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Anesthesia Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What are methods in surgical technique that lead to less SSI?

A 
gentle traction
Effective hemostasis
removal of devitalized tissues
obliteration of deadspace
irrigation with saline
fine non-absorbed suture
closed suction drains
wound closure without tension
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2
Q

What patient conditions may lead to increased SSI?

A 
Extremes of age
malnourished
obesity
Diabetes
Recent operation
corticosteroid therapy
immunocompromised
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3
Q

What are perioperative factors that may increase SSI?

A 
Body temperature
FiO2
fluid management
blood glucose
blood transfusion
antimicrobial prophylaxis
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4
Q

What are the benefits of normothermia during surgery?

A

wound healing

less vasoconstriction

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5
Q

how does hypothermia lead to SSI?

A

decreased tissue perfusion
decreased super oxide radicals
induced anti-inflammatory profile
decreased collagen production

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6
Q

More oxygen leads to _______ wound healing

A

improved

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7
Q

At what FiO2 is decreased incidence of SSI seen?

A

0.8

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8
Q

Which fluid is better for preventing SSI, colloid or crystalloid?

A

no difference

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9
Q

Why is keeping the patient euvolemic important for preventing SSI?

A

prevents subq tissue from being hypervolemic

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10
Q

HOw does hyperglycemia affect infection?

A

increased morbidity and mortality
Deactivation of immunoglobulins
functional deficits in neurtophil function

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11
Q

SSI is decreased with _____ PRBC transfusion

A

auto

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12
Q

HOw should rbc’s be prepared to reduce risk of infection?

A

leukocyte reducted

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13
Q

What are the goals of surgical prophylaxis?

A 
prevent postoperative SSI
Prevent post-op M&M
reduce duration of healthcare
Reduce cost of healthcare
Produce no adverse effects
Have no adverse consequences
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14
Q

What are the normal flora of the skin?

A

Staph epidermidis

staph aureas

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15
Q

What is the ideal antibiotic therapy

A 
active against most likely pathogen
given in appropriate dosage
given at appropriate time
safe
administered for shortest period
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16
Q

when and how often are antimicrobials dosed?

A

1 hour before incision
must exceed minimum inhibitory concentration
Every 1-2 half lives, terminating within 24 hours

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17
Q

This type of proceure is elective, not emergency, nontraumatic, primarily closed, no breack in techinique. Respiratory , GI, biliary and GU tracts not entered

A

clean procedure

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18
Q

What is a contaminated procedure?

A

Nonpurilent inflammation, gross spillage from GI tract, entry ito GU or biliary tract i presence of infected bile or urine. penetrating trauma <4 hours old

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19
Q 
Purulent inflammation (e.g., abscess); preoperative perforation of respiratory, gastrointestinal, biliary or genitourinary tract; penetrating trauma > 4 hours old
l
A

dirty procedure

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20
Q

Urgent or emergency case that is otherwise clean; elective opening of respiratory, gastrointestinal, biliary or genitourinary tract with minimal spillage (e.g., appendectomy) not encountering infected urine or bile; minor technique break

A

clean contaminated

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21
Q

Nonpurulent inflammation; gross spillage from gastrointestinal tract; entry into biliary or genitourinary tract in the presence of infected bile or urine; major break in technique; penetrating trauma

A

contaminated procedure

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22
Q

Which antibiotic should be used for clean procedures?

A

cefazolin 1-2 grams IV

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23
Q

What antibiotic should be given for thoracic/orthopedic procedures?

A

cefuroxime 1.5 grams IV

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24
Q

What antibiotics should be given for bowel procedures?

A

cefoxitin 1-2 grams IV
cefazolin 1-2 gram + methonidazole 500mg
Ampicillin/subactam (unasyn) 3 grams

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25
Q

What class of antimicrobial is ampicillin and amoxicillin?

A

penicillinase with gram (-) activity

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26
Q

What class of antimicrobial is methicillin, oxacillin and nafcillin?

A

Pinicillinase-resistant

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27
Q

What class of antimicrobial is ampicilln-sulbactam

A

penicillin with beta lactamase inhibitor

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28
Q

What class of antimicrobial is imipenem?

A

carbapenem

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29
Q

What class of antimicrobial is gentamicin, tobramycin?

A

aminoglycosides

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30
Q

What class of antimicrobial is erythromycin, clrithomycin?

A

macrolide

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31
Q

What class of antimicrobial is clindamycin

A

lincomycins

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32
Q

What class of antimicrobial is vancomycin?

A

glycopeptide derivative

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33
Q

What class of antimicrobial is ciprofloxacin, levofloxacin?

A

fluroquinolones

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34
Q

Cephazolin belongs to which cephalosporin class?

