Antibiotics/Cardiovascular Flashcards
1
Q
define incisional surgical site infection
A
superficial: skin and subQ
Deep: fascial and muscular layers
2
Q
define organ/space surgical site infections
A
occurs anywhere within the operative field other than where the body wall tissues were excised
3
Q
how are antibiotics classified
A
mechanism of action and spectrum of activity
4
Q
what are the beta lactams
A
penicillins
cephalosporins
carbapenems
5
Q
what are the non beta lactams
A
macrolides
sulfonamides
quinolines
aminoglycosides
6
Q
what are 5 major mechanisms of abx
A
inhibition of cell wall synthesis
inhibition of protein synthesis
inhibition of DNA/RNA synthesis
Disruption of cell membrane integrity
inhibition of metabolic pathways
7
Q
what is the target for inhibition of cell wall synthesis
A
peptidoglycan, leads to weaken the cell wall and cell lysis
8
Q
what is the target for inhibition of protein synthesis
A
bacterial ribosomes, prevents production of bacterial proteins and lead to cell death
9
Q
what is the target for inhibition of DNA/RNA synthesis
A
bacterial enzymes, prevents cell division
10
Q
what is the target for disruption of cell membrane integrity
A
bacterial cell membrane, leads to increased membrane permeability and bacterial death
11
Q
what is the target for inhibition of metabolic pathways
A
bacterial enzymes involved in folic acid synthesis, prevents bacterial growth
12
Q
what are beta lactamases
A
enzymes produced that destroy beta lactam abx and lead to abx resistance
13
Q
mechanism of action of beta-lactams
A
inhibit cell wall synthesis
14
Q
3 examples of beta-lactams
A
penicillins
cephalosporins
carbapenems
15
Q
mechanism of action for glycopeptides
A
inhibit cell wall synthesis
16
Q
glycopeptide example
A
vancomycin
17
Q
Aminoglycosides mechanism of action
A
inhibit protein synthesis
18
Q
aminoglycoside examples
A
gentamicin
19
Q
macrolide examples
A
azithromycin
erythromycin
19
Q
Marcolides mechanism of action
A
inhibit protein sythesis
20
Q
fluoroquinolones mechanism of action
A
inhibit DNA synthesis
21
Q
fluoroquinolones examples
A
ciprofloxacin
levofloxacin
22
Q
Rifamycins mechanism of action
A
inhibit RNA synthesis
23
Q
Rifamycins example
A
rifampin
24
Polymyxins mechanism of action
disrupt cell membrane
25
Polymyxins example
Polymyxin B
26
Sulfonamides mechanism of action
inhibit folic acid synthesis
27
Sulfonamides example
sulfamethoxazole
28
what are examples of beta-lactamase inhibitors
clavulanic acid
sulbactam
tazobactam
29
what is time dependent killing
time the drug concentration exceeds the minimum inhibitory concentration (MIC) of the target organism
30
what is concentration dependent killing
bactericidal activity is directly related to peak concentration of the drug achieved relative to MIC of the pathogen
31
when to re-dose abx
after two half lives
32
does single dose corticosteroid for PONV promote infection growth?
NO
33
amount of blood loss that would require redosing
1500mL
34
do abx cross placenta barrier?
yes most do
35
infections where penicillin is indicated
pneumococcal
streptococcal
meningococcal
syphilis
36
what is the metabolism for penicillin
rapid renal excretion
37
what is probenecid
used to decrease clearance of penicillin to prolong action
38
what are examples of penicillinase-resistant penicillins
methicillin
oxacillin
nafcillin
cloxacillin
dicloxacillin
39
what penicillin has the highest incidence of skin rash
ampicillin
40
which penicillin is more efficiently absorbed from GI tract
amoxicillin
41
what is clavulanic acid with oral amoxicillin
Augmentin
42
what is parenteral ampicillin with sulbactam
Unasyn
43
what is parenteral piperacillin with tazobactam
Zosyn
44
what is the most common adverse reaction to beta-lactam antimicrobials
hypersensitivity
45
options for history of IgE mediated reaction to penicillin
Clindamycin
Vancomycin
46
