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Summary

Dr. Aisha Musa, presents the eighth webinar of the National teaching series titled "Prescribing in Surgery." The series aims to educate attendees about General surgery, Colorectal and Urology prescription while following various case studies. The multiple-choice questions encourages in-depth understanding and practical application of knowledge, making it highly beneficial for medical professionals and medical students interested in consolidating their prescribing knowledge in the surgical context.

Learning objectives

  1. To understand the key principles of antimicrobial stewardship in the surgical setting, specifically in general surgery, colorectal surgery, and urology.
  2. To enhance learners' ability to formulate a rational and evidence-based approach to perioperative management in general surgery, colorectal surgery, and urology.
  3. To familiarize with best practice and guidelines for safe and effective prescribing in surgical settings, specifically in general surgery, colorectal surgery, and urology.

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Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi, welcome to uh prescribing surgery series. This is our eighth session which will be on general surgery, uh colorectal uh and urology. Um And my name is uh doctor. So I'm of the colleagues for the prescribing surgery series. So just a disclaimer. Um The series has been created by two doctors who have a passion for uh teaching. Uh It's entirely entirely on a voluntary basis. Um And the lecture slides and teaching contents are um accurate to the best of our knowledge and neither us nor the mind, the take responsibility for any unintentional inaccuracies. Uh And our session next week by doctor JT will be on TN O ent and pediatrics. So straight onto the first case, uh a 54 year old man presents to the surgical emergency assessment unit with severe left iliac cause of pain, bloody diarrhea and a fever. He has a past medical history of asthma for which he takes albuterol 4 mg T DS and he has no known drug allergies Act scan is conducted which shows acute diverticulitis with generalized per peritonitis. The general surgical consultant asks you to commence him on antibiotics whilst he obe his surgical procedure Um So the first question is uh which antibiotic were you prescribed for his acute diverticulitis? And I just pretty simple. Mhm. Ok. So far most people are going for option eight which is 1.2 g I VT yes. With some going for options D Doxycycline, metroNIDAZOLE and options E Levofloxacin. Mhm. Ok. Any, any more responses? OK. So far, um most people are going for a followed by E and then D OK. So the correct answer is a. Um, so the correct answer is a because uh he has complicated diverticulitis uh with generalized peritonitis and he's not allergic to penicillin. The reason why it's not B is because uh famcin uh 200 mg per or B, the second line with vancomycin in is ineffective in patients with C difficile infection. The reason why it's not option C is because option C is used in uh non uh burs inver in patients who are not systemically unwell or at a high risk of complications. And the reason why it's not D is because doxycycline and metroNIDAZOLE is used to treat human and animal bites in patients who are pen allergic. Uh and the reason why it's not e is because this is an alternative choice for um human acquired pneumonia. Um But this is only in um if specialist, uh if kind of approved through specialist advice. Uh So this is just to show you, um, the it to the left, the venous guidelines which says in patients with suspected or confirmed complicated acute diverticulitis. Uh first by IV, you start them on Comox and uh to the right, just showing you my local guidelines which say the same thing. OK. Any questions for this case? OK. Um Alternatively, you could give cephalexin with metroNIDAZOLE or amoxicillin with gentamicin and metroNIDAZOLE. But neither of uh of those were, were kind of uh listed in the Mle choice. OK. Let's move on to the second case then. Uh so case two, a 35 year old female presents to her GP with constipation and pruritus, she denies rectal bleeding. Uh Pr exam shows external hemorrhoids that hasn't, that's not from rose. Uh She's got a cosmetic history of hypertension for which she takes Ramipril 2.5 mg once daily. Uh She has no known drug allergies. She's given antiseptic cream to aid with the itching and painkillers. And you've been asked to prescribe laxatives for her constipation. So which laxatives were you prescribed for her constipation? Just place the second please. Deep. Um I'm gonna turn the slides on moving forward. OK. Let me just go backwards and then forwards. Mhm. Mhm. And it should say case two. OK. So far um 40% of people going for options, a lactulose, 40% going for option B Macrogol and uh 20% going for s any responses. OK. Um So the answer is actually e which is it for hos um The reason why is that uh in the BF, it says that in patients with hemorrhoids, if constipation is reported, um it should be treated using a bulk forming laxative. Um So options A and B are osmotic laxatives. Option C is a stimulant laxative and option D is a sa stool