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Pharm 2-EXAM #2 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Surgical site infections are ____

A

60% preventable

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2
Q

Surgical site infection happens

A

Within 30 days post

1 year post device implantation

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3
Q

Surgical site infection can involve

A

Incision

Deep soft tissue

Anatomy opened/manipulated

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4
Q

SSI pathogenesis can be _____ or _____

A

Endogenous
Exogenous

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5
Q

SSI infections are diagnosed by

A

The surgeon

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6
Q

What are some Endogenous risk factors

A

Extremes of age

Obese/poor nutrition

DM

Vascular disease

Tobacco/corticosteroid use

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7
Q

Exogenous risk factors include

A

Sterile technique

Foreign bodies & implants

Placement of drains

OR environment

Long surgery >2 hrs/type of surgery

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8
Q

Wound classification 1 is

A

Clean

No infection/inflammation

Closed

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9
Q

What are the common pathogens for Class 1 (clean)

A

Skin flora

Staphylococci (gram +/ staph aureus)

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10
Q

Wound classification 2 is

A

Clean-contaminated

Controlled conditions

No unusual contamination

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11
Q

What are the sites for Class 2 infections?

A

Respiratory

GI/GU

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12
Q

What are the common pathogens for Class 2 (clean-contamination)?

A

Skin flora

Gram-negative rods

Enterococci

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13
Q

Wound classification 3 is

A

Contaminated

Open & fresh

Major break in sterile technique

Major spillage from GI

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14
Q

Site of infection for Class 3 (contaminated)

A

Respiratory

GI/GU

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15
Q

Common pathogens for class 3 (contaminated)

A

Skin flora

Gram- rod

Enterococci

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16
Q

Wound class 4 is

A

Dirty/Infected

Existing clinical infection

Old wound /perforated viscera

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17
Q

Site for class 4 (dirty/infected)

A

Any previous sites

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18
Q

SCIP-1 measure includes a prophylactic ABX given

A

1 hour prior to surgical incision

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19
Q

What is the goal of a patient receiving an ABX 1 hour prior to surgical incision?

A

Bactericidal serum, & tissue levels at time of incision

Progressive increase in infection 1hr

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20
Q

Vancomycin or a fluoroquinolone should be

A

Initiated within 2 hours before incision

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21
Q

What are characteristics of ABX selection?

A

Narrow spectrum

1st & 2nd generation cephalosporins (effective against gram + staph)

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22
Q

Which ABX isn’t recommended as routine?

A

Vancomyci, since there is a risk for ABX resistance & beta-lactam allergy

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23
Q

When is vancomycin used?

A

If there is a beta-lactam allergy to clindamycin allergy

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24
Q

When should ABX be discontinued?

A

Within 24 hours after surgery end time (increased risk of CDIFF with extended use)

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25
Q

ABX should be given

A

30-60 min prior to skin incision

Less effective if given after application of a tourniquet

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26
Q

What groups oof ABX fall under beta-lactams?

A

PNC (PENAMS)

Cephalosporins

Carbapenems

Monobactams

Carabcephems

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27
Q

Beta-Lactams interfere with

A

Peptidoglycan & cause cell lysis in a hypo/iso osmotic environment (cell wall synthesis)

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28
Q

Beta-Lactams inhibit

A

PNC binding proteins (cross-link cell wall) by PNC & cephalosporins

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29
Q

Beta-Lactams have an interference with

A

Murein hydrolase inhibitors, which leads to destruction of the cell wall

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30
Q

Beta-Lactams are considered

A

Bacterialcidal (kill though cell wall)

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31
Q

Gram + are more susceptible to beta lactase because

A

Gram _ has an additional lipopolysaccharide layer

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32
Q

What makes a drug bacterial resistant?

