Medications in Surgery

Question 1

Most drugs can be continued during surgery because of the risk of losing control of disease if stopped suddenly.
Which medications cannot be stopped?

Which medications have to be stopped?

Answer 1

CCBs, Beta blockers, and long term steroid must be continued

Stopped:
1) COCP/HRT
2) K-sparing diuretics
3) ACE inhibitors
4) Lithium
5) Anticoagulants
6) Oral hypoglycaemics

Question 2

Long term steroids should be continued during surgery however they need to be modified. What modification needs to be applied?

What is the consequence if not?

Answer 2

Sick day rules need to be applied which is doubling the dose. (This is done to be able to mount a physiological stress response to surgery)

If not, Addisonian crisis

Question 3

How far ahead of surgery does COCP or HRT need to be stopped?

Answer 3

4 weeks before surgery

Question 4

K-sparing diuretics and ACE-inhibitors need to be stopped before surgery at the same time. What should they be stopped?

Answer 4

Day of surgery

Question 5

When should lithium be stopped pre-op?

Answer 5

Day before surgery

Question 6

Anticoagulants need to be stopped before surgery. When should they be stopped?

Answer 6

Question 7

When should LMWH be started Post-op in general?

Answer 7

6-12 hours post-op

Question 8

When should PO hypoglycemic drugs/ insulin be stopped pre-op? When is it restarted?

Answer 8

Question 9

What is the target INR for warfarin in general and for valves?

Answer 9

Question 10

What are some indications for warfarin use?

Answer 10

Question 11

A patient with a metallic heart valve is currently on warfarin but is set to undergo surgery in the coming weeks. Outline how you would change her medication from pre-op to post-op.

Answer 11

Question 12

A patient on warfarin has an INR of 5. What is your action plan?

Answer 12

Reduce dose (<6)

Question 13

A patient on warfarin has an INR of 6. What is your action plan?

Answer 13

6-8 - reduce dose and omit warfarin for 2 days

Question 14

A patient on warfarin has an INR of 8. What is your action plan?

Answer 14

8+ - give PO vitK and omit warfarin for 2 days

Question 15

What agents are involved in the reversal of warfarin?

Answer 15

Question 16

Which LMWH is used for PE?

Answer 16

tinzaparin

Question 17

A patient is about to undergo a surgery. What are the options available for DVT prophylaxis. Are there any contraindications for your options?

Answer 17

Question 18

What are some commonly prescribed antiemetic drugs? Will they be a regular prescription or PRN?

Answer 18

cyclizine
metoclopramide
ondansetron

Question 19

What is the dosage and route of administration for Cyclizine. When should it not be used?

Answer 19

PO/IM/IV 50mg TDS
not in HF/ fluid retention

Question 20

What is the dosage and route of administration for metoclopramide. When is it especially useful and when should it not be used?

Answer 20

Question 21

What is the dosage and route of administration for ondansetron. When should it be used?

Answer 21

Question 22

What drug should be co-prescribed with opioids?

Answer 22

Laxative (esp in elderly)

Question 23

What are the signs of opioid OD? How is it managed?

Answer 23

Question 24

What drug should be co-prescribed with NSAIDS?

Answer 24

PPI (omeprazole)

Question 25

Outline the pain management ladder.

Answer 25

Question 26

How would you define constipation?

Answer 26

Question 27

How would you manage constipation conservatively?

Answer 27

Question 28

What are some reversible causes of constipation?

Answer 28

Question 29

What are the types of laxatives. Give examples

Answer 29

Question 30

What patient group may require specialist referral for constipation? Why?

Answer 30

Question 31

What stimulant laxatives are indicated for: 1. soft stools 2. hard stools 3. both

Answer 31

Question 32

Outline the possible options for pharmacological management of constipation.

Answer 32

Question 33

What drugs can be used for faecal impaction? What are the contraindications to these drugs?

Answer 33

Question 34

What drug can be used to treat both fecal impaction and colonic atony?

Answer 34

Question 35

What laxative should be used if the patient presents with an acute abdomen?

Answer 35

Question 36

Give some examples of PPIs. What is the MOA of a PPI? WHat are the indications for use?

Answer 36

Question 37

What are the SEs of PPIs?

Answer 37

Question 38

What are the antibiotics of choice for: 1. intra abdominal infection

Answer 38

Question 39

What are the antibiotics of choice for: 1. urosepsis

Answer 39

Question 40

What are the antibiotics of choice for: 1.CAP 2. HAP

Answer 40

Question 41

What are the antibiotics of choice for: 1. cellulitis

Answer 41

Question 42

For the following types of diuretics, give examples and state the SEs. 1. loop 2. thiazide 3. K-sparing

Answer 42

Question 43

Whe MOA and SEs of statins?

Answer 43

Question 44

You are observing an open midline laparotomy. The surgeon asks you to outline what structures are being cut during the initial incision. What would you say?

Answer 44

The abdominal wall is composed of several layers, organized from superficial to deep: 1. Skin * The outermost layer, consisting of epidermis and dermis. 2. Subcutaneous Tissue (Superficial Fascia) * Camper’s fascia: A fatty superficial layer. * Scarpa’s fascia: A deeper, membranous layer. 3. Muscles and Their Fasciae * External Oblique Muscle: The most superficial muscle layer. * Internal Oblique Muscle: Lies beneath the external oblique. * Transversus Abdominis Muscle: The innermost muscle layer. 4. Transversalis Fascia * A thin connective tissue layer deep to the transversus abdominis muscle. 5. Extraperitoneal Fat * A layer of fat located between the transversalis fascia and the peritoneum. 6. Parietal Peritoneum * The innermost layer, lining the abdominal cavity and forming the outermost layer of the peritoneal cavity.