softener as well as a stimulant laxative. Um and this is showing you um at the top that's taken form the B NF which says if constipation is reported, it should be treated um using bulk forming laxative in patients that have hemorrhoids and just showing you the two most common examples of bulk forming laxatives, which is fibro gel, also known as HOF and uh cellulose. Ok. Um Any questions for this case? Ok. I'll move on to the next case. Um Someone said they can't see the questions. Uh I'll just released the questions into the um into the chat by the pool. Um ok. So moving on to case three, let me know if you can answer the questions for case three. So case three, a 42 year old male presents to A&E with a fever, dysuria and straining when urinating. He has um no past medical histories. He's not currently on any medications has no known drug allergies. The pr exam shows uh tender and bulky prostate, the blood and urine cultures have been taken. Painkillers have been prescribed. He's been referred to the urology team. The ROS team have asked you to prescribe him antibiotics for his prostatitis. Um So the question is, which antibiotic were you prescribed for his prostatitis? And I'm just gonna release the poll for question three into the chart. OK. So 80% of people are going for C A Ciprofloxacin 500 mg BD. Um 83%. Now uh with 16% going for 100 mg modified release BD. OK. Any, any other choices? OK. So currently, C is the most popular option followed by a Levofloxacin and then E nitrofur. OK. So the correct answer is C uh cloacin 500 mg per oral BD. Um I'll go through why it's not the other options. So it's not A or B because A uh so Levofloxacin 500 mg OD as well as oxole, 960 mg BD are both second line alternatives uh to for prostatitis and they are only initiated on specialist advice. It's not d because flu flucloxacillin 1 g uh gram Q DS is used for cellulitis and it's not e because my to um is used for UTI and it does not help in prostatitis. Um So this is just showing you that oral first line for acute prostatitis is either Ciprofloxacin or floxacin. Um And to the right, just showing you my local guidelines which show 500 mg per or BD um of ciprofloxacin for acute prostatitis. Any questions for this scenario? OK. Um can move on to the next case. So case four A 28 year old female presents to A&E with dysuria, polyuria, urgency and foul smelling urine. She's not pregnant. Her symptoms have not improved over the past 48 hours. In terms of her past medical history, she takes fibromyalgia for which she takes citalopram, 10 mg, 30. She has no known drug allergies. Um You've taken some blood from her and um her EGFR is 92. You have been asked to start her on antibiotics for her uti. So the question is, which antibiotic were you prescribed for her? Uti? Just raise, pull into the child. So we've got five responses so far with 100% of people going for B nitrofur 50 mg, Q DS. Mhm OK. Any more responses? OK. So 75% of people going for B nitro 50 mg of PT S with 25% going for a Phosphomycin 3 g uh as a single dose. So the correct answer is BN 50 mg, Q DS. Uh but I can talk to you why? It's not the other options? So options. AC and D are all second line for UTI in nonpregnant women. Um And this is used if there's no improvement after at least 48 hours or the first line is not suitable. Option B is correct because this is the first line treatment uh for, for UTI. Um It is not e because acyclovir 800 mg uh five times a day is used for chickenpox. Mhm. Um So this is just showing to you in nonpregnant women. First line, you would prescribe nitrofur her or me. Um And we tend to use nitro over trimethoprim. Um We only tend to use methoprene if there's no risk of resistance. Um and her egfr was above 45. So we're OK to use the nitro to uh any any questions for this case? OK. Let's move on to the next case. So case five, a 60 year old male presents to A&E with foul swelling, urine, dysuria, fever, urgency and frequency of urine, uh, urine culture has been taken uh in terms of his past medical history, he's got right knee osteoarthritis. He doesn't currently take any medications and he has no known drug allergies. Um It's noted that his ETF R is 35 you have been asked to, to commence him on antibiotics for his UTI. And so the question is, which antibiotic were you prescribed for his uti? Just release the pole into the chat. So for 100% of people going for B trimethoprim BT 200 mg, any responses? Ok. So far, um everyone's gone for B tram and 200 mg BD, which is the correct answer. Um So the reason why it's not A is because phenoxyethyl penicillin, 500 mg of Q DS is used for acute sore throat. Um The reason why it's not C is because um amoxicillin 500 mg of T DS. Um It can be used in UTI but it, it um it tends to be used in catheter associated uti at first line if culture sensitive or second line in nonpregnant women or pregnant women, this is again, only if it's culture sensitive. Um The reason why it's not d is because um amoxicillin, cycin omeprazole, it's therapy for H pylori. Uh and the reason why it's not E is because uh ofloxacin 200 mg BD is used for um ee oritis. Um And this is just showing you that it's um trimethoprim uh 200 mg BD per or because his eeg fr is