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Pharmacology N929 > Anitbiotics > Flashcards

Anitbiotics Flashcards

1
Q

SCIP: Surgical Care Improvement Project

A

anesthesia providers can make impact on prevention through timely and appropriate use of abx, maintenance of normothermia, proper syringe/med administration practices

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2
Q

SCIP Measures

A
  • Inf-1: prophylactic antibiotic received within one hour prior to surgical incision
  • Inf-2: prphylactic antibiotic selection for surgical patients
  • Inf-3- prophylactic antibiotics discontinued within 24 hours after surgery end time
  • Inf-4: cardiac surgery patients with controlled 6a postop BG (<200)
  • Inf-6: surgery patients with appropriate hair removal
  • Inf-9: urinary catheter removed on POD 1 or 2
  • Inf-10: surgery patients with preoperative temperature management
  • Card-2: surgery patients on BB therapy prior to arrival who received BB during periop period
  • VTE 1: surgery patients with recommended venous thromboembolism prophylaxis ordered
  • VTE 2: surgery patients who received appropriate venous thromboembolism prophylaxis within 24h proper to surgery to 24h after surgery
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3
Q

adverse outcomes associated with hypothermia

A 
increased blood loss
increased transfusion requirements
prolonged PACU stay
postop pain
impaired immune function (neutrophil)
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4
Q

SBE prophylaxis standard medications

A

amoxicillin 2g PO

IV ampicillin 2g

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5
Q

SBE prophylaxis standard medications: PCN allergy

A

clindamycin 600mg IV

cefazolin 1g IV

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6
Q

examples of bactericidal abx

A 
PCN's and cephalosporins
isonazid
metronidazole
polymyxins
rifampin
vancomycin
aminoglycosides
bacitracin
quinolones
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7
Q

examples of bacteriostatic abx

A 
chloramphenicol
clindamycin
macrolides
sulfonamides
tetracyclines
trimethoprim
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8
Q

PCN structure

A

diciclic nucleus that consists of thiazolidine ring connected to B lactam ring

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9
Q

PCN MOA, excretion, adverse reactions

A

MOA: bactericidal, interferes with synthesis of peptidoglycan which is an essential component to cell walls of susceptible bacteria
Excretion: rapid, renal. 50% plasma concentration decrease in 1h.
adverse rx: hypersensitivity, rash, hemolytic anemia, maculopapular rash, anaphylaxis

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10
Q

PCN organisms targeted

A

pneumococcal
meningococcal
streptococcal
actinomycosis

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11
Q

probenecid

A

administration of probenecid will reduce renal excretion of PCN and prolong action

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12
Q

2nd gen PCN organism targets

A 
pneumococcal
meningococcal
streptococcal
actinomycosis
wider range of activity: gram negative bacilli, H influenza, e coli
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13
Q

2nd gen PCN examples (2)

A

amoxicillin, ampicillin

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14
Q

IgE mediated anaphylaxis to B lactam abx alternatives

A

Clindamycin, Vancomycin

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15
Q

Cefazolin MOA, class, excretion, allergy

A

MOA, class: bactericidal antimicrobial that inhibit bacterial cell wall synthesis and have low toxicity

excretion: renal
allergy: cross reactivity with other cephalosporins, allergy incidence 1-10%

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16
Q

all cephalosporins do these 2 things:

A

penetrate joints and cross placenta

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17
Q

1st gen, 2nd gen, 3rd gen cephalosporin examples

A

1st: cefazolin
2nd: cefoxitin
3rd: cefotaxime
(as you go up in generation, it becomes more effective against gram (-) bacteria)

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18
Q

macrolide examples (2)

A

erythromycin, azithromycin

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19
Q

macrolide structure

A

compounds characterized by macrolytic lactone ring containing 14-16 atoms with deoxy sugar attached

20
Q

macrolide target organisms

A

gram (+) bacilli, pneumococci, streptococci, staphylococci, mycoplasma, chlamydia

21
Q

erythromycin MOA, metabolism, excretion, SE

A

MOA: bacteriostatic or bactericidal. inhibits bacterial protein synthesis
metabolism: by CYP450 system and thus increases serum concentration of theophylline, warfarin, cyclosporine, methylprednisone, digoxin
excretion: bile
SE: GI intolerance, severe N/V, gastric emptying, cholestasic hepatitis, QT effects (prolongs cardiac depolarization, torsades), thrombophlebitis

22
Q

Clindamycin MOA, class, SE

A

class: linomycins
MOA: bacteriostatic. similar to emycin in antimicrobial activity. more active with anaerobes.
SE: skin rash, prolonged pre and post junctional effects at NMJ in absence of NDMR (not antagonized with anti cholinesterase or calcium). pseudomembranous colitis- severe diarrhea should indicate d/c of therapy

23
Q

Clindamycin surgical use, dosing

A

surgical use: female GU surgeries
dosing: only 10% of administered dose excreted unchanged in urine, rest is inactive. decrease dose with severe liver disease

24
Q

Vancomycin Glycopeptide Derivative MOA, excretion, elimination t1/2, procedural use, SE

A

MOA: bactericidal, impairs cell wall synthesis
excretion: 90% unchanged in urine. glomerular filtration
elimination t1/2: 6h. can be prolonged up to 9 days with renal failure patients
procedural use: cardiac/ortho procedures using prosthetic devices, CSF and shunt related infections
SE: rapid infusion can cause profound hypotension, red man syndrome (histamine release), ototoxicity, nephrotoxicity

25
Q

vancomycin dosage

A

10-15mg/kg over 60 minutes

1g mixed in 250ml

26
Q

vancomycin target organisms

A

gram (+) bacteria, severe staph infections, streptococcal, enterococcal endocarditis, MRSA.
(administered with amino glycoside for endocarditis)

