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Crozer Surgery > antibiotics > Flashcards

antibiotics Flashcards

1
Q

What should you always consider before starting an antibiotic

A

1) what is the most likely infecting organism
2) Have a gram stain and Culture/ Staining done
3) Allergies
4) Kidney function (BUN and Cr)
5) Interactions

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2
Q

Augmentin

A

amoxacillin/ clavulonic acid

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3
Q

Zosyn

A

piperacillin/tazobactam

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4
Q

Unasyn

A

ampicillin/sulbactam

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5
Q

Timentin

A

Ticarcillin/clavulonic acid

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6
Q

Zyvox

A

linezolid

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7
Q

Invanz

A

ertapenem

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8
Q

Cubicin

A

daptomycin

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9
Q

Tygacil

A

Tigecycline

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10
Q

Bactrim

A

TMP/SMX

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11
Q

Rocephin

A

cetriaxone

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12
Q

Avelox

A

moxifloxacin

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13
Q

zithromax

A

azithromycin

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14
Q

primaxim

A

imipenem/cilastatin

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15
Q

synercid

A

dafopristin/quinupristin

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16
Q

Cleocin

A

clindamycin

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17
Q

flagyl

A

metronidazole

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18
Q

Dose of augmentin

A

500 or 875 mg PO BID

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19
Q

Amount of clavulonic acid in Augmentin 500mg and 875 mg

A

both have 125 mg

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20
Q

Spectrum of activity for augmentin

A

staph, strep, enterococci, gram negatives, anaerobes

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21
Q

What is the dose for Zosyn (3 alternatives)

A

3.375 g IV every 6 hours

Renal dose- 2.25g IV 6 hours

Alternate dose- 4.5g IV q6hours

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22
Q

Spectrum of action for zosyn

A

staph, strep, enterococci, gram negatives and anaerobes

COVERS PSEUDOMONAS

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23
Q

Unasyn dosing (2)

A

3.0 IV Q6

Renally- 1.5g IV q6

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24
Q

Unasyn indications

A

for polymicrobial diabetic foot infections

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25
Q

Spectrum of activity

A

Staph, strep, enteroccoci, gram negatives

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26
Q

Timentin dosing

A

3.1 g IV q4-6 hours

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27
Q

Timentin indications

A

broad spectrum antibiotic for polymicrobial infections

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28
Q

Spectrum for Timentin

A

Staph, strep, gram neg, anaerobes, COVERS PSEUDOMONAS

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29
Q

What lab value do you watch for with Timentin

A

increased NA loads

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30
Q

Penicillins that cover pseudomonas (9)

A

4th and 5th generation cephalosporins

Piperacillin

Zosyn

Ticaricillin

Timentin

Carbenicillin

Mezlocillin

Azlocillin

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31
Q

What are IV alternatives for PCN allergic patients (4)

