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HANA Part 4 – PM4B > (SYNOPTIC) Surgery > Flashcards

(SYNOPTIC) Surgery Flashcards

1
Q

What website would you use for guidance on drug cessation pre/post surgery?

A

UKCPA

The Handbook of Perioperative Medicines

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2
Q

What does the term ‘pre-med’ refer to?

A

Medicines given prior to surgery

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3
Q

What does the term ‘anastomosis’ refer to?

A

Surgical procedure where
Artificial connection
between two tubular structures, such as blood vessels, intestines, or nerves.

(usually between same structure?)

For example, when part of an intestine is surgically removed, the two remaining ends are sewn or stapled together (anastomosed).

Usually blood vessels/ loops of intestine

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4
Q

What does the term ‘dehiscence’ refer to?

A

Breaking open of a wound/ incision site

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5
Q

What does the term ‘adhesions’ refer to?

A

Fibrous bands that form between tissues/ organs

Result of injury following surgery

Scar tissue which attaches to organs

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6
Q

What does this prefix refer to? angio-

A

Related to blood vessels

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7
Q

What does this prefix refer to? arthr-

A

Related to joints

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8
Q

What does this prefix refer to? colono- or col-

A

Related to the large bowel

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9
Q

What does this prefix refer to? cysto-

A

Related to the bladder

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10
Q

What does this prefix refer to? gastr-

A

Related to the stomach

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11
Q

What does this prefix refer to? hyster-

A

Related to the uterus

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12
Q

What does this prefix refer to? lapar-

A

Related to abdominal cavity

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13
Q

What does this prefix refer to? mammo-/masto-

A

Related to the breast

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14
Q

What does this prefix refer to? nephro-

A

Related to the kidney

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15
Q

What does this suffix refer to? -ectomy

A

To remove

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16
Q

What does this suffix refer to? -otomy

A

To open up

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17
Q

What does this suffix refer to? -ostomy/-stomy

A

Artificial opening/ hole

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18
Q

What does this suffix refer to? -oscopic

A

To use a scope

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19
Q

What does this suffix refer to? -plasty

A

To modify/ reshape

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20
Q

What is a paralytic ileus?

A

Intestinal blockage in the absence of a physical obstruction

Usually a malfunction in the nerves/ muscles of intestine

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21
Q

What is wound dehiscence?

A

Breakdown of a wound

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22
Q

What is the breakdown of a wound called?

A

Wound dehiscence

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23
Q

What is a blockage in the intestine, in the absence of a physical obstruction, called?

A

Paralytic ileus

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24
Q

What is a pre-op assessment, briefly?

A

Determining anaesthetic risks

Predicting complications

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25
Q

What is conducted in a pre-op assessment?

A

(1) Anaesthetic review

(2) Does any medication need to be stopped?
- provide alternative if necessary

(3) Communicate (1) and (2) to patients
(4) Plan for potential post-operative complications

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26
Q

What is the role of pre-op pharmacists?

A
  • Drug history taking
  • Prescribing regular medications
  • Giving advice on appropriate medication management during the peri-operative period
  • Foresee post-op complications before they arise
  • Smoking cessation counselling
  • Producing guidelines for pre-op team
  • Preparing for discharge
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27
Q

How is anaesthetic risk to a patient assessed?

A

ASA classifications

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28
Q

What are the ASA classification categories?

A

(1) ASA-I
(2) ASA-II
(3) ASA-III
(4) ASA-IV
(5) ASA-V
(6) ASA-VI

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29
Q

What are some high risk patient groups for anaesthesia?

A
  • Cardiovascular problems
  • Multiple co-morbidities
  • Asthma/ COPD
  • Elderly
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30
Q

What is ASA-I?

A

Normal healthy patient

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31
Q

What is ASA-II?

A

Patient with mild systemic disease

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32
Q

What is ASA-III?

A

Patient with severe systemic disease which is limiting but not incapacitating

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33
Q

What is ASA-IV?

A

Patient with a severe systemic disease that is a constant threat to life

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34
Q

What is ASA-V?

A

Moribund patient who is not expected to survive without operation
- moribund = person at point of death

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35
Q

What is ASA-VI?

A

Declared brain dead patient

Organs are being removed for donor purposes

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36
Q

What ASA classification is a normal healthy patient?

A

ASA-I

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37
Q

What ASA classification is a patient with mild systemic disease?