27
Q

indications for vancomycin

A

MRSA, endocarditis due to strep viridans or enterococci, patients allergic to B lactam

28
Q

vancomycin SE concomitant drugs to administer

A

diphenhydramine 1mg/kg and cimetidine 4mg/kg 1 hour before induction to limit histamine related effects

29
Q

aminoglycoside examples (5)

A

streptomycin, kanamycin (limited uses, frequent occurrence of vestibular damage)
gentamicin (broader spectrum, toxic level >9mcg/ml
amikacin: derivative of kanamycin, tx for infections cause by gentamicin or tobramycin resistant gram (-) bacilli
neomycin: tx for skin, eye, mucous membrane info. adjunct therapy for hepatic coma, administered to decrease bacteria in intestine before GI surgery. most nephrotoxic

30
Q

ahminoglycosides MOA, excretion, elimination t1/2, SE

A

MOA: bactericidal
excretion: renal through glomerular filtration
elimination: 2-3h t1/2 that increases 20-40 fold with renal failure
SE: limited by toxicity. ototoxicity, nephrotoxicity, skeletal muscle weakness, potentiation of NDMR blockade, muscle weakness (inhibit pre junctional release of Ach and decreases post synaptic sensitivity to neurotransmitter)

31
Q

aminoglycoside target organisms

A

effective for aerobic gram (-) and (+)
effective for mycobacterium TB
generally rx as combination therapy with beta lactam for gram (-)

32
Q

ahminoglycosides and potentiation of muscle relaxants

A

reversible with calcium gluconate or neostigmine but likely not a sustained reverse

33
Q

Fluroquinolones (2)

A

ciprofloxacin, moxiflocacin

34
Q

Ciprofloxacin treats

A

respiratory infections, TB, and anthrax. useful in tx of variety of systemic infections including bone, soft tissue, respiratory tract

35
Q

Moxifloxacin tx, SE

A

suitable for long acting tx of acute sinusitis, bronchitis, complicated abdominal infections
SE: QT prolongation, peripheral neuropathy, psychosis, SJS

36
Q

Fluroquinolones MOA, absorption, excretion, elimination t1/2, SE

A

MOA: broad spectrum, bactericidal
absorption: GI absorption rapid and penetration to body fluids/tissues is excellent
excretion: renal, through glomerular filtration and renal tubular secretion. decrease dose in renal dysfunction
elimination t1/2: 3-8h. can inhibit CYP450 enzymes
SE: mild GI disturbances, N/V, CNS dizziness, insomnia, tendon or achilles rupture, muscle weakness in patients with MG

37
Q

Sulfonamide examples (2)

A

sulfamethoxazole, trimethoprim

38
Q

Sulfonamide MOA, metabolism, SE

A

MOA: bacteriostatic. antimicrobial activity due to ability of these drugs to prevent normal use of PABA by bacteria to synthesize folic acid. inhibit microbial synthesis of folate production
metabolism: portion of drug is acetylated in liver and other is renal excretion. renal disease dose reduced
SE: skin rash to anaphylaxis, photosensitivity, allergic nephritis, drug fever, hepatotoxicity, acute hemolytic anemia, thrombocytopenia, increase effect of PO anticoagulant

39
Q

sulfonamide clinical uses

A

UTI’s, IBD, burns

40
Q

metronidazole MOA, absorption, SE

A

MOA: bactericidal, anaerobic gram (-) bacilli clostridium
absorption: well absorbed orally and widely distributed in tissue including CNS
SE: dry mouth, metallic taste, nausea, avoid ETOH

41
Q

metronidazole target organisms and uses/recommendations

A 
anaerobic gram (-) bacilli clostridium
useful for: CNS infx, abdominal and pelvic sepsis, pseudomembranous colitis (cdiff), endocarditis
recommended for preop prophylaxis for colorectal surgery
42
Q

antimycobacterial agents (1st line) (4)

A

isoniazid- bacteriostatic-cidal if bacteria are dividing (hepato renal toxicity)
rifampin-bactericidal. hepatic enzyme induction, hepato renal toxicity, theombocytopenia, anemia
ethambutol-bacteriostatic, optic neuritis
pyrazinamide-bacteriostatic, liver toxicity

43
Q

how are antimycobacterial agents used:

A

in combination therapy (3 or 4 agents) for 2 months, followed by a minimum of 4 months therapy with 2 agents

44
Q

amphotericin B MOA, class, use, excretion, SE

A

MOA: anti fungal
use: for yeasts and fungi
excretion: slow renal excretion. renal fx is impaired in 8-% of patients treated with this drug. most recover after drug is stopped but some resulting permanent decrease in GFR may remain
SE: fever, chills, dyspnea, hypotension can occur during infusion, impaired hepatic function, hypokalemia, allergic reactions, seizure, anemia, thrombocytopenia

45
Q

interferons definition, MOA, tx, SE

A

definition: term used to designate glycoproteins produced in response to viral infections
MOA: bind to receptors on host cell membranes and induce production of enzymes that inhibit viral replication- degradation of viral mRNA
-enhance tumorcidal activities of macrophages
tx: hep B and C
SE: flu like sx, hematologic toxicity, depression, irritability, decreased mental concentration, development of auto immune conditions, rashes, alopecia, changes in CV/thyroid, hepatic function

46
Q

acyclovir

A

used to tx herpes, may cause renal damage if infused rapidly, thrombophlebitis, patients may complain of HA’s during IV infusion

47
Q

when patients are on ARV’s, CRNA’s should note

A

existence of adverse effects (liver toxicity, peripheral neuropathy, nephro toxicity, neuromuscular weakness,) interactions with other medications (PPI’s, cimetidine, NDMR, opioids, benzos)

Pharmacology N929 (11 decks)

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