HAI & Antibiotics (Mordecai) Exam II Flashcards
What is a nosocomial infection?
a) An infection that occurs after hospital discharge
b) An infection that is acquired in the hospital
c) An infection present at the time of hospital admission
d) An infection caused by patient’s prior medical history
b) An infection that is acquired in the hospital.
Select 2
True or Flase
A nosocomial infection is when a patient has been admitted to a hospital and a infection is present or incubating at admission.
False
A nosocomial infection is when a patient has been admitted to a hospital and a infection is NOT present or incubating at admission.
Select 2
According to the CDC, how many hospitalized patients are affected by nosocomial infections?
a) 1 in 10
b) 1 in 31
c) 1 in 100
d) 1 in 50
b) 1 in 31
Select 3
Which source of hospital-acquired infections is commonly associated with ICU patients?
a) Clostridium difficile infections
b) Surgical site infections
c) Central line-associated sepsis
d) Urinary catheter-associated UTI
c) Central line-associated sepsis
M - central line associated sepsis is a big one…we see a lot of our ICU patients where bacteria colonizes on the lines…on top of that, these patients are immunocompromised and fighting off other illnesses and traumas in their bodies, so they’re associated with a higher rate of infection
Slide 4
What percentage of hospital-acquired infections is due to urinary catheter-associated UTIs?
a) 12.9%
b) 21.8%
c) 10.5%
d) 15.3%
a) 12.9%
M - not everyone that you put to sleep is going to get a Foley catheter…if the procedure is under two hours, generally, we just have them void before we take them back to surgery and avoid that Foley catheter **altogether.
Slide 4
Which of the following infections is associated with ventilated ICU patients?
a) Surgical site infections
b) Ventilator-associated pneumonia
c) Urinary catheter-associated UTI
d) Clostridium difficile infections
b) Ventilator-associated pneumonia (VAP)
M- with the ICU long -term ventilated patients, we do a lot of sedation vacations, a lot of things to promote endogenous respiratory effort…the practice has moved more towards the use of dexaminetomidine over propofol to kind of keep that respiratory drive as much as possible and get the patients back and not ventilator dependent.
Slide 4
Surgical site infections account for approximately what percentage of hospital-acquired infections?
a) 12.9%
b) 22.5%
c) 21.8%
d) 15.4%
c) 21.8%
Slide 4
Clostridium difficile infections account for what percentage of hospital-acquired infections?
a) 12.1%
b) 21.8%
c) 15.6%
d) 10.2%
a) 12.1%
Slide 4
What two sources account for approximately 21.8% of hospital-acquired infections? Select 2
a) Surgical site infections
b) Ventilator-associated pneumonia
c) Urinary catheter-associated UTI
d) Clostridium difficile infections
e) Hospital-aquired pneumonia
a) Surgical site infections
e) Hospital-aquired pneumonia
Slide 4
Which of the following is a major risk factor for hospital-acquired infections?
a) Short hospital stay
b) Infection control practices
c) Younger age
d) Med Surg unit stays
b) Infection control practices
M - Infection control practices, so whether or not PPE is appropriately being utilized… properly donning and dispose of it without contaminating anything
Slide 5
Which of the following patient populations are at increased risk of contracting a hospital-acquired infection? Select 3
a) Elderly patients
b) Multiple chronic illness patients
c) Young, healthy adults
d) Non-invasive airway support
e) Patients in critical care units
f) Strong immune systems
a) Elderly patients,
b) Patients with multiple chronic illnesses,
e) Patients staying in critical care units
Slide 5
Which of the following factors can increase the risk of hospital-acquired infections (HAIs) in patients?
(Select 4)
a) Compromised immune system
b) Less prevalent the pathogens
c) Longer hospital stays
d) More prevalent the pathogens
e) Mechanical ventilatory support
a) Compromised immune system
c) Longer hospital stays
d) More prevalent pathogens in the community
e) Mechanical ventilatory support
Slide 5
Direct contact with ____________ is a common method of transmission of hospital-acquired infections.
a) Contaminated food
b) Healthcare workers
c) Curtains
d) IV poles
b) Direct contact with healthcare workers
M - *at the nurses station.. if there’s contamination, it can just keep on getting passed on and on. It’s kind of hard to stop that cycle. *
Slide 6
Which of the following areas are particularly prone to contamination in patients with invasive lines?
a) Feet
b) Inguinal
c) Axilla
c) Knees
d) Neck
e) Perineal
f) Scalp
b) Inguinal
c) Axilla
e) Perineal
M - a lot of the body areas where invasive lines are located, lack airflow and or hard to keep clean, the bacteria can start to proliferate. Maintaining clean dressings and keeping the patients bathed and can cut down on that bacterial growth.
Slide 6
True or False
Gloves alone don’t prevent contamination
TRUE
What type of bacteria is commonly associated with extraluminal migration along catheters and invasive lines?
a) Escherichia coli
b) Coagulase-negative staphylococci
c) Streptococcus pneumoniae
d) Bacillus anthracis
e) Methicillin-resistant Staphylococcus aureus
b) Coagulase-negative staphylococci (skin flora)
M - *where bacteria travels along the lines and the catheters. *
Slide 6
Which of the following symptoms are suggestive of a pre-existing infection?
(Select 5)
a) Chills
b) Dysuria
c) Hypertension
d) Night sweats
e) Altered mental status
f) Productive cough
g) High blood pressure
a) Chills
b) Dysuria
d) Night sweats
e) Altered mental status
f) Productive cough
Slide 7
Which symptoms could indicate a respiratory infection or pulmonary issue?
