Exam 1B: Dr. Wright Flashcards
1
Q
This drug reacts with almost every drug.
A
Coumadin
2
Q
If a patient is allergic to PCN, you need to perform ___ prior to administering cephalosporins.
A
skin test (give 1/10th of a cc)
2
Q
Allergic reactions to cephalosporins has a majority consists of cutaneous manifestations that occur ____h after exposure.
A
24H
2
Q
This drug was largely replaced by gentamicin and other amino glycosides; less ototoxic.
A
Kanamycin
2
Q
Aminoglycosides accumulate in the renal cortex and can produce _______ that initially manifests as an inability to concentrate urine, presence of protein and RBC casts
A
acute tubular necrosis
2
Q
This is considered as the ideal Vancomycin plasma levels in patients with renal dysfunction.
A
20-30 mg/ml
2
Q
Sulfonamides: Acetyl metabolites are often less soluble increasing the likelihood of ____.
A
crystalluria
3
Q
Anuria increases PCN elimination half life approximately ___fold
A
10
3
Q
This is the continued use of antibiotics after the operative procedure based upon the intraoperative findings.
A
Empiric Therapy
3
Q
During prolonged procedures, antibiotic prophylaxis should be read ministered every
A
3 hours
4
Q
PCN’s true hypersensitivity is mediated by
A
Ig E Ab
5
Q
This is the drug of choice for antimicrobial prophylaxis in the preoperative period (well tolerated IM/ IV).
A
Cefazolin
5
Q
This amino glycoside is given to patients who are allergic to PCN.
A
Gentamicin
6
Q
Complication of clindamycin therapy.
A
Severe pseudomembranous colitis. Note: should be used only to treat infections that cannot be adequately treated by less toxic antimicrobials.
7
Q
High doses of PCN G IV to patients with renal dysfunction may result in (2)
A
neurotoxicity and hyperkalemia
7
Q
JC and CMS mandated reporting of the following performance measures on a monthly basis. They are (2)
A
- Prophylactic antibiotics must be administered to a patient within 1 hour prior to surgical incision 2. Prophylactic antibiotics must be discontinued with 24 hours from the end of surgery.
8
Q
The neuromuscular blocking effects of this drug can also enhance the potentiation of NMB effects seen early postop if given to patient that received amino glycoside and NMB
A
Lidocaine
9
Q
These are bactericidal antimicrobial that inhibit bacterial cell wall synthesis with LOW intrinsic toxicity.
A
Cephalosporins
9
Q
Aminoglycosides: Rapid systemic absorption occurs after ____ injection with peak plasma concentration occurring 30-90 minutes.
A
IM injection
9
Q
This drug is expensive and offer few advantages over gentamicin.
A
Tobramycin
10
Q
Renal excretion of PCN is rapid. _____% of IM dose is excreted in the first hour.
A
60 - 90%
11
Q
This drug is given to increase plasma concentration of PCN and prolong its effects.
A
Probenecid Note: It inhibits renal excretion
11
Q
Resistance to cephalosporins may be due to ___
A
inability of the drug to penetrate to its site of action
12
Q
The presence of pus, which contains _____ that may bind to or inhibit the drug, makes therapy less effective. Also, areas of infection have less blood supply so penetration of the drug is reduced. If a foreign body such as prosthesis is involved, the foreign body may beed to be removed for antibiotic therapy.
A
phagocytes and proteins
12
Intrathecal (Spinal cord) use of PCN is prohibited because it can cause (3)
1. Convulsion 2. Arachnoiditis 3. Encephalopathy
12
\_\_\_\_\_\_ occur in about 100% of patient treated with clindamycin.
Skin rashes
13
Erythromycin is extensively metabolized by \_\_\_\_\_\_. Therefore, meds that inhibit effects of these enzymes may increase plasma erythromycin concentration increasing risk of _____________ (2)
Cytochrome P450 (CYP3A) ....... Vtach and sudden death.
14
Tetracycline is used as an adjuvant therapy with \_\_\_
severe cystic acne
16
The IM injection of this drug delays PCN absorption and prolongs duration of action.
Procaine
16
This drug has broader range of activity than PCN G. It is well absorbed after oral administration.
