Common Surgical Medications, Chapter21 P130-138 Flashcards Preview

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Flashcards in Common Surgical Medications, Chapter21 P130-138 Deck (92)
1

ANTIBIOTICS
Which antibiotics are commonly used for anaerobic infections?
P130

Metronidazole, clindamycin, cefoxitin, cefotetan, imipenem, ticarcillin-clavulanic acid, Unasyn®, Augmentin®

2

ANTIBIOTICS
Which antibiotics are commonly used for gram-negative infections?
P131

Gentamicin and other aminoglycosides, ciprofloxacin, aztreonam, third-generation cephalosporins, sulfamethoxazole-trimethoprim

3

ANTIBIOTICS
Which antibiotic, if taken with alcohol, will produce a
disulfiram-like reaction?
P131

Metronidazole (Flagyl®) (disulfiram is Antabuse®)

4

ANTIBIOTICS
What is the drug of choice for treating amoebic infections?
P131

Metronidazole (Flagyl®)

5

ANTIBIOTICS
Which antibiotic is associated with cholestasis?
P131

Ceftriaxone (Rocephin®)

6

ANTIBIOTICS
Which antibiotic cannot be given to children or pregnant
women?
P131

Ciprofloxacin (interferes with the growth plate)

7

ANTIBIOTICS
With which common antibiotics must serum levels be determined?
P131

Aminoglycosides and vancomycin

8

ANTIBIOTICS
Is rash (only) in response to penicillins a contraindication to cephalosporins?
P131

No, but breathing problems, urticaria, and edema in response to penicillins are contraindications to the cephalosporins

9

ANTIBIOTICS
Describe the following medications:
Augmentin®
P131

Amoxicillin and clavulanic acid

10

ANTIBIOTICS
Describe the following medications:
Unasyn®
P131

Ampicillin and sulbactam

11

ANTIBIOTICS
Describe the following medications:
Cefazolin (Ancef ®)
P131

First-generation cephalosporin; surgical prophylaxis for skin flora

12

ANTIBIOTICS
Describe the following medications:
Cefoxitin (Mefoxin®)
P131

Second-generation cephalosporin; used for mixed aerobic/anaerobic infections; effective against Bacteroides fragilis and anaerobic bacteria

13

ANTIBIOTICS
Describe the following medications:
Ceftazidime (Ceftaz®)
P131

Third-generation cephalosporin; strong activity against Pseudomonas

14

ANTIBIOTICS
Describe the following medications:
Clindamycin
P131

Strong activity against gram-negative anaerobes such as B. fragilis; adequate gram-positive activity

15

ANTIBIOTICS
Describe the following medications:
Gentamicin
P132

Aminoglycoside used to treat gramnegative bacteria; nephrotoxic, ototoxic; blood peak/trough levels should be
monitored

16

ANTIBIOTICS
Describe the following medications:
Imipenem and cilastatin (Primaxin®)
P132

- Often used as a last resort against serious, multiresistant organisms
- Usually combined with cilastin, which inhibits renal excretion of imipenem
- Has a very wide spectrum

17

ANTIBIOTICS
Describe the following medications:
Metronidazole (Flagyl®)
P132

Used for serious anaerobic infections (e.g., diverticulitis); also used to treat amebiasis; patient must abstain from
alcohol use during therapy

18

ANTIBIOTICS
Describe the following medications:
Nafcillin (Nafcil®)
P132

Antistaphylococcal penicillin commonly used for cellulitis

19

ANTIBIOTICS
Describe the following medications:
Vancomycin
P132

Used to treat methicillin-resistant Staphylococcus aureus (MRSA); used orally to treat C. difficile pseudomembranous
colitis (poorly absorbed from the gut); with IV administration, peak/trough levels should be monitored

20

ANTIBIOTICS
Describe the following medications:
Ciprofloxacin (Cipro®)
P132

Quinoline antibiotic with broad-spectrum activity, especially against gram-negative bacteria, including Pseudomonas

21

ANTIBIOTICS
Describe the following medications:
Aztreonam (Azactam®)
P132

Monobactam with gram-negative spectrum

22

ANTIBIOTICS
Describe the following medications:
Amphotericin
P132

IV antifungal antibiotic associated with renal toxicity, hypokalemia

23

ANTIBIOTICS
Describe the following medications:
Fluconazole (Diflucan®)
P132

Antifungal agent (IV or PO) not associated with renal toxicity

24

ANTIBIOTICS
Describe the following medications:
Nystatin
P132

PO and topical antifungal

25

STEROIDS
What are the side effects?
P133

Adrenal suppression, immunosuppression, weight gain with central obesity, cushingoid facies, acne, hirsutism, purple striae, hyperglycemia, sodium retention/hypokalemia, hypertension, osteopenia, myopathy, ischemic bone necrosis (avascular necrosis of the hip), GI perforations

26

STEROIDS
What are its uses?
P133

Immunosuppression (transplant), autoimmune diseases, hormone replacement (Addison’s disease), spinal cord trauma, COPD