(Select 4)
a) Costovertebral tenderness
b) Shortness of breath
c) Clear sputum
d) Night sweats
e) Dysuria
f) Oliguria
g) Suprapubic pain
a) Costovertebral tenderness (CVA) - CVA tenderness can be a sign of: Kidney infections, Inflammation of the tissues around the kidney
b) Shortness of breath
d) Night sweats
g) Suprapubic pain
Slide 7
True or False
Symptoms suggestive of pre-existing infection could be a runny nose and chills
True
Slide 7
Which of the following vital signs may indicate infection?
(Select 4)
a) Hypotension
b) Tachycardia
c) High oxygen saturations
d) Tachypnea
e) Normal blood pressure
f) Low oxygen saturations
g) Bradycardia
a) Hypotension
b) Tachycardia
d) Tachypnea
f) Low oxygen saturations
Slide 8
Which of the following external devices might require evaluation or replacement upon a patient’s admission to the hospital?
(Select 4)
a) Central line
b) Bulb suction drains
c) Foley catheter
d) Insulin pump
e) Chest tube
f) Endotracheal tube
g) Tracheostomy tube
a) Central line
c) Foley catheter
d) Insulin pump
f) Endotracheal tube
Slide 8
When a patient presents with an already placed IV, it is important to evaluate when and where the line was placed to determine if __________ is necessary.
a) Replacement
b) Removal
c) Tapering
d) Addition of new lines
a) Replacement
M - look at how are they placed, where were they placed, how long have they been placed, and oftentimes, we go ahead and have these lines replaced on admission to ensure sterility in our patients.
Slide 8
Which of the following laboratory values might indicate organ dysfunction or infection?
(Select 5)
a) Lactic acid
b) Decreased white blood cell count
c) Prothrombin time
d) BUN
e) Creatinine levels
f) Elevated blood pressure
g) Increased white blood cellc count
a) Elevated lactic acid
c) Elevated prothrombin time
d) Increased BUN
e) Creatinine levels
g) Increased white blood cellc count
slide 9
True or False
Evidence of organ dysfunction could be hypo or hyperglycemia
True
Slide 9
Which of the following is the most precise laboratory test to identify the specific bacteria causing an infection?
a) Lactic acid level
b) White blood cell count (WBC)
c) Blood cultures
d) Blood pressure
c) Blood cultures
Slide 9
Surgical site infections typically occur within how many days after surgery?
a) 7 days
b) 14 days
c) 30 days
d) 60 days
c) 30 days
Slide 11
What percentage of nosocomial infections are surgical site infections?
a) 10%
b) 25%
c) 38%
d) 50%
c) 38%
Slide 11
How much is estimated to be spent yearly due to prolonged recovery and hospitalization from surgical site infections?
a) $1-2 billion
b) $3.5-8 billion
c) $10-12 billion
d) $15-20 billion
b) $3.5-8 billion
slide 11
Which type of surgical site infection is isolated to just the area of the incision?
a) Deep incisional
b) Organ/space
c) Superficial incisional
d) Subcutaneous tissue infection
c) Superficial incisional
Slide 12
Which type of infection involves being in the muscles and tissues surrounding the incision?
a) Organ/space infection
b) Deep incisional infection
c) Superficial incisional infection
d) Muscle abscess
b) Deep incisional infection
M - This is when we start to see like pus and elevated white blood cell counts and things that are more indicative of a more serious infection
Slide 12
An infection that involves any area other than skin and muscle and spaces between organs is referred to as __________.
a) Superficial incisional
b) Deep incisional
c) Organ/space
d) Muscle-related
c) Organ/space
Slide 12
Signs of Surgical Site Infection (SSI) include redness, pain, ______, and ______.
A) Fever, drainage of pus
B) Warmth, itching
C) Fever, numbness
D) Coolness, bruising
A) Fever, drainage of pus
Slide 13
Delayed healing in a surgical wound, along with ______ and ______, may be signs of Surgical Site Infection (SSI).
A) Swelling, warmth
B) Redness, bruising
C) Coldness, itching
D) Discoloration, tingling
A) Swelling, warmth
Slide 13
Which of the following is a potential sign of a Surgical Site Infection (SSI)?
A) Increased blood flow
B) Delayed healing
C) Bruising
D) Numbness
B) Delayed healing
Slide 13
Slide 14
Which of the following bacteria are most commonly associated with Surgical Site Infections (SSI)? Select 3
A) Escherichia coli,
B) Staphylococcus
C) Clostridium
D) Pseudomonas
E) Listeria
F) Bacillus
G) Streptococcus
B) Staphylococcus
D) Pseudomonas
G) Streptococcus
Slide 14
Which type of wound is not inflamed or contaminated; does not involve internal organs and least likely to result in a Surgical Site Infection (SSI)?
A) Dirty wound
B) Contaminated wound
C) Clean wound
D) Clean-contaminated wound
C) Clean wound
Slide 15
A ______ wound involves an internal organ without evidence of infection, while a ______ wound involves an internal organ and has spillage of contents from the organ.
A) Clean-contaminated, dirty
B) Clean-contaminated, contaminated
C) Dirty, clean
D) Clean, clean-contaminated
B) Clean-contaminated, contaminated
Slide 15
What type of wound is described as having a known infection at the time of surgery?
A) Clean-contaminated
B) Contaminated
C) Dirty
D) Clean
C) Dirty
Slide 15
Surgeries lasting longer than ______ hours are more likely to result in infection.
A) 1
B) 4
C) 2
D) 3
C) 2
slide 15
Patients with comorbidities such as ______ and ______ are at higher risk of developing a Surgical Site Infection (SSI).