Ampicillin.
16
2nd and 3rd generation cephalosporins have extended activity against \_\_\_.
Gram Negative bacteria
18
PCN is highly effective against streptococcal infections, accounting for its value in patients with \_\_\_\_\_.
rheumatic fever
19
These (3) drugs may displace sulfonamides and increase amount of free drug in the plasma.
1.Indomethacin 2. probenicid 3. Salicylates
21
This drug is given for severe staph infections or streptococcal or enterococcal endocarditis in patients allergic to PCN or cephalosporins.
IV Vancomycin
23
\_\_\_\_\_\_ are susceptible to B lactamases and are ineffective against most S. aureus strains.
PCN V&G
23
Alternative drug to PCN G IV (aqueous PCN G) if K poses a risk to the patient.
Na salt of PCN G Na salt of a similar PCN such as AMPICILLIN.
24
This drug resembles erythromycin, but more active against many anaerobes.
Clindamycin
25
This drug is an effective alternative for patients with pharyngitis, bronchitis, and pan that can't tolerate PCNs or cephalosporins.
Erythromycin
26
These factors determine the choice of antibiotic and the route it is administered. (2)
1. Location of infection 2. Host factors
27
CYP 450 inducer will (increase or decrease) metabolism.
Increase. Dilantin will eliminate muscle relaxants faster because it is an enzyme inductor.
28
T/F: Other drugs should not be mixed with PCN as the antimicrobial effects may be inactivated.
True
30
These group of drugs are bactericidal interfering with the ribosomal function and inhibition of protein synthesis.
Aminoglycosides
30
Oral erythromycin has been used by GI docs before endoscopy and in as a prep emergency anesthesia because if its effects on \_\_\_\_\_.
gastric emptying (increases LES tone)
32
Antibodies to PCN may cause \_\_\_.
hemolytic anemia
33
Lab test you need to check in Renal disease patients receiving PCNs.
K level \*\*Make sure they excrete K.
33
These are the most potent of all the antimicrobials in their actions at the NMJ (pre junctional).
Polymyxins Polymyxin B can produce skeletal muscle weakness
35
This is a semisynthetic derivative of kanamycin. Used primarily in treatment of infections caused by gentamicin-or tobramycin-resistant gram Neg bacilli.
Amikacin
35
These antibiotics can be given upon arrival to OR. (3)
1. Ancef 2. Kefurox 3. Zinacef
36
FYI: Therapy more likely to be effective if the material is removed.
e.g. Infections behind obstructing lesions such as pneumonia behind a blocked bronchus will not respond to antimicrobials until the obstruction is removed.
38
It is chemically identical to ampicillin except for an OH substituent instead of an -H on the side chain.
Amoxicillin
38
Tetracyclines are not given to pregnant and children because it can cause
permanent discoloration of teeth
39
Amoxicillin is associated with the highest incidence of skin rash which typically appears ____ days after beginning of therapy
7-10 days
41
Nearly 80% of nosocomial infections occur in the \_\_\_(3)
Urinary tract (catherters), respiratory tract (vents), bloodstream (catheters)
41
Erythromycin is the drug of choice for
atypical PNA
42
A single preoperative dose of antibiotic is as effective as a _______ of postoperative therapy assuming an uncomplicated procedure.
5-day course
43
This drug poses a risk of bleeding with concurrent use of alcohol.
Cefamandole
43
Oral erythromycin prolongs cardiac depolarization and is associated with \_\_\_\_\_\_.
torsades de pointes
45
Name 4 beta-lactam compounds
1. PCNs 2. Monobactams 3. Cephalosporins 4. Carbapenems
45
FYI: All cephalosporins can penetrate into joints and can readily cross the placenta.
Used in ortho procedures
46
Amoxicillin: Aproximately 50% of an oral dose is excreted unchanged by kidneys in the first \_\_\_\_h
6 hours
47
This drug is used for prophylaxis against endocarditis in PCN-allergic patients who have valvular heart disease and are undergoing dental procedures.
Vancomycin
48
Doxycline may be given po or IV. Elimination half-life after an oral dose is \_\_\_\_.
