Brainscape's Knowledge GenomeTM

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


See full index

Pharmacology II - CP > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

Goals and general rules

A
  • inhibit microorganisms at concentrations that are tolerated by the host
  • seriously ill/immunocompromised select bactericidal
  • narrow spectrum before broad spectrum or combo therapy to preserve normal flora
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Potential adverse reactions

A

hypersensitivity, direct organ toxicity, superinfection, cross-reactions with other medications

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

SSI (surgical site infections) are ___ most common healthcare associated infection

A

second

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

SSIs develop in ___ % of 30 million surgical patients

A

2-5%

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

SSIs represent approximately ____ % of all hospital acquired infections annually in the US

A

14-16%

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

SSIs lead to

A
  • increased readmits
  • increased length of stay (7-10 days)
  • increased hospital costs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SSI definition

A

infection related to a operative procedure that occurs at or near the surgical incision within 30 days of the procedure

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

Characteristics of SSIs

A
  • purulent exudate from surgical site
  • positive culture from surgical site that was closed initially
  • surgeon’s diagnosis of infection
  • surgical site that requires reopening d/t at least one s/s: tenderness, swelling, redness, or heat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Surgical risks for developing SSI

A
  • procedure type
  • skill of surgeon
  • use of foreign material or implantable device
  • degree of tissue trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Patient risks for developing SSI

A

diabetes, smoking use, obesity, malnutrition, systemic steroid use, immunosuppressive therapy, intraop hypothermia, trauma, prosthetic heart valves

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

How does hypothermia put someone at risk of developing a SSI?

A

decreases basal metabolic rate and constricts blood vessels
it makes the blood more viscose and causes a shift on the curve to the left (hold onto O2)
left = love O2

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

SSI Prevention Measures

A
  • Surgical Care Improvement Project (SCIP)
  • timely and appropriate use of antibiotics
  • maintenance of normothermia
  • proper syringe/med administration practices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SCIP Inf-1

A

prophylactic antibiotic received w/in one hour prior to incision

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

SCIP Inf -2

A

prophylactic antibiotic selection for surgical patients

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

SCIP Inf-3

A

prophylactic antibiotics discontinued w/in 24 hours after surgery end time

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

SCIP Inf-4

A

cardiac surgery patients with controlled 6am postop blood glucose

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

SCIP Inf - 6

A

surgery patients with appropriate hair removal

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

SCIP Inf - 9

A

Urinary cath removed on postop day 1 or 2 w/ day of surgery being day 0

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

SCIP Inf - 10

A

surgery patients w/ periop temp management

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

SCIP Card - 2

A

on beta blocker therapy prior to arrival who received beta blocker during periop period

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

SCIP VTE -1

A

surgery patients with recommended VTE prophylaxis ordered

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

SCIP VTE -2

A

received appropriate VTE prophylaxis w/in 24 hours prior to surgery to 24 hours after surgery

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

Ideal window for drug administration

A

30-60 minutes before incision

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

hypothermia is associated with

A
  • increased blood loss
  • increased transfusion requirements
  • prolonged PACU stay
  • postop pain
  • impaired immune function (compromised neutrophil = vasoconstriction = tissue hypoxia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Subacute Bacterial Endocarditis (SBE) Prophylaxis

A

standard:
amoxicillin 2 g PO
ampicillin 2g IV

penicillin allergy:
clindamycin 600 mg IV
cefazolin 1 g IV (not in pts. w/ hypersensitivity to PCN)

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

Appropriate antibiotic for cardiothoracic and vascular surgery

A

cefazolin, cefuroxime, vancomycin

if B lactam allergy - vancomycin or clindamycin

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

Appropriate antibiotic for hysterectomy

A

cefotetan, cefazolin, cefoxitin, cefuroxime, ampicillin/sulbactam
if B lactam allergy - clindamycin + gentamycin or metronidazole + gentamycin or clindamycin alone

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

Appropriate antibiotic for hip or knee arthroplasty

A

cefazolin or cefuroxime

if B lactam allergy - vancomycin or clindamycin

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

Appropriate antibiotic for colon surgery

A

cefotetan, cefoxitin, cefazolin + metronidazole, ampicillin/sulbactam
if B lactam allergy - clindamycin + gentamycin or metronidazole + gentamicin

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

where might we use gentamycin over cefazolin?

A

in urology procedures

31
Q

Staphylococci pathogens are common in which procedures and what is it treated with?