why are 3rd generation cephalosporins good for meningitis
able to achieve therapeutic levels in CSF
47
what is the only available 4th generation cephalosporin in the US
Cefepime
48
side effects of aminoglycoside abx
ototoxicity
nephrotoxicity
skeletal muscle weakness
potentiation of NDMRs
49
preferred route for macrolides
GI
50
what should be told about taking azithromycin
take 1 hour before or 2 hours after meals because bioavailability is decreased by food
51
side effects of clindamycin
prejunctional and postjunctional effects at NMJ
large doses can lead to profound neuromuscular blockade in the absence of NDMR
52
side effects of vancomycin
rapid infusion causes profound hypotension
histamine release
anaphlyactoid reactions
ototoxicity
return of NMB is recovering from succs
53
linezold is effective against what
gram-positive bacteria
54
long term use of linezold can cause what
bone marrow suppression
55
what needs to be avoided when taking metronidazole
alcohol
56
what are fluoroquinolones used for
enteric gram-negative bacteria
57
what is ciprofloxacin good for
UTI and GI infections
58
what side effects are seen with moxifloxacin
neuropathy
SIADH
tendonitis
liver failure
long QTc
psychotic reactions
Stevens-Johnson syndrome
59
what is the most widely used iodophor
povidone-iodine
60
stage 1 hypertension
SBP 130-139 or DBP 80-89
61
Stage 2 hypertension
SBP >140 or DBP >90
62
Stage 3 hypertension
SBP >180 and/or DBP> 120
63
what are causes of secondary HTN
OSA
Renal disease
Endocrine disease
Birth control
chronic NSAIDs
antidepressants
ETOH
Aortic coarctation
63
what percentage of HTN are primary
95%
64
when should secondary HTN be suspected
when more than 3 BP agents are required
65
what is cerebral autoregulation
range of blood pressure in which cerebral perfusion pressure remains constant
66
what is usually the first line HTN agent prescribed
thiazide diuretic
67
suffix for alpha 1 antagonists
-zosin
also phentolamine and phenoxybenzamine
68
suffix for beta 1 antagonists
-lol
69
what are the 2 mixed alpha and beta antagonists
carvedilol and labetalol
70
what are the 2 alpha 2 agonists
clonidine and dexmedetomidine
71
suffix for CCB (dihydropridines)
-dipine
72
examples of CCB non-dihydropyridines
verapamil and diltiazem
73
Arteriodilators examples
hydralazine and nipride
74
venodilators examples
nitro and nipride
75
what anti-HTN agents target the kidney
ACE/ARB
Diuretics
Aldosterone antagonists
76
suffix for ACE inhibitors
-pril
77
suffix for ARB
-sartan
78
what are the 2 main loop diuretics
furosemide (lasix) and bumetanide (bumex)
79
what is the main thiazide diuretic
hydrochlorothiazide
80
what are 2 potassium sparing diuretics
triamterene and amiloride
81
what is the main aldosterone antagonist
spironolactone
82
what is renin produced by
juxtaglomerular cells of kidney
83
where does the conversion of angiotensin I --> II take place
lungs
84
what 2 things stimulate renin release
decreased renal perfusion and enhanced SNS activity
85
Side effects of beta blockers
bradycardia
bronchospasm, claudication
mask hypoglycemia
impotence
86
CV effects of alpha 1 antagonists
Decreased SVR and decreased venous return
87
side effects of alpha 1 antagonists
vertigo
fluid retention
orthostatic hypotension
dry mouth
nasal congestion
lethargy
sexual dysfunction
88
what happens with alpha 1 antagonists are combined with beta blockers
refractory hypotension during regional anesthesia
blunted responses to beta 1 and alpha 1 agonists
89
what medication type interferes with alpha 1 antagonists
NSAIDs
90
what do alpha 2 agonists do
decrease sympathetic output from CNS
91
side effects of alpha 2 agonists
sedation and dry mouth
92
abrupt d/c of alpha 2 agonists leads to what
rebound HTN 8-36 hours later
93
what medications are most effective for HTN secondary to increased renin production
ACE inhibitors
94
do ACE inhibitors effect aldosterone?
yes, decrease levels by blocking the RAAS cascade
95
what are ACE inhibitors effect on bradykinin
they block the breakdown of bradykinin leading to further vasodilation
96
difference in ARB side effects vs ACE inhibitors
no inhibition of bradykinin
no cough
less chance of angioedema
97
treatment for angioedema
maintain airway
Icatibant: bradykinin B2 receptor antagonist
FFP
98
effects of ACE/ARB on anesthesia
exaggerated hypotension
99
what are the 3 systems that maintain BP
SNS
RAAS
vasopressin
100
what is metabolism for clevidipine
plasma esterase
101
what are the side effects of clevidipine
reflex tachy
negative inotropy
inhibit hypoxic pulmonary vasoconstriction
102
what are effects of inhibiting hypoxic pulmonary vasoconstriction
increased V/Q mismatch
increased pulmonary shunting
pulmonary hypertension
103
what are examples of PDE3 inhibitors
amrinone and milrinone
104
what are examples of PDE5 inhibitors
sildenafil
tadalafil
vardenafil
105
PDE5 inhibitors action
increase levels of cGMP leading to smooth muscle relaxation and vasodilation in lungs and corpus cavernousum of penis
106
nitric oxide toxicity
increases methemoglobin levels
oxidizes to NO2 which is a pulmonary toxin
107
108
nipride metabolism
after administration rapidly dissociates to release nitric oxide and cyanide ions
in liver cyanide reacts with thiosulfate to form thiocyanate (requires cofactor thiosulfate B12)
thiocyanate is excreted via kidneys
109
cyanide toxicity treatment
sodium thiosulfate 150mg/kg over 15 minutes
110
fenoldopam class
dopamine 1 agonist
increases cAMP
111
bolus and drip dose for metoprolol
Bolus: 1-5mg
No drip
112
bolus and drip dose for labetalol
Bolus: 5-20mg
Drip: .5-2mg/min
113
bolus and drip dose for esmolol
Bolus: 500-1000mcg/kg
Drip: 50-300mcg/kg/min
114
bolus and drip dose for nicardipine
bolus: 100-400mcg
drip: 5-15mg/hr
115
bolus and drip dose for clevidipine
No bolus
Drip: 1-16mg/hr
116
bolus and drip dose for hydralazine
Bolus: 5-20mg
No drip
117
bolus and drip dose for Fenoldopam
No bolus
Drip: .05-1.6mg/kg/min
118
bolus and drip dose for nipride
No blus
Drip: .25-4mcg/kg/min
119
what is considered high risk in cardiac clearance
cardiac risk >5%
major vascular surgery
emergent major operations
prolonged procedures with large blood loss
120
what is considered intermediate cardiac risk
cardiac risk 1-5%
endarterectomy
aortic aneurysm repair
head and neck surgery
etc.
121
what aspects of CHF must anesthesia manage
All aspects in perioperative area
122
what are contributing OR factors to arrhythmias
Hypoxemia
Electrolyte imbalance
Acid-base abnormalities (acidosis more likely)
MI
Altered SNS activity
Certain drugs
Bradycardia
123
are anesthetics cardiac depressant
yes
124
when to stop antiarrhythmic drugs before surgery
continue up to time of induction
125
what are the effects of drugs that block inward sodium flow
slow conduction
suppress maximal upstroke velocity of cardiac action potential
126
what are the effects of drugs that block potassium channels
prolong repolarization
increase duration of the cardiac action potential
results in prolonged QT
127
what are the effects of drugs that block calcium channels in myocardial cells
reduce conduction velocity in AV node
128
what are class 1 anti-arrhythmic
inhibit fast sodium channels
129
what are class 2 anti-arrhythmic
decrease rate of depolarization
130
what are class 3 anti-arrhythmic
inhibit potassium ion channels
131
what are class 4 anti-arrhythmic
inhibit slow calcium channels
132
what are examples of Class 1A
quinidine, procainamide, disopyramide
133
what are examples of Class 1B
lidocaine, mexiletine, phenytoin
134
what are examples of class 1C
flecainide
propafenone
135
what are examples of Class 2 drugs
beta blockers
metoprolol, propanolol
136
what are examples of Class 3
amiodarone
137
what are examples of Class IV
verapamil
diltiazem
138
what happens during phase 0 of cardiac action potential
depolarization
rapid sodium influx
139
what happens during phase 1 of cardiac action potential
initial repolarization
potassium efflux
140
what happens during phase 2 of cardiac action potential
plateau phase
Calcium efflux
141
what happens during phase 3 of cardiac action potential
repolarization
Stop of calcium efflux, more potassium efflux
142
what happens during phase 4 of cardiac action potential
resting membrane potential
normalization of electrolyte balance between intra and extracellular concentration
143
what is the class 0 drug
Ivabradine
causes "funny current"
144
what does proarrhythmic effects mean
delayed repolarization and increased duration of refractoriness (prolonged QT) increase chances of VT
145
what drug classes are more likely to causes incessant VT
Class 1A and Class 1C
146
what is the only prophylactic antiarrhythmic
amio
147
elimination half time of amio
29-60 days
148
metabolism of amiodarone
hepatic metabolism and biliary excretion
has a metabolite
149
most serious side effect of amio
Pulm toxicity
150
CV effects of amio
prolongs QT
HR slows resistant to amio
decreases responsiveness to catecholamines
IV can cause hypotension
151
what drug is potentiated by amio and why
Warfarin, depresses Vitamin K
152
what enzymes are inhibited by Amio
P450
153
Endocrine effects of Amio
contains iodine so can cause hypo or hyperthyroid
154
MOA of adenosine
slows conduction of cardiac impulses through AV node
155