11-22 Hrs
50
What is the goal of prophylactic antibiotics?
to reduce the incidence of postop wound infection
51
When realizing your patient has PCN allergy, ask if they have had a ___ test
skin.
51
This amino glycoside is the MOST nephrotoxic and is not given parenterally. (given as cream/ irrigation)
NEOMYCIN
52
The synergistic effects of 2 antibiotic agents may be utilized to achieve a greater effect need. Give 2 examples.
1. Ampicillin + gentamicin = for enterococcal endocarditis 2. Ampicillin + Sulbactam = inhibits enzymatic inactivation.
52
Side effects of INH (4)
1. Seizures 2.Optic neuritis 3. Mental changes (euphoria, psychoses) 4. Excessive sedation (pts on dilantin and are slow acetylators)
53
Transient bacteremia may occur in patients undergoing ___ (4)
1. Dental extractions especially in patients with congenital/acquired heart disease 2. Tonsillectomy 3.GI, GU surgeries 4. Vaginal deliveries
54
IV push is contraindicated in this antibiotic.
Gentamicin
55
Vestibular toxicity to aminoglycosides manifests as (4).
1. nystagmus 2. Vertigo 3. Nausea 4. Meniere's syndrome
57
This is an adverse reaction, not considered an allergy nor toxicity.
Hypersensitivity
58
This is indicated for procedures associated with high infection rates, those involving implantation of prosthetic material, and those in which the consequences of infection are serious.
Prophylaxis
59
Aminoglycosides are highly polar compounds, which means they have _____ penetrating the cells
difficulty
60
Erythromycin can be given IV, but only with severe infections due to ______ and development of _______ in some patients.
thrombophlebitis .... tinnitus and hearing loss
61
The presence of a common nucleus in the structure of all penicillin means that allergy to one PCN increases the likelihood of an allergic reaction to another penicillin. This is an example of \_\_\_.
Cross-sensitivity
63
This is a significant risk of using polymyxins.
Nephrotoxicity
64
This drug is useful in prophylactic antimicrobial in patients undergoing cardiac and orthopedic surgical procedures that involve placement of prosthetic device.
Vancomycin
65
This is an indication to discontinue clindamycin therapy.
severe diarrhea
66
These antibiotics all need to be started by CRNA before leaving the preoperative area (4)
1. Ampicillin 2. Gentamicin 3. Unasyn 4. Invanz
67
Aminoglycosides are attenuated by \_\_\_\_
Diuretics (Lasix and Mannitol)
69
Vancomycin is used to treat shunt-related infections due to \_\_\_\_\_\_\_
coagulase-negative staphylococcus
70
Side effect of Invanz (2)
hypotension and flushed skin
71
This is vancomycin-induced histamine release.
Redman syndrome
72
This is a quinolone antibiotic used in adults as a lung, sinus, skin, and UTI treatment when such infections are caused by certain bacteria
levaquin (GIVE SLOW)
73
Skin rash associated with ampicillin is due to \_\_\_\_\_\_\_. Does not represent true allergy.
protein impurities in the commercial preparation of the drug.
74
S/Sx of PCN true hypersensitivity (3)
Laryngeal spasm, CV collapse, Bronchospasm
75
Aminoglycosides should not be given too fast secondary to \_\_\_\_
ototoxicity
76
For colorectal and abdominal procedures, ___________ may provide a less costly alternative.
a bowel prep with oral antimicrobials
77
name 4 Side effects of Aminoglycosides
1. Nephrotoxicity 2. Ototoxicity 3. Skeletal muscle weakness 4. Potentiation of non depolarizing neuromuscular blockers
78
This is considered the primary drug for chemotherapy of TB and the only medication proved effective for prevention of TB.
Isoniazid
79
This is the prototype of 1st gen cephalosporins.
Cephalothin
80
This is the best approach for recognizing potentially toxic levels of gentamicin.
Monitor plasma concentration
82
PCN plasma concentration decreases to 50% of its peak value within ___ Hour(s) after injection
1 hour
82
True or False: There are also 3rd and 4th generation PCNs extending their spectrum of activity.
True
83
This is the most common cause of bacteremia and fungemia in hospitals.