A) Smoking, diabetes
B) Overweight, youth
C) Elderly, exercise
D) Clean wound, obesity
A) Smoking, diabetes
Slide 15
Which of the following comorbidities increase the risk of Surgical Site Infection (SSI)? (Select 2)
A) Immunocompromised
B) Cancer
C) Smoking
D) Asthma
E) Overweight
A) Immunocompromised
B) Cancer
Slide 15
Which of the following factors are associated with an increased risk of Surgical Site Infection (SSI)? (Select 2)
A) 30 min procedure
B) Emergency surgery
C) Elderly patient
D) Plastic Surgery
B) Emergency surgery
C) Elderly patient
Slide 15
What percentage of Surgical Site Infections (SSIs) may be preventable?
A) 10%
B) 25%
C) 50%
D) 75%
C) 50%
Slide 16
The GRADE approach used in the 2017 guidelines for SSI prevention evaluated the following aspects: (Select 3)
A) Recommendations
B) Development
C) Literature review
D) Diagnostic tests
E) Hypothesis
F) Evaluation
A) Recommendations
B) Development
F) Evaluation
170 studies appraised and synthesized
Systematic Review of the literature from 1998-2014
Slide 17
What does a “1A” grading in the SSI prevention guidelines represent?
A) Strong recommendation with low-quality evidence
B) Weak recommendation
C) Strong recommendation with moderate to high-quality evidence
D) Recommendation required by state/federal regulation
C) Strong recommendation with moderate to high-quality evidence
M - most highly recommended anti-infection measures that we can take…something like giving IV antibiotics is a level 1A highly recommended intervention
Slide 18
Which of the following best describes the 1B grading category?
A) Strongly recommended based on low-quality evidence
B) Required by state or federal regulation
C) Strong recommendation with moderate to high-quality evidence
D) Weak recommendation based on very low evidence
A) Strongly recommended based on low-quality evidence
M - the level of evidence is a little lower, not as great, may have some bias, but still oftentimes used because it doesn’t seem to be harmful, just not as highly associated with eliminating infections
Slide 18
Which of the following represents a “1C” grading?
A) Strong recommendation required by state/federal regulation
B) Weak recommendation
C) Strong recommendation with moderate to high-quality evidence
D) Strong recommendation with low-quality evidence
A) Strong recommendation required by state/federal regulation
Slide 18
A “II” grade recommendation for SSI prevention is characterized by:
A) Strongly recommended by federal regulations
B) Weak recommendation with limited evidence
C) Strong recommendation based on low-quality evidence
D) Required by federal law regardless of evidence
B) Weak recommendation with limited evidence
M - there’s no strong evidence, but we still see type II interventions occurring in practice just because surgeons will sometimes do everything in their power to prevent infection, even if the interventions aren’t necessarily known to be all that helpful.
Slide 18
Which of the following studies were excluded from the SSI prevention guidelines? (Select 3)
A) Studies involving only orthopedic procedures
B) Studies involving only dental procedures
C) Studies involving dirty procedures
D) Studies involving primary closure procedures
E) Studies where SSIs were not reported as outcomes
B) Studies involving only dental procedures
C) Studies involving dirty procedures
F) Studies where SSIs were not reported as outcomes
M - they excluded studies that didn’t have surgical site infections as a reported outcome. And they did not include patients that had dirty procedures…if the patients were dirty to begin with, came in with pre -infected wounds, then those were eliminated from their studies
*Dental or oral health procedures are not considered sterile, and so they would skew the results. *
Slide 19
Which of the following exclusion criteria were applied in the development of the SSI prevention guidelines? (Select 2)
A) Use of wound protectors post-incision
B) Procedures with no primary closure
C) Clean procedures with primary closure
D) Studies reporting SSI outcomes
A) Use of wound protectors post-incision
B) Procedures with no primary closure
M - So if the wound was left open, it’s obviously going to be more likely to be infected, a more vulnerable situation…and with wound vacs
Slide 19
When should parenteral antibiotics be administered before surgery?
A) Only when indicated
B) Always, regardless of the procedure
C) After the incision has been made
D) Only in emergency cases
A) Only when indicated (SCIP Protocol)
Slide 20
What grade of recommendation is given to the practice of administering parenteral antibiotics before surgery?
A) 1A
B) 2C
C) 1B
D) II
C) 1B
Strongly recommended based on low-quality evidence
Slide 20
The timing of administering parenteral antibiotics should ensure the agent is established in the tissue:
A) Immediately after surgery
B) Before anesthesia
C) Upon incision
D) During post-op recovery
C) Upon incision
M - generally within 30 minutes of incision.
Slide 20
Which of the following is NOT recommended for use in surgical incisions?
A) Saline irrigation with antibiotics
B) Antibiotic ointments
C) Dry dressings
D) Sterile closure techniques
B) Antibiotic ointments (1B)
Dry incisions are better.
Slide 21
True or False
There are strict recommendations and guidlines for antibiotic irrigation and soaking prosthetic devices in antibiotic solution to help prevent infection.
FALSE
M - there’s no recommendations for soaking prosthetic devices in antibiotic solution. No known benefit based on the research, but also probably not harmful. We do still see that.
Slide 21
What is the grade of evidence for perioperative glycemic control?
A) 1A
B) 2B
C) 1B
D) 2A
A) 1A
strongly recommended; moderate-to high quality of evidence
M - it’s becoming common practice to check everybody’s blood sugar within 30 minutes after putting them to sleep and making sure that they’re in that target range…and if not, then you do your interventions and you continue to check it every 30 minutes
Slide 22
What is the recommended perioperative glucose target for blood sugar control?
