Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

LTC-CIP > Antimicrobial Stewardship > Flashcards

Antimicrobial Stewardship Flashcards

1
Q

define mechanism of action

A

how a drug inhibits or kills bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define spectrum of activity

A

which bacteria the drug is able to cover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

does cidal or static require more drug?

A

static

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

define cidal

A

kills bacteria on its own and requires less drug to do so

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

define static

A

inhibits future growth of bacteria and require more drug and immune system assistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are 3 parameters we can use to optimize the way antibiotics kill bacteria?

A
  1. Time > MIC
  2. Cmax > MIC (max concentration above the MIC)
  3. AUC/MIC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

drug concentration needs to be above the ___ for as long as possible

A

MIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which drugs need to be above the MIC?

A

time-dependent killers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

are beta lactams cidal or static?

A

cidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

true or false. You want to optimize time above the MIC with beta-lactams

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

list some beta-lactam drugs

A

penicillins, cephlasporins, carbapenemes, aztreonam (monobactam)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what routes can penicillin be given?

A

IV, IM, or oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the drug of choice for susceptible enterococcus and listeria?

A

aminopenicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are some examples of antistaphylcoccal penicillins?

A

-Nafcillin
-oxacillin
-dicloxacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which drug has no activity against enterococcus?

A

cephlasporins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Augmentin is a combination of what drugs? (PO)

A

amoxycillin and clavulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Unasyn is a combination of which drugs? (IV)

A

ampicillin and sulbactam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is unasyn used for?

A

bite wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Zosyn is a combination of which drugs?

A

piperacillin and tazobactam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

which drug is known as vitamin z?

A

zosyn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what broad spectrum treatment is given if infection is suspected in the ER (hint: it covers MRSA and pseudomonas. You must monitor kidney function)

A

vancomycin and zosyn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which drug class has no activity against enterococcus?

A

cephlasporins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which cephlasporin is primarily used against gram negative bacteria but can treat some gram positive infections like strep?

A

Cefepime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

as you move from 1st generation cephlasporins down, you lose gram ___ and gain gram ____ activity. The exception is the ___ generation

A

positive; negative; 5th (covers MRSA but not pseudomonas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

which drug combination is used for the most drug-resistant bacteria?

A

cephlasporins and beta-lactamase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

do cephlasporins + beta-lactamase inhibitors have acctivity against enterococcus?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

List 2 cephlsporin + beta lactamase inhibitor drug combos

A

-ceftolozane/tazobactam (zerbaxa)
-ceftazidime/avibactam (Avycaz)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

which carbapenems are seen most often?

A

entrapenem and meropenem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

is entrapenem broad or narrow?

A

narrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

which carbapenem has a high rate of causing seizures?

A

Imipenem. It is reserved for infections with unique activity/nocardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

all carbapenems have the possibility to cause seizures by

A

lowering the threshold to have a seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which carbapenem can treat APE (acinetobacter, pseudomonas, and enterococcus) and which carbapenem can’t?

A

Mertapenem can; ertapenem can’t

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which drugs are carbapenems?

A

-ertapenem (Invanz)
-Doripenem (doribax)
-Meroapenem (Merrem)
-Imipenem/Cilastatin (primaxin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Do not use ___ ___ with carbapenems

A

valproic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

aztreonam has gram ___ activity only

A

negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which drug has an inhaled form which is typically used for the cystic fibrosis population which are normally colonized with pseudomonas?

A

Aztreonam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Aztreonam combined with ____ could treat carbapenemase resistant infections

A

Avibactam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

True or false. Aztreonam is used a lot.

A

False. It is not used a lot because of resistance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Are fluroquinolones time or concentration dependent?

A

concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the mechanism of action for fluroquinolones?

A

inhibit DNA gyrase, resulting in DNA breakage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What year was the first fluroquinolone introduced?

A

1964

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what are some potential side effects of fluoroquinolines?

A

-ruptures or tears of the aortta
-hypoglycemic risks
-psyhciatric risks
-joint pain, tendon rupture, anxiety, depression, altered mental status, peripheral neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the PK/PD of beta lactams?

A

T>MIC (optimize time above the MIC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is the PK/PD of fluroquinolones?

A

AUC: MIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the PK/PD of aminoglycosides?

A

Cmax/MIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the mechanism of action of aminoglycosides?