IV catheters. usually comes from the colonized hub/ lumen and reflect skin flora.
84
This is the metabolite of INH. It is a known hepatotoxin.
Acetylisoniazid
86
Gentamicin penetrates \_\_\_\_\_, \_\_\_\_\_,\_\_\_\_\_ in the presence of inflammation.
pleural, ascitic, and synovial fluids
87
This drug is a bactericidal glycopeptide that impairs cell wall synthesis of Gram + bacteria
Vancomycin Note: It has large Volume distribution, including CSF
89
This is the maximum time between start time of antibiotic and incision.
Window
91
\_\_\_\_\_\_ has essentially the same antimicrobial spectrum but has the advantage of achieving higher blood levels, presumably due to slower renal elimination.
Cefazolin
92
The use of oral vancomycin is only for
1. staph enterocolitis 2. Antimicrobial-associated pseudomembranous enterocolitis
93
This antibiotic class is stable in the presence of gastric fluid, so well absorbed from the GIT.
Macrolides
94
It should not be given with PCN as it may antagonize bactericidal actions of PCN
Amikacin
96
Antibiotics need to be given within
1 hour prior to surgery
97
These antibiotics will be started by the preop RN (2)
1. Vancomycin 2. Levaquin
98
Skeletal muscle weakness effect of amino glycosides most likely is because of the ability of these drugs to inhibit _____ while also decreasing \_\_\_\_\_\_.
pre junctional release of ACh............... postsynaptic sensitivity to ACh. NOTE!!!! IV calcium: to strengthen muscle tone Neostigmine (Acetylcholinesterase inhibitor) : reversal for NMB; overcomes this effect at the NMJ
100
Allergic reactions to _____ noted in 1-10% of patients making these the most allergenic of all drugs.
PCNs
102
It is commonly used topically for skin infections (burns), cornea, and mucous membranes.
Neomycin
103
Simultaneous use of multiple antibiotics is avoided because of the risk of ___ (3)
1. drug toxicity 2. superinfections 3. antagonism between each drug Note: Initial treatment of life-threatening infections may be initiated with combinations until offending organism can be identified.
104
This side effect can occur with intrapleural or intraperitoneal institution of large doses of amino glycosides.
Skeletal muscle weakness
106
This adverse reaction may manifest as damage to virtually any organ.
Direct drug toxicity
107
What medication is given in patients who are hypotensive due to rapid infusion of Vancomycin (
Neosynephrine, ephedrine, benadryl (H1), Cemetidine (H2)
108
Patients receiving amino glycosides should be checked frequently for \_\_\_\_\_\_.
Vestibular or auditory dysfunction
109
Gastric emptying secondary to oral erythromycin can be seen when administered \_\_\_hr(s) before induction. In contrast, when given \_\_\_hr(s) before induction, no significant change in gastric acidity.
1 hour...... 3 hours Note: Give 100 mg
110
The National Nosocomial Surveillance System (NNSS) mentioned the factors which increase the risk of infection during surgery. Name 4.
1. ASA: Comorbidities 2. Level of contamination 3. Duration of the procedure 4. Use of Laparoscope
111
10 million units of PCN contains ____ mEq of K.
16
112
Cephalosporins have \_\_\_\_% chance of cross-reactivity/sensitivity if they are allergic to PCN.
8%
113
This is the most common side effect of erythromycin.
GI intolerance
114
IV Vanc infusion dose
10-15mg/kg over 1 hour
115
The use of this involves risk-to-benefit evaluation that varies depending on the procedure. (clean vs dirty procedure)
Antimicrobial prophylaxis
116
Why are newborns at higher risk of adverse reactions? (2)
Poorly developed renal excretion and hepatic biotransformation mechanism
117
Clindamycin is indicated in treatment of anaerobes, particularly originating in the \_\_\_\_(2)
GI and female Genital tract
119
A hospital that does not report monthly performance to JC and CMS and has no action plan for improvement will have a _____ % cut in reimbursement.
3%
120
Prophylactic antibiotics should be administered within \_\_\_
1 hour prior to incision.