A

The drug has an inability to access the site of action

Production of beta-lactamases

Altered or new PCN binding protein

Efflux of ABX (active pumps)

Gram _ bacteria

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33
Q

Beta-lactamases causes

A

Hydrolysis of beta lactam ring

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34
Q

Anti-staphylococcal PCN include

A

Nafcillin
Oxacillin
Cloxacillin
Dicloxacillin

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35
Q

Penicillianse-producing staphylococci is the same as

A

Beta-lactamase, just effective against PNC

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36
Q

Broad spectrum 2nd generation PNC are

A

Ampicillin

Amoxicillin

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37
Q

Broad spectrum 3rd generation PNC are

A

Carbenicillin

Ticarcillin

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38
Q

Broad spectrum 4th generation PNC are

A

Piperacillin

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39
Q

PNC G is effective against

A

G+/- cocci

G+ rods

Anaerobes

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40
Q

PNC ampicillin & piperacillins should be

A

Dose adjusted in renal disease

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41
Q

Beta-lactamase inhibitors include

A

Clavulanic acid

Sulbactams

Tazobactam

They bind enzymes & the bacteria becomes sensitive to antimicrobial action

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42
Q

Ampicillin, amoxicillin, PNC g & V have

A

Active mono therapy against Group A streptococci

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43
Q

What is the most common drug allergy?

A

PNC allergy

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44
Q

PNC allergy has no

A

Genetic or inheritable train

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45
Q

A PNC allergy has the potential to have a

A

Cross-sensitivity to other beta-lactams, in which other beta lactase should be avoided

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46
Q

1st generation cephalosporins include

A

Cefazolin

Cephalexin

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47
Q

2nd generation cephalosporins include

A

Cefaclor

Cefotetan

Cefoxitin

Cefurixime

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48
Q

3rd generation cephalosporins includes

A

Cefixime

Cefotaxime

Ceftazidime

Ceftriaxone

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49
Q

4th generation cephalosporin

A

Cefepime

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50
Q

MOA for cephalosporins

A

Bind PNC protein & prevents cross linkage of cell wall

51
Q

Cephalosporin resistance can be due to

A

Production of cephalosporinase

52
Q

What lab value should be evaluated with a patient on cephalosporins?

A

Creatinine Clearance

53
Q

What is the drug of choice for surgical prophylaxis?

A

Cefazolin (Ancef/Kefzol), a 1st genration cephalosporin

54
Q

Cefazolin (Ancef/Kefzol), a 1st genration cephalosporin is susceptible to

A

Gram + cocci

55
Q

Cefazolin (Ancef/Kefzol), a 1st genration cephalosporin, is resistant tto

A

G-

56
Q

Cefazolin (Ancef/Kefzol), a 1st genration cephalosporin, as a poor

A

Ability to cross BBB & into CSF, but does cross the placenta

57
Q

Cefazolin (Ancef/Kefzol), a 1st genration cephalosporin is given with

A

Metronidazole for colorectal surgery

58
Q

What should be watched when giving Cefazolin (Ancef/Kefzol), a 1st genration cephalosporin?

A

Kidney function

59
Q

What is the dose of Cefazolin (Ancef/Kefzol), a 1st genration cephalosporin?

A

1-2 grams IV for <120kg

3grams IV >120kg

60
Q

Cefazolin (Ancef/Kefzol), a 1st genration cephalosporin, should be administered over

A

3-5 minutes & has a peak of 5 min

61
Q

When should Cefazolin (Ancef/Kefzol), a 1st genration cephalosporin, be administered & repeated?

A

Administer within 60 minutes

Repeat Q4H until closure

62
Q

What are adverse effects of Cefazolin (Ancef/Kefzol), a 1st genration cephalosporin?

A

Hypersensitivity

Increases effects of anticoags (heparin/warfarin) & increases risk of Lassie-induced nephrotoxicity

Phlebities & pain

Pregnancy B

Seizure

Steven Johnson Syndrome

Superinfection

Transient elevation in hepatic enzymes

63
Q

4th generation, cefepime (maxipime) is effective against

A

G+/-

64
Q

With a 4th generation, cefepime (maxipime), there is enhancement in

A

Resistance against beta-lactamase

65
Q

What is the dose of 4th generation, cefepime (maxipime)?

A

2 grams IV Q12H

66
Q

What are adverse effects of 4th generation, cefepime (maxipime)?