A) Less than 100 mg/dL
B) Less than 150 mg/dL
C) Less than 200 mg/dL
D) Less than 250 mg/dL
C) Less than 200 mg/dL (1A)
Slide 22
Which of the following is true regarding tighter glycemic control during surgery?
A) Recommended for all diabetic patients
B) Targeting glucose levels below 70 mg/dL is necessary
C) Tighter control leads to better surgical outcomes
D) No recommendation for tighter control exists
D) No recommendation for tighter control exists
M - *research shows it helps prevent a surgical site infection. *
Slide 22
There is no recommendation for targeting which of the following in perioperative glycemic control?
A) Blood pressure
B) Insulin sensitivity
C) A1C levels
D) Electrolyte balance
C) A1C levels
Slide 22
What is the grade of recommendation for maintaining perioperative normothermia?
A) 1B
B) 2C
C) 1A
D) 2A
C) 1A
maintaining perioperative normothermia helps reduce and cut down on our surgical site infections
Slide 23
Which of the following statements is true regarding strategies for maintaining perioperative normothermia?
A) Specific strategies are required
B) There is no recommendation for specific strategies
C) Only warming blankets are recommended
D) Fluid warming is mandatory
B) There is no recommendation for specific strategies
Slide 23
For which patient population was the increase in FiO2 found to have potential benefits in reducing surgical site infections? Select 2
A) Patients with neuroaxial anesthesia
B) Patients with normal pulmonary function
C) Patients receiving sedation only
D) GETA intraoperative and immediately after extubation
E) Patients with postoperative oxygen therapy
B) Patients with normal pulmonary function
D) GETA intraoperative and immediately after extubation
M - there were some studies that looked at patients with normal pulmonary function who received general anesthesia and then with an increased FiO2 at 80%, it did show some benefit and some reduction in surgical site infections.
Slide 24
What percentage of FiO2 was studied for its potential to reduce surgical site infections?
A) 40%
B) 60%
C) 80%
D) 100%
C) 80%
Slide 24
What other types of anesthesia have no clear recommendation due to a lack of supporting evidence or trials when increasing FiO2 and decreasing surgical site infections?
(Select 3)
A) Neuraxial anesthesia
B) Patients with normal lung function
C) Sedation only
D) Only intraoperatively with GETA
E) GETA intraoperative and immediately after extubation
F) Postoperatively by mask or nasal cannula
A) Neuraxial anesthesia
D) Only intraoperatively with GETA
F) Postoperatively by mask or nasal cannula
M - there was no recommendations ultimately based on the type of delivery of oxygen and no trials, no studies looked at the percentage of oxygen, the duration of oxygen or the delivery method of oxygen.
Slide 24
What is the recommendation level for showering or bathing with soap or antiseptic the night before surgery?
A) 1A
B) 2B
C) 1B
D) 3C
C) 1B
Slide 25
Which type of antiseptic solution is recommended for intraoperative skin preparation?
A) Alcohol-based antiseptic
B) Povidone-iodine solution
C) Chlorine-based antiseptic
D) Water and soap only
A) Alcohol-based antiseptic
M - *this is level 1A, so you will always see a circulator prep their patient before surgery, and so that kind of sterilizes the area before the incision is made. *
Slide 25
Evidence suggests that iodine irrigation in deep tissues has a recommendation level of______.
A) 1A
B) 1B
C) 1C
D) II
D) II
Slide 25
Which of the following practices have been shown to have NO benefit related to intraoperative iodine irrigation according to current evidence? (Select 4)
A) Bathing with soap the night before
B) Intraoperative skin preparation
C) Intra-peritoneal irrigation with iodine
D) Preoperative bathing with antiseptic
E) Using iodine-embedded adhesive drapes
F) Soaking prosthetic devices in iodine
C) Intra-peritoneal irrigation with iodine
E) Using iodine-embedded adhesive drapes
F) Soaking prosthetic devices in iodine
M - I still see surgeons do this, but the evidence doesn’t show that’s really all that necessary…the cons are that it can be wasteful, you also have the potential for allergy to these betadine solutions and stuff on prosthetic devices
Slide 25
In the context of preventing SSIs, it is recommended that necessary blood transfusions should ______ be withheld from surgical patients.
A) Always
B) Not
C) Sometimes
D) Only
B) Not
1B - Do not withhold necessary blood transfusions as a means to prevent SSI.
Slide 26
What is the primary concern with using systemic corticosteroids in joint arthroplasty surgeries?
A) Decreased risk of surgical site infection
B) Increased risk of surgical site infection
C) Reduced joint mobility
D) Prolonged recovery time
B) Increased risk of surgical site infection (SSI)
M - systemic immunosuppressive therapy - it’s anti -inflammatory, cuts down on sore throat, helps with PONV.
Slide 27
Infection is the most common reason for ______ in total knee arthroplasty (TKA).
A) Early mobilization
B) Revision surgery
C) Postoperative pain
D) Delayed recovery
B) Revision surgery
Slide 27
The use of intra-articular corticosteroids before planned joint arthroplasty has ______ evidence for reducing infection risk.
A) Strong
B) Unclear
C) No
D) Definitive
B) Unclear
Slide 27
What are goals of proper preoperative prophylaxis measures?
Select 2
A) Achieve bactericidal concentration in the tissues at the time of incision
B) Give the antibiotic more than an hour before the incision
C) Achieve bactericidal concentration in the serum at the time of incision
D) Use antibiotic ointments on surgical wounds postoperatively
A) Achieve bactericidal concentration in the tissues at the time of incision
C) Achieve bactericidal concentration in the serum at the time of incision
Slide 29
The goal of preoperative antibiotics is to reach a ________________ concentration in serum and tissues.