A

inhibits protein synthesis at the level of the ribosome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what are some ADEs of aminoglycosides?

A

nephrotoxicity, ototoxicity (kidneys and hearing affected… think of the meme)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

True or false. Pharmacy doses aminoglycosides in a patient specific manner and they are almost always used in combination with something else

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Aminoglycosides are almost always used for gram ____ infections

A

negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what are aminoglycosides usually used to treat?

A

resistance or infection of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is the mechanism of action for macrolides?

A

they are static and inhibit protein synthesis at the ribosome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are some ADEs of macrolides?

A

QTc prolongation, GI upset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

with which drug do we see resistance because it is used to treat viral infections like colds?

A

azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what is the mechanism of action for sulfonamides?

A

interferes with bacterial folic acid synthesis (static)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Bactrim (the oral option for MRSA) is a combination of which drugs?

A

sulfamethoxozole and trimethoprim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what are some ADEs of sulfonamides?

A

rashes, dermatolic reactions
-monitor potassium, serum creatinine, and CBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what is the mechanism of action of tetracyclines?

A

inhibit protein synthesis at the ribosome (statcic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is the most commonly prescribed tetracycline?

A

doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what are some ADEs of tetracyclines?

A

tooth discoloration (in children under 8), esophagitis (take with a full glass of water and sit up for at least half hour otherwise it can errode your esophagus, nausea, and photosensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

which drugs are not used for tick borne illness?

A

tetracyclines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Which drugs are not given to pregnant women to not disrupt dentition of children in utero?

A

tetracyclines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

when in doubt

A

doxy it out (given to treat odd infection if they can’t figure out the infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

glycopeptides and lipoglycopeptides are used for gram ___ infections

A

positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

vancomycin is used to treat which MDRO?

A

MRSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what drug class does vancomycin fall under?

A

glycopeptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

describe some characteristics of vancomycin

A

-vitamin v
-mostly concentration dependent
-dosed in a patient specific manner
-Red man syndrome (not an allergy; infuse the drug slowly to prevent)
-harsh on kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Which drugs are lipoglycopeptides?

A

dalbavancin and oritavancin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what are some characteristics of dalbavancin and oritavancin?

A

-longer half life
-1-2 dose treatment for skin infections
-can avoid hospital admission for IV treatment
-not always sure how to use them because they are newer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what does Linezolid treat and what must be monitored?

A

-gram positive and VRE
-Monitor platelets (patients are at risk of bleeding) and serotoninergic interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what does Daptomycin treat and what must be monitored?

A

-gram positive and VRE
-monitor CPK and statin use
-CPK can cause muscle pain and urine discoloration if it builds up in blood too much

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What does Clindamycin treat?

A

-gram positive mostly
-some gram negative anaerobes
-causes antibiotic associated diarrhea and c. diff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Are IV drugs normally cidal or static?

A

cidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

true or false. Linezolid is an oral option for MRSA?

A

True

74
Q

The use of what other drug may be discontinued when a patient takes daptomycin?

A

statin use

75
Q

which drug is the second line agent after vancomycin?

A

daptomycin

76
Q

what are 4 oral MRSA options?

A

-bactrum (sulfamethoxozole/trimethoprim)
-doxy
-clinda
-linezolid

77
Q

what is Metronidazole used to treat?

A

-anaerobes (mostly gram negative)

78
Q

what are some characteristics of Metronidazole?

A

-metallic taste
-cause nausea and vomiting
-used to be for c. diff, now only in combo if fulminant

79
Q

What is nitrofuratoin used to treat?

A

UTIs

80
Q

what are some side effects of nitrofurantoin?

A

-pulmonary toxicity
-not for use in elderly

81
Q

Synercid is a combination of which drugs? how is it adminstered?

A

-clinda and delphaprstin
-horrible and causes flu like symptoms. obselete.
-can only be administered via central line and is very harsh on veins

82
Q

What is an example of a glycyclcines

A

tigercycline (tygacil)

83
Q

what is a side effect of glycyclines?

A

-increased mortality in pneumonia and bloodstream infections
-last line option

84
Q

what are examples of polymixins?

A

polymistin B and colistin

85
Q

what are polymixins used to treat?

A

only MDROs if they are used at all

86
Q

what are adverse events associated with polymixins?

A

neurotoxicity and nephrotixicty

87
Q

What information does an antibiogram provide?