A

cardiac, noncardiac/thoracic, vascular, neuro, ortho

cefazolin!

32
Q

Enteric gram negative rods are common pathogens in which procedures

A

cardiac, noncardiac/thoracic, vascular, gastroduodenal, biliary tract, colorectal, appendectomy, hysterectomy, c section

33
Q

Streptococci pathogens are common in which procedures

A

noncardiac/thoracic, hysterectomy, c section

34
Q

S aureus and oral flora are common pathogens in which procedures

A

head and neck, gastroduodenal, biliary tract

35
Q

Enterococci are common pathogens in which procedures

A

biliary tract, hysterectomy, c section

36
Q

Anaerobes are common pathogens in which procedures

A

colorectal, appendectomy, hysterectomy, c section

37
Q

Group B streptococci pathogens are common in which procedures

A

hysterectomy, c section

38
Q

Bactericidal

A

kill the susceptible bacteria
usually what the OR uses
give to immunosuppressed patients

39
Q

Bacteriostatic

A

reversibly inhibit the growth of bacteria
have to be on medication long enough so body can develop a response
for UTIs usually

40
Q

Types of bactericidals

A

penicillins, cephalosporins, isoniazid, metronidazole, polymyxins, rifampin, vancomycin, aminoglycosides, bacitracin, quinolones

41
Q

types of bacteriostatics

A

chloramphenicol, clindamycin, macrolides, sulfonamides, tetracyclines, trimethoprim

42
Q

penicillin basic structure

A

dicyclic nucleus that consists of a thiazolidine ring connected to a B lactam ring

43
Q

Penicillin MOA and organisms it acts on

A

inhibits the enzyme needed to keep bacteria wall

organisms: pneumococcal, meningococcal, streptococcal, actinomycosis

44
Q

Penicillin excretion, DOA, and adverse reactions

A

excretion: renal (anuria increases elimination 1/2 time by 10x)
DOA: probenecid (gout med) will reduce renal excretion and prolong action so decrease PCN dose
adverse: hypersensitivity (most allergenic), cross sensitivity (d/t B lactam ring), rash/fever, hemolytic anemia, maculopapular rash

45
Q

Penicillin uses

A

otitis media, meningitis, sore throat, pneumonia and respiratory infections, septicemia, peritonitis, gonorrhea, UTIs

46
Q

Second generation penicillins and advantages/disadvantages

A

amoxicillin and ampicillin

advantage: wider range of activity (gram negative bacilli, H. influenza, ecoli)
disadvantage: more expensive

47
Q

Cephalosporins (Cefazolin aka Ancef)

A 
bactericidal
inhibit bacterial cell wall synthesis
low toxicity
broad spectrum
renal excretion 
penetrates joints and placenta
48
Q

1st generation cephalosporins

A

cover mostly strep pneumoniae and gram positives.. some coverage of gram negatives
example: cefazolin

49
Q

2nd generation cephalosporins

A

even coverage of gram negatives, gram positives, and strep pneumoniae
example: cefoxitin

50
Q

3rd generation cephalosporins

A

cover mostly against gram negatives and strep pneumoniae; some coverage of gram positives
example: cefotaxime

51
Q

4th generation cephalosporins

A

covers mostly gram negatives and strep pneumoniae, good coverage of gram positives
example: cefepime

52
Q

which cephalosporin generation is best for meningitis?

A

3rd generation
achieve therapeutic levels in the CSF
lower toxicity than earlier generations

53
Q

patients with IgE mediated anaphylactic reactions to B lactam antibiotics can be given ___ in substitution

A

clindamycin or vancomycin

54
Q

Macrolide - (Erythromycin)

A

effective against gram + bacilli, penumococci, streptococci, mycoplasma, chlamydia
bacteriostatic or bactericidal (depends on organism and dose)
inhibits bacterial protein synthesis
metabolized by CYP450 system so will increase serum concentration of theophylline, warfarin, cyclosporine, methylprednisone, and digoxin
excreted in bile
don’t need to alter with renal disease

55
Q

Erythromycin uses and side effects

A

uses: otitis media, uncomplicated skin infections, ulcers, pneumonia, MAC, legionnaire’s, anthrax, pharyngitis, tonsillitis, sore throat, STDs (Chancroid, chlamydia, gonorrhea)
s/e: GI intolerance, N/V, increase gastric emptying, cholestasic hepatitis, prolongs repolarization, torsades, thrombophlebitis