A) Maximum
B) Minimum inhibitory
C) Moderate
D) Target
B) Minimum inhibitory
Based on evidence and
Given by anesthesia
Slide 29
True or False
Hospitals will be penalized if the SCIP antibiotics are not given within the expected window…even if you gave them and didn’t document it
True
Document.. reciepts
Which of the following are general principles of antibiotic prophylaxis for surgery?
Select 4
A. Must be active against common surgical wound pathogens
B. Shortest possible course is effective, ideally one dose
C. Newer antibiotics should be preferred over older ones
D. Proven efficacy in clinical trials
E. Antibiotics should be avoided unless infection is present
F. Must achieve minimum inhibitory concentration (MIC)
A. Must be active against common surgical wound pathogens
B. Shortest possible course is effective, ideally one dose
D. Proven efficacy in clinical trials
F. Must achieve minimum inhibitory concentration (MIC)
slide 30
Which statements are true regarding general principles of antibiotic prophylaxis for surgery?
Select 2
A. Should only be administered if infection is present
B. Newer antibiotics reserved for resistant infections
C. Proven inefficacy in clinical trials
D. Administered only after incision has been made
E. Always administer even without infection risk
F. Rely on basic, older and cheaper antibiotics
B. Newer antibiotics reserved for resistant infections
C. Should be timed so the agent is established in tissue upon incision (1B recommendation)
F. Rely on basic, older and cheaper antibiotics
M - *unless the patient has MRSA, VRE.. one of those big superbugs, we’re going to try to rely on the more basic, older, cheaper antibiotics *
Slide 30
According to guidelines, when should antibiotics be administered prior to surgery?
A) Within 30 minutes to 1 hour before the incision.
B) 2 hours before incision for all antibiotics.
C) After the surgery is completed.
D) Administered only after tourniquet release.
A) Within 30 minutes to 1 hour before the incision.
Slide 31
Which of the following statements are true regarding antibiotic timing and administration?
Select 2
A) May hold antibiotics for cultures
B) Vancomycin and fluoroquinolones can be initiated within 2 hours before incision.
C) Antibiotics should always be administered after tourniquet use.
D) Antibiotics should be completely infused after tourniquet use
A) May hold antibiotics for cultures
B) Vancomycin and fluoroquinolones can be initiated within 2 hours before incision.
Slide 31
True or False
Antibiotics should be completely infused prior to tourniquet use
True!
Slide 31
Antibiotics may need to be redosed after procedures such as __________ due to a decrease in tissue concentrations of the drug.
A) Appendectomy
B) Cardiopulmonary bypass
C) Cholecystectomy
D) Laparoscopic hysterectomy
B) Cardiopulmonary bypass
Slide 32
Redosing of antibiotics is usually required after __________ or with excessive blood loss during surgery.
A) 1 half-life
B) 3 half-lives
C) 2 half-lives
D) 4 half-lives
C) 2 half-lives
slide 32
True or False
Antibiotic redosing is drug dependent, usually every 2-4 hours and required for prolonged procedures and when transferred to the PACU
FALSE
Antibiotic redosing is drug dependent, usually every 2-4 hours and required for prolonged procedures and NOT redosed in the PACU
M - The PACU is not responsible for keeping that four hours going. That’s only an intraoperative thing. So sometimes you’ll end your surgery and you might just go ahead and give that extra dose, but it’s not required to give the dose after they’re out of the operating room.
Slide 32
KRISTA START :D
Which of the following drugs are β-lactam based? (Select all that apply)
A) Penicillins
B) Cephalosporins
C) Carbapenems
D) Macrolides
A) Penicillins
B) Cephalosporins
C) Carbapenems
Slide 33
Which of the following are major common surgical antibiotics? (Select all that apply)
A) β-Lactams
B) Vancomycin
C) Aminoglycosides (Gentamycin)
D) Fluoroquinolones (Cipro)
E) Macrolides
F) Metronidazole (Flagyl)
A) β-Lactams
B) Vancomycin
C) Aminoglycosides (Gentamycin)
D) Fluoroquinolones (Cipro)
F) Metronidazole (Flagyl)
Slide 33
How do Penicillin β-lactam antibiotics work?
A) Inhibition of bacterial protein synthesis
B) Disruption of bacterial DNA replication
C) Inhibition of bacterial cell wall synthesis
D) Enhancement of bacterial cell wall synthesis
C) Inhibition of bacterial cell wall synthesis
Slide 34
The β-lactamase enzyme is located on the outer surface of the bacterial cytoplasmic membrane and contributes to resistance against Penicillin β-lactam.
True
Slide 34
Penicillin β-lactams are the drug of choice for which of the following pathogens? (Select all that apply)
A) Streptococci
B) Staphylococci
C) Meningococci
D) Pneumococci
E) Mycobacteria
A) Streptococci
C) Meningococci
D) Pneumococci
Gram + Bacterium (Cocci)
Slide 34
β-Lactams are effective for treating healthcare-associated infections such as ___, ___, and ___.
A) Skin
B) Fungal
C) Catheter-related
D) Tuberculosis
E) Upper respiratory
A) Skin
C) Catheter-related
E) Upper respiratory
Slide 34
Which of the following are examples of penicillin-based antibiotics? (Select all that apply)
A) Penicillin G
B) Methicillin
C) Nafcillin
D) Amoxicillin
E) Ciprofloxacin
A) Penicillin G
B) Methicillin
C) Nafcillin
D) Amoxicillin
Slide 34
Which of the following are common adverse reactions to penicillin β-lactams? (Select all that apply)
A) Hypersensitivity
B) GI upset
C) Hyperglycemia
D) Vaginal Candidiasis
E) Hepatitis
A) Hypersensitivity
History of reaction unreliable
Skin rashes to anaphylaxis
B) GI upset
D) Vaginal Candidiasis
Slide 35
__ β-lactams are more stable against β-lactamase.
A) Penicillins
B) Cephalosporins
C) Carbapenems
D) Monobactams
B) Cephalosporins
Broader spectrum.