A

1st generation

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35
Q

Cefuroxime (and cefaclor) belongs to which cephalosporin class?

A

2nd generation

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36
Q

ceftizoxime belongs to which cephalosporin class?

A

3rd generation

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37
Q

Cefclidine and cefepime belongs to which cephalosporin class?

A

4th generation

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38
Q

As the generation of cephalosporin increases, there is increased coverage for gram _____, while some coverage for gram ____ is lost

A

negative

positive

39
Q

Which abx may be used if pt is allergic to penecillin?

A 
Vancomycin 1gram (15 mg/kg)
clindamycin (600-900 mg)
40
Q

What abx may be used to add gram negative coverage?

A

gentamicin
ciprofloxacin
levofloxacin
aztreonam

41
Q

What are the possible benefits of adding vancomycin to the mix?

A

prevention of MRSA
prosthetic heart valve and vascular graft
recent broad spectrum therapy
–studies show no benefit to using vanc.
-muse be cautious due to increased incidence of VRE

42
Q

Repeat dosing shows no benefit in procedures +/- ___ hours but significant benefit in those > ____ hours

A

4, 7

43
Q

How long are antibiotics given post closure?

A 
24 hours (most)
48 hours (cardiac)
44
Q

REpeat dosing for Cefazolin

A

2-5 hour

45
Q

Repeat dosing for cefoxitin

A

2-3 hour

46
Q

Repeat dosing for cefuroxime

A

3-4 hours

47
Q

Repeat dosing for Ampicillin/sulbactam

A

2-4 hours

48
Q

Repeat dosing for Nafcillin

A

2 hours (used for neurosugery

49
Q

Repeat dosing for Vancomycin

A

6-12 hours

50
Q

Repeat dosing for clindamycin

A

3-6 hours

51
Q

Repeat dosing for metronidazole

A

6-8

52
Q

What organisms do you need to treat for in neurosurgery? How do you treat it?

A

staph aureus, s. epidermatis
Cefazolin (1-2g)
Nafcillin(1-2g)
Vancomycin (1-2g)

53
Q

Head and neck procedures are clean or clean-contaminated t or f?

A

true

54
Q

What organisms are in head and neck?

A

Mouth: streptococci, S. epidermidis
Nose: Staph and strep

55
Q

What are recommendations for head and neck surgery?

A

Clean: Not clear
Clean-contaminated:
Cefazolin (1-3g)
Clindamycin (600-900mg) + gentamicin(1.5/mg/kg)

56
Q

Cardiac Sx is clean contaminated. T/F

A

F. Clean

Low risk but catastrophic complications

57
Q

Organisms associated with cardiac Sx.

A

S. aureus and coagulase-neg staph

Gram (-) bacilli with saphenous vein harvest

58
Q

Recommendations for cardiac Sx

A

Cefuroxime is agent of choice

Vancomycin and clindamycin are alternatives

59
Q

Organisms associated with noncardiac thoracic Sx

A

same as cardiac

S. aureus and coagulase-neg staph

60
Q

recommendations for noncardiac thoracic Sx

A

Cefazolin (1-2 grams)
Cefuroxime (1.5 grams)
Vancomycin* (1 gram [10-15 mg/kg])
Clindamycin** (600-900 mg)

61
Q

organisms associated with Colorectal Sx

A

Gram-neg bacilli, anaerobes, enterococci

62
Q

recommendations for Colorectal Sx

A 
Oral regimen 
 -Neomycin + erythromycin
 -Neomycin + metronidazole
Intravenous regimen
 -Cefazolin (1-2 g) + metronidazole (0.5 g)
 -Cefoxitin or cefotetan (1-2 g)
 -Ampicillin-sulbactam (3 g)
63
Q

what are recommendations for colorectal Sx for PCN and Cephalosporin allergic pts

A 
Clindamycin (600-900 mg) plus
-Gentamicin (1.5 mg/kg) or
-Ciprofloxacin (400 mg) or
-Levofloxacin (750 mg) or
-Moxifloxacin (400 mg)
Metronidazole + aztreonam (1-2 g) + gentamicin
64
Q

Organisms associated With GI-Appendectomy

A

Aerobic / anaerobic gram-neg enteric

65
Q

Recommendatinos for GI-appendectomy

A

Cefoxitin (1-2 g)
Ampicillin-sulbactam (3 g)
Cefazolin (1-2 g) + metronidazole (0.5 g)

66
Q

Recommendations for GI-appendectomy-PCN allergic

A

Clinamycin + gentamicin (cipro, Levo)