A

-compile all isolates within the last year and describe susceptibility patterns
-provide a description of antimicrobial susceptibility for the community
-bacteria must be represented by a certain number of isolated to be reported

88
Q

antibiograms are useful only for _____ selection

A

empiric

89
Q

how much does antimicrobial resistance cost in expenditures yearly?

A

20 billion

90
Q

how many unnecessary prescriptions are filed each year?

A

47 million

91
Q

how many premature deaths are expected by 2050?

A

300 million

92
Q

What are 4 mechanisms of antibiotic resistance?

A
  1. enzymes
  2. efflux pumps: bacteria vomits the antibiotic back out
  3. target site alteration: fool the antibiotic, change so it can’t bind and kill
  4. decreased uptake: reverse channels; don’t take up the antibiotic
93
Q

which professionals are the core of antimicrobial stewardship?

A

ID trained MDs and PharmDs

94
Q

define antimicrobial stewardship

A

the coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of adminstration

95
Q

true or false. It is now legislated that all facilities have a formal stewardship program

A

True

96
Q

what are the basic principles of antimicrobial stewardship?

A

right drug, dose, route, duration

97
Q

when was MRSA first detected?

A

1960s

98
Q

when was VRE first detected?

A

the 1980s in Europe and 90s in USA

99
Q

when were ESBLs detected?

A

1990s

100
Q

Define antimicrobial

A

a substance that inhibits or kills microbes

101
Q

define antibiotic

A

a type of antimicrobial that is synthesized by a living microorganism, usually a fungus

102
Q

how are most antimicrobials administered?

A

IV or oral

103
Q

what is the MIC?

A

the lowest concentration of drug that can still inhibit microbial growth

104
Q

what is half-life

A

how long the body takes to metabolize half of a drug

105
Q

what is concentration dependent activity?

A

achieving a higher concentration in the blood over a short time is more effective at eliminating infection than maintaining a lower concentration over a longer period.

106
Q

what is the goal of concentration dependent drugs?

A

maximize serum or tissue drug concentrations (often allows for once daily dosing)

107
Q

what are examples of concentration dependent drugs?

A

-aminoglycosides
-fluoroquinolones

108
Q

what is time-dependent activity?

A

maintain drug concentrations above the MIC. Lower doses at an increased frequency over time.

109
Q

what are examples of time-dependent drugs?

A

-natural penicillins
-vancomycin
-beta lactams

110
Q

define in vitro

A

lab susceptibility testing

111
Q

define in vivo

A

patient

112
Q

antibiograms can help answer questions in what 2 main areas?

A

-clinical care
-infection prevention strategies

113
Q

what does an antibiogram do?

A

simplifies multiple patients antimicrobial sensitivity information at an institution into a single number for pathogens of interest in an effort to monitor trends emerging in drug resistance.

114
Q

how many isolates are need for an antibiogram?

A

at least 30

115
Q

For patients with multiple positive cultures, how many isolates should be included in an antibiogram?

A

Only the first (regardless of body fluid tested or antimicrobial susceptibility pattern)

116
Q

can surveillance isolates be used for antibiograms?

A

no, only diagnostic

117
Q

When developing an antibiogram for s. aureus, should MRSA be included?

A

Yes

118
Q

True or false. Antibiograms do not underestiminate the activities of drugs for multi-drug resistant strains?

A

False

119
Q

What are some methods of antimicrobial susceptibility testing?

A

-agar disk diffusion (Kirby-Bauer)
-antimicrobial gradient diffusion method (e-test or d-test)

120
Q

How is the spread of resistance expressed?

A

as episodes of newly detected colonization or infection per 100 admissions or 1000 patient days

121
Q

What is the main selective pressure responsible for antimicrobial resistance?

A

antimicrobial use

122
Q

How do patients come to possess a resistant pathogen?

A

by transmitting bacteria that already have a resistance gene in place or by having the bacteria acquire a gene that codes for resistance

123
Q

cidal agents kill _____% while static kills ___%

A

99.9%; 90-99%

124
Q

when a drug is cidal or static can depend on what?

A

the concentration a pathogen is exposed to

125
Q

what are some types of toxicities that may occur as a result of taking drugs?

A

-hepatotoxicity
-myelosupression
-renal toxicity
-auditory toxicity
-vestibular toxicity
-CNS toxicity

126
Q

what are 3 indications for antimicrobial use?