Beta-lactam rings bind to Penicillin-binding protein and inhibit the normal activity of the protein. Resistance occurs by protein altering its structure
Slide 36
Cephalosporin β-lactam antibiotics are the drug of choice for what?
(Select all that apply)
A) Surgical prophylaxis
B) Treatment of viral infections
C) Patients allergic to penicillin
D) Fungal infection treatment
A) Surgical prophylaxis
C) Patients allergic to penicillin
(except true anaphylaxis)
Slide 36
Match each cephalosporin to its appropriate generation:
- Cefazolin – A. First Generation
- Ceftriaxone – C. Third Generation
- Cefepime – D. Fourth Generation
- Cefuroxime – B. Second Generation
- Cefotaxime – C. Third Generation
- Cefoxitin – B. Second Generation
- Ceftazidime – C. Third Generation
- Cefotetan – B. Second Generation
Slide 37
Waiting for verificaiton from Mordecai
Which of the following cephalosporins do NOT penetrate the blood-brain barrier? (Select all that apply)
A) Cefazolin (Ancef)
B) Cefuroxime (Ceftin)
C) Cefoxitin (Mefoxin)
D) Cefotetan (Cefotan)
E) Ceftriaxone
A) Cefazolin (Ancef)
B) Cefuroxime (Ceftin)
C) Cefoxitin (Mefoxin)
D) Cefotetan (Cefotan)
Slide 37
Waiting for verificaiton from Mordecai
Cefazolin is primarily used to treat which of the following conditions? (Select all that apply)
A) Cellulitis
B) Abscesses
C) Upper respiratory infections
D) Urinary tract infections
E) Meningitis
A) Cellulitis
B) Abscesses
C) Upper respiratory infections
D) Urinary tract infections
Most gram + (staph and streptococci)
Slide 37
Waiting for verificaiton from Mordecai
Cefuroxime is effective in treating which of the following conditions? (Select all that apply)
A) H. influenzae pneumonia
B) Urinary tract infections
C) Meningitis
D) Otitis media
A) H. influenzae pneumonia
B) Urinary tract infections
D) Otitis media
Better gram – coverage
Slide 37
Waiting for verificaiton from Mordecai
Which of the following cephalosporins can cross the blood-brain barrier to some extent? (Select all that apply)
A) Ceftriaxone
B) Cefotaxime
C) Cefuroxime
D) Ceftazidime
A) Ceftriaxone
B) Cefotaxime
D) Ceftazidime
Slide 37
Waiting for verificaiton from Mordecai
Cefotaxime is most commonly used to treat which of the following conditions?
A) Gonorrhea
B) Urinary tract infections
C) Meningitis
D) Otitis media
C) Meningitis
Slide 37
Waiting for verificaiton from Mordecai
What drug was noted for treatment of gonorrhea?
A) Cefazolin
B) Cefepime
C) Ceftriaxone
D) Cefoxitin
C) Ceftriaxone
Slide 37
Waiting for verificaiton from Mordecai
What generation of cephalosporins penetrate the blood brain barrier well?
A) Cefazolin
B) Cefepime
C) Ceftriaxone
D) Cefoxitin
B) Cefepime
Most resistant to hydrolysis by β-lactamase.
Reserved for multi-resistant organisms.
Slide 37
What drugs should be used if true anaphylaxis to Penicillin exists when giving Cephalosporin?
A) Ceftriaxone or cefazolin
B) Vancomycin or clindamycin
C) Erythromycin or ampicillin
D) Tetracycline or doxycycline
B) Vancomycin or clindamycin
Cross reaction approx. 1%
Slide 38
What are the adverse effects are associated with Cephalosporins?
A) Rashes
B) Fever
C) Nephritis
D) Anaphylaxis
E) Vitamin K production deficit
All of the above
Slide 38
What drugs are a common cause of colitis?
A) First-generation cephalosporins
B) Second-generation cephalosporins
C) Third-generation cephalosporins
D) Fourth-generation cephalosporins
C) Third-generation cephalosporins
Slide 38
**
Carbapenem β-lactams have good activity against?
A) Gram-negative rods
B) Gram-positive cocci
C) Fungi
D) Enterobacter
A) Gram-negative rods
(Pseudomonas Aeruginosa)
D) Enterobacter
Slide 39
What β-lactam drug class has the broadest spectrum of activity and can inhibit the β-lactamase enzyme?
A) Penicillins
B) Cephalosporins
C) Carbapenems
D) Monobactams
C) Carbapenems
Slide 39
Carbapenems are considered last-line agents used for treating which of the following infections?
A) Skin infections and ear infections
B) Intra-abdominal infections, resistant UTIs, and pneumonia
C) Viral infections and fungal infections
D) Sinusitis and otitis media
B) Intra-abdominal infections, resistant UTIs, and pneumonia
Slide 39
Which of the following are examples of carbapenem antibiotics? (Select all that apply)
A) Ertapenem (Invanz)
B) Meropenem (Merrem)
C) Imipenem (Primaxin)
D) Cefepime (Maxipime)
A) Ertapenem (Invanz)
B) Meropenem (Merrem)
C) Imipenem (Primaxin)
Most penetrate BBB to treat Meningitis
Slide 39
Which of the following are common adverse reactions to Carbapenems?
