antibiotics

Question 1

Where in the cell are the receptors that are activated by most anesthetic drugs?

Answer 1

phospholipid bilateral/cell membrane

Question 2

What drugs act on intracellular proteins?

Answer 2

caffeine, insulin, steroids

Question 3

What drug effects circulating proteins?

Answer 3

Anti-coagulants

Question 4

What’s an example of a drug that doesn’t target a receptor at all?

Answer 4

Antacids

Question 5

What is an agonist?

Answer 5

something that binds to a receptor and achieves a full response/high efficacy

Question 6

What is a partial agonist?

Answer 6

binds to and activates receptor but no as much as a full agonist/low efficacy

Question 7

What is an inverse agonist?

Answer 7

binds at the same site as an agonist but produces an opposite effect (turns off receptor)

Question 8

What is an antagonist?

Answer 8

binds to and inactivated receptor (turns off)/prevents action

Question 9

what is the surgical classification of a cyst removal?

Answer 9

clean

Question 10

a Bronchoscopy is technically a _______ procedure

Answer 10

clean-contaminated

Question 11

what’s the difference between clean-contaminated and contaminated?

Answer 11

major break in sterility, spillage/acute inflammation

Question 12

What’s an example of “dirty or infected” surgical classification

Answer 12

fecal peritonitis, perforated bowel, purulent material visible

Question 13

What is the difference between the cellular structure of a gram negative and positive bacterium?

Answer 13

gram negative has a thin will with a outer membrane. these are more chalking to treat and cause more side effects with their destruction/sepsis more likely
gram positive has a thick wall with NO membrane, easier to kill

Question 14

Gram negative bacteria that are most likely to cause a surgical site infection are:

Answer 14

e. coli, Klebsiella

Question 15

What is a common bacteria for respiratory infections?

Answer 15

Pseudomonas

Question 16

what are patient controlled risk factors for SSI?

Answer 16

extreme ages
poor nutrition
obesity
diabetes/hyperglycemia
PVD
tobacco use
current infection
immunosuppression

Question 17

provider affected risk factors of SSI:

Answer 17

Steroid use
skin prep
length of preop stay
technique (open vs laparoscopic)
duration of procedure
hospital environment
periop normothermia

Question 18

When should an individual stop smoking before surgery?

Answer 18

IDEALLY 3-6 months but at least 4-8 weeks indications 50% less risk of infection

Question 19

Why is hypothermia not preferred for surgical patients?

Answer 19

vasoconstriction, decreased WBC in tissues

Question 20

What temperature is ideal for surgical patients?

Answer 20

36°

Question 21

What is our glucose goal?

Answer 21

less than 200

Question 22

4 Anesthesia performance measures:

Answer 22

abx in 1 hour
correct abx for procedure
BG control
temp control

Question 23

in what cases are bactericidal antibiotics preferred?

Answer 23

endocarditis, meningitis, osteomyelitis, and neutropenia

Question 24

What antibiotic classes are Beta-lactams?

Answer 24

Penicillins
cephalosporins
carbapenems
monobactams

Question 25

how do beta lactams and glycoproteins work?

Answer 25

inhibit peptidoglycan synthesis in bacterial cell wall

Question 26

example of a glycopeptide:

Answer 26

vancomycin

Question 27

example of a aminoglycoside:

Answer 27

gentamicin

Question 28

example of a macrolide:

Answer 28

azithromycin

Question 29

example of a quinolone:

Answer 29

ciprofloxacin

Question 30

how do aminoglycosides work?

Answer 30

target ribosomal subunit 30s

Question 31

how do macrolides work?

Answer 31

target bacterial ribosomal subunit 50s

Question 32

how do quinolones work?

Answer 32

inhibit DNA replication

Question 33

How do Sulfonamides work?

Answer 33

inhibit folate synthesis

Question 34

How does the beta lactam ring work?

Answer 34

inhibits transpeptidase which is used for cell wall synthesis

Question 35

What is beta-lactomase?

Answer 35

an enzyme bacteria can develop or have naturally that breaks down the beta lactam ring *causes abx resistance*

Question 36

What bacteria do beta lactams target?

Answer 36

gram positive and gram negative

Question 37

Which three beta lactams are not effected by beta lactamase?

Answer 37

Methicillin, oxacillin, dicloxacillin

Question 38

What are the three beta lactamase inhibitors?

Answer 38

Clavulanic acid, tazobactam, sulbacta Clavulanic acid (augmentin: amox-clav) Zosyn (piperacillin + tazobactam

Question 39

What antibiotic is commonly prescribed for dental prophylaxis?

Answer 39

Penicillin

Question 40

Bad side effects of penicillin:

Answer 40

neurotoxicity and hyperkalemia in CKD IM preferred bc long half life and large vd

Question 41

What drug is the reason we have many false penicillin allergies?

Answer 41

ampicillin

Question 42

What causes the ampicillin skin rash?

Answer 42

protein impurities in the drug formulation

Question 43

What antibiotic class is most common in surgery?

Answer 43

Cephalosporins

Question 44

Side effect of cephalosporins:

Answer 44

thrombophlebitis/expensive

Question 45

What antibiotic class can penetrate into joints and cross the placenta?

Answer 45

cephalosporins

Question 46

what first generation cephalosporin is the best choice for preventing SSI?

Answer 46

Cefazolin

Question 47

What is the only 4th generation cephalosporin?

Answer 47

Cefepime

Question 48

What generation of Cephalosporins treat MRSA?

Answer 48

5th

Question 49

Why would we use a 2nd gen rather than a 1st?

