(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
2
Q
What does the term ‘pre-med’ refer to?
A
Medicines given prior to surgery
3
Q
What does the term ‘anastomosis’ refer to?
A
Artificial connection made between 2 ends of the same organ, during surgery
Usually blood vessels/ loops of intestine
4
Q
What does the term ‘dehiscence’ refer to?
A
Breaking open of a wound/ incision site
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
6
Q
What does this prefix refer to? angio-
A
Related to blood vessels
7
Q
What does this prefix refer to? arthr-
A
Related to joints
8
Q
What does this prefix refer to? colono- or col-
A
Related to the large bowel
9
Q
What does this prefix refer to? cysto-
A
Related to the bladder
10
Q
What does this prefix refer to? gastr-
A
Related to the stomach
11
Q
What does this prefix refer to? hyster-
A
Related to the uterus
12
Q
What does this prefix refer to? lapar-
A
Related to abdominal cavity
13
Q
What does this prefix refer to? mammo-/masto-
A
Related to the breast
14
Q
What does this prefix refer to? nephro-
A
Related to the kidney
15
Q
What does this suffix refer to? -ectomy
A
To remove
16
Q
What does this suffix refer to? -otomy
A
To open up
17
Q
What does this suffix refer to? -ostomy/-stomy
A
Artificial opening/ hole
18
Q
What does this suffix refer to? -oscopic
A
To use a scope
19
Q
What does this suffix refer to? -plasty
A
To modify/ reshape
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
21
Q
What is wound dehiscence?
A
Breakdown of a wound
22
Q
What is the breakdown of a wound called?
A
Wound dehiscence
23
Q
What is a blockage in the intestine, in the absence of a physical obstruction, called?
A
Paralytic ileus
24
Q
What is a pre-op assessment, briefly?
A
Determining anaesthetic risks
Predicting complications
25
What is conducted in a pre-op assessment?
(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
26
What is the role of pre-op pharmacists?
- 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
27
How is anaesthetic risk to a patient assessed?
ASA classifications
28
What are the ASA classification categories?
(1) ASA-I
(2) ASA-II
(3) ASA-III
(4) ASA-IV
(5) ASA-V
(6) ASA-VI
29
What are some high risk patient groups for anaesthesia?
- Cardiovascular problems
- Multiple co-morbidities
- Asthma/ COPD
- Elderly
30
What is ASA-I?
Normal healthy patient
31
What is ASA-II?
Patient with mild systemic disease
32
What is ASA-III?
Patient with severe systemic disease which is limiting but not incapacitating
33
What is ASA-IV?
Patient with a severe systemic disease that is a constant threat to life
34
What is ASA-V?
Moribund patient who is not expected to survive without operation
- moribund = person at point of death
35
What is ASA-VI?
Declared brain dead patient
Organs are being removed for donor purposes
36
What ASA classification is a normal healthy patient?
ASA-I
37
What ASA classification is a patient with mild systemic disease?
ASA-II
38
What ASA classification is a patient with severe systemic disease which is limiting but not incapacitating
ASA-III
39
What ASA classification is a patient with a severe systemic disease that is a constant threat to life
ASA-IV
40
What ASA classification is a moribund patient who is not expected to survive without operation?
ASA-V
41
What ASA classification is a declared brain dead patient
ASA-VI
42
Why do RA patients often have impaired wound healing?
RA patients are often on immunosuppressants
Impacts healing
43
What are the 7 areas of pharmaceutical intervention in surgery?
(1) Pain
(2) PONV
(3) NBM period
(4) VTE prophylaxis
(5) Fluid management
(6) Anticoagulation in peri-operative period
(7) Antibiotic prophylaxis
44
What is pain rated a 2-5/10 treated with?
Paracetamol +/- ibuprofen
45
What is pain rated a 5-8/10 treated with?
Codeine/ dihydrocodeine/ co-codamol
46
What is pain rated 8-10/10 treated with?
Morphine/ diamorphine/ fentanyl
47
What is PCA?
Patient-controlled analgesia
48
What are the benefits of PCA?
Gives patient control of their pain
Do not have to wait for nurse
49
How long does a PCA lock out for following use?
5 minutes
50
What are the benefits of a local anaesthetic nerve block?
Good pain relief results for fracture
51
What drug is given in spinal pain management?
Diamorphine
52
What is an epidural?
