Exam 2 (Antibiotics) Flashcards
- What is a nosocomial infection?
Any infection acquired in the hospital
- What are the two biggest sources of HAI’s?
Surgical site infection & HAI PNE
- What are some S/S suggesting a pre-existing infection?
- Fever
- chills
- night sweats
- AMS
- productive cough
- SOB
- rebound tenderness
- dysuria
- CVA tenderness
- suprapubic pain
- When do surgical site infections present?
Within 30 days of surgery
- What is involved in a deep incisional SSI?
Muscle and surrounding tissues
- What is involved in an organ or space SSI?
Any area other than skin and muscle
- What are the 3 most common types of bacteria?
- Staphylococcus
- streptococcus
- pseudomonas
- What is a clean-contaminated wound?
- No evidence of infection
- do involve internal organ
- What is a contaminated wound?
Involve internal organ with spillage of contents from the organ
- What is a dirty wound type?
Known infection at time of surgery
- What are some risks for SSI?
- Comorbidities
- elderly
- emergency or abdominal surgery
- surgery >2hrs
- What is a 1A grading category of studies?
Strong recommended, moderate to high-quality evidence
- What is a 1B grading category of studies?
Strong recommended, low-quality evidence
- When are parental Abx administered?
With 1B grading category
- When are IV Abx not needed?
- Wound irrigation,
- Do not apply Abx ointments to incisions (1B)
- soaking prosthetic devices
- Glycemic control is what kind of evidence & what is the target?
- 1A
- <200 mg/dL
- Intraop iodine irrigation in deep tissue is what kind of evidence?
2
- What are some general principles for Abx prophylaxis?
- Shortest possible course effective (1 dose)
- newer Abx reserved for resistant infections
- if everything equal then oldest and cheapest first
- What Abx are initiated within 2hrs of incision?
Vancomycin & fluoroquinolones
- Which Abx is redosed after coming off bypass & which is not?
- Ancef is redosed
- Vanc is not
- Which Abx are beta lactams?
PCN, cephalosporins & Carbapenems
- Which Abx is an Aminoglycoside?
Gentamycin
- How do penicillin-beta lactams work?
Inhibit bacterial cell wall synthesis
- PCN’s are the drug of choice for?
- Streptococci
- meningococci
- pneumococci
- PCN Beta lactams are usually used for what kind of infections?
Skin, catheter infections & URI’s
- What are some adverse reactions to beta lactams?
- Skin rash
- GI upset
- vaginal candidiasis
- Can cephalosporins be used on patients with a PCN allergy?
Yes, unless it is anaphylaxis
- What is the difference between PCN & cephalosporins?
Cephalosporins are more stable against beta lactamases
- Which cephalosporin generation can cross the BBB?
- Some of Gen 3
- Gen 4 & 5
- Which cephalosporin generation does not work on Gram -?
Generation 1 (Cefazolin)
- Which cephalosporin is the DOC for gonorrhea?
Ceftriaxone (Rocephin)
- Which cephalosporin are generation 2?
- Cefuroxime (Zinacef)
- Cefoxitin (Mefoxin)
- Cefotetan (Cefotan)
- Which cephalosporin treats resistance meningitis?
- Cefotaxime (Claforan)
- It’s Gen 3
- Which cephalosporin drug is generation 4 & what is it good for?
- Cefepime.
- Most resistant to hydrolysis by lactamases.
- Good for multi-resistant organisms & crosses BBB
- Which Abx should not be used for Pts with bleeding issues?
Cephalosporins
- Which antibiotics can used for a Pt with a true anaphylaxis reaction to PCN?
Vancomycin or Clindamycin
Which beta-lactam Abx have good activity against Gram (-) & enterobacter
- Carbapenems
Examples: - Ertapenem (Invanz)
- Meropenem (Merrem)
- Imipenem (Primaxin)
- What are carbapenem ABX used for?
- Intra-abdominal
- Resistant UTI
- PNE
- What do you need to check before giving carbapenem IM?
- LA allergies
- If Pt is on Depakote
- When does Vancomycin work?
Only if bacteria is actively dividing
- Vancomycin is most valuable in treating?
- Bloodstream infections
- Endocarditis caused by MRSA
- How do aminoglycosides work?
Inhibit ribosomal proteins and cause mRNA to misread
- Which Abx is synergistic with aminoglycosides?
Beta lactams or Vancomycin
- What are the adverse effects of aminoglycosides?
- Ototoxicity
- nephrotoxicity &
- curare-like effect leading to longer NMBD effects
- Which receptors are adversely affected by Gentamycin?
nACHr
- How do fluoroquinolones work?
Inhibit DNA protein synthesis
- What are examples of fluoroquinolones?
Ciprofloxacin & Levofloxacin
- Which Abx is used for GU cases?
Levofloxacin
- Fluoroquinolones are excellent for?
- Gram (–) organisms (UTI
- bacterial diarrhea
- bone/joint infections)
Per SCIP Abx prophylaxis is there to?
Reduce Abx resistance
- What are the adverse reactions of Fluoroquinolones?
- N/V/D
- prolonged QT
- cartilage damage
- tendon rupture
- Which Abx is an anaerobic antibacterial?
Metronidazole (Flagyl)
- Flagyl is indicated for?
- Intra-abdominal infections
- Vaginitis
- C-diff
- superinfections
- What are the adverse reactions of Metronidazole?
- Nausea
- peripheral neuropathy (w/ prolonged use)
- disulfiram-like effect
- Which Abx should a patient not drink alcohol with?
Flagyl
- Which surgeries require the use of 2 Abx & what is the 2nd Abx?
- Small intestine obstruction
- Colorectal & clean-contaminated head & neck surgeries including cancer.
- 2nd Abx is Flagyl
- How is Ancef dosed in adults?
By weight:
- If < 80kg= 1g
- If 81-119kg= 2g
- If > 120kg= 3g
- What is the usual adult dose for Vancomycin?
15 mg/kg
- What is the goal of SCIP?
Decrease morbidity & mortality rate of SSI
- What is the SCIP protocol for foleys?
Removed on or before POD 2 unless reason document to extend
- What SCIP measures for SCD’s?
- Place on Pt if surgery >1hr
- Appropriate post-op orders & given by RN within 24hrs after surgery
- What 1st temp must a patient have in PACU?
36℃ within 15mins after leaving OR
When are Abx D/c’ed in SCIP?
- Within 24hrs
- Within 48hrs for cardiovascular surgeries
Which Abx affect the neuromuscular junction?
Aminoglycosides
Who is at an increased risk for SSI?
- Diabetics
- Cancer Pts
Which bacteria is most likely to cause a HAI?
C-diff
What are some signs of an acute infection?
- Hyperglycemia
- Leukocytosis
