130 Section I / Overview and Background Surgical Information
Vessel “tied in continuity” Tie, tie, cut in between
Surgicel®
Fibrin glue
Harmonic scalpel
Clips
Cellulose sheets—act as a framework for clotting factors/platelets to adhere to (Think: SurgiCEL CELlulose)
Fibrinogen and thrombin sprayed simultaneously and mixed to produce a fibrin “glue”
Ultrasonic scalpel that vibrates50,000 times per second; seals vessels and cuts tissue
Metallic clips for clipping vessels
C h a p t e r 21
Common Surgical
Medications
ANTIBIOTICS
Which antibiotics are commonly used for anaerobic infections?
Which antibiotics are commonly used for gram-negative infections?
Metronidazole, clindamycin, cefoxitin, cefotetan, imipenem, ticarcillin-clavulanic acid, Unasyn®, Augmentin®
Gentamicin and other aminoglycosides, ciprofloxacin, aztreonam, third-generation cephalosporins, sulfamethoxazoletrimethoprim
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Chapter 21 / Common Surgical Medications 131 |
Which antibiotic, if taken |
Metronidazole (Flagyl®) (disulfiram is |
with alcohol, will produce a |
Antabuse®) |
disulfiram-like reaction? |
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What is the drug of choice |
Metronidazole (Flagyl®) |
for treating amoebic |
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infections? |
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Which antibiotic is associated with cholestasis?
Which antibiotic cannot be given to children or pregnant women?
With which common antibiotics must serum levels be determined?
Ceftriaxone (Rocephin®)
Ciprofloxacin (interferes with the growth plate)
Aminoglycosides and vancomycin
Is rash (only) in response to penicillins a contraindication to cephalosporins?
Describe the following medications:
Augmentin®
Unasyn®
Cefazolin (Ancef ®)
Cefoxitin (Mefoxin®)
No, but breathing problems, urticaria, and edema in response to penicillins are contraindications to the cephalosporins
Amoxicillin and clavulanic acid
Ampicillin and sulbactam
First-generation cephalosporin; surgical prophylaxis for skin flora
Second-generation cephalosporin; used for mixed aerobic/anaerobic infections; effective against Bacteroides fragilis and anaerobic bacteria
Ceftazidime (Ceftaz®) |
Third-generation cephalosporin; strong |
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activity against Pseudomonas |
Clindamycin |
Strong activity against gram-negative |
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anaerobes such as B. fragilis; adequate |
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gram-positive activity |
132 Section I / Overview and Background Surgical Information
Gentamicin |
Aminoglycoside used to treat gram- |
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negative bacteria; nephrotoxic, ototoxic; |
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blood peak/trough levels should be |
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monitored |
Imipenem and cilastatin |
Often used as a last resort against serious, |
(Primaxin®) |
multiresistant organisms |
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Usually combined with cilastin, which |
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inhibits renal excretion of imipenem |
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Has a very wide spectrum |
Metronidazole (Flagyl®) |
Used for serious anaerobic infections |
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(e.g., diverticulitis); also used to treat |
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amebiasis; patient must abstain from |
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alcohol use during therapy |
Nafcillin (Nafcil®) |
Antistaphylococcal penicillin commonly |
|
used for cellulitis |
Vancomycin |
Used to treat methicillin-resistant |
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Staphylococcus aureus (MRSA); used |
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orally to treat C. difficile pseudomembra- |
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nous colitis (poorly absorbed from the |
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gut); with IV administration, peak/trough |
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levels should be monitored |
Ciprofloxacin (Cipro®) |
Quinoline antibiotic with broad-spectrum |
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activity, especially against gram-negative |
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bacteria, including Pseudomonas |
Aztreonam (Azactam®) |
Monobactam with gram-negative |
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spectrum |
Amphotericin |
IV antifungal antibiotic associated with |
|
renal toxicity, hypokalemia |
Fluconazole (Diflucan®) |
Antifungal agent (IV or PO) not associated |
|
with renal toxicity |
Nystatin |
PO and topical antifungal |
Chapter 21 / Common Surgical Medications 133
STEROIDS
What are the side effects?
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
What are its uses? |
Immunosuppression (transplant), |
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autoimmune diseases, hormone |
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replacement (Addison’s disease), spinal |
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cord trauma, COPD |
Can steroids be stopped abruptly?
Which patients need stress-dose steroids before surgery?
What is the “stress dose” for steroids?
Which vitamin helps counteract the deleterious effects of steroids on wound healing?
No, steroids should never be stopped abruptly; always taper
Those who are on steroids, were on steroids in the past year, have suspected hypoadrenalism, or are about to undergo adrenalectomy
100 mg of hydrocortisone IV every
8 hours and then taper (adults)
Vitamin A
HEPARIN
Describe the action. |
Heparin binds with and activates |
|
antithrombin III |
What are its uses? |
Prophylaxis/treatment—DVT, pulmonary |
|
embolism, stroke, atrial fibrillation, acute |
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arterial occlusion, cardiopulmonary bypass |
What are the side effects? |
Bleeding complications; can cause |
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thrombocytopenia |
What reverses the effects? |
Protamine IV (1:100, 1 mg of protamine |
|
to every 100 units of heparin) |