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Anes. Pharm. Me > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What surgical techniques can we use to prevent SSI (surgical site infection)? (7)

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 are patient medical conditions that would affect healing and increase risk of infection? (7)

A

Extremes of age
Malnourished
Obesity
Diabetes
Recent operation
Corticosteroid therapy
Immunocompromised

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3
Q

What are perioperative factors that would affect post-surgical healing? (6)

A

Body Temperature
FiO2
Fluid Management
Blood Glucose
Blood transfusion
Antimicrobial Prophylaxis

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4
Q

Pts that are cold are at reduced risk for infection. True or false?

A

False, is at increased risk because when pt is cold, there is vasoconstriction, ie. less blood flow to encourage healing.

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5
Q

What are the benefits of normothermia? (2)

A

Better wound healing

Less vasoconstriction

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6
Q

When pt is hypothermic, what are the causes of SSI? (4)

A

Decreased tissue perfusion
Decreased super oxide radicals
Induced anti-inflammatory profile
Decreased collagen production

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7
Q

How can we prevent hypothermia? (3)

A

Forced air warming
Warmed fluids
Warm the room

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8
Q

We realize a decrease of SSI with FiO2 = _____.

A

0.8

Note: Not feasible post operatively.

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9
Q

Sometimes sub-cutaneous tissue is hypovolemic when the pt seems to be euvolemic. True or false?

A
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10
Q

Is there a significant change in rate of SSI when colloid vs. crystalloid is used?

A

No.

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11
Q

What is the goal when dealing with pt’s fluid management?

A

Euvolemia to maintain perfusion.

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12
Q

What are the adverse effects of hyperglycemia? (4)

A

Increased morbidity/mortality
Decreased leukocyte count
Deactivation of immunoglobulins
Functional deficits of neutrophils

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13
Q

We strictly monitor blood glucose because: (2)

A

Reduce multi-organ failure with sepsis
Reduce rate of SSI

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14
Q

Risk of SSI is decreased with autologous PRBC via cell saver. True or false?

A

True

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15
Q

What are the goals of surgical prophylaxis? (6)

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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16
Q

What is the normal flora found in the nasopharynx? (4)

A

Staph
Strep (mainly pneumoniae)
Moraxella catarrhalis
Hemophilus

17
Q

What is the normal flora found on the skin? (2)

A

Staph epidermidis
Staph aureus

18
Q

What is the normal flora found in the oropharynx? (3)

A

Strep: viridans

  1. pyogenes (strep throat)
  2. pneumoniae

Moraxella catarrhalis
Hemophilus

19
Q

What is the normal flora found in the intestine? (3)

A

Bacteroides fragilis
Strep
Enterococci

20
Q

What is the normal flora of the female GU tract? (2)

A

Strep
Staph

21
Q

What does ideal therapy consist of? (5)

A

Active against most likely pathogen
Given in an appropriate dosage
Given at appropriate time
Safe
Administered for shortest period

  1. Minimize adverse effects
  2. Minimize resistance
  3. Minimize cost
22
Q

How much Ancef do you need to give a patient:

< 50 kg
normal adult
> 120 kg

A

1 gram

2 grams

3 grams

23
Q

Within what time frame must antibiotics be administered?

What about vanc?

A

1 hr

2 hrs

24
Q

You must have the antibiotics delivered before the tourniquet is inflated. True or false?

A

true, duh

25
Q

True allergies to antibiotics are rare. True or false?

A

true

26
Q

What is considered a “clean” wound? (20

A

Closed, elective procedure

No pus involved

Ie. neurosurgery

27
Q

What is considered “clean-contaminated”? (2)

A

GI,GU, biliary

Re-operation within 7 days

Ie. when there is pus involved.

Example: VP SHUNT because down by GI, NONRUPTURED APPENDICITIS

28
Q

What is considered a “contaminated” wound?

A

Acute inflammation

Penetrating trauma (<4hrs)

Ie. RUPTURED APPENDICITIS

29
Q

What is considered a “dirty” wound? (3)

A

Preexisting infection

Perf GI

Trauma (>4hr)

30
Q

What type of classification is this type of wound?

Elective, not emergency, nontraumatic, primarily closed; no acute inflammation; no break in technique; respiratory, gastrointestinal, biliary and genitourinary tracts not entered

A

Clean

31
Q

What type of classification is this type of wound?

Urgent or emergency casen; 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

32
Q

What type of classification is this type of wound?

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 < 4 hours old; chronic open wounds to be grafted or covered

A

Contaminated

33
Q

What type of classification is this type of wound?

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

A

Dirty

34
Q

What type of antibiotic do you give in neuro cases?

A

Nafcillin

35
Q

What are the penicillinase-resistant antibiotics? (3)

A

Methiciliin
Oxacillin
Nafcillin

36
Q

What is a PCN with beta-lactamase inhibitor?

A

Ampicillin-sulbactam

37
Q

Name widely used:

aminoglycosides (2)
lincomycin
glycopeptide
flouroquinolones

A

Gentamicin, Tobrammycin

Clindamycin

Vancomycin

Ciprofloxacin, Levofloxacin

38
Q

What cephalosporin:

more Gram (-) in GI
 more Gram (+) on skin
A

Cefoxitin

2nd generation

39
Q

What generation cephalosporin is ceftazidime and when is it often used?

A

3rd

lung transplants

Anes. Pharm. Me (15 decks)

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