121
PCN is the drug of choice for ___ (3)
pneumococcal, streptococcal, and meningococcal infections
122
Simultaneous administration of amino glycosides and _____ increases risk for toxicity.
diuretics
123
This drug is more effective against H. influenza and only 2nd generation effective in MENINGITIS.
Cefuroxime
124
This is found in PCNs, Cephalosporins, etc...
Beta lactam ring
125
Life-threatening anaphylaxis to cephalosporins is estimated to occur in \_\_\_\_\_\_% of patients.
0.02%
126
The goal of antibiotic therapy should be to achieve a drug concentration at the site of infection ___________ for the infecting organism. Plus, this concentration must be tolerable by the host. (Host factors --inadequate immune system).
equal to or greater than the MIC
127
This is the lowest concentration of a given antimicrobial at which an organism's growth is inhibited.
Minimum inhibitory concentration (MIC)
128
Combination drug in the treatment of otitis media in children.
Sulfonamide + erythromycin
129
This generation of cephalosporins is not recommended for treatment of meningitis because it can't enter CSF in significant amounts
1st gen
130
IV administration of any cephalosporins can cause \_\_\_\_.
thrombophlebitis
132
Name 3 categories of adverse reactions
1. Hypersensitivity 2. Direct Drug toxicity 3. Microbial superinfection
133
Patients with ______ are susceptible to skeletal muscle weakness if treated with aminoglycoside
myasthenia gravis
134
Tetracycline is the drug of choice in treatment of (2)
rickettsial diseases and mycoplasma pneumoniae.
135
This is the antibiotic drug of choice for surgical procedures in which skin flora and normal flora of the GI/GUT are the most likely pathogens.
cephalosporins (1st generation)
136
Tetracycline is not recommended for topical use because of high incidence of \_\_\_\_\_.
sensitization
137
FYI: Slow acetylators may be susceptible to accumulation of toxic concentrations if renal function is impaired.
!
138
Why are the elderly prone to adverse reactions? (4)
1.Oral Absorption: Decreased Gi motility and acidity 2. Distribution:Decreased body fat and albumin (more free drug) 3. Metabolism: Decreased hepatic blood flow 4. Excretion: Decreased GFR
139
What is the Mechanism of Action of Beta-Lactam compounds?
Inhibits cell wall synthesis.
141
This drug was used for treatment of bubonic plague.
streptomycin
142
Sulfonamides increase the effect of these drugs (4)
1. Anticoagulants 2. Methotrexate 3. Sulfonylurea hypoglycemic drugs 4. Thiazide diuretics
144
Ampicillin covers not only what PCN does but also \_\_\_\_.
H. influenzae and E.coli
145
General factors associated with risk for infection (7)
1. Age 2. Obesity 3. Tobacco Use 4. Malnutrition 5. DM 6. ISchemia 7. Prolonged surgical procedure
147
FYI: Erythromycin is enteric-coated because gastric acids inactivate it
;)
148
Patients with renal failure should have the PCN dose adjusted because high doses may cause \_\_\_.
seizures
149
PCN Allergy: Fatal reactions have occurred in patients receiving PCN as little as _____ of PCN for skin testing.
1 unit
150
Excretion of PCN (2)
10% eliminated by GFR 90% of renal tubular secretion
151
Incidence of infection complication.
1-5% (Increase hospital stay = $1.6M)
152
Isoniazid is given with ______ to prevent peripheral neuropathy and anemia.
Vit B6 (Pyridoxine) INH promotes excretion of Vit B6
153
Auditory dysfunction related to amino glycosides manifests as (2)
1. Tinnitus 2. Sensation of pressure/ fullness in the ears.
154
These are enzymes produced by bacteria that hydrolyze the beta lactam ring, rendering the molecule ineffective.
Beta Lactamase
155
The metabolism of sulfonamide is primarily by ______ by pharmacologically inactive compounds.
acetylation in the liver
156
This drugs are used principally to treat uncomplicated UTI caused by E.coli
Sulfonamides
157
Side effects of Levaquin (fluoroquinolones) (3)
1. Palpitations, Aflutter 2. CNS distrubance 3. Tendon rupture, muscle pain
158
Side effects of Vancomycin (histamine-release)
1. Redman syndrome (facial and truncal erythema) 2. hypotension