A) Nausea, vomiting, diarrhea, and rashes
B) Hypertension, dry mouth, and constipation
C) Hair loss, anemia, and joint pain
D) Weight gain, insomnia, and blurred vision
A) Nausea, vomiting, diarrhea, and rashes
Slide 40
IM formulations of Carbapenems contain _______.
A) Epinephrine
B) Lidocaine
C) Saline
D) Propofol
B) Lidocaine
Consider LA allergies prior to IM administration.
Slide 40
Carbapenems can decrease what medication by up to 90%?
A) Phenytoin
B) Valproic acid
C) Warfarin
D) Digoxin
B) Valproic acid
can precipitate seizures
Slide 40
How does vancomycin work to combat bacterial infections?
A) Inhibiting protein synthesis
B) Inhibiting DNA replication
C) Inhibition of cell wall synthesis
D) Disrupting bacterial metabolism
C) Inhibition of cell wall synthesis
Slide 41
Vancomycin is active against ___ bacteria but is too large to penetrate __ bacteria.
A) Gram-negative, Gram-positive
B) Gram-positive, Gram-negative
C) Aerobic, Anaerobic
D) Anaerobic, Aerobic
B) Gram-positive, Gram-negative
Vancomycin is active against gram + but is too large for gram - bacteria
Only works if bacterial is actively dividing; Is very slow
Slide 41
Vancomycin is most useful against what infections?
A) MRSA bloodstream infections
B) MRSA endocarditis
C) Viral pneumonia
D) E. coli urinary tract infections
A) MRSA bloodstream infections
B) MRSA endocarditis
Slide 41
What are the most common adverse reactions to vancomycin? (Select all that apply)
A) Phlebitis at the injection site
B) Chills and fever
C) Nephrotoxicity
D) “Red man” syndrome
All of the above
Slide 42
How do Aminoglycosides work?
A) Inhibition of cell wall synthesis
B) Inhibition of ribosomal proteins and causing mRNA misreading
C) Inhibition of DNA replication
D) Disruption of bacterial membrane integrity
B) Inhibition of ribosomal proteins and causing mRNA misreading
Slide 43
True or False
Aminoglycosides have a short post-antibiotic effect
FALSE
Aminoglycosides have a **significant **post-antibiotic effect
Slide 43
Aminoglycosides are __ w/ β lactams or vancomycin.
A) Antagonistic
B) Synergistic
C) Inhibitory
D) Neutral
B) Synergistic
Especially useful for enterococcal endocarditis.
Slide 43
Which of the following is an example of an aminoglycoside antibiotic?
A) Amoxicillin
B) Ceftriaxone
C) Gentamicin
D) Erythromycin
C) Gentamicin
Slide 43
What drug(s) increases the likelihood of nephrotoxicity when paired with aminoglycosides?
A) Beta-blockers
B) Loop diuretics
C) Antihistamines
D) NSAIDs
B) Loop diuretics
Slide 44
What are the adverse reactions associated with Aminoglycosides?(Select all that apply)
A) Ototoxicity
B) Nephrotoxicity
C) Curare-like effect
D) Hepatotoxicity
A) Ototoxicity
B) Nephrotoxicity
C) Curare-like effect
Slide 43
The curare-like effect of Gentamicin (an aminoglycoside) involves which of the following?
A) Potentiation of acetylcholine release
B) Interference with acetylcholine receptors
C) Stimulation of muscle contraction
D) Reduction in heart rate and blood pressure
B) Interference with acetylcholine receptors
leading to muscle paralysis
treatment is Ca++
Slide 44
How do fluoroquinolones exert their antibacterial effect?
A) Inhibition of cell wall synthesis
B) Inhibition of bacterial DNA synthesis
C) Inhibition of protein synthesis
D) Disruption of bacterial membrane integrity
B) Inhibition of bacterial DNA synthesis
Slide 45
Fluoroquinolones are most effective against which type of bacteria?
A) Gram-positive organisms
B) Gram-negative organisms
C) Fungal infections
D) Viral infections
B) Gram-negative organisms
- UTI
- Bacterial diarrhea
- Bone/joint infections
Slide 45
What examples are there of fluoroquinolones? (Select all that apply)
A) Ciprofloxacin
B) Levofloxacin
C) Amoxicillin
D) Azithromycin
A) Ciprofloxacin (Cipro)
B) Levofloxacin (Levaquin)
Slide 45
What are the adverse reactions for fluoroquinolones?Select all that apply)
A) Nausea, vomiting, and diarrhea (N/V/D)
B) QT interval prolongation
C) Cartilage damage and tendon rupture
D) Hepatotoxicity
A) Nausea, vomiting, and diarrhea (N/V/D)
B) QT interval prolongation
C) Cartilage damage and tendon rupture
Slide 46
What three factors will exacerbate cartilage damage and tendon rupture associated with fluoroquinolones? (Select all that apply)
A) Advanced age
B) Renal insufficiency
C) Concurrent steroid use
D) Diabetes
A) Advanced age
B) Renal insufficiency
C) Concurrent steroid use
Slide 46
What type of antibiotic is Metronidazole?
A) Antifungal
B) Antiprotozoal / Anaerobic antibacterial
C) Broad-spectrum antibacterial
D) Antiviral
B) Antiprotozoal / Anaerobic antibacterial
Slide 47
True or False
Metronidazole inhibits bacterial protein synthesis as its primary mechanism of action.