more than 30 but it's less than 45. So we can't use nitro for to um and if that makes sense, uh s sorry, any questions for that case. Uh Yes, the recording um will be made available after um the session along along with the slides. Ok. Um So moving on to our sixth case, a 30 year old uh pregnant woman presents to A&E with a fever, left groin pain and nausea and vomiting. Uh on examination of her abdomen, she's got left costovertebral angle tenderness. In terms of her past medical history. She's got um eczema. She doesn't take any medications for it and she's not on any other medications and she has no known drug allergies. Um So urine culture has been collected and she's been referred to urology team who have asked you to prescribe antibiotics for her pyonephritis and to order a renal ultrasound scan. Um So the question for this case is which antibiotic were you prescribed for her pyelonephritis? Uh And I'll just finish the um questions in. Mhm So, so far 60% of people grow fatigue um cephalexin um 20% going for E ce and 14% going for C fluoxil. OK. Any more responses? Mhm OK. So equal amount of people going for D and E uh with 11% of people going for C OK. So the correct answer is the cephalexin 500 mg 2 to 3 times a day per oral. Um and I'll just go through why it's not the other options. So uh clotrimazole um cream is used for uh vaginal candidiasis in pregnant women. Um metroNIDAZOLE 400 mg, BD per is uh used for bacterial vaginosis. Uh fluoxil 500 mg. Q DS is the dose we would use for uh patients that present with mastitis and it's not e because cephalitis on 2 g. IV BD is what we would use for meningitis. Um So just to show you the guidelines. So to the left, we've got the uh guidelines, uh B NF guidelines for pregnant women with pyonephritis. And as you can see, all first line is cephalexin. Um to the right, we've got guidelines for nonpregnant women and men. And in that case, we can use cephalexin or ciprofloxacin. Um We could also use Comox aab or trimethoprim as well as all first signs if sensitivity is known, um I hope that makes sense. Uh Any questions for this scenario? OK. So then we can move on to uh the next case, which I think is our last case for today. Um So a 50 year old man presents to Amy with right groin or groin pain, which is severe and associated with nausea and vomiting. So, in terms of his um past medical history, um he's got epilepsy for which he takes carBAMazepine 200 mg BD per all and he's got no known drug allergies. Um So his noncontrast ct Kub shows the distal ureteric stone which is seven millimeters in diameter he's seen by for shockwave lithotripsy and the asked me to prescribe a uh adjunctive uh medical therapy. So the question is which adjunctive uh medical therapy will you prescribe for his distal ureteric stone? Mhm. Gonna question 24. So past Pyonephritis can prescribe orals. Yes, we can, we can prescribe orals. Uh As first line, you can also prescribe ivs first line if they're severely unwell or unable to take oral treatment. Um So just in terms of the responses for question seven, so 42% of people saying tamsulosin with 28% of people saying Vancomycin and 28% of people saying watchful waiting. Uh any more responses. OK. OK. So 44% of people going for C tamsulosin, 33% going for watchful waiting and 23% going for Vancomycin. So the correct answer is c tamsulosin 400 mcg OD per oral. So, the reason why it's not a is because uh we tend to be watchful waiting for asymptomatic renal stones or stones if they're less than five millimeters in uh diameter. And his stone was seven millimeters in diameter and it was asymptomatic. The reason why it's not to be is because um hyacin butylbromide um is used for symptomatic relief um in gi or gu disorders caused by smooth muscle spasm. Um And in the V NS, they mentioned not to offer antispasmodics to patients with suspected colic. Um So, c is the correct answer. The reason. The reason why it's not D is because chlorphenol uh is used for conjunctivitis. Uh And the reason why it's not Vancomycin 100 25 mg. Q DS is because it's used for C diff cell infection. So, this is just from the B NF uh showing you that alpha adrenoreceptor blockers can be considered as an adjunctive therapy for patients having shockwave lithotripsy for ureteric stones less than 10 millimeters. And he's undergoing shockwave lithotripsy for a distal ureteric stone that is seven millimeters in diameter. I hope that makes sense. Uh Any questions for me. OK. Um So these are the references uh for today's uh I used uh for today's session. Um and this is a, a feedback form. Um So I'll just release into the chart. Uh So the feedback form is very helpful for us because it helps us, uh, know what we've done well, how we could improve. Um, I know today's talk was a bit uh shorter than previous talks, but, um, we've got, uh for more talks coming up in the future, uh, and please do fill out the feedback form because it allows you to have a certificate for your attendance. Um, and as I mentioned earlier on next week's session will be on to an orthopedics, pediatrics and ent by doctor uh GME. Uh and this is the eighth session out of our 10 part series. Uh So thank you very much for doing this today. I hope it was useful.