27

STEROIDS
Can steroids be stopped
abruptly?
P133

No, steroids should never be stopped abruptly; always taper

28

STEROIDS
Which patients need stress-dose steroids before surgery?
P133

Those who are on steroids, were on steroids in the past year, have suspected hypoadrenalism, or are about to undergo adrenalectomy

29

STEROIDS
What is the “stress dose” for steroids?
P133

100 mg of hydrocortisone IV every 8 hours and then taper (adults)

30

STEROIDS
Which vitamin helps counteract the deleterious effects of steroids on wound healing?
P133

Vitamin A

31

HEPARIN
Describe the action.
P133

Heparin binds with and activates antithrombin III

32

HEPARIN
What are its uses?
P133

Prophylaxis/treatment—DVT, pulmonary embolism, stroke, atrial fibrillation, acute arterial occlusion, cardiopulmonary bypass

33

HEPARIN
What are the side effects?
P133

Bleeding complications; can cause thrombocytopenia

34

HEPARIN
What reverses the effects?
P133

Protamine IV ( 1:100, 1 mg of protamine to every 100 units of heparin)

35

HEPARIN
What laboratory test should be used to follow effect?
P134

aPTT—activated partial thromboplastin time

36

HEPARIN
What is the standard lab target for therapeutic heparinization?
P134

1.5–2.5 times control or measured antifactor X level

37

HEPARIN
Who is at risk for a protamine anaphylactic reaction?
P134

Patients with type 1 diabetes mellitus, s/p prostate surgery

38

HEPARIN
What is the half-life of heparin?
P134

≈90 minutes (1–2 hours)

39

HEPARIN
How long before surgery should it be discontinued?
P134

From 4 to 6 hours preoperatively

40

HEPARIN
Does heparin dissolve clots?
P134

No; it stops the progression of clot formation and allows the body’s own fibrinolytic systems to dissolve the clot

41

HEPARIN
What is LMWH?
P134

Low Molecular Weight Heparin

42

HEPARIN
What laboratory test do you need to follow LMWH?
P134

None, except in children, patients with obesity, and those with renal failure, which is the major advantage of LMWH
(check factor X levels)

43

WARFARIN (COUMADIN®)
ACRONYM basis for name?
P134

Wisconsin Alumni Research Foundation

44

WARFARIN (COUMADIN®)
Describe its action.
P134

Inhibits vitamin K–dependent clotting factors II, VII, IX, and X, (i.e., 2, 7, 9 and 10 [Think: 2 + 7 = 9 and 10]), produced in the liver

45

WARFARIN (COUMADIN®)
What are its uses?
P134

Long-term anticoagulation (PO)

46

WARFARIN (COUMADIN®)
What are its associated risks?
P134

Bleeding complications, teratogenic in pregnancy, skin necrosis, dermatitis

47

WARFARIN (COUMADIN®)
What laboratory test should be used to follow its effect?
P134

PT (prothrombin time) as reported as INR

48

WARFARIN (COUMADIN®)
What is INR?
P134

International Normalized Ratio

49

WARFARIN (COUMADIN®)
What is the classic therapeutic INR?
P135

INR of 2–3

50

WARFARIN (COUMADIN®)
What is the half-life of effect?
P135

40 hours; thus, it takes about 2 days to observe a change in the PT

51

WARFARIN (COUMADIN®)
What reverses the action?
P135

Cessation, vitamin K, fresh-frozen plasma (in emergencies)

52

WARFARIN (COUMADIN®)
How long before surgery should it be discontinued?
P135

From 3 to 5 days preoperatively and IV heparin should be begun; heparin should be discontinued from 4 to 6 hours
preoperatively and can be restarted postoperatively; Coumadin® can be restarted in a few days

53

WARFARIN (COUMADIN®)
How can warfarin cause skin necrosis when first started?
P135

Initially depressed protein C and S result in a HYPERcoagulable state! Avoid by using heparin concomitantly when starting

54

MISCELLANEOUS AGENTS
Describe the following drugs:
Sucralfate (Carafate®)
P135

Treats peptic ulcers by forming an acidresistant barrier; binds to ulcer craters; needs acid to activate and thus should not be used with H(2) blockers

55

MISCELLANEOUS AGENTS
Describe the following drugs:
Cimetidine (Tagamet®)
P135

H(2) blocker (ulcers/gastritis)

56

MISCELLANEOUS AGENTS
Describe the following drugs:
Ranitidine (Zantac®)
P135

H(2) blocker (ulcers/gastritis)

57

MISCELLANEOUS AGENTS
Describe the following drugs:
Ondansetron (Zofran®)
P135

Antinausea
Anti-emetic

58

MISCELLANEOUS AGENTS
Describe the following drugs:
PPI
P135

Proton-Pump Inhibitor:
Gastric acid–secretion inhibitor; works by inhibiting the K⁺/H⁺-ATPase (e.g., omeprazole [Prilosec®])

59

MISCELLANEOUS AGENTS
Describe the following drugs:
Promethazine (Phenergan®)
P135

Acute antinausea agent; used postoperatively

60

MISCELLANEOUS AGENTS
Describe the following drugs:
Metoclopramide (Reglan®)
P136

Increases gastric emptying with increase in LES pressure; dopamine antagonist; used in diabetic gastroparesis and to help move feeding tubes past the pylorus

