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Part 4 – PM4B Ali > (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

Artificial connection made between 2 ends of the same organ, during surgery

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

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

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

- 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

89
Q

What would be some examples of vascular organ surgery?

A
  • Liver
  • Spleen
  • Thyroid
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 bolus

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

Part 4 – PM4B Ali (19 decks)

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