Surgical Medications

Question 1

Which antibiotics are commonly used for anaerobic infections (Clostridium, Listeria)?

Answer 1

Metronidazole, Clindamyacin, Cefoxitin, Unasyn (Ampicillin/Sulbactam), Augmentin

Question 2

What antibiotics are commonly used for gram-negative infections (E. coli, Salmonella, Pseudomonas, Shigella)?

Answer 2

Aminoglycosides, Cipro, 3rd Gen Cephs (Cefdinir, Cefixime, Cefotaxime), Bactrim

Question 3

Which abx should not be taken with alcohol due to disulfiram-like reaction (flushing, increased HR, SOB, N/V, HA, confusion)?

Answer 3

Flagyl

Question 4

What is the drug of choice for amoebic infections?

Answer 4

Flagyl

Question 5

Which abx is associated with cholestasis?

Answer 5

Ceftriaxone (Rocephin)

Question 6

What antibiotics are used to treat Staph infections (not MRSA)?

Answer 6

1st generation Cephs- cefazolin, cephalexin

Clindamycin, Erythromycin

Question 7

What is the abx of choice for group A strep?

Answer 7

Penicillin or amoxicillin (can also use cephalexin, clindamycin, azithromycin)

Question 8

What abx cannot be given to pregnant women or children?

Answer 8

CIPRO :(

Question 9

With which abx must serum levels be determined?

Answer 9

Aminoglycosides and Vanc

Question 10

What is Cefazolin and what is it used for?

Answer 10

Ancef, 1st gen ceph, used for surgical prophylaxis for skin flora

Question 11

What 3rd generation Ceph has strong activity against Pseudomonas?

Answer 11

Ceftazidime

Question 12

What abx has strong activity against gram-negative anaerobes and adequate gram-positive activity?

Answer 12

Clindamycin

Question 13

What abx is known to be nephrotoxic and ototoxic–> blood peak/trough levels should be monitored?

Answer 13

Gentamicin (treats gram NEGATIVE bacteria)

Question 14

Describe Metronidazole…

Answer 14

Used for serious ANAEROBIC infections (diverticulitis); patient must abstain from alcohol!

Question 15

What drug is commonly used for cellulitis?

Answer 15

Nafcillin

Question 16

Describe Vancomycin…

Answer 16

Used to treat MRSA, C. diff pseudomembranous colitis, should monitor peak/trough with IV administration

Question 17

Describe Ciprofloxacin…

Answer 17

Broad-spectrum abx, especially against gram negative bacteria, including Pseudomonas!

Question 18

_____ is an IV antifungal antibiotic associated with renal toxicity and hypokalemia

Answer 18

Amphotericin

Question 19

What preop abx are given for appendectomies?

Answer 19

Cefoxitin, Unasyn (anaerobic coverage)

Question 20

What preop abx are given for colon surgery?

Answer 20

Cefoxitin, Unasyn (anaerobic coverage)

Question 21

Should patients continue to take anti-HTN meds on day of surgery?

Answer 21

Yes

Question 22

What pre-op medication can decrease post-operative cardiac events and death?

Answer 22

BETA BLOCKERS :)

Question 23

What electrolyte must you check preoperatively if a patient is on hemodialysis?

Answer 23

Potassium

Question 24

Who gets a pre-op ECG?

Answer 24

Patients older than 40

Question 25

What reverses the effects of heparin?

Answer 25

Protamine

Question 26

How long before surgery should heparin be discontinued?

Answer 26

4-6 hrs

Question 27

Does heparin dissolve clots?

Answer 27

NO, it stops the progression of clot formation

Question 28

What are the uses of warfarin?

Answer 28

Long term anticoagulation

Question 29

What lab tests should you use for patients on warfarin?

Answer 29

PT/INR

Question 30

How long before surgery should warfarin be discontinued?

Answer 30

3-5 days

Question 31

How can warfarin cause skin necrosis when first started?

Answer 31

Initially depressed protein C and S result in HYPERcoaguable state. Avoid by using heparin concomitantly when starting

Question 32

What is an antibiotic option for colon/appendectomy if a patient is allergic to penicillin?

Answer 32

1. IV Cipro AND | 2. IV Clindamycin or IV Flagyl

Question 33

If a patient doesn't respond to a dose of Lasix, should the dose be repeated, increased, or decreased?

Answer 33

Dose should be doubled if there is no response to initial dose.

Question 34

What medication is classically associated with mesenteric ischemia?

Answer 34

Digitalis

Question 35

What type of anti-HTN med is contraindicated in patients with renal artery stenosis?

Answer 35

ACE inhibitors

Question 36

What is the danger in prolonged use of Demerol (pain reliever)?

Answer 36

Oversedation, hallucinations, seizures

Question 37

What narcotic is used to decrease postoperative shivering?

Answer 37

Demerol

Question 38

What is clonidine rebound?

Answer 38

Abruptly stopping clonidine can cause the patient to have severe "rebound" HTN (also seen with beta blockers)