A

ASA-II

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38
Q

What ASA classification is a patient with severe systemic disease which is limiting but not incapacitating

A

ASA-III

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39
Q

What ASA classification is a patient with a severe systemic disease that is a constant threat to life

A

ASA-IV

40
Q

What ASA classification is a moribund patient who is not expected to survive without operation?

A

ASA-V

41
Q

What ASA classification is a declared brain dead patient

A

ASA-VI

42
Q

Why do RA patients often have impaired wound healing?

A

RA patients are often on immunosuppressants

Impacts healing

43
Q

What are the 7 areas of pharmaceutical intervention in surgery?

A

(1) Pain
(2) PONV
(3) NBM period
(4) VTE prophylaxis
(5) Fluid management
(6) Anticoagulation in peri-operative period
(7) Antibiotic prophylaxis

44
Q

What is pain rated a 2-5/10 treated with?

A

Paracetamol +/- ibuprofen

45
Q

What is pain rated a 5-8/10 treated with?

A

Codeine/ dihydrocodeine/ co-codamol

46
Q

What is pain rated 8-10/10 treated with?

A

Morphine/ diamorphine/ fentanyl

47
Q

What is PCA?

A

Patient-controlled analgesia

48
Q

What are the benefits of PCA?

A

Gives patient control of their pain

Do not have to wait for nurse

49
Q

How long does a PCA lock out for following use?

A

5 minutes

50
Q

What are the benefits of a local anaesthetic nerve block?

A

Good pain relief results for fracture

A local anesthetic nerve block is a medical procedure in which a local anesthetic is injected near a nerve or group of nerves to numb a specific area of the body

51
Q

What drug is given in spinal pain management?

A

Diamorphine

52
Q

What is an epidural?

A

Pain management, injected into epidural space

Consists of local anaesthetic and opioid

An epidural is a medical procedure in which a local anesthetic or combination of anesthetic and steroid medication is injected into the epidural space, which is the space surrounding the spinal cord within the spinal column. The medication blocks pain signals from the nerves that transmit pain from the body to the brain, resulting in pain relief in the lower back, hips, legs, and pelvic region.

53
Q

What are the advantages of PCA?

A
  • Patient in control
  • Lockout period prevents overdose
  • Fast-acting
  • Improves patient experience
  • Reduces patient anxiety
  • Useful for incident pain
  • Suitable if patient NBM
  • Patients do not have to have multiple injections
54
Q

What are the disadvantages of patient controlled analgesia (PCA)?

A
  • Renal impairment, due to accumulation of morphine metabolites
  • Not to be used with other opioids
  • Side effects, N+V, pruritus, constipation, sedation
  • May wake up in pain if patient sleeps without pressing
  • Not suitable for all patients
55
Q

Which takes faster effect in PCA, morphine or fentanyl?

A

Fentanyl

160x more liposolubility

56
Q

Which is cheaper, morphine or fentanyl?

A

Morphine is cheaper

57
Q

Which is worse for the kidney, morphine or fentanyl?

A

Morphine

Metabolites build up causing renal impairment

58
Q

When is methadone prescribed in hospital?

A

Hospitalised heroine users

59
Q

Are long-acting or short-acting opioids preferred during hospital admission?

A

Long-acting

Potentially fewer side-effects

60
Q

What is buprenorphine OST?

A

Buprenorphine opioid substitution treatment

61
Q

What is mu-opioid receptor blockade?

A

Buprenorphine dose >12mg/ day

Achieves minimal analgesic effect

62
Q

What are some pharmacological methods of VTE prophylaxis?

A
  • LMWH
  • Heparin
  • Rivaroxiban/ dabigatran
  • Fondaparinux
63
Q

What is Fondaparinux?

A

Synthetic anticoagulant

Used for VTE prophylaxis

64
Q

What are some non-pharmacological methods of VTE prophylaxis?

A
  • TED stockings

apply compression, improve blood circulation?

- Foot pumps

65
Q

What duration of surgical procedure is deemed to increase risk of VTE?

A

60 minutes- pelvis/ lower limb

90 minutes - normally

66
Q

What patient age is associated with increased risk of VTE?

A

> 60yrs

67
Q

What BMI is associated with increased risk of VTE?

A

> 30kg/m2 (obese)

68
Q

Which patient groups are at increased risk of PONV?

A
  • Young + female
  • Non-smoker
  • History of PONV/ motion sickness
  • Use of pre-post op. opioids
69
Q

What are some consequences of PONV?