A

clindamycin, vancomycin, levaquin, bactrim

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32
Q

How are PCN’s excreted

A

all are renally excreted except mezlocillin, azlocillin, piperacillin

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33
Q

What concern is there of a patient on PCN and probenecid

A

probenecid will increase duration of serum levels of PCN and most cephalosporins

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34
Q

Vancomycin dosing

A

1g IV q12hours with slow infusion

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35
Q

Vancomycin- when are levels drawn

A

peak taken 30 minutes after the 3rd dose

trough taken 30 minutes before the 4th dose

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36
Q

Vancomycin- what should the peaks and troughs be

A

peak: 15-30 mg/mL

Trough < 10mg/mL

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37
Q

How to adjust the dose based on peaks and troughs

A

If peak is too high decrease the dose

If the peak is too low increase the dose

If the trough is too high increase the interval between doses

If the trough is too low decrease the interval between doses

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38
Q

What happens when you infuse Vanco too quickly

A

Red Man syndrome- pruritis and erythema

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39
Q

How to decrease the risk of Red Man syndrome

A

slow infusion over one hour

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40
Q

How to treat Red Man syndrome

A

anti histamines until symptoms resolve

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41
Q

Other side effects of vancomycin

A

ototoxicity and nephrotoxicity

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42
Q

When should PO vancomycin be used and what is the dose

A

for treatment of pseudomembranous colitis

125mg PO q6 hours

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43
Q

What is the dose for bactrim

A

one tab PO BID

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44
Q

How much is in the single strength tablet of bactrim, and in the double strength

A

single strength- TMP 80mg/SMX 400mg

double strength- TMP 160mg/ SMX-800mg

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45
Q

Does Bactrim cover pseudomonas

A

NO

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46
Q

Contraindications with bactrim

A

patient on oral hypoglycemic or with G6PD deficiencies

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47
Q

Zithromax dosing

A

250mg PO

48
Q

Half life of zithromax

A

68hours

49
Q

Can zithromax be given with a PCN allergy

A

yes

50
Q

Dosing for Primaxin

A

500mg IV q6-8
OR
1 gram q6-8

51
Q

Does Primaxin cover MRSA or Pseudomonas

A

no and no

52
Q

What is a side effect of primaxin

A

seizures in patients with a history of seizures

risk of seizure increases with the dosing

53
Q

How does primaxin work. (the individual parts)

A

imipenem is the antibiotic portion

cilastatin is the renal dehydropeptidase inhibitor which prevents imipenem from being metabolized by the kidneys

54
Q

Which antibiotic is nicknamed gorrilamycin

A

imipenem

55
Q

Invanz dosing

A

1g IV q24 hours

56
Q

indications for Invanz

A

approved for use in adults for treatment of moderate to severe diabetic foot infections

57
Q

What class is Invanz

A

it is a structural unique 1 beta methyl carbapenem related to Beta-lactam

58
Q

What is the dose for Zyvox

A

400-600mg PO/IV q12 hours

59
Q

indication for Zyvox

A

oral Zyvox used for outpatient treatment of MRSA infections

60
Q

Major side effect for Zyvox

A

thrombocytopenia

61
Q

Dose for cipro (2)

A

250-750mg PO q 12 hours

200-400mg IV q 12 hours

62
Q

Levaquin dosing

A

250-500mg PO/IV q24 hours

63
Q

Dose for avelox (moxifloxacin)

A

400mg PO/IV q24 hours

64
Q

Spectrum of activity

A

good for pseudomonas

Cipro- limited gram positive
Levaquin and Avelox- better for gram positives

65
Q

Who should not be given a quinolone

A

children with open growth plates. May have risk of cartilage degeneration

66
Q

Aztreonam dosing

A

1-2grams IV q8 hours

67
Q

aztreonam spectrum of activity

A

gram negatives and pseudomonas

68
Q

Aztreonam side effects

A

none

69
Q

What are the aminoglycosides (3)

A

Gentamycin, Tobramycin and Amikacin

70
Q

Spectrum of activity for aminoglycosides

A

Gram negative anaerobes

71
Q

Side effects for aminoglycosides

A

Ototoxicity- irreversible

Nephrotoxicity- reversible

Neuromuscular blockade- prevented with slow infusion

72
Q

Clindamycin dosing

A

600-900mg IV q8hours OR

150-300mg PO BID

73
Q

Spectrum of activity for clindamycin

A

most gram positives and most anaerobes

74
Q

What is a side effect of clindamycin

A

pseudomembranous colitis

75
Q

How is clindamycin metabolized

A

by the liver

76
Q

Flagyl dosing

A

500 mg PO TID

77
Q

spectrum of activity for flagyl

A

some gram positive anaerobes and most gram negative anarobes

78
Q

What antibiotics cover MRSA
PO-4
IV-8
Topical- 1

A

PO-Linezolid, minocycline, cipro/rifampin, bactrim/rifampin

IV- Vancomycin, linezolid, minocyclin, cipro/rifampin, bactrim/rifampin, synercid, tigecyclin and telavancin

