Surgery Drugs

Question 1

Metoclopramide

Answer 1

Reglan
IV, PO

indications: GERD resistant to other treatments; DM gastroparesis; promotility, chemo-induced nausea/vomiting

Question 2

Adverse effects of metoclopramide

Answer 2

drowsiness, restlessness, fatigue, anxiety, insomnia, HA, confusion, dizziness, extrapyramidal sx, glactorrhea, amenorrhea, fluid retention, hypo/hypertension, nausea, diarrhea, urinary frequency, incontinence, rash, urticaria

BBW: tardice dyskinesia

Question 3

Contraindications to metoclopramide

Answer 3

pheochromocytoma
seizure disorder
GI bleeding or obstruction

Question 4

Indications for Metoclopramide

Answer 4

GERD resistant to other treatments
diabetic gastroparesis
promotility, chemo-induced nausea/vomitting

safe in pregnancy

used off label for post-op nausea/vomiting that is unresponsive to other meds like Zofran

Question 5

Erythromycin

Answer 5

IV, PO

can induce diarrhea
does not alleviate N/V
should be used for short term only

MOA: evokes powerful, lumen-occluding antral contractions via action on neural and smooth muscle receptors for motilin, the physiologic regulator of fasting gastroduodenal motility

Question 6

What are the indications for erythromycin?

Answer 6

a macrolide ABX that can be used off label for gastroparesis/prokinetic agent
generally used for persons who are intolerant of Reglan

Question 7

Adverse effects of erythromycin

Answer 7

abdominal pain, N/V, rare QT prolongation
long term use associated with C.diff
caution in liver disease

Question 8

contraindications of erythromycin

Answer 8

allergy to macrolides

pts with prolonged QT

Question 9

Banana Bag indications

Answer 9

alcohol use disorder (AUD)/ETOH withdrawal, magnesium deficiency in ICU pts

Thiamine deficiency: Wernicke’s encephalopathy
Korsakoff syndrome

Question 10

What will you see with folate deficiency?

Answer 10

megaloblastic anemia 
confusion 
sleep disturbances 
depression 
psychosis

Question 11

What will you see with magnesium deficiency?

Answer 11

QT prolongation
torsades de pointes
altered mental status 
seizures
tremors
hyperreflexia

Question 12

What are the contraindications of banana bag?

Answer 12

none

Question 13

RSI drugs

Answer 13

Ketamine
Etomidate
Propofol
Midazolam

Suxamethonium
Rocuronium
Vecuronium

Question 14

Ketamine

Answer 14

induction agent
analgesia, amnesia, sedation

good for:

• head injury
• increased ICP
• hypOtension
• bronchospasm
• hemodynamically UNstable

adverse:

• increased secretions
• increased IOP
• caution in CV disease

Question 15

Etomidate

Answer 15

induction agent
sedation with NO ANALGESIC effect –> pre-treat with IV fentanyl

good for:

• head injury
• increased ICP
• hypotension
• bronchospasm
• CV disease
• status epilepticus
• hemodynamically UNstable

adverse:
- adrenal supression
- myoclonus

Question 16

Propofol

Answer 16

induction agent

sedation with NO analgesia

good for:
bronchospasm
head injury
status epilepticus

adverse:
hypotension
myocardial depression
increased TGs/lipase

Question 17

Midazolam

Answer 17

induction agent

sedation with NO analgesia

good for:
status epilepticus

adverse:
hypotension

Question 18

Which induction agents can be used for status epilepticus?

Answer 18

propofol
midazolam
etomidate

Question 19

Which induction agents have the adverse effect of hypotension?

Answer 19

propofol and midazolam

Question 20

Which induction agents have the adverse effect of adrenal insufficiency?

Answer 20

etomidate

Question 21

Which induction agent is best used in pts with hypotension?

Answer 21

ketamine

Question 22

Which induction agent provides analgesia?

Answer 22

Ketamine

Question 23

With which induction agent should you pre-treat with fentanyl?

Answer 23

etomidate

Question 24

Atropines function in RSI?

Answer 24

used to prevent bradycardia upon induction (particularly used in children)

Question 25

Which anesthesia drugs are used for spinal?

Answer 25

lidocaine | bupivicane

Question 26

Which anesthesia drugs are used for epidural?

Answer 26

ropivicaine bupivicane same as peripheral nerve block

Question 27

Which anesthesia drugs are used for general?

Answer 27

Propofol ketamine etomidate

Question 28

What drugs are used in induction?

Answer 28

midazolam --> fentanyl and lidocaine --> propofol and lidocaine and NMDB

Question 29

What drugs are used in maintenance?

Answer 29

``` inhalation agent (Sevoflurane or desflurane) NO opioid and muscle relaxant ```

Question 30

What can occur during the emergent phase?

Answer 30

autonomic hyper responsiveness HTN Tachycardia bronchiospasm

Question 31

How can you mitigate the autonomic hyper responsiveness in the emergent phase?

Answer 31

BB Lidocaine Narcotics

Question 32

DOAC

Answer 32

Eliquis (apixiban) Pradaxa (dabigtran) Xarelto (rivaroxaban) direct acting anticoags

Question 33

Plavix

Answer 33

clopidogrel antiplatelet (similar to ASA)

Question 34

Which NOAC is best for pts with renal problems?

Answer 34

Apixiban

Question 35

Macrolides

Answer 35

Azithromycin Erythromycin Clarithromycin

Question 36

What prophylactic antibiotic is recommended for bariatric surgery?

Answer 36

Cefazolin or Clindamycin

Question 37

Nucynta

Answer 37

only FDA approved opioid for neuralgia

Question 38

Which anticoagulants are used in surgery?

Answer 38

Unfractionated Heparin LMV Heparin (Lovenox) Warfarin (Coumadin)

Question 39

Which antiplatelet drugs are used in surgery?

Answer 39

Clopidogrel (plavix) | ASA (aspirin)

Question 40

What DOACs are used in surgery?

Answer 40

Direct oral anti-coagulants Abixaban (Eliquis) Dabigatran (Pradaxa) Rivaroxaban (Xarelto)