A
  • Delayed administration of opioid analgesia
  • Wound disruption after abdominal/ max factor surgery
  • Bleeding
  • Dehydration + electrolyte imbalance
  • Interference with nutrition
  • Patient discomfort + distress
  • Delay in recovery
70
Q

Which drugs are most commonly used for PONV treatment and prevention?

A

(1) Cyclizine
(2) Ondansetron/ granisetron
(3) Dexamethasone

71
Q

What are some drugs less commonly used for PONV treatment and prevention?

A
  • metoclopramide
  • domperidone
  • hyoscine
72
Q

What route(s) of administration routes are used for cyclizine?

A

IV/ IM

73
Q

What route(s) of administration routes are used for ondansetron?

A

IV

74
Q

What route(s) of administration routes are used for metoclopramide?

A

IV

SC can be used but is unlicensed

75
Q

What route(s) of administration routes are used for hyoscine?

A

Transdermal

76
Q

What route(s) of administration routes are used for prochlorperazine?

A

Buccal

77
Q

When are PO anti-emetics avoided?

A

When patient is actively experiencing N+V?

78
Q

What are some non-pharmacological methods to improve PONV?

A
  • Rehydration + pain management
  • Minimise opioid use
  • Ginger/ mint
  • Acupuncture
  • Avoid nitrous oxide
79
Q

What is the NBM period, with regard to surgery?

A

Specific time pre- and post-op that a patient is advised to not eat or drink during

80
Q

Why can a patient not be induced on full analgesia when on a full stomach?

A

High risk of regurgitation of stomach contents

81
Q

What considerations should be made during a NBM period?

A

(1) Medications to stop
- Half-life of drugs

(2) Medications to continue
- Alternative routes

(3) Length of NBM period
(4) Interactions with anaesthetic medications

82
Q

Describe the half-life of levothyroxine.

A

Long

83
Q

How long before a major surgery should warfarin be stopped?

A

5 days

84
Q

How long before major surgery should aspirin be stopped?

A

10 days

85
Q

Why does aspirin have to be stopped before major surgery?

A

Increases bleeding risk

Takes 10 days to replenish platelets

86
Q

What should be done if patient is on warfarin but surgery is emergency?

A

Reversal with vitamin K

87
Q

How may anaesthesia affect patients with hypertension?

A

May provoke tachycardia/ high BP

88
Q

What should a warfarin patient’s INR be prior to surgery?

A

<1.5

In healthy people an INR of 1.1 or below is considered normal. An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for certain disorders

89
Q

What would be some examples of vascular organ surgery?

A
  • Liver
  • Spleen
  • Thyroid

Vascular organs are organs or tissues that contain blood vessels and have rich BLOOD supply and RELY on blood suppply?

90
Q

How long before surgery should dabigatran be stopped, if the patient has low bleeding risk and CrCl of ≥80mL/min?

A

24hrs

91
Q

How long before surgery should dabigatran be stopped, if the patient has high bleeding risk and CrCl of ≥80mL/min?

A

48 hours

92
Q

What should be done if patient is on dabigatran but surgery is emergency?

A

Idarucizumab

Dabigatran antidote

93
Q

How is the fluid status of a patient assessed?

A 
A - Airways
B - Breathing
C - Circulation 
D - Disability
E - Exposure
94
Q

How is fluid resuscitation achieved?

A

Fluid resuscitation is a medical treatment used to replenish the body’s fluids and electrolytes in patients who are dehydrated or in shock

Fluid bolus

A fluid bolus is a medical term that refers to a large amount of fluid (usually saline solution) that is rapidly administered intravenously to a patient. The purpose of a fluid bolus is to quickly increase a patient’s circulating blood volume and blood pressure, and to help restore fluid and electrolyte balance.

95
Q

What are some risk factors for surgical site infections?

A
  • Diabetes
  • Corticosteroid use
  • Obesity
  • Malnutrition
  • Extremes of age
  • Recent surgery
  • Smoking
  • Immunodeficiency status
  • Renal impairment
  • Liver impairment
  • ASA class 3/4/5
  • Bacterial colonisation
96
Q

For surgery, when must the first prophylactic antibiotic dose be given?

A

Before skin incision is performed

Ideally within 60 minutes of time of incision

97
Q

How are prophylactic antibiotics selected?

A

Should be chosen against organisms most likely to cause infection

HANA Part 4 – PM4B (28 decks)

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