Topical- Bactroban

79
Q

What are the only FDA approved drugs for treating MRSA

A 
Vancomycin
Linezolid
Daptomycin
Tigecyclin
Telavancin
80
Q

How do you treat VRE

2

A

Linezolid

Dalfopristin-quinupristin

81
Q

What is the only PO therapy for VRE

A

Linezolid

82
Q

What drugs cover Pseudomonas

A 
Cipro
Ceftazidime, Cefepime
Aztreonam
Aminoglycosides
Timentin
Zosyn
83
Q

What are some empiric therapies for polymicrobial foot infections

A

Vanco/Zosyn
Clinda/Cipro
Vanco/Invanz

84
Q

What are the only FDA approved drugs for treating diabetic foot infections

A

3 Z’s
Zosyn
Zyvox
Invanz

85
Q

2 main causes of antibiotic associated diarrhea

A

Pseudomembranous colitis-Cdif

Non-specific colitis: staph aureus

86
Q

How to test for C-dif

A

check stool for C diff

87
Q

What is the most common cause of C-dif colitis

A

clindamycin

88
Q

How do you treat c-dif colitis

A

Vanco- 125mg PO q6

Flagyl 500mg PO TID

89
Q

What antibiotics are metabolized by the liver

A 
3C's and 1 E
Clindamycin
Cefoperazone
Chloramphenicol
Erythromycin
90
Q

Can antibiiotics affect PT/INR

A

yes antibiotics can affect normal flora, which can alter Vitamin K levels.

PT INR can increase

91
Q

What can Beta lactams cause

A

leukopenia

92
Q

What is the MOA of aminoglycosides and Macrolides

A

Aminoglycosides inhibit 30S ribosomes

Macrolides inhibit 50S ribosomes

A boy at 30 will not become a Man until 50

93
Q

What antibiotics can be safely used with PMMA beads

A

Vancomycin
Gentamycin
Tobramycin
Cefazolin

The curing of PMMA is exothermic, therefore the antibiotic must not be heat labile

94
Q

What open fractures should be treated with antibiotics

A

Grade 2 and 3

95
Q

Postoperative Day 1-2 source of fever (4)

A 
"Wind"
everything with the lungs 
-pneumonia
 -aspirations 
-pulmonary embolisms
-atelectasis
96
Q

Postoperative Day 3-5 source of fever

A

“Water”

-urinary tract infection

97
Q

Postoperative Day 5-7 source of fever

A

“wound”

-infection of the actual surgical incision

98
Q

Postoperative day 5+ source of fever

A

“walk”

-deep vein thrombosis/ PE

99
Q

Anytime postoperative source of fever

A

“wonder drugs”

drug fever reaction to blood products

100
Q

DOC for clostridium perfringens

A

-12 million units of Penicillin G

101
Q

Penicillins that are hepatically cleared(4)

A

Nafcillin, Mezlocillin, Azlocillin and Piperacillin

102
Q

Anti-anaerobic antibiotics (2)

A

Clindamycin and Metronidazole

103
Q

Anti-pseudomonal drugs (5)

A
  • Maxipime
  • Ciprofloxacin
  • Avelox
  • Tobramycin
  • Timentin
104
Q

What to give PO for mild MSSA infection

A

Keflex

105
Q

What to give IV for mild MSSA infection

A

Ancef

106
Q

What to give for moderate MSSA infection

A

Unasyn

107
Q

What to give PO for Mild infection of MSSA+anerobes

A

Augmentin

108
Q

What to give for moderate infection of MSSA+ anaerobes

A

ertapenem

109
Q

What to give for moderate infection of MSSA+ ESBL

A

Imipenem/Cilastatin

110
Q

What to give PO for mild MRSA infection (4)

A
  • doxycycline
  • daptomycin
  • Bactrim
  • Clindamycin (300mg)
111
Q

What to give IV for mild MRSA infection

A

-Clindamycin( 900mg)

112
Q

What to give for moderate MRSA infection

A

Linezolid and vancomycin

113
Q

What to give for mild and moderate pseudomonas infection

A

piperacillin

114
Q

What to give for a MRSA+ pseudomonas infection

A
  • Vanco and Zosyn

- Cipro and clindamycin

115
Q

What to give for a patient who has recurring infections but has used antibiotics recently

A

-try to cover for gram negative bacilli

—–fluoroquniolones or aminoglycosides

Crozer Surgery (16 decks)

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