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Sp: Pharm 1 > Pharm Unit 3: Aspiration/PONV, Antiarrhythmics, Fluids, LA, Abx (FINAL) > Flashcards

Pharm Unit 3: Aspiration/PONV, Antiarrhythmics, Fluids, LA, Abx (FINAL) Flashcards

1
Q

What types of drugs are used for aspiration prevention

A

H1 blockers
H2 blockers
PPI’s
Dopa receptor antagonists

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2
Q

H1 blockers MOA

A

decreased contraction of intestinal smooth muscle

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3
Q

H1 blockers uses

A

sedation
decreased GI motility
antimuscarinic

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4
Q

what is the H1 blocker

A

diphenhydramine

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5
Q

H2 blockers MOA

A

decrease acidity of gastric acid

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6
Q

H2 blockers uses

A

ulcers
GERD

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7
Q

H2 blockers common drugs

A

“tidine”

ranitidine
famotidine
nizatidine
cimetidine

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8
Q

PPI MOA

A

inhibit acid secretion

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9
Q

PPI uses

A

ulcers, GERD

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10
Q

PPI common drugs

A

“prazole”
pantoprazole
omeprazole
lansoprazole

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11
Q

dopamine receptor antagonist MOA

A

increase LES tone
increase GI motility

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12
Q

dopamine receptor antagonist uses

A

GERD
diabetic gastroparesis

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13
Q

dopamine receptor antagonist adverse effects

A

acute dystonic reaction

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14
Q

common dopamine receptor antagonist

A

metoclopramide

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15
Q

5HT3 antagonists MOA

A

block serotonin
- peripherally: vagal nerve terminals
- centrally: chemoreceptor trigger zone

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16
Q

5HT3 antagonists uses

A

emesis due to vagal stimulation

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17
Q

5HT3 antagonists adverse effects

A

QT prolongation

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18
Q

5HT3 antagonists contraindications

A

pts w/prolonged QT interval
use w/ drugs that inhibit CYP enzymes

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19
Q

common 5HT3 antagonists

A

“setron”

ondansetron
granisetron
dolasetron
palonosetron

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20
Q

antimuscarinics uses

A

motion sickness
PONV

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21
Q

antimuscarinics adverse effects

A

dry mouth
blurry vision
cognitive impairment

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22
Q

common antimuscarinic for PONV

A

scopalamine patch

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23
Q

D2 receptor antagonist MOA

A

block D2 receptor in CTZ

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24
Q

D2 receptor antagonist adverse effects

A

acute dystonic reaction
prolonged QT

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25
Q

D2 receptor antagonist common drugs

A

“peridol”

droperidol
haloperidol

“azine”

perphenazine
promethazine
prochlorperazine

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26
Q

Neurokinin receptor antagonists MOA

A

inhibits substance P

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27
Q

Neurokinin receptor antagonist drug

A

Aprepitant

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28
Q

dexamethasone adverse effects

A

perineal burning, impaired glucose tolerance

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29
Q

Class IA antiarrhythmics

A

Quinidine
Procainamide
Disopyramide

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30
Q

Class IA antiarrhythmics MOA

A

block VG Na+ and VG K+ in myocytes

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31
Q

quinidine indications

A

PVC’s
Systained VT/VF
Afib/Aflutter
short QT syndrome

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32
Q

quinidine adverse effects

A

N/V
diarrhea
tinnitus/hearing loss
hypotension
QRS & QT prolongation, torsades

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33
Q

quinidine contraindications

A

prolonged QT

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34
Q

Procainamide Indications

A

sustained VT, Afib in WPW

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35
Q

procainamide adverse effects

A

rash, myalgia, vasculitis, hypotension, bradycardia, QT prolongation, torsades, drug induced lupus

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36
Q

Procainamide Contraindications

A

prolonged QT

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37
Q

disopyramide indications

A

PVC’s, VT
Afib

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38
Q

dispyramide adverse effects

A

urinary retention, constipation, glaucoma, QT prolongation, torsades

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39
Q

disopyramide contraindications

A

prolonged QT

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40
Q

Class IB Antiarrhythmics

A

Lidocaine
Mexiletine

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41
Q

Class IB Antiarrhythmics MOA

A

block VG Na+ in myocytes

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42
Q

Class IB Antiarrhythmics indications

A

V tach, V fib

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43
Q

Class IB Antiarrhythmics adverse effects

A

increased potency in ischemic tissue, GI effects

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44
Q

lidocaine SE

A

visaul disturbances
tremor
seizure
drowsiness
hallucination/coma
asystole
hypotension
N/V

