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ICU > Alimentary Prophylaxis > Flashcards

Alimentary Prophylaxis Flashcards

1
Q

What is the word for the movement of enteric organisms across the bowel wall?

A

Translocation

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2
Q

What is multiorgan failure?

A

Persistent inflammation and progressive dysfunction of 2 or more organ systems

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3
Q

What is the gut hypothesis?

A

Splanchnic hypo perfusion caused but hypoperfusion –> sepsis –> SNS activation –> splanchnic vasoconstriction

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4
Q

How much of the splanchnic blood supply goes to the gastric mucosa?

A

70-90%

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5
Q

What are the risk factors for stress ulcer bleeding?

A 
Mechanical ventilation over 24 hours
Coagulopathy: platelets less than 50k, INR greater than 1.5, PTT greater than 2x control
Burns involving more than 30% of body
Shock
Sepsis
Trauma
TBI
Renal failure
Steroid therapy
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6
Q

What is clinically significant bleeding in the ICU?

A

A drop in bp or hgb by more than 2

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7
Q

What is the ph goal for using acid blockers in ICU?

A

Ph above 4

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8
Q

What are the 3 mechanisms of protection against microbial invasion in the alimentary tract?

A
  1. Stomach acid
  2. Mucosal barrier of bowel wall
  3. Reticuloendothelial system on extra luminal side of bowel wall
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9
Q

How long does ranitidine last?

A

6-8h

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10
Q

What is the typical dosing of ranitidine?

A

50 mg IV q 8h

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11
Q

How long does famotidine last?

A

20 mg lasts 10-15 hours

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12
Q

How are H2 blockers cleared?

A

Renally

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13
Q

What can happen if patients with renal failure is given H2 blockers intravenously?

A

They may accumulate and cause neurotoxicosis: confusion, agitation, seizures

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14
Q

What are the risks of using H2 blockers?

A

Infectious gastroenteritis
c. Dif
Aspiration pneumonia

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15
Q

What is MOA of PPI?

A

Binds irreversibly to the membrane proton pump and prevents gastric acid secretion

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16
Q

What are the advantages of ppi over H2 blockers?

A
  1. Greater reduction in acidity
  2. Longer duration of action
  3. Responsiveness does not diminish with continued usage
  4. Metabolized by the liver
17
Q

What are the risks of using PPI?

A

Higher risk of infectious gastroenteritis

Higher incidence of hospital acquired pneumonia and C.dif

18
Q

Which drug do PPI’s inhibit?

A

Clopidogrel because they are both metabolized by the same P450 enzyme.
Can reduce clopidogrel effect through competitive inhibition

19
Q

What is the disadvantage to sucralfate?

A

It binds other drugs in the lumen and inhibits their absorption

20
Q

Which drugs does sucralfate bind in the lumen?

A 
Warfarin
Theophylline 
Tetracycline
Cipro
Norfloxacin
Digoxin
Ketoconazole 
Phenytoin
Ranitidine
Thyroxin
21
Q

Which drug (sucralfate or h2/PPI) was shown to cause less adverse events?

A

Sucralfate

22
Q

What are the benefits of enteral tube feeds?

A
  1. Trophic to gastric mucosa

2. Raises ph

23
Q

What is believed to be the inciting event in hospital acquired pneumonia?

A

Aspiration of mouth secretions into the upper airways

24
Q

What bacteria is the mouth of a critically ill patient usually populated with?

A

Aerobic gram negative bacilli: Pseudomonas,

25
Q

Why do critically ill patient get colonization of pathogenic organisms in their mouth?

A

The epithelial receptors change

26
Q

What is the change in micro flora in the mouth directly correlated with?

A

The severity of illness

27
Q

Who benefits most from chlorhexidine washes of the mouth?

A

Cardiac patients

28
Q

What is chlorhexidine most effective against?

A

Gram positives

29
Q

What is selective oral decontamination?

A

Direct application of antibiotic to the buccal mucosa

30
Q

What is the formula of SOD?

A

Gentamicin (gram negatives)
Colistin (candida)
Vanc (gram positives)

31
Q

What are the benefits of SOD.

A
  1. Reduced incidence of hospital acquired pneumona
  2. Reduced incidence of bacteremia by gram negatives
  3. Decline of tracheal colonization
32
Q

What is the SDD formula?

A

10 ml of polymixin, tobramycin, amphotericin

33
Q

Who is SDD recommended for?

A

ICU patients who will stay for more than 72 hours because it takes a week to decontaminate the gut

34
Q

What organ metabolizes PPi?

A

Liver

35
Q

What drug should not be used with PPi?

A

Plavix because it decreases its anti platelet activity

ICU (17 decks)

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