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SRNAPharmacology II > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Antibiotics that are given when there is a strong

possibility of an established infection are termed

A

presumptive (examples include acute cholecystitis and

acute pancreatitis of less than 24 hour duration).

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2
Q

Intrinsic Patient Risk: The following conditions are known to increase the risk of surgical wound infections;

A
  • Diabetes
  • Chronic immunosuppressed states
  • Recent corticosteroid use
  • Prolonged hospitalization
  • Perhaps obesity
  • d Preexisting infection
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3
Q

Individual risk for surgical wound infections

A
  • > 3 underlying medical diagnosis
  • Abdominal operations > 2 hours
  • Contaminated or dirty procedures
  • ASA pre-op assessment score >=3
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4
Q

Most neurotoxic ABT

A

Polymixin (Nephrototic and Neurotoxic)

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5
Q

All enzymes are

A

Proteins

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6
Q

Five most common organisms found in surgical wounds

include;

A

Staph Aureus
Enterococcus
Coagulase-Negative Staph (ex. Staph. Epidermidis), E.Coli, and Pseudomonas Aeruginosa

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7
Q

1st generation have

A

No anaerobes

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8
Q

Biliary tract

A

Gram negative aerobic (Ecoli, Klebsiella, Enterobacter

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9
Q

Associated with Heart valves

A

Enterococcus

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10
Q

Gram + Narrow spectrum

A

Vancomycin

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11
Q

Antibiotics should be delivered to target tissues

A

prior to initial incision.

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12
Q

It is recommended that antibiotics be given

A

preoperatively in the OR before induction of anesthesia.

No sooner than 1 hour prior to the procedure.

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13
Q

If the procedure is long (ex. >4 hours)

A

then subsequent doses may be required, depending on the individual patient and antibiotic used.

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14
Q

Colorectal surgery

A

Cefoxitin or cefotetan 2g x 1 or cefazolin <120 kg:2g IV≥120 kg: 3g
Plus metronidazole 500mg or ampicillin-sulbactam 3g or
Oral used in conjunction with bowel prep
Neomycin plus erythromycin base or metronidazole

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15
Q

Most surgeries

A

Cefazolin < 120 kg : 2g Kg; >120kg 3 G IV

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16
Q

Cardiac surgery dose

A

Cafazolin <120 kg: 2 g IV≥120 kg: 3 g IV or
cefuroxime 1.5g or
Vancomycin 15mg/kg (max2 grams)
Or Clindamycin 900mg

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17
Q

PCN: Beta-lactams that interfere with the synthesis of

A

peptidoglycan, an essential component of the bacterial cell wall. Bacterial cells are therefore unable to maintain the integrity of the cell wall. Eventual the cell wall and the bacterial cell lyses.

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18
Q

Bleeding abnormalities with

A

ticarcillin, mezlocillin, piperacillin (ex elevated bleeding times, PT) may occur.

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19
Q

Electrolyte abnormalities

Penicillin G K contains

A

1.7mEq of potassium per 1

million units.

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20
Q

Penicillin G Sodium contains

A

2mEq of sodium per 1

million units.

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21
Q

1st Generation

A

Cefazolin* ! Cephalexin*

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22
Q

2nd Generation

A

Cefotetan(MTT)! Cefuroxime

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23
Q

3rd Generation

A

Ceftriaxone*
! Ceftazadime*
! Ceftazadime/avibactam*
! Ceftolozone/tazobactam*

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24
Q

4th Generation

A

! Cefepime*

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25
Q

Prednisone equivalent to cortisol 1

A

7mg

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26
Q

Cephalosporins: Cross sensitivity with penicillin in

A

patients with a penicillin allergy reported to be approximately 5%.

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27
Q

Imipenem/Cilastatin

A

One of the broadest spectrum of any beta lactam
Activity against most gram positive and gram negative organism
Excellent Anaerobic activity

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28
Q

Bleeding abnormalities with has

A

Cefamandol,
Cefoperazone, and Cefotetan due to
mehtlytetrazolethiol (MTT) side chain.

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29
Q

Been reported to prolong PT and possibly cause bleeding.

A

! Ceftriaxone
! If bleeding should occur and PT is prolonged, give vitamin K 10mg or FFP.! Packed RBC’s or platelet transfusions may be indicated.

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30
Q

Ceftriaxone Predisposing factors for bleeding include

A

preexisting renal or hepatic disease.

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31
Q

Less likely to cause seizures than imipenem. Slightly better activity against aerobic GNR than Imipenem.