Answer 49

to treat drugs resistant/also have extended activity against gram negative

Question 50

What antibiotic is frequently given for prostate biopsy?

Answer 50

Cefoxitin

Question 51

What drug can penetrate CSF to treat meningitis?

Answer 51

Ceftriaxone

Question 52

What antibiotic class is best at treating ventilator associated pneumonia?

Answer 52

Carbapenems

Question 53

Why should carbapenems never be users for simple prophylaxis?

Answer 53

they're the "heavy hitters" last antibiotic option to treat resistant bacteria

Question 54

IgE penicillin reaction:

Answer 54

laryngeal edema, bronchospasm, cardiopulmonary collapse

Question 55

Type A drug reaction:

Answer 55

side effects such as diarrhea, nausea

Question 56

Type B 1 drug reaction:

Answer 56

IgE mediated: mild urticaria to severe cardiopulmonary collapse onset minutes to 2 hours

Question 57

Type B Type 2 medication reaction:

Answer 57

antibody dependent cytotoxicity: hemolytic anemia, thrombocytopenia

Question 58

Type III drug reaction:

Answer 58

immune complex, serum sickness weeks after

Question 59

Type IV drug reaction:

Answer 59

T-cell mediated rash, steven johns syndrome 48H-weeks

Question 60

What is the antibiotic of choice for colorectal surgery?

Answer 60

cefazolin and metronidazole

Question 61

What is the antibiotic of choice for appendectomy?

Answer 61

Cefotetan or Cefoxitin

Question 62

Dosage for Cefazolin:

Answer 62

2 grams, >120 kg 3 grams

Question 63

(T/F) Vanomycin is good for gram negative

Answer 63

FALSE

Question 64

What is the target bacteria for flagyl?

Answer 64

Anaerobic gram negative

Question 65

What antibiotic class has unique anti inflammatory effects?

Answer 65

Macrolides

Question 66

Vancomycin dosage:

Answer 66

15-20mg/kg: 1 g, 1.5 g, 2g

Question 67

What is red man syndrome?

Answer 67

Histamine release reaction due to vancomycin- give antihistamines

Question 68

What's the difference between Anaphalaxis and Anaphalctoid reactions?

Answer 68

Anaphylaxis: Ige Anaphactoid: mast cells, basophils (NOT IgE) also receives hydroxyzine

Question 69

What's a high risk side effect of aminoglycosides:

Answer 69

neurotoxicity, otoxixity, vertigo- meniere's syndrome, skeletal muscle weakness

Question 70

Organ perfusion rank:

Answer 70

kidneys liver heart brain

Question 71

What drug is given to overcome skeletal muscle side effects?

Answer 71

Calcium

Question 72

In what population should tetracycline not be given?

Answer 72

pregnancy and children

Question 73

what is an indication for a glycopeptide (vancomycin)?

Answer 73

BL allergy or MRSA outbreak

Question 74

What physiological changes occur with histamine release?

Answer 74

increase myocardial contractility venodialation decrease LV filling

Question 75

What antibiotic class has the highest occurance of resistance?

Answer 75

Macrolides

Question 76

What are the most common side effects of erythromycin?

Answer 76

prolonged QT leads to torsades - sudden cardiac death GI side effects

Question 77

What's an off label use of erythromycin?

Answer 77

increase of lower esophageal sphincter tone (decreases aspiration)

Question 78

What is the antibiotic of choice in BL allergy?

Answer 78

Clindamycin/ vancomycin ONLY in MRSA

Question 79

Side effect of Clindamycin:

Answer 79

significant diarrhea

Question 80

Clindamycin dosage:

Answer 80

900mg

Question 81

What does Rifampin treat?

Answer 81

TB

Question 82

What bacteria does metronidazole treat?

Answer 82

Anaerobic gram negative and clostridium

Question 83

metronidazole dosage:

Answer 83

500mg

Question 84

what cannot be given with sulfonamides?

Answer 84

anticoagulants, methotrexate, sulfonylurea, and thizides

Question 85

When before surgery should antibiotics be given?

Answer 85

1 hour before incision

Question 86

What is MIC?

Answer 86

minimum inhibitory concentration - tissue concentration to prevent bacterial growth

Question 87

dosing for Cefoxitin:

Answer 87

2 grams

Question 88

Dosing for Cefotetan:

Answer 88

2g

Question 89

Dosing for Ceftriaxone:

Answer 89

2G

Question 90

Dosing for Gentamicin:

Answer 90

5mg/kg

Question 91

Dosing for piperacillin-tazobactam (zosyn):

Answer 91

3.375

Question 92

What are the antibiotics of choice for urinary procedures?

Answer 92

cefazolin and cipro

Question 93

IM epinephrine dosage for anaphylaxis

Answer 93

0.01mg/kg OR 0.5mg max Q5-15min 1:1,000

Question 94

IV Epinephrine Dose for Anaphylaxis:

Answer 94

50-100mcg over 1-10 minutes 1:10,000

Question 95

Apart from Epinephrine, what are other treatment options for anaphylaxis?

Answer 95

remove inciting cause call for help supine position (unless airway swelling) supplemental oxygen IV Fluids

Question 96

What antibiotics are safe in pregnancy?

Answer 96

PCN and cephalosporins

Question 97

Elderly considerations w/ ABX:

Answer 97

decrease GI motility and acidity increased fat & decreased albumin decreased hepatic blood flow decreased GFR

Question 98

what antibiotic class causes tendon rupture

Answer 98

fluroquinolones