67
Q

Organisms associated with esophageal and gastroduodenal Sx

A

E. coli, staph, strep, enterococci

68
Q

Recommendations for esophageal/gastroduodenal Sx

A

cefazolin (1-2 g)

69
Q

Recommendations for esophageal/gastroduodenal Sx-PCN or cephalosporin allergy

A

Clindamycin +

-Ciprofloxacin, Levofloxacin, gentamicin

70
Q

Organisms-GI-Biliary tract

A

E.coli, Klebsiella, enterococci

71
Q

recommendations for GI-Biliary tract

A

Cefazolin (1-2g)

(may ask for cefoxitin just in case they puncture the gut

72
Q

recommendations for GI-Biliary tract-PCN or cephalosporin allergy

A

Clindamycin +

-Ciprofloxacin, Levofloxacin, gentamicin

73
Q

Recommendation-clean orthopedic procedures

A

None

74
Q

organisms-orthopedic

A

S. epidermidis, S. aureus, gram- neg bacilli

75
Q

which orthopedic procedures should antibiotic be used for

A

Hip repair, joint replacement, fixation

76
Q

What are recommendations if you ar going to give prophylaxis for orthopedic procedures?

A 
Cefazolin (1-2 g)
Vancomycin (1 g)
Other options
-Antimicrobials in bone cement
-Ultraclean O.R.
77
Q

how often does endometritis happen in cesarean?

A

85%

-prolonged labor and ruptured membranes

78
Q

Organisms-cesarean delivery

A

Vaginal tract: strep, staph, enterococci

Wound: S. Aureus, staphylococci

79
Q

recommendation-cesarean delivery

A

Single dose of cefazolin before incision
-Historically post clamping
Clindamycin+gentamicin

80
Q

Organisms-hysterectormy

A

Post op differs from Pre-op

polymicrobial

81
Q

recommendation-hysterectomy

A

Cefazolin, Cefoxitin, Ampicillin-Sulbactam
Clindamycin or Vancomycin + aminoglycoside, aztreonam or fluoroquinolone
Metronidazole + aminoglycoside or fluroquinolone

82
Q

Organism-GU

A

E. coli

83
Q

Procedures indicating prophylaxis for GU Sx

A

any transurethral Sx or catheter placement

84
Q

Recommendations for GU

A

Clean procedures—cefazolin
Clean contaminated—see bowel prophylaxis
Aminoglycoside + metronidazole or clindamycin

85
Q

Infections associated with vascular Sx are associated with extensive morbidity and mortality. T or F

A

T

86
Q

Organisms associated with vascular Sx

A

S. aureus, S. epidermidis, gram-neg bacilli

87
Q

Recommendations-vascular Sx

A

Cefazolin (1-2 g)

Vancomycin (1g ) ± gentamicin (2 mg/kg)

88
Q

Which procedures are at a high risk for SBE?

A

Prosthetic heart valves
-Biprosthetic and homograft valves
Prior history of IE
Complex cyanotic congenital heart dz
-Transposition of great vessels, single ventricle, Tetralogy of Fallot
Surgically constructed systemic and pulmonary conduits

89
Q

Which procedures are at a moderate risk for SBE?

A 
Other congenital cardiac malformation
-Bicuspid aortic valve
Acquired valvular dysfunction
-AS, MS or valve repair
Hypertrophic Obstructive Cardiomyopathy
Mitral valve prolapse
-With regurgitation on auscultation
-Thickened leaflets on echo
90
Q

Which procedures are at a low risk for SBE?

A 
Physiologic or innocent murmurs
Isolated secundum ASD
Repair of ASD,VSD or PDA 
MVP without regurgitation
Aortic valve sclerosis
Physiologic MR on echo
Mild TR
CAD, rheumatic fever, pacemaker, stent
91
Q

What are AHA guidelines for SBE prophylaxis?

A

Situations in which the risk of IE is considered by most authorities to be high
Antimicrobial prophylaxis is generally accepted as advisable
Conditions in which risk of IE is considered moderate

92
Q

ABX for SBE prophylaxis

A 
Ampicillin (2 g)
Gentamicin (1.5 mg/kg; 120 mg max)-For GI and GU
PCN allergy
-Clindamycin (600 mg)
-Cefazolin (1 g)
-Vancomycin (1 g) 
   ± Gentamicin for GI and GU
93
Q

What can occur if vancomycin is given too fast? What are the symptoms? How should vanco be given?

A

Redman syndrome
Pruritus, flushing, erythema of head and torso
Arterial hypotension
Give over 1 hour

94
Q

What happens if gentamycin is given too quickly? How fast should it be given?

A

Ototoxicity

give aminoglycosides over 20-30 minutes

Anesthesia Pharmacology (25 decks)

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