Surgical Pharmacology

Question 1

Drugs cause surgery

Answer 1

Asp, NSAID, warfarin- ulcer, perforat, bleed, haematoma
Steroid- prev heal, imm supp
OCP- PE, VTE, isch colitis, hepatic adenoma, ectopic preg

Question 2

Drugs linked to pancreatitis

Answer 2

Alc
Azathiprine
ACEi
Thiazides
Steroid
Oestrogen
Teracycline
Metronidazole

Question 3

Drugs cause diarr

Answer 3

BB
AB
Iron
Metformin
ACEi
Statin

Question 4

Drugs cause constipation

Answer 4

Antimuscarinic eg TCA
Opiates
Iron
Chronic laxative
Gaviscon

Question 5

Drugs cause colitis

Answer 5

AB
NSAID
Methyldopa
Penicillamine

Question 6

Pseudomembranous colitis

Answer 6

Caused by c diff

Question 7

Corticosteroid

Answer 7

Can hide severe intra perit pathol eg lower WCC and CRP

Question 8

Drugs that mask tachy

Answer 8

BB
Digoxin
Amiodarone

Question 9

periop drug mx

Answer 9

Clopidogrel antipl- stop 7d pre op. Excep carotid surg or pl transfus.
Asp- DONT STOP as cardioprotective
Statin- DONT STOP
BB- DONT STOP in IHD, can cause angina/MI
Oral hypog- stop from day of surg, as NBM
OCP and HRT- stop at least 4wk bef, restart 2 wk after. As risk DVT.
CS- DONT STOP. May need to give IV top up bef and after to prev CVS collapse.
Warfarin for AF, DVT, PE, valve- stop 5d pre op, may req LMWH, check INR. AF check INR day bef, aim 1.5. DVT/PE admit day bef and give LMWH if req, aim 1.5. prosthet valve amit 2-3d bef, aim INR 2, give IV unfrac hep to keep APTT 2-3, but stop this 4 hr pre op.
Warfarin if emerg surg- beriplex CFs and prot C. IV vit K 1-5mg if can wait 3hr.
Herbal- stop 2wk pre op
Metformin and iodine contrast can cause renal fail- so stop on day, check UE, restart after 2/3d if okay

Question 10

post op ileus

Answer 10

SI 0-24hr recov
Stomach 24-48hr
Colon 48-72hr
Opiates delay this recov

Question 11

Preop drugs given

Answer 11

SC LMWH, not for neck surg- eg dalteparin 2500U once daily started at least 2 hr preop.
AB to minim infec and endocarditis

Question 12

high risk pts get 5000U LMWH

Answer 12

OCP
Prev DVT, PE
Obese
Intr aabdo malig
Preg
Amputee

Question 13

wound infec

Answer 13

Colon surg- bacillus fragillis, ecoli, pa, proteus, klensiella
Skin contam- Sa
Mx- cefuroxime, metronidazole, co amox

Question 14

Bacterial endocarditis

Answer 14

RF- RHD, prosthetic valve
Laryngeal intubat- strep viridans, tx with amox
For GI or GU procedure add gentamycin

Question 15

Post op drugs given

Answer 15

Opiates- need senna if 3d, RD risk if renal or liver dis, 0.4mg IV naloxone. Unresp post op likely opioid OD or hypog.
NSAID- caution if renal impair
Stemetil- can cause acute dystonia, tx with procyclidine 5mg IV.

Question 16

NSAID ulcer RFs

Answer 16

Simult STEROID
Age
Prev ulcer
Type and dose. Ibup safest. 
Anticoag.