Anitbiotics Flashcards
SCIP: Surgical Care Improvement Project
anesthesia providers can make impact on prevention through timely and appropriate use of abx, maintenance of normothermia, proper syringe/med administration practices
SCIP Measures
- 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
adverse outcomes associated with hypothermia
increased blood loss increased transfusion requirements prolonged PACU stay postop pain impaired immune function (neutrophil)
SBE prophylaxis standard medications
amoxicillin 2g PO
IV ampicillin 2g
SBE prophylaxis standard medications: PCN allergy
clindamycin 600mg IV
cefazolin 1g IV
examples of bactericidal abx
PCN's and cephalosporins isonazid metronidazole polymyxins rifampin vancomycin aminoglycosides bacitracin quinolones
examples of bacteriostatic abx
chloramphenicol clindamycin macrolides sulfonamides tetracyclines trimethoprim
PCN structure
diciclic nucleus that consists of thiazolidine ring connected to B lactam ring
PCN MOA, excretion, adverse reactions
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
PCN organisms targeted
pneumococcal
meningococcal
streptococcal
actinomycosis
probenecid
administration of probenecid will reduce renal excretion of PCN and prolong action
2nd gen PCN organism targets
pneumococcal meningococcal streptococcal actinomycosis wider range of activity: gram negative bacilli, H influenza, e coli
2nd gen PCN examples (2)
amoxicillin, ampicillin
IgE mediated anaphylaxis to B lactam abx alternatives
Clindamycin, Vancomycin
Cefazolin MOA, class, excretion, allergy
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%
all cephalosporins do these 2 things:
penetrate joints and cross placenta
1st gen, 2nd gen, 3rd gen cephalosporin examples
1st: cefazolin
2nd: cefoxitin
3rd: cefotaxime
(as you go up in generation, it becomes more effective against gram (-) bacteria)
macrolide examples (2)
erythromycin, azithromycin
macrolide structure
compounds characterized by macrolytic lactone ring containing 14-16 atoms with deoxy sugar attached
macrolide target organisms
gram (+) bacilli, pneumococci, streptococci, staphylococci, mycoplasma, chlamydia
erythromycin MOA, metabolism, excretion, SE
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
Clindamycin MOA, class, SE
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
Clindamycin surgical use, dosing
surgical use: female GU surgeries
dosing: only 10% of administered dose excreted unchanged in urine, rest is inactive. decrease dose with severe liver disease
Vancomycin Glycopeptide Derivative MOA, excretion, elimination t1/2, procedural use, SE
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
vancomycin dosage
10-15mg/kg over 60 minutes
1g mixed in 250ml
vancomycin target organisms
gram (+) bacteria, severe staph infections, streptococcal, enterococcal endocarditis, MRSA.
(administered with amino glycoside for endocarditis)
indications for vancomycin
MRSA, endocarditis due to strep viridans or enterococci, patients allergic to B lactam
vancomycin SE concomitant drugs to administer
diphenhydramine 1mg/kg and cimetidine 4mg/kg 1 hour before induction to limit histamine related effects
aminoglycoside examples (5)
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
ahminoglycosides MOA, excretion, elimination t1/2, SE
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)
aminoglycoside target organisms
effective for aerobic gram (-) and (+)
effective for mycobacterium TB
generally rx as combination therapy with beta lactam for gram (-)
ahminoglycosides and potentiation of muscle relaxants
reversible with calcium gluconate or neostigmine but likely not a sustained reverse
Fluroquinolones (2)
ciprofloxacin, moxiflocacin
Ciprofloxacin treats
respiratory infections, TB, and anthrax. useful in tx of variety of systemic infections including bone, soft tissue, respiratory tract
Moxifloxacin tx, SE
suitable for long acting tx of acute sinusitis, bronchitis, complicated abdominal infections
SE: QT prolongation, peripheral neuropathy, psychosis, SJS
Fluroquinolones MOA, absorption, excretion, elimination t1/2, SE
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
Sulfonamide examples (2)
sulfamethoxazole, trimethoprim
Sulfonamide MOA, metabolism, SE
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
sulfonamide clinical uses
UTI’s, IBD, burns
metronidazole MOA, absorption, SE
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
metronidazole target organisms and uses/recommendations
anaerobic gram (-) bacilli clostridium useful for: CNS infx, abdominal and pelvic sepsis, pseudomembranous colitis (cdiff), endocarditis recommended for preop prophylaxis for colorectal surgery
antimycobacterial agents (1st line) (4)
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
how are antimycobacterial agents used:
in combination therapy (3 or 4 agents) for 2 months, followed by a minimum of 4 months therapy with 2 agents
amphotericin B MOA, class, use, excretion, SE
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
interferons definition, MOA, tx, SE
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
acyclovir
used to tx herpes, may cause renal damage if infused rapidly, thrombophlebitis, patients may complain of HA’s during IV infusion
when patients are on ARV’s, CRNA’s should note
existence of adverse effects (liver toxicity, peripheral neuropathy, nephro toxicity, neuromuscular weakness,) interactions with other medications (PPI’s, cimetidine, NDMR, opioids, benzos)