False
Metronidazole forms toxic byproducts that cause unstable DNA molecules
Slide 47
What is Metronidazole (Flagyl) indicated for?(Select all that apply)
A) Intra-abdominal infections
B) Vaginitis
C) C-diff infections
D) Fungal infections
A) Intra-abdominal infections
B) Vaginitis
C) C-diff infections
Slide 47
What are the adverse reactions associated with metronidazole?
A) Nausea, peripheral neuropathy, and disulfiram-like effect
B) Hypertension, dizziness, and visual disturbances
C) Increased heart rate and hyperkalemia
D) Dry mouth, dizziness, and photosensitivity
A) Nausea,
Peripheral neuropathy (In prolonged use),
and Disulfiram-like effect-
Slide 48
Which substance should be avoided while taking Metronidazole (Flagyl)?
A) Dairy products
B) Caffeine
C) Alcohol
D) NSAIDs
C) Alcohol (EtOH)
Disulfiram effect induces hangover-like s/s
Slide 48
What is (essentially) the first line antibiotic for essentially all surgical prophylaxis?
A) Ciprofloxacin
B) Vancomycin
C) Cefazolin
D) Metronidazole
C) Cefazolin
What is the most common alternative to cefazolin for surgical prophylaxis?
A) Clindamycin
B) Gentamicin
C) Azithromycin
D) Ceftriaxone
A) Clindamycin
(or vancomycin)
Slide 50
Which of the following Cefazolin doses are correct for the corresponding weight ranges? (Select all that apply)
A) 1g for adults weighing < 80 kg
B) 2g for adults weighing ≥ 120 kg
C) 2g for adults weighing 81-119 kg
D) 1g for adults weighing 81-119 kg
E) 3g for adults weighing ≥ 120 kg
F) 3g for adults weighing 100-119 kg
A) 1g for adults weighing < 80 kg
C) 2g for adults weighing 81-119 kg
E) 3g for adults weighing ≥ 120 kg
Slide 50
What is the recommended administration time for Cefazolin (Ancef) during surgical prophylaxis?
A) 60 minutes
B) 15-20 minutes
C) 3-5 minutes
D) 30 minutes
C) 3-5 minutes
Slide 50
Which of the following antibiotics are administered over 30 minutes? (Select all that apply)
A) Ampicillin
B) Aztreonam (Azactam)
C) Cefotaxime (Claforan)
D) Ciprofloxacin (Cipro)
E) Clindamycin (Cleocin)
F) Ertapenem (Invanz)
G) Gentamicin (Garamycin)
H) Levofloxacin (Levaquin)
I) Metronidazole (Flagyl)
J) Piperacillin with tazobactam (Zosyn)
A) Ampicillin
B) Aztreonam (Azactam
D) Ciprofloxacin (Cipro)
E) Clindamycin (Cleocin)
F) Ertapenem (Invanz)
G) Gentamicin (Garamycin)
H) Levofloxacin (Levaquin)
I) Metronidazole (Flagyl)
J) Piperacillin with tazobactam (Zosyn)
Slide 50
Which of the following antibiotics are administered over 60 minutes? (Select all that apply)
A) Ceftriaxone (Rocephin)
B) Fluconazole (Diflucan)
C) Moxifloxacin (Avelox)
D) Trimethoprim-Sulfamethoxazole (Bactrim)
E) Vancomycin (Vancocin)
C) Moxifloxacin (Avelox)
D) Trimethoprim-Sulfamethoxazole (Bactrim)
E) Vancomycin (Vancocin)
Slide 50
Fluconazole, when used as an antifungal, should be administered over how many minutes?
A) 30 minutes
B) 45 minutes
C) 60 minutes
D) 120 minutes
D) 120 minutes
Slide 50
Which of the following antibiotics are redosed every 2 hours in the operating room? (Select all that apply)
A) Ampicillin 2g (Principen)
B) Cefoxitin 2g (Mefoxin)
C) Piperacillin with tazobactam 3.375g (Zosyn)
D) Vancomycin 15 mg/kg (Vancocin)
A) Ampicillin 2g (Principen)
B) Cefoxitin 2g (Mefoxin)
C) Piperacillin with tazobactam 3.375g (Zosyn)
Slide 50
Which of the following antibiotics are redosed every 3 hours in the operating room? (Select all that apply)
A) Cefotaxime 1g (Claforan)
B) Cefotetan 2g (Cefotan)
C) Cefoxitin 2g (Mefoxin)
D) Vancomycin 15 mg/kg (Vancocin)
A) Cefotaxime 1g (Claforan)
Slide 50
Which of the following antibiotics are redosed every 4 hours in the operating room? (Select all that apply)
A) Aztreonam 2g (Azactam)
B) Cefazolin 1g (Ancef)
C) Cefuroxime 1.5g (Zinacef)
D) Piperacillin with tazobactam 3.375g (Zosyn)
A) Aztreonam 2g (Azactam)
B) Cefazolin 1g (Ancef)
C) Cefuroxime 1.5g (Zinacef)
Slide 50
Which of the following antibiotics are redosed every 6 hours in the operating room? (Select all that apply)
A) Cefotetan 2g (Cefotan)
B) Clindamycin 900mg (Cleocin)
C) Metronidazole 500mg (Flagyl)
D) Vancomycin 15 mg/kg (Vancocin)
A) Cefotetan 2g (Cefotan)
B) Clindamycin 900mg (Cleocin)
Slide 50
Trimethoprim-Sulfamethoxazole 160 mg/800 mg (Bactrim) is redosed every ________ hours in the OR.
A) Every 2 hours
B) Every 4 hours
C) Every 6 hours
D) Every 8 hours
D) Every 8 hours
Slide 50
