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Pharm > Abx, Steroids, & Antiemetics > Flashcards

Abx, Steroids, & Antiemetics Flashcards

1
Q

Risk Factors for SSI

A 
DM
Smoking
Hypothermia 
Preoperative shaving
Skin antisepsis
Antimicrobial prophylaxis
Inadequate sterilization of instruments 
Surgical technique
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2
Q

Redosing Time of Ampicillin and Cefazolin

A

Depends on the abs half life A: 2 hrs C: 4hrs

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3
Q

Redosing Considerations

A

Normal renal function: creatine clearance is 100 ml/min
- If < 60 ml/min consider adjusted dosing

Blood loss > 1.5L redone Vance half dose, redone all others full dose

Post-op redose limit to 24 hrs

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4
Q

Clean Wound Organism & Abx & Allergy Abx

A

staphylococcus aureus & coagulase negative staphylococci
Cefazolin
beta lacatam allergy –> clindamycin or vancomycin

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5
Q

Contaminated Wound Organism, Abx, & Allergy Abx

A

staphylococcus aureus & streptococci
Cefazolin & metronidazole
beta lactam allergy –> clindamycin

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6
Q

Contaminated Oral Organism, Abx, & Allergy Abx

A

non-bacteroides fragilis, peptostreptococcus & prevotella
Ampicillin/sulbactam
Beta lactam allergy –> clindamycin

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7
Q

Biliary & GI Wound Organism, Abx, & Allergy Abx

A

staphylococcus aureus & anaerobic gram – rods
Cefazolin & metronidazole
Beta lactam allergy –> clindamycin + aminoglycoside or fluoroquinolone

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8
Q

Cefazolin

A 
1st gen cephalosporin
o	MOA: beta lactam antimicrobial. Binds to the PBP (pcn-binding proteins) – inhibition of bacterial cell wall synthesis. Bacteriocidal. 
Dosing: 
- 2g for healthy adults 
- 3g > 120kg
- 25 mg/kg < 40 kg
- IV push over 3-5 min
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9
Q

Vancomycin

A

broad spectrum abx
o MOA: Inhibits bacterial cell wall synthesis via inhibition of polymerization of peptidoglycans
- Often for pts with MRSA
Dosing:
- 1g over 1 hr
at least 50% should be infused before procedure

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10
Q

Admin time of Abx

A

Cephalosporins up to 2 min before incision

Vanco & Flagyl 60 min before

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11
Q

Beta Lactam Abxs & Risks

A

PCNs, cephalosporins, ampicillin

Risk: Allergic reaction

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12
Q

Aminoglycosides

A

Gentamycin & Streptomycin

Risk: ototoxicity, nephrotoxicity, skeletal muscle weakness

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13
Q

Tetracyclines

A

Doxycycline

Risk: Hepatotoxicity, Nephrotoxicity

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14
Q

Fluoroquinolones

A

Ciprofloxacin, Levofloxacin

Risk: GI intolerance

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15
Q

Macrolides

A

Erythromycin

Risk: P450 inhibition

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16
Q

Vancomycin Infusion

A

Hypotension with rapid infusion
Red man syndrome
Steven Johnson Syndrome

17
Q

Gluccocorticoids

A

Released from adrenal gland.

Potent inhibitors of inflammatory mediators & up-regulate anti-inflammatory mediators. Depress immune system.