61

MISCELLANEOUS AGENTS
Describe the following drugs:
Haloperidol (Haldol®)
P136

Sedative/antipsychotic (side effects extrapyramidal symptoms, QT prolongation)

62

MISCELLANEOUS AGENTS
Describe the following drugs:
Ondansetron (Zofran®)
P136

Anti-emetic/serotonin receptor blocker

63

MISCELLANEOUS AGENTS
Describe the following drugs:
Albumin
P136

5% albumin
25% albumin—draws extravascular fluid into intravascular
space by oncotic pressure

64

MISCELLANEOUS AGENTS
Describe the following drugs:
Albuterol
P136

Inhaled ℬ(2) agonist (bronchodilator)

65

MISCELLANEOUS AGENTS
Describe the following drugs:
Octreotide
P136

Somatostatin analog

66

MISCELLANEOUS AGENTS
Describe the following drugs:
Famotidine (Pepcid®)
P136

H(2) blocker

67

MISCELLANEOUS AGENTS
Describe the following drugs:
Aspirin
P136

Irreversibly inhibits platelets by irreversibly inhibiting cyclooxygenase

68

MISCELLANEOUS AGENTS
Describe the following drugs:
Furosemide (Lasix®)
P136

Loop diuretic (watch for hypokalemia)

69

MISCELLANEOUS AGENTS
Describe the following drugs:
Dantrolene (Dantrium®)
P136

Medication used to treat malignant hyperthermia

70

MISCELLANEOUS AGENTS
Describe the following drugs:
Misoprostol (Cytotec®)
P136

Prostaglandin E(1 )analog
Gastroduodenal mucosal protection

71

MISCELLANEOUS AGENTS
What is an antibiotic option for colon/appendectomy
coverage if the patient is allergic to penicillin?
P136

1. IV ciprofloxacin (Cipro) AND
2. IV clindamycin or IV Flagyl

72

MISCELLANEOUS AGENTS
If the patient does not respond to a dose of furosemide, should the dose be repeated, increased, or decreased?
P136

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

73

MISCELLANEOUS AGENTS
What medication is used to treat promethazine-induced
dystonia?
P137

Diphenhydramine hydrochloride IV (Benadryl®)

74

MISCELLANEOUS AGENTS
Which medication is classically associated with mesenteric ischemia?
P137

Digitalis

75

MISCELLANEOUS AGENTS
What type of antihypertensive medication is contraindicated
in patients with renal artery stenosis?
P137

ACE inhibitors

76

MISCELLANEOUS AGENTS
Does acetaminophen (Tylenol®) inhibit platelets?
P137

No

77

MISCELLANEOUS AGENTS
What medications are used to stop seizures?
P137

Benzodiazepines (e.g., lorazepam [Ativan®]); phenytoin (Dilantin®)

78

MISCELLANEOUS AGENTS
List examples of preop antibiotics for:
Vascular prosthetic graft
P137

Ancef ® (gram-positive coverage)

79

MISCELLANEOUS AGENTS
List examples of preop antibiotics for:
Appendectomy
P137

Cefoxitin, Unasyn® (anaerobic coverage)

80

MISCELLANEOUS AGENTS
List examples of preop antibiotics for:
Colon surgery
P137

Cefoxitin, Unasyn® (anaerobic coverage)

81

NARCOTICS
What are common postoperative IV narcotics?
P137

Morphine (most common), meperidine (Demerol®), fentanyl, Percocet®, Dilaudid®

82

NARCOTICS
What is Percocet®
P137

PO narcotic pain reliever with acetaminophen and oxycodone

83

NARCOTICS
What is Demerol’s claim to fame?
P137

Used commonly with acute pancreatitis/biliary pathology because classically morphine may cause sphincter of Oddi
spasm/constriction

84

NARCOTICS
What are side effects of narcotics?
P137

Respiratory depression, hypotension, itching, bradycardia, nausea

85

NARCOTICS
What is the danger of prolonged use of Demerol?
P138

Accumulation of metabolite normeperidine (especially with renal/hepatic dysfunction), which may result in oversedation, hallucinations, and seizures!

86

NARCOTICS
What medication reverses the effects of narcotic overdose?
P138

Naloxone (Narcan®), 0.4 mg IV

87

NARCOTICS
Narcotic used to decrease postoperative shivering?
P138

Demerol®

88

MISCELLANEOUS
What reverses the effects of benzodiazepines?
P138

Flumazenil (Romazicon®), 0.2 mg IV

89

MISCELLANEOUS
What is Toradol®?
P138

Ketorolac = IV NSAID

90

MISCELLANEOUS
What are the risks of Toradol®?
P138

GI bleed, renal injury, platelet dysfunction

91

MISCELLANEOUS
Why give patients IV Cipro if they are eating a regular diet?
P138

No reason—500 mg of Cipro PO gives the same serum level as 400 mg Cipro IV! And PO is much cheaper!

92

MISCELLANEOUS
What is clonidine “rebound”?
P138

Abruptly stopping clonidine can cause
the patient to have severe “rebound”
hypertension (also seen with ℬ-blockers)