A
  1. empiric
  2. pathogen directed
  3. prophylactic
127
Q

define prophylactic

A

Prevents rather than treats known or suspected infection

128
Q

what is the most common prophylaxis?

A

surgical antimicrobial prophylaxis where wound infection risk is high. For prostetic devices and patients with immunosuppresion

129
Q

what are some basic principles of antimicrobial prophylaxis?

A

-drug spectrum should be appropriate for the organisms likely to cause infection
-usually staph or strep
-adueqate tissue levels, usually 1st gen cephlasporin, should be used from first incision onward
-duration should be as short as necessary to minimize resistance, side effects, and costs

130
Q

when should antimicrobial prophylaxis be considered?

A

-anytime skin or mucosa is incised
-patients travelling to areas with endemic malaria
-endocarditis in ptients with high risk valvular lesions
-spontaneous bacterial peritonitis in patients with ascites

131
Q

What are 2 organisms where prophylaxis may be used?

A

-meningococcal meningitidis
-HIV

132
Q

What dosage is normally required for propphylaxis?

A

a single preoperative dose and sometimes one or two additional doses is surgery duration is prolonged

133
Q

What is empiric therapy?

A

When no definitive information about a causative pathogen is available, therapy is empiric

134
Q

When is empiric therapy done?

A

when the results of cultures are pending. Patients are usually sufficiently ill at this time.

135
Q

When are cultures collected for empiric therapy?

A

Before therapy is started

136
Q

What directs empiric therapy?

A

site of infection and host factors (i.e., immunocomprised) give an indication of likely pathogens which can direct empiric therapy.

137
Q

Does a NAAT (PCR) provide susceptibility results?

A

No, a culture needs to be done for this

138
Q

True or false. Nonculture results can direct therapy for pathogen with predictable susceptibility?

A

True (i.e., chlamydia and gonorrhea)

139
Q

Which factors contribute to successful antimicrobial therapy? (hint: there are 5)

A
  1. prompt institution of an appropriate antimicrobial
  2. The bug factor (virulence and susceptibility)
  3. The drug factor (activity of the antimicrobial at a particular site of infection)
  4. Host factor (underlying condition and patient immunocompetence)
  5. site factor (infections at certain body sites like the heart are more difficult to treat)
140
Q

Dose should be ___enough to be therapeutic but ___ enough to minimize toxicity

A

high; low

141
Q

Hepatic insufficiency requires dose reduction of drugs excreted by the

A

Liver

142
Q

Define switch therapy

A

switch from IV to oral after initial response to therapy

143
Q

What are 3 possible effects of co-administering antimicrobials?

A
  1. some inactivate others (piperaccilin/tazobactam and aminoglycosides)
  2. Antigonism: inactivatoin. two antimicrobials become less effective (tetracycline and penicillin).
  3. Synergy: two co-administered antimicrobials are more effective
144
Q

What is an example of a synergetic drug combination

A

endocarditis due to enterococcus. Protein inhibitory agent (aminoglycoside) with a cell wall active agent (penicillin or vancomycin) to achieve bactericidal activity

145
Q

describe the microtiter brother dilution systems

A

trays of small volume wells consisting of various concentrations of antibiotic read with an automated commercial instrument

146
Q

describe the antimicrobial gradient diffusion method (e-test or d-test)

A

a regent strip of gradient antimicrobial is placed on an agar plate to produce a gradient of concentrations in the medium

147
Q

results of antimicrobial susceptibility testing should be based on what

A

susceptible, intermediate susceptible (drug is only effective at body sites where it is concentrated) and resistant

148
Q

what are some mechanisms of antimicrobial resistance?

A

-drug inactivation and alteration in target site
-decreased permeability or efflux
-bypass of a metabolic pathway
-point mutations in genes or acquisition of new genes

149
Q

most forms of resistance result from

A

newly acquired genes

150
Q

Which organism has become resistant through decreased permeability or efflux?

A

pseudomonas resistant to carbapenems

151
Q

Which organism has become resistant to drugs through bypass of a metabolic pathway

A

trimethoprim/sulfamethoxazole

152
Q

What are mutations

A

random errors that occur during DNA replication resulting in the ubstitution of one base pair for another which may result in the subtitution of one amino acid for another in a protein structure or enzyme. Mutations occur infrequently at the correct location at the bacterial genome to cause mutation.

