers/gastritis)
55
Define - Ondansetron (Zofran)
Antinausea and anti-emetic | Serotonin receptor blocker
56
Define - PPI
Proton-pump inhibitors Gastric acid secretion inhibitors Inhibit the K/H-ATPase
57
Define - Promethazine (Phenergan)
Acute antinausea agent | Used postoperatively
58
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
59
Define - Haloperidol (Haldol)
Sedative/antipsychotic | AE - extrapyramidal symptoms, QT prolongation
60
Define - Albumin
Draws extravascular fluid into intravascular space by oncotic pressure Type of colloid
61
Define - Albuterol
Inhaled B2 agonist | Bronchodilator
62
Define - Octreotide
Somatostatin analog
63
Define - Famotidine (Pepcid)
H2 blocker
64
Define -ASA
Irreversibly inhibits platelts by irreversibly inhibiting Cyclooxygenase
65
Furosemide (Lasix)
Loop diuretic | Monitor for hypokalemia
66
Dantrolene (Dantrium)
Medication used to treat malignant hyperthermia
67
Misoprostol (Cytotec)
PGE1 analog | Gastroduodenal mucosal protection
68
Antibiotic option for colon/appendectomy coverage if the patient is allergic to penicillin?
IV Ciprofloxacin AND | IV Clindamycin OR IV Flagyl
69
If the patient does not respond to a dose of Furosemide - what do you do?
Double the dose
70
Medication to treat promethazine-induced dystonia?
Benadryl (Diphenhydramine hydrochloride) IV
71
Which medication is classically associated with mesenteric ischemia?
Digitalis
72
What type of antihypertensive medication is contraindicated in patients with renal artery stenosis?
ACE inhibitors
73
Does acetaminophen (Tylenol) inhibit platelets?
NO
74
What medications are used to stop seizures?
Benzos (lorazepam/ativan) | Phenytoin (Dilantin)
75
Pre-op antibiotics for vascular prosthetic graft?
Ancef (Gram-positive coverage)
76
Pre-op antibiotics for appendectomy?
Cefoxitin, Unasyn (anaerobic coverage)
77
Pre-op antibiotics for colon surgery?
Cefoxitin, Unasyn (anaerobic coverage)
78
Common post-op IV narcotics?
``` Morphine Meperidine (Demerol) Fentanyl Percocet Dilaudid ```
79
What is Percocet?
PO narcotic pain reliever | Acetaminophen and oxycodone
80
What is Demerol's claim to fame?
Used with acute pancreatitis/biliary pathology | Morphine classically causes sphincter of oddi spasm/constriction
81
What are AE of narcotics?
``` Respiratory depression Hypotension Itching Bradycardia Nausea ```
82
Danger of prolonged use of Demerol?
Accumulation of metabolite normeperidine (especially with renal/hepatic dysfunction) AE - oversedation, hallucinations, seizures
83
What medication reverses the effect of narcotic overdose?
Naloxone (Narcan) | 0.4mg IV
84
Narcotic used to decrease post-op shivering?
Demerol
85
What reverses the effects of benzos?
Flumazenil (Romazicon) | 0.2mg IV
86
What is Toradol?
Ketorolac | IV NSAID
87
What are the risks of Toradol?
GI bleed Renal injury Platelet dysfunction
88
Why give patient IV Cipro if they are eating a regular diet?
You shouldn't 500mg PO = 300mg IV And, PO is much cheaper

Surgical Recall (32 decks)

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