Pain management, injected into epidural space
Consists of local anaesthetic and opioid
53
What are the advantages of PCA?
- 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
What are the disadvantages of patient controlled analgesia (PCA)?
- 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
Which takes faster effect in PCA, morphine or fentanyl?
Fentanyl
160x more liposolubility
56
Which is cheaper, morphine or fentanyl?
Morphine is cheaper
57
Which is worse for the kidney, morphine or fentanyl?
Morphine
Metabolites build up causing renal impairment
58
When is methadone prescribed in hospital?
Hospitalised heroine users
59
Are long-acting or short-acting opioids preferred during hospital admission?
Long-acting
Potentially fewer side-effects
60
What is buprenorphine OST?
Buprenorphine opioid substitution treatment
61
What is mu-opioid receptor blockade?
Buprenorphine dose >12mg/ day
Achieves minimal analgesic effect
62
What are some pharmacological methods of VTE prophylaxis?
- LMWH
- Heparin
- Rivaroxiban/ dabigatran
- Fondaparinux
63
What is Fondaparinux?
Synthetic anticoagulant
Used for VTE prophylaxis
64
What are some non-pharmacological methods of VTE prophylaxis?
- TED stockings
| - Foot pumps
65
What duration of surgical procedure is deemed to increase risk of VTE?
60 minutes- pelvis/ lower limb
90 minutes - normally
66
What patient age is associated with increased risk of VTE?
>60yrs
67
What BMI is associated with increased risk of VTE?
>30kg/m2 (obese)
68
Which patient groups are at increased risk of PONV?
- Young + female
- Non-smoker
- History of PONV/ motion sickness
- Use of pre-post op. opioids
69
What are some consequences of PONV?
- 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
Which drugs are most commonly used for PONV treatment and prevention?
(1) Cyclizine
(2) Ondansetron/ granisetron
(3) Dexamethasone
71
What are some drugs less commonly used for PONV treatment and prevention?
- metoclopramide
- domperidone
- hyoscine
72
What route(s) of administration routes are used for cyclizine?
IV/ IM
73
What route(s) of administration routes are used for ondansetron?
IV
74
What route(s) of administration routes are used for metoclopramide?
IV
SC can be used but is unlicensed
75
What route(s) of administration routes are used for hyoscine?
Transdermal
76
What route(s) of administration routes are used for prochlorperazine?
Buccal
77
When are PO anti-emetics avoided?
When patient is actively experiencing N+V?
78
What are some non-pharmacological methods to improve PONV?
- Rehydration + pain management
- Minimise opioid use
- Ginger/ mint
- Acupuncture
- Avoid nitrous oxide
79
What is the NBM period, with regard to surgery?
Specific time pre- and post-op that a patient is advised to not eat or drink during
80
Why can a patient not be induced on full analgesia when on a full stomach?
High risk of regurgitation of stomach contents
81
What considerations should be made during a NBM period?
(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
Describe the half-life of levothyroxine.
Long
83
How long before a major surgery should warfarin be stopped?
5 days
84
How long before major surgery should aspirin be stopped?
10 days
85
Why does aspirin have to be stopped before major surgery?
Increases bleeding risk
Takes 10 days to replenish platelets
86
What should be done if patient is on warfarin but surgery is emergency?
Reversal with vitamin K
87
How may anaesthesia affect patients with hypertension?
May provoke tachycardia/ high BP
88
What should a warfarin patient's INR be prior to surgery?
<1.5
89
What would be some examples of vascular organ surgery?
- Liver
- Spleen
- Thyroid
90
How long before surgery should dabigatran be stopped, if the patient has low bleeding risk and CrCl of ≥80mL/min?
24hrs
91
How long before surgery should dabigatran be stopped, if the patient has high bleeding risk and CrCl of ≥80mL/min?
48 hours
92
What should be done if patient is on dabigatran but surgery is emergency?
Idarucizumab
Dabigatran antidote
93
How is the fluid status of a patient assessed?
```
A - Airways
B - Breathing
C - Circulation
D - Disability
E - Exposure
```
94
How is fluid resuscitation achieved?
Fluid bolus
95
What are some risk factors for surgical site infections?
- 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
For surgery, when must the first prophylactic antibiotic dose be given?
Before skin incision is performed
Ideally within 60 minutes of time of incision
97
How are prophylactic antibiotics selected?
Should be chosen against organisms most likely to cause infection