A

Superinfection

Hypersensitivity

Increased INR (prolonged tx)

Neurotoxicity

67
Q

Allergy to PNC increases

A

Likelihood of allergy to a different PNC

Potential for cross reactivity across beta lactase are RARE

68
Q

What is the most important determinant in a beta-lactam cross reactivity?

A

Side chain group

69
Q

What other option do you have for an ABX without beta lactams reactivity?

A

Quinolones

Macrolides

BUT you risk reduced effectiveness & increased antimicrobial resistance & higher costs

70
Q

What is an immediate hypersensitivity reaction with beta lactams?

A

Laryngeal edema

Bronchospasm

CV collapse

Sensitivity may be lost over time

71
Q

What is a delayed hypersensitivity reaction with beta lactams?

A

Maculopapular rash

Fever

72
Q

Which specific drug is the most common cause of anaphylaxis?

A

Cefazolin

73
Q

What are examples of Aminoglycosides?

A

Gentamicin

Tobramycin

Amikacin

Streptomycin

Neomycin

74
Q

What is the MOA of Aminoglycosides?

A

Interferes with protein (peptide) synthesis during mRNA translation

75
Q

Aminoglycosides have

A

Poor lipid solubility

76
Q

What is the post ABX effect of ahminoglycosides?

A

Bactericidal activity continues after serum concentration fail

77
Q

When should ahminoglycosides by avoided?

A

In patients with MG due to the risk of prolonged NMB (will prolong paralysis

78
Q

Gentamicin, an aminoglycoside dose is

A

1.5-5mg/kg IV (single dose)

79
Q

Gentamicin, an aminoglycoside administration time & infusion rate

A

Given within 60 min or procedure start

Infuse over 30-120min

Decrease dose in renal patient

80
Q

Gentamicin, an aminoglycoside interactions

A

Increases effects of neuromuscular blockers

Increased toxicity risk with loop diuretics

81
Q

Adverse effects of aminoglycosides

A

Ototoxicity (inner ear)-
vestibular dysfunction
auditory dysfunction

Nephrotoxic
accumulation in renal cortex
acute tubular necrosis

inability to concentrate urine & presence of protein

Skeletal muscle weakness

82
Q

Aminoglycosides inhibit

A

Prejunctional release of ACh

83
Q

With ahminoglycosides causing skeletal muscle weakness, administer

A

IV calcium

84
Q

Aminoglycoside hypersensitivity is well-tolerated, but there is a risk for

A

Allergic contact dermatitis (topical administration)-Neomycin common

85
Q

Macrolides include

A

Erythromycin

Azithromycin

Clarithromycin

86
Q

What is the MOA of macrolides?

A

Interferes with protein (peptide) synthesis during mRNA translation

87
Q

Macrolides broad spectrum uses are

A

Active against some G- bacteria

Are bacteriostatic (-cidal in high doses) against most G+

88
Q

What is the risk of giving Macrolides IV?

A

Thrombophlebitis

N/V

tinnitus

89
Q

Erythromycin undergoes

A

Extensive metabolism by CYP-450

90
Q

Azithromycin half life

A

~68 hrs

91
Q

Adverse effects of Macrolides

A

Prolonged depolarization & QTc

Risk of torsades & arrhythmias

Diarrhea, nausea, ABD pain

Interacts with effects of anticoags

92
Q

Clindamycin (Cleocin) is apart of the

A

Lincosamide class

93
Q

What is the MOA of Clindamycin (Cleocin), a lincosamide?

A

Binds 50s ribosome subunit inhibiting peptide-chain synthesis

94
Q

Distribution of Clindamycin (Cleocin)?

A

High concentration in bone & urine

Crosses placenta

Minimal levels in CSF

Extended post-ABX effect against some bacteria

95
Q

What is the dosing of Clindamycin (Cleocin)?