56
Q

Clindamycin

A

linomycin
bacteriostatic
active with anaerobes
can cause pseudomembranous colitis (discontinue if occurs)
decrease dose with severe liver disease
use: female GU surgeries, oral infections, lung abscess and aspiration pneumonia, MRSA soft tissue, nec fasc
s/e: skin rash, prolonged pre and post junctional effects at NMJ
concurrent use with NDMR can produce long lasting and profound blockade

57
Q

Vancomycin

A

glycopeptide
bacteriocidal
impairs cell wall synthesis
gram positive bacteria
renal excretion
elimination 1/2 time 6 hours
uses: severe staph infection, strepto/enterococcal endocarditis, MRSA***, PCN/cephalosporin allergy, cardiac/ortho surgeries using prosthetic devices, CSF and shunt related infections
dose: 10-15mg/kg over 60 minutes; 1 g mix in 250mL
profound hypotension if given rapidly!!
can cause red man syndrome (erythema), ototoxicity, nephrotoxicity

58
Q

what can you give prior to vancomycin administration to limit histamine release?

A

diphenhydramine 1 mg/kg and cimetidine 4mg/kg 1 hour before

59
Q

Amikacin

A

derivative of kanamycin

treatment for infections caused by gentamycin or tobramycin resistant gram negative bacilli

60
Q

which aminoglycoside is most nephrotoxic?

A

neomycin

61
Q

toxic level of gentamicin

A

> 9 mcg/mL

62
Q

aminoglycosides

A

bactericidal
effective for aerobic gram - and + bacteria, mycobacterium tuberculosis
combo with B lactam antibiotic for gram -
2-3 hour elimination 1/2 time increased 20-40x with renal failure
s/e: oto/nephrotoxicity, muscle weakness

63
Q

IV admin of aminoglycosides is associated with

A

potentiation of nondepolarizing neuromuscular blocking drugs
can be reversed with calcium gluconate or neostigmine
some people could be reparalyzed after reversal!

64
Q

fluoroquinolones

A

broad spectrum
bactericidal
effective: enteric gram - bacilli, mycobacterium, GI/GU infections, bone, soft tissue, respiratory tract systemic infections, opthalmic infections
can inhibit P450 enzymes
s/e: GI, n/v, dizziness, insomnia, tendon or achilles rupture!, muscle weakness

65
Q

ciprofloxacin uses

A

respiratory infections, tuberculosis, anthrax

66
Q

moxifloxacin

A

use: long acting treatment of acute sinusitis, bronchitis, complicated abd infections
s/e: QT prolongation, peripheral neuropathy, psychosis, stevens-johnson syndrome

67
Q

sulfonamides

A

bacteriostatic
prevent normal use of PABA by bacteria to synthesize folic acid
inhibit microbial synthesis of folate production
uses: UTIs, inflammatory bowel disease, burns
s/e: skin rash, photosensitivity, nephritis, fever, hepatotoxicity, hemolytic anemia, thrombocytopenia, increase effect of PO anticoag

68
Q

metronidazole

A

bactericidal
use: anaerobic gram - bacilli clostridium, CNS infections, abd and pelvic sepsis, c diff, endocarditis
recommended preop prophylaxis for colorectal surgery!
s/e: dry mouth, metallic taste, nausea, avoid alcohol

69
Q

amphotericin B

A 
antifungal
yeast and fungi
poor PO absorption (give IV)
renal function is impaired in 80% of pts
monitor plasma creat
s/e: fever, chills, dyspnea, hypotension, impaired hepatic, hypokalemia, seizure, anemia, thrombocytopenia
70
Q

antimycobacterial agents

A

isoniazid, rifampin, ethambutol, pyrazinamide

71
Q

when patients are on antiretrovirals CRNAs should note

A

existence of adverse effects (liver toxic, peripheral neuropathy, nephrotoxic, neuromuscular weakness)
interactions with other meds (PPIs, cimetidine, NDMR, opioids, benzos)

72
Q

6 classes of antiretrovirals

A 
nucleoside/non nucleotide
protease inhibitors
fusion inhibitors
CCR5 receptors
integrase inhibitors
73
Q

antiviral side effects

A

flu like symptoms, hematologic toxicity, depression, irritable, decreased mental concentration, autoimmune condition development, rash, alopecia, changes in CV, thyroid, and hepatic function

74
Q

acyclovir

A

treat herpes
may cause renal damage if given rapidly
can cause thrombophlebitis
may complain of HA during infusion

Pharmacology II - CP (12 decks)

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