A

MEROPENEM

32
Q

Know Aminoglycosides since they potentiate NMB

A 
Amikacin
Gentamycin
Neomycin
Tobramycin
Steptomycin
33
Q

Drugs that interfere with the synthesis of the mucopeptide layer of the bacterial cell wall are

A

PCN, Cephalosporins, Vancomycin

34
Q

Allowing leakage of cell contents, alter permeability of cell membrane

A

Polymixins

35
Q

Act on the subunit 30S of the bacterial ribosomees so as the inhibit bacterial protein synthesis at the translational level

A

Aminoglycosides

Tetracyclines

36
Q

Inhibit bacterial synthesis of folic acid

A

Sulfonamides

37
Q

Act on the 50S subunit of the bacterial ribosomes so the inhibit bacterial protein synthesis at the translational level

A

Chloramphenicol
Erythromycin
Clindamycin

38
Q

Only situation to use ethacrynic acid

A

True sulfanamides allergy

39
Q

Monobactam

A

Aztreonam

40
Q

Aztreonam

A

Good gram - and NO gram +

41
Q

These agents are highly water soluble and are therefore not absorbed when given via oral route

A

Aminoglycosides

42
Q

Aminoglycosides coverage

A

Excellent gram - coverage
Minimal gram + coverage
No anaerobic coverage

43
Q

Nephrotoxicity characterized by a

A

decrease in creatinine clearance, the presence of casts in urine, a decrease in urine specific gravity, oliguria, and
proteinuria.

44
Q

! Ototoxicity- Directly related to duration

A

> 10 days. Concurrent administration of ototoxic drugs.

45
Q

Neurotoxicity- Aminoglycosides can cause
! IV Calcium can overcome weakness caused by
aminoglycosides.

A

skeletal weakness.

46
Q

Aminoglycosides and skeletal weakness

A

This effect is most likely due to the ability of
aminoglycosides to inhibit the prejunctional release
of acetylcholine, while also decreasing the
postsynaptic sensitivity of the acetylcholine.

47
Q

Caution of aminoglycosides with patients

A

Use with caution with Parkinson’s patients, and patients with myasthenia gravis.

48
Q

Macrolides

A

Erythromycin
! Clarithromycin (Biaxin®)
! Azithromycin (Zithromax®)

49
Q

Macrolides activity

A

Activity against most gram positive organisms, and atypical organisms (Chlamydia pneumonia, Legionella Sp.,
Mycobacterium Sp.)

50
Q

Clarithromycin and erythromycin

A

Clarithromycin- Has a longer half life than erythromycin allowing BID dosing

51
Q

Erythromycin stimulates

A 
GI intolerance (most frequent side effect)
Due to stimulation of motlin a gastric hormone that stimulates peristalsis.
52
Q

Ototoxicity with IV erythromycin

A

Transient deafness

53
Q

Cardiac toxicity with erythromycin

A

Prolongation of QT interval

54
Q

Drug interactions with macrolides such as erythromycin

A

Macrolides are inhibitors of hepatic Enzymes

55
Q

A lincomycin antibiotic

A

Clindamycin

56
Q

Clindamycin coverage

A

with excellent anaerobic coverage, good gram positive

coverage.

57
Q

Only outlier not cleared by the kidneys but liver

A

Clindamycin

58
Q

Clindamycin is useful for prophylaxis in

A

dental procedures in PCN allergic patients.

59
Q

Has been reported with the use of clindamycin.

A

! Severe pneudomembranous colitis

60
Q

Decrease the dose in patients with severe liver disease

A

Clindamycin

61
Q

Chloramphenicol **

A

! Because of the rare occurrence of aplastic anemia, clinical use of chloramphenicol is limited to severe
infections (typhoid fever, salmonellosis) for which alternative agents may be less effective.

62
Q

A glycopeptide antibiotic

A

Vancomycin

63
Q

Vancomycin MOA

A

that impairs cell wall synthesis of gram positive organisms.

64
Q

Vancomycin and activity

A

has a narrow spectrum of activity, excellent coverage for most gram positive organisms. Has no gram negative coverage.

65
Q

Should be reserved for treatment of infections due to resistant species.

A

Vancomycin

66
Q

Vancomycin must be given IV for

A

treatment of systemic infections

67
Q

Vancomycin Oral dosage forms is indicated

A

for treatment of C. Difficile associated colitis.

68
Q

Vancomycin should be given over

A

at least 60 minutes to minimize the histamine release and hypotension associated with rapid infusion rates.
! Such reactions are termed “Red neck or Redman syndrome.

69
Q

Vancomycin Adverse reactions

A

! Nephrotoxicity
! Ototoxicity
! Allergic reactions

70
Q

Vancomycin and NMB

A

Potentiate NMB effects of succinylcholine

71
Q

Rhabdo suspects with

A

Daptomycin

72
Q

Treatment of SIADH

A

Demeclomycin

73
Q

Dilsufiram reaction is

A

Metronidazole taken with alcohol

74
Q

Fluoroquinolones advers reactions

A

Risk of tendon rupture

75
Q

Most potent at the NMJ

A

Polymixin

76
Q

Rarely causes reaction

A

Bacitracin

SRNAPharmacology II (32 decks)

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