A

600-900mg IV

MUST DILUTE

96
Q

Clindamycin (Cleocin) should infuse over____ & be administered within _____

A

Infuse over 10-60 min

Administer within 60 min of incision

97
Q

Clindamycin (Cleocin) should be redosed

A

Q6H until closure

98
Q

Clindamycin (Cleocin) is IV incompatible with

A

Barbiturates

Calcium glutinate

Many other ABX

99
Q

Adverse effects of Clindamycin (Cleocin)

A

Neuromuscular blockade (pre & post), not improved by Calcium or anticholinesterases

Increased effects of NMB

Diarrhea, CDIFF, ABD pain, N/V

Thrombophlebitis

100
Q

Most common clindamycin hypersensitivity reaction?

A

Maculopapular eruptions & skin rash

Reports of SJS & eosinophilia reactions

101
Q

MOA of vancomycin (vancocin)

A

Tight binding to cell wall precursor blocking glycopeptide formation

Inhibition of cell wall synthesis

102
Q

Vancomycin distribution

A

Distributes widely in tissue/fluids (not CSF)

103
Q

What should be monitored with a patient taking Vanc

A

Serum trough= lowest concentration in plasma

Renal function

CBC

104
Q

Dose & administration time of Vanc

A

10-15 mg/kg IV (MAX 2 gram)

Start within 60-120 min of incision

Infuse over at least 60 min

Minimize histamine release & HOTN

Plasma concentration up to 12H

105
Q

Vancomycin can cause red man syndrome, which

A

Is due to rapid IV infusion

Histamine release, erythema, pruritus

HOTN, dyspnea

Rare CV toxicity & cardiac arrest

Restart infusion at half of original dose

Give H1 & H2 antag

106
Q

Vancomycin can cause hives, laryngeal edema & wheezing. You should consider

A

Giving EPI

Discontinue infusion

Assess for hypoxemia

107
Q

What are Vanc warning?

A

Nephrotoxicity

Ototoxicity

Superinfection

Pregnancy C-IV form, but can take PO

108
Q

What is the MOA of Metronidazole (Flagyl)

A

Drug diffusion across organism cell membrane

Creates a concentration gradient (more drug in)

Cytotoxic particles break down & destabilize cell

109
Q

What is the dosing of Metronidazole?

A

500-1,000mg PO & IV

Administer within 60 min of incision

110
Q

Adverse effects of Metronidazole

A

HA

Nausea/ABD pain

Dry mouth/metallic taste

Bacterial infection

Neurologic disturbances

111
Q

Metronidazole should be avoided when?

A

With ETOH use

Will cause ABD disturbances, N/V, HA & flushing

112
Q

Fluoroquinolones include

A

Ciprofloxacin

Moxifloxacin

Levofloxacin

Ofloxacin

113
Q

What is the MOA of Fluoroquinolones?

A

Inhibits DNA synthesis & promotes DNA breakage

114
Q

What is the dose of Ciprofloxacin (Cipro) & the administration time

A

400mg IV

Administer 120 min of incision

Give slowly over 60+ min & through a large bore IV

115
Q

Adverse effects of Fluoroquinolones

A

Bacterial resistance

Gastritis/GI upset

CNS disturbances (dizzy, AMS, neuropathy)

Hepatotoxicity

Tendinopathy, tendon rupture, muscle weakness

QT interval prlongation

116
Q

What are the agents of choice for PEDs?

A

1st & 2nd generation cephalosporins

Vanc in beta lactam allergy

117
Q

PEDs have the potential for toxicity with what class?

A

Fluoroquinolones

118
Q

In PEDs, ABX are often

A

Wight based (<40kg)

119
Q

How long should you apply Chlorhexidine?

A

2min+ & then repeat

120
Q

What is the toxic reaction of Chlorhexidine?

A

Corneal toxicity (chemical burn)

Potential for neurotoxicity in neuraxial space

121
Q

Povidone Iodine increases

A

Iodine solubility

122
Q

Povidone Iodine duration of action & application time

A

6-8 hrs

Apply for 5 min

123
Q

Toxic reaction of Povidone Iodine

A

Least risk of corneal toxicity

124
Q

Toxic reaction of Iodine

A

Increases with high concentrations

Corneal toxicity

Rare local toxicity & allergic reaction (fever & skin eruptions)

Pharm 2-EXAM #2 (5 decks)

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