18
Q

Chronic Steroid Therapy Complication

A

suppression of hypothalamic-pituitary-adrenal axis (HPA)
Hypothalamus: cortico-releasing hormone
anterior pituitary: adrenocorticotropic hormone
adrenal cortex: cortisol
- Assume suppression if they take > 20mg/day of prednisone (or equivalent) for > 3 weeks
(16 mg/day of methylprednisolone, 2 mg/day of dexamethasone, or 80 mg/day of hydrocortisone)

  • Body stops normal activation & release of hormones during stress because it has been used to receiving exogenous steroids
19
Q

Risk of Supra-physiologic Steroid Administration

A
  • HPA suppression
  • Impaired wound healing
  • friability of skin, superficial blood vessels & other tissues
  • risk of fx, infections, GI hemorrhage, ulcer
20
Q

Risk of Stress Dose Steroid

A
  • Hyperglycemia
  • HTN
  • Fluid retention
  • Increased risk of infection
21
Q

Steroid Requirement for Minor Surgery

A

no stress dose – take normal home dose

22
Q

Steroid Requirement for Moderate Surgery

A

take normal dose +
50 mg hydrocortisone IV prior to procedure
- Then 25 mg hydrocortisone q8hr for 24 hrs

23
Q

Steroid Requirement for Major Surgery

A

take normal dose +
100 mg IV hydrocortisone before induction
- 50mg q8hrs for 24 hrs
- Taper dose by half per day to maintenance level

24
Q

Steroid Choice

A

Consider glucocorticoid : mineralocorticoid ratio
- Hydrocortisone 1:1
- If > 100 mg – transition to Methylprednisone G > M
o Cortisol is influence by G

25
Q

Dexmethasone

A

synthetic glucocorticoid
Use: PONV, edema/inflammation, post-op pain
Dose: IV 4-12mg
SE: delayed wound healing, HPA axis suppression, hyperglycemia
DOA: up to 72 hrs
All gluccocorticoid

26
Q

Risk Factors for PONV in adults

A

female
nonsmoker
hx of PONV/motion sickness
post-op opioids

27
Q

Risk Factors for PONV in Pediatrics

A

surgery > 30 min, age > 3, strabismus surgery, hx of PONV

28
Q

Anesthesia related Risk Factors for PONV

A

Volatile anesthetics, duration of anesthesia, sugammadex

29
Q

Central pathway of PONV

A

stimulation of vestibular system –> central pattern generator (vomiting center) in medulla

30
Q

Peripheral pathway of PONV

A

irritation of GI tract –> nucleus tractus solitaries in brainstem –> area postrema at base of fourth ventricle in medulla (CTZ) –> central pattern generator (vomiting center)

31
Q

Neurotransmitters Involved in PONV

A

5HT3, D2, H1, M1, Neurokinin 1 via substance P

32
Q

Ondansteron

A

5HT3 receptor antagonist. Inhibits serotonin peripherally on vagus nerve & centrally in medulla’s CTZ
• Dose: 4-8 mg
• Use: PONV, chemo N/V
• SE: HA, prolonged QT

33
Q

Phenothiazines

A 
Promethazine (phenergen)
o	Antagonizes D2 (CTZ), H1, M1
o	Use: PONV & motion sickness
o	Dose: 6.25-25mg IV 
o	Caution in Parkinson’s & prolonged QT
34
Q

Butyrophenones

A 
Droperidol 
o	Use: PONV & sedation 
o	Antagonizes D2 (CTZ) 
o	Dose: 0.625 – 1.25 mg IV 
o	Caution in Parkinson’s & prolonged QT
35
Q

Benzamines

A

Reglan
o Use: antiemetic, decrease gastric volume, gastroparesis
o Antagonizes D2 (CTZ) & enhances response to ACh in upper GI tract
o Dose: 10 mg IV
o Avoid in GI obstruction & Parkinson’s disease

36
Q

Diphenhydramine

A

H1 antagonist.
o Use: hypersensitivities, anaphylaxis, motion sickness, antiemesis, & sedation
o Antagonizes H1 receptors at effector cells in GI tract, BV, & resp tact
o Dose: 10-50 mg IV
o SE: somnolence, hypotension, dry mouth, thickening of bronchial secretions

37
Q

Scopolamine

A 
o	Use: transdermal 
o	Antagonizes M1 receptors 
o	Most effective admin the night before 
o	Can cause sedation 
o	Antisialagogue

Pharm (11 decks)

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