153
Q

ESBLs are resistant to all ______ except ____

A

beta-lactams except carbapenems

154
Q

Define antibiotic cycling

A

alternate using different antimicrobials to prevent resistance

155
Q

audits of the AS program can be ____ or _____

A

prospective or retrospective

156
Q

What of the AS program can be audited?

A

-dosing
-whether surgical prophylaxis is used appropriately
-whether empiric is switched to pathogen directed therapy once culture results are available

157
Q

What is the goal of antimicrobial stewardship?

A

optimize antimicrobial treatment that results in the best outcome with minimal toxicity to the patient

158
Q

True or false. Antimicrobials are the only pharmaceutical therapy whose effectiveness dimishes with time and use.

A

True

159
Q

How many deaths and illnesses annually are attributed to AMR?

A

23,000 deaths; 2 million illnesses

160
Q

how many ER visits are due to an adverse antimicrobial reaction?

A

1 in 5 (140,000)

161
Q

on average ______ of LTC residents will be taking antibiotics at any given time

A

6-10%

162
Q

studies show that ____ of antibiotic prescribing may be unecessary

A

40-75%

163
Q

ASP programs have been shown to

A

-improve patient outcomes
-reduce antimicrobial age related adverse events
-decrease antimicrobial resistance

164
Q

up to ___ of nursing home residents received one or more courses of systemic antibitoics in a year

A

70%

165
Q

what are the 7 core elements of antibiotic stewardship?

A
  1. leadership
  2. accountability
  3. drug expertise
  4. action
  5. tracking
  6. reporting
  7. education
166
Q

describe leadership

A

-ASP efforts in written statements and sharing this with staff, residents, and families
-including ASP duties in positions for medical director, pharmacists, and nursing leader
-communicate prescription policies
-supporting a culture and activities that promote ASP

167
Q

describe accountability

A

identify and appoint individuals responsible for ASP activities

168
Q

describe drug expertise

A

estbalish relationships with pharmaicsts or other individuals with ASP training or experience:
-ID docs
-ASP leads in hospitals within the network

169
Q

describe action

A

requiring an ab timeout for all new ab starts
-improving the evaluation and communication of signs and symptoms when infection is first suspected (SBAR tool)

170
Q

describe tracking

A

-montior at least one process and outcome measure of antibiotic use
-determine if antibiotics are prescribed per policy
-tracking antibiotic usedto review patterns and determining the impact of stewardship efforts.

outcome measures include: days of therapy, antibitoics starts, and prevalence surveys
-monitoring clinical outcomes

171
Q

describe reporting and education

A

-reporting: provide regular feedback on antibiotic use and resistance to relevant staff
-education: provide resources to everyone about resistance and opportunities to improve use

172
Q

what are some harms associated with antimicrobial prescribing

A

-anaphylaxis
-c. diff
-oral and vaginal superinfection (due to disruption of flora)
-adverse drug reactions
-increased healthcare expenditures
-resident and family suffering
-potential heavier work burden
-unecessary diagnoatic testing
-toxicity
-unfaovrable perception of a facility with increased infection rates
-related costs and burdens of adding TBP
-increased risk of MDRO colonization and infection

173
Q

MDRO/ARO infections could result in what compared to susceptible infections?

A

-greater morbidity and mortality
-extended hospitalizations
-greater use of healthcare resources
-prolonged and costlier treatments

174
Q

What are the 4 moments for antimicrobial decision making?

A

-1. make the diagnosis
2. cultures and empiric therapy
3. duration of therapy
4. stop, narrow, change to oral

175
Q

define contamination

A

the introduction of undesired microbes or toxins to a specimen, the environment, or equipment (i.e., urine C & S with mixed growth).

176
Q

where does VRE colonize?

A

GI/ GU tract

177
Q

where does ESBL colonize?

A

GI/GU tract

178
Q

where does c. diff colonize?

A

the GI tract

179
Q

contamination is common associated with improper specimen collection such as:

A
  1. urine culture (not utilizing clean catch or sterile collection)
  2. wound swabs: taking a specimen from necrotic, exudate, or eschar rather than wound bed
  3. blood cultures: improper cleaning of skin or top of collection containers
180
Q

define cross contamination

A

part of one specimen is transferred into another (occurs if samples are improperly stored, have cracks, or are improperly handled)

LTC-CIP (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions