INFECTION & ABs

Question 1

what are the class of ABs that WFA carry

Answer 1

cephalosporins

Question 2

what are cephalosporins

Answer 2

broad spectrum antibiotics that treat an array of bacterial infections

Question 3

what are the differences between the generations of ABS

Answer 3

the older ones have a more narrow reach, where as the new generations target more types of bacteria

Question 4

what generation is cefazolin and what dose it target

Answer 4

is a first generation that mainly targets gram positive cocci, and some select gram negative

Question 5

what generation is ceftriaxone and what dose it target

Answer 5

it is 3rd generation and it targets more gram negative, but some select gram positive

Question 6

what is the difference between cefazolin and ceftriaxone

Answer 6

cefazolin is predominately targeting gram positive and ceftriaxone is predominately targeting gram negative bacteria

Question 7

bacteria cell walls are made up of….

Answer 7

peptides and polysaccharide layer called peptidoglycan

Question 8

composition of gram positive bacteria cell walls

Answer 8

thick cell walls with up to 30 layers of peptidoglycan

Question 9

composition of gram negative bacteria cell wall

Answer 9

single layer of peptidoglycan sandwiched between 2 layers of lipid (fat)

Question 10

what protein builds the bacterias cell walls

Answer 10

penicillin binding protein (PBP)

Question 11

mechanism of ABs

Answer 11

1. the AB’s binds to the penicillin binding protein
2. PBP function inhibited, thus cell walls of bacteria not built effectively
3. due to ineffective cell wall, the cell cannot withstand the osmotic pressure, thus ruptures, killing the bacterias cell

Question 12

Cefazolin indication

Answer 12

Sepsis, where the source of infection appears to be the soft tissues or joint, and:

1.The patient is aged greater than or equal to 12 years, and
2. Has one or more clinical features indicating antibiotics, and
3. Time to hospital is greater than 30 minutes.

4.Cellulitis. In this setting a single dose may be administered if the patient is not being directly referred (or transported) to a medical facility.

Question 13

cefazolin contraindications and cautions

Answer 13

Known severe allergy to cephalosporins.

Cautions: nil

Question 14

pregnancy and cefazolin

Answer 14

Safe and should be administered if indicated.

Question 15

cefazolin dosage

Answer 15

1g

Question 16

cerfazolin administration

Answer 16

1. Add approximately 4 ml of 0.9% sodium chloride to a 1 g ampoule and shake until dissolved.
2. Draw up the ampoule contents and dilute to a total of 10 ml.
3. Administer IV over 1-2 minutes preferably into a running line.

Question 17

cefazolin adverse effects

Answer 17

nil

Question 18

cefazolin onset and duration

Answer 18

O: 30-60m

D: 6-8H

Question 19

what is the guidelines mechanism of cefazolin

Answer 19

Cefazolin is a first-generation cephalosporin antibiotic with activity against gram-negative and gram-positive bacteria. It inhibits production of the bacterial cell wall, causing bacteria to die

Question 20

guidelines mechanism of ceftriaxone

Answer 20

Ceftriaxone is a cephalosporin antibiotic with broad activity against gram-negative and gram-positive bacteria. It inhibits production of the bacterial cell wall, causing bacteria to die.

Question 21

indications for ceftriaxone

Answer 21

1. Suspected meningococcal septicaemia.
2. Sepsis, where cefazolin is not indicated, and:
   -The patient is aged greater than or equal to 12 years,

-One or more clinical features indicating antibiotics are present,

-Time to hospital is greater than 30 minutes.

Question 22

ceftriaxopne contras and cautions

Answer 22

CONTRA: Anaphylaxis to cephalosporins.
Cautions: None.

Question 23

dosage of ceftriaxone

Answer 23

2 g IV for an adult.
2 g IM for an adult if IV access cannot be immediately obtained (meningoccocal septicaemia only).
See the paediatric drug dose tables for a child.

Question 24

admin of ceftriaxone

Answer 24

IV administration:
Add approximately 4 ml of 0.9% sodium chloride to a 2 g ampoule and shake until dissolved.

Draw up the ampoule and dilute to a total of 10 ml.
Discard unrequired volume before administration for a child.

Administer IV over 1-2 minutes preferably into a running line

Question 25

onset and duration of ceftriaxone

Answer 25

30-60 minutes.
Usual duration of effect 24 hours.

Question 26

As meningococcal bacteria die they release endotoxins which results in

Answer 26

The body’s immune response to endotoxins can cause profound worsening of shock following antibiotic administration. Be prepared to treat this with 0.9% sodium chloride IV, and metaraminol or adrenaline IV. It is rare for significant amounts of endotoxins to be released from other bacteria.

Question 27

History or CNS features in indicating ABs

Answer 27

Objective evidence of new onset of an altered mental status.
Known neutropenia.

Question 28

resp Features indicating ABS

Answer 28

New need for oxygen via reservoir mask to maintain SpO2 > 92% (or > 88% in known COPD).

Question 29

BP features indicating Abs

Answer 29

Systolic blood pressure ≤ 90 mmHg.
Systolic blood pressure > 40 mmHg below known normal

Question 30

circulation features indicating Abs

Answer 30

Heart rate > 130/minute.

Question 31

skin fetures indicating ABs

Answer 31

Mottled or ashen appearance.
Petechiae or purpura.

Question 32

other word for mottled skin

Answer 32

blotchy

Question 33

what is Petechiae or purpura

Answer 33

red orm purple spots on the skin

Question 34

Comorbidities that increase the risk of developing sepsis can include:

Answer 34

Chronic lung, heart, liver or kidney disease.
Cancer.
Immunocompromise.
Diabetes.
Morbid obesity.

Question 35

Factors that increase the risk of developing sepsis can include:

Answer 35

Age ≥ 65 years or ≥ 45 years for Māori, or > 40 years for Pacific People.
Challenges with health literacy.
Frailty or disability.
Drug or alcohol addiction.
Complex social circumstances.
An indwelling venous line or urinary catheter.
Surgery or an invasive procedure within the last four weeks.
A breach of skin integrity, for example wounds or blisters.
Birth, termination of pregnancy or miscarriage in the last four weeks.

Question 36

what is Meningococcal septicaemia

Answer 36

It is a systemic infection from the bacterium Neisseria meningitidis.

Question 37

Patients with early meningococcal septicaemia commonly have non-specific influenza-like symptoms. Antibiotics are not indicated unless there are clear clinical signs of meningococcal septicaemia such as

Answer 37

petechiae or purpura

Question 38

meningitis presentation

Answer 38

The patient will usually present with headache and signs of infection. They may have nausea, a stiff neck and photophobia.

Question 39

difference between meningitis and meningococcal

Answer 39

Meningitis is an infection/inflammation of the brain and spinal cord surrounding membranes known as the meninges. Meningococcal meningitis is the term used to describe a bacterial form of meningitis caused by Neisseria meningitidis.