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45
Q

Mexiletine SE

A

GI upset
N/V
blurred vision
tremor
headache
ataxia
confusion

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46
Q

Class IB Antiarrhythmics contraindications

A

atrial tachyarrhythmias, HF/liver disease

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47
Q

Class IC antiarrhythmics

A

Flecainide, Propafenone

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48
Q

Class IC antiarrhythmics MOA

A

dramatically prolong phase 0 in myocyte AP (block VG NA+)

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49
Q

Class IC antiarrhythmics indications

A

AFib (w/o CAD), SVT

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50
Q

flecainamide adverse effects

A

dizziness, dyspnea, headache, blurred vision, nausea, HF exacerbation, AV block, VT/VF in pt’s with CAD

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51
Q

flecainamide contraindications

A

heart failure
CAD

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52
Q

propafenone adverse effects

A

dizziness, dyspnea, headache, blurred vision, nausea, bradyccardia
bronchospasm

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53
Q

propafenone contraindications

A

heart failure
CAD
asthma

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54
Q

Class II antiarrhythmic drugs

A

beta blockers

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55
Q

beta blockers MOA

A

decreased slope of phase 4 depolarization
prolong depolarization at AV node

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56
Q

beta blocker indications

A

Afib/Aflutter (slow HR down)
SVT’s
ventricular arrhythmia prevention

will not convert back into normal sinus

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57
Q

beta blocker adverse effects

A

fatigue
hypotension
bronchospasm
mask hypoglycemic symptoms
aggravation of heart failure

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58
Q

Class III antiarrhythmics

A

Amiodarone

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59
Q

Class III MOA

A

K+ blocker
– prolongs QT interval

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60
Q

Class III SE

A

torsades the pointes
higher proarryhthmia risk

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61
Q

Amiodarone MOA

A

K+ blocker (high)
- prolongs AP duration
- phase 3
Na+ blocker
Ca2+ blocker
beta blocker (slow SA/AV conduction)

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62
Q

when does amiodarone work best?

A

at high heart rates due to use-dependence

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63
Q

amiodarone indications

A

VT/VF
SVT
Afib/Aflutter

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64
Q

amiodarone features

A

lg volume of distribution due to lipophilicity

requires loading dose (10g)
delayed onset
long half life (2 months)

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65
Q

amiodarone adverse effects

A

pulmonary toxicity
liver injury
hypotension
bradycardia
AV block
worsening dysrhthmias
thyroid abnormalities

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66
Q

amiodarone contraindications

A

hypersensitivity (iodine)
cardiogenic shock
bradycardia
AV blocks

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67
Q

amiodarone drug interactions

A

digoxin
warfarin
statins

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68
Q

amiodarone metabolism

A

hepatic by CYP3A4 and 2C8

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69
Q

amiodarone inhibits

A

CYP3A4
CYP2C9
P-glycoprotein

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70
Q

Class III drugs that can cause torsades

A

dofetilide
sotalol

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71
Q

dronedarone compared to amiodarone

A

less efficacy than amiodarone
does not contain iodine

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72
Q

dronedarone SE

A

GI impacts

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73
Q

dronedarone indications

A

atrial flutter
afib

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74
Q

Class IV antiarrhythmics

A

non-DHPR CCB’s
verapamil
diltiazem

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75
Q

non-DHPR CCB MOA

A

inhibition of L-type Ca2+ channels (phase 0 in nodal tissue)

slow depolarization in pacemaker cells

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76
Q

non-DHPR CCB indications

A

SVT
Afib/Aflutter

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77
Q

non-DHPR CCB adverse effects

A

hypotension
bradycardia
AV block
decreased SV

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78
Q

adenosine adverse effects

A

dyspnea
bronchospasm
flushing
chest pressure

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79
Q

Adenosine indications

A

SVT

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80
Q

digoxin MOA

A

increases parasympathetic tone via vagus nerve
– decr sinus node
– prolongs AV node refractory
inhibits Na/K-ATPase pump
–incr Ca2+
–incr contractility
–incr proarrhythmic potential

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81
Q

digoxin indications

A

atrial fibrillation
aflutter
heart failure w/ reduced EF

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82
Q

digoxin CI

A

afib
aflutter
WPW

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83
Q

digoxin adverse effects

A

narrow therapeutic window
GI upset
halo vision
malaise
bradycardia
AV block
VT/VF

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84
Q

when is digoxin used?

A

on a resting heart rate
– pt is just sitting not walking around

rate control in combination with BB/CCB

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85
Q

Antimuscarinics indications

A

bradycardia
AV block

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86
Q

antimuscarinic side effects

A

dry mouth
blurry vision
photophobia
tachycardia

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87
Q

antimuscarinic drugs

A

atropine
glyco

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88
Q

antimuscarinic MOA

A

block ACH from binding to muscarinic receptors
alters parasympathetic response

anti-parasympathetic drugs

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89
Q

preop causes of volume derangements

A

bowel preps
bowel obstruction
pancreatitis
blood loss

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90
Q

anesthetic causes of volume derangements

A

anesthetic hypotension
(vasodilation)
sympathetic blockade

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91
Q

surgical causes of volume derangements

A

hemorrhage
coagulopathy
decreased venous return
long operative time

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92
Q

when is hypervolemia clincally significant

A

> 10% above basewline

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93
Q

hypervolemia SE

A

incr morbidity
tissue edema
impaired wound healing
pulm edema
decr GI motility

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94
Q

what lab value reflects total body water status

A

serum sodium

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95
Q

what content in IV fluid dictates fluid distribution?

A

Na+

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96
Q

what factors influence total body water content

A

gender
age
nutritional status
disease state

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97
Q

TBW and age relationship

A

less water with increased age

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98
Q

neonates TBW

A

70-80% of body weight is water

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99
Q

calculating TBW

A

50-60% of body weight

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100
Q

ICF:ECF

A

2:1

2/3 ICF and 1/3 ECF

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101
Q

ECF

A

interstitial fluid (3)
plasma (1)

ISF: plasma = 3:1

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102
Q

electrolyte content of ECF

A

Na+
Cl-

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103
Q

electrolyte content of ICF

A

K+
Phosphate

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104
Q

what is colloid osmotic pressure

A

pulls fluid into vessels

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105
Q

what maintains fluid components of blood within vessels?

A

colloid osmotic pressure (oncotic pressure)

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106
Q

what changes oncotic pressure

A

allbumins
proteins
etc

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107
Q

what is hydrostatic pressure

A

pushes fluid out of vessels

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108
Q

what is osmolar force

A

push and pull in and out of vessels

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109
Q

what does lactate do in LR?

A

provides circulating bicarb to provide normal HCO3- levels during acidosis

???????

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110
Q

what is the main contributor of osmolarity

A

sodium

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111
Q

Tonicity of Crystalloids

A

isotonic

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112
Q

Distribution of water

A

ECF and ICF

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113
Q

distribution of saline/LR

A

distributes only to ECF

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114
Q

distribution of colloids

A

distributes only to intravascular space

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115
Q

colloid types

A

albumin
hetastarch
dextrans

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116
Q

HES SE

A

acute kidney
incr moprtaloity
incr need to PRBC transfusion

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117
Q

albumin

A

source of capillary oncotic pressure (80%)

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118
Q

types of albumin

A

hyperoncotic (25%)
5% albumin (isotonic to plasma)

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119
Q

pts low in albumin

A

nutritionally deficient
renal disease
liver disease

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120
Q

most potent colloid

A

25% albumin

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121
Q

Hetastarches (HES)

A

amylopectin and synthetic glycogen

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122
Q

HES molecular weight

A

high MW = slower degradation

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123
Q

Dextrans

A

long chains of glucose (polysaccharides)

124
Q

Dextran unique property

A

rhological properties
– moderate plt function
– antithrombotic

used in vascular sx to prevent post-op stroke

125
Q

typical water loss per day

126
Q

causes of increased water loss

A

fever
sweating
gastric
colon
insensible losses

127
Q

normal Na loss

A

77 mEq/day

128
Q

normal K loss

A

40-60 mEq/day

129
Q

normal Cl loss

A

same as sodium

130
Q

where will LR/Saline distribute

A

ECF- 1/4 IV 3/4 IS

131
Q

where will D5W distribute

A

ECF and ICF proportionally

132
Q

where will Albumin distribute

A

intravascular space

133
Q

best fluid for maintenance

A

D5W + 0.225% NaCl

134
Q

best fluid for metabolic acidosis

135
Q

preferred IVF in anesthesia

136
Q

which colloid solutions have a risk for bleeding

A

6% hetastarch, Dextran 40

137
Q

how to calculate total body water

138
Q

N/S SE

A

hyperchloremic acidosis
reduction of renal perfusion

139
Q

water distribution

A

across all compartments

vascular compartment
Interstitial space
cell membranes

140
Q

Na+ distribition

A

capillary membrane
interstitial fluid

pumped out of cell

141
Q

colloids distribution

A

confined to vascular compartment

does not cross into capillary membrane

142
Q

crystalloids use

A

mx
replacement of losses
treatments of symptoms
– fluid or electrolyte deficits

143
Q

colloids uses

A

add oncotic pressure
volume replacement
rheologic propoerties

144
Q

sensible loses

A

measurable

145
Q

insensible losses

A

respriation
fever
evaproration (surgical)

146
Q

adult fluid maintenance

A

30mL/kg/day

147
Q

minimal losses

148
Q

moderate losses

149
Q

severe losses

150
Q

what fluid dosing is recommended during major invasive surgery?

A

zero balance approach
- only fluid lost is replaced

151
Q

mechanism of action of local anesthetics

A

Block voltage-gated sodium channels

152
Q

what does Blockage of voltage-gated sodium channels do

A

blocks generation and conduction of action potentials

153
Q

when do local anesthetics gain access to Na channels

A

during activated state

154
Q

when is the affinity of LA for Na channels greater

A

when Na channels are open

155
Q

what does the lipophillic region of LA affect

A

onset of action
potency
duration

156
Q

increasing lipophilicity

A

increases potency
slower onset

157
Q

what does ester or amide linkage of LAs affect

A

duration of action

158
Q

if someone has an allergy to amid local anesthetics, can you safely give an ester?

A

yes (& vice versa)

159
Q

what does a higher % neutral affect

A

enhanced absorption

160
Q

how does % neutral affect absoprtion

A

neutral form penetrates the membrane

161
Q

what do we want the pKa of the LA to be

A

closest to physiologic pH

162
Q

what is the determining factor for LA toxicity

A

vascularity

163
Q

Vascularity ranking Highest to lowest

A

HIGH
IV
tracheal
intercostal
caudal
paracervical
epidural
brachial plexus
subarachnoid/sciatic/femoral
subQ
LOW

164
Q

what does the risk for systemic LA toxicity depend on

A

lipid solubility
amount of connective tissue in area
pH of tissue
% neutral
is epi added?

165
Q

how does lipophilicity and tissue protein binding affect duration

A

remains in tissue longer

166
Q

how does epi affect the LA

A

makes LA more acidic

167
Q

what does bicarb addition to epi + LA

A

makes it neutral for a faster onset

168
Q

what delays LA redistribution

A

vasoconstriction

169
Q

why is epi added to local?

A

prolongs duration of action
reduced peak serum concentration

170
Q

onset of LA: lipid solubility

A

less lipid soluble = less potent

(typically delays onset)

171
Q

duration of action of LA

A

potency
lipid solubility - more = slower diffusion = longer DOA

172
Q

what type of axon is more sensitive to LA blcok

A

myelinated

173
Q

what is the most common feature of LAST

174
Q

what does a low CC/CNS ratio mean

A

more cardiotoxic

175
Q

what does a high CC/CNS ratio mean

A

more CNS toxiv

176
Q

what type of pt is at increased risk for LAST

A

pregnant elderly
neonate

177
Q

how to treat LAST

A

lipid emulsion 20% IV, 100 ml bolus over 2-3 min
rebolus 200 mil over 15-20 in

178
Q

Lidocaine maximum dose

179
Q

Lidocaine + Epi maximum dose

180
Q

ropivacaine max dose

181
Q

bupivacaine max dose

182
Q

lidocaine pKa

183
Q

ropivacaine/bupivacaine pKa

184
Q

how does pKa affect onset

A

pKa closer to physiologic pH = higher % neutral, faster onset

185
Q

which local anesthetics can cause methemoglobinemia

A

prilocaine and benzocaine

186
Q

which local anesthetics are more cardiotoxic

A

bupivacaine

187
Q

which local anesthetics are more CNS toxic

A

mepivacaine

188
Q

what does extreme lipophilicity promote

A

continued binding and increased duration of action

189
Q

LA that is extremely lipophilic

A

bupivacaine

190
Q

what LA property does protein binding affect

A

duration of action

191
Q

what LA property does pKa affect

A

onset of action

192
Q

what correlates with toxicity risk

A

Cmax
time to Cmax

193
Q

what drugs could be used to manage LA systemic toxicity

A

epinephrine, amiodarone
midazolam
lipid emulsion

194
Q

What is the minimum inhibitory concentration (MIC)?

A

lowest concentration of a given antimicrobial that will inhibit an organisms growth

195
Q

bacteriostatic

A

do not kill organism
interfere w/growth/replication

196
Q

bacteriocidal

A

kill the organism

197
Q

how is antibiotic susceptibility related to MIC

A

MIC increases with reduced susceptibility

198
Q

when does resistance occur

A

when MIC exceeds the tolerable dose

199
Q

What is the post-antibiotic effect?

A

Bacterial killing continues after the serum level drops below the MIC

200
Q

what is time dependent killing

A

cidal activity continues as long as the concentration in plasma is greater than MIC

201
Q

for a long surgery, what abx do you need to re-dose

A

time-dependent agents

202
Q

what is an example of time dependent killing

A

beta lactams

203
Q

what is concentration dependent killing

A

efficacy increases as concentration increases

204
Q

examples of concentration dependent killling

A

aminoglycosides and quinolones

205
Q

what type are antibiotics are typically bacteriostatic

A

protein synthesis inhibitors

206
Q

characteristic of a bacteriostatic antibiotic

A

interfere with growth and replication

207
Q

what is empiric therapy

A

treat based on most likely organisms

208
Q

what type of antibiotics are typically bactericidal

A

cell wall acting

209
Q

when are bactericidal abx always used

A

immunosuppressed or severe infection

210
Q

definitive therapy

A

treat based on identified organism

211
Q

preventative therapy

A

prophylaxis based on the most likely organism

212
Q

post antibiotic effect

A

Persistent suppression of bacterial growth after antibiotic concentration has fallen below the specified MIC is known as

213
Q

Antibiotic which may prolong the neuromuscular blocking effects of rocuronium

A

levofloxacin

214
Q

When this agent is combined with ampicillin, it extends the spectrum of activity to be active against more gram negative and anaerobic bacteria

215
Q

The mechanism of action of cefotetan is

A

inhibition of crosslinking of peptidoglycan to inhibit bacterial cell wall synthesis

216
Q

Prolonged QT on ECG and cardiac arrhythmia is a possible risk with

A

quinolones

217
Q

antibiotic to avoid in a pregnant patient

A

doxycycline

218
Q

Agent that may be used for decolonization of patients who are nasal carriers of MRSA and MSSA

219
Q

vancomycin is associated with all of the following adverse effects except

220
Q

Select the antiemetic agent that is associated with dry mouth, blurry vision, and may cause cognitive impairment in elderly patients:

A

scopalamine

221
Q

An agent that may be useful for late or delayed nausea and vomiting:

A

palonosetron

222
Q

Dexamethasone IV injection has been associated with:

A

perineal burning sensation

223
Q

A patient treated with droperidol in the PACU develops an acute and painful cervical dystonic reaction. Select appropriate therapy to relive the dystonia

A

diphenhydramine or glycopyrrolate

224
Q

Are beta lactams bactericidal or bacteriostatic?

A

bactericidal

225
Q

beta lactams MOA

A

Inhibition of cell wall synthesis: Interference with peptidoglycan crosslinking

226
Q

penicillins spectrum

A

G+, G-,
non-b lactamase anaerobes (broad spectrum) (streph/staph)

227
Q

Penicillins: Adverse Effects

A

hypersensitivity reaction, seizure

228
Q

difference between cephalosporins and penicillins

A

more stable against bacterial beta lactamase

229
Q

1st gen cephalosporin

230
Q

1st gen cephalosporin coverage

A

gram positive, some gram negative

231
Q

2nd gen cephalosporin

A

Cefotetan (also anaerobes)
cefoxitin

232
Q

2nd gen cephalosporin coverage

A

gram positive, more gram negative

233
Q

3rd gen cephalosporin

A

Ceftriaxone

234
Q

3rd gen cephalosporin coverage

A

decreasing gram positive, increasing gram negative

235
Q

4th gen cephalosporin

236
Q

4th gen cephalosporin coverage

A

G+, G-, pseudomonas

237
Q

5th gen cephalosporin

A

Ceftaroline

238
Q

5th gen cephalosporin coverage

239
Q

cephalosporin adverse effects

A

allergy, bleeding, disulfiram reaction

240
Q

beta lactamase inhibitors

A

Clavulanate (amoxicillin or ticarcillin/clav
Sulbactam (ampicillin/sulb)
Tazobactam (piperacillin/tazo)

241
Q

beta lactamase inhibitors MOA

A

inactivate beta lactamase to make other abx more active

242
Q

carbapenems

A

Meropenem, Ertapenem
Doripenem

243
Q

carbapenems MOA

A

inhibit cell wall synthesis (resistant to beta lactamases)

244
Q

Carbapanems spectrum

A

gram positive, gram negative
anaerobes
pseudomonas

245
Q

Carbapenems adverse effects

A

seizure, renal impairment

246
Q

beta lactamase inhibitors spectrum

A

G+, G-
anaerobes

247
Q

vancomycin MOA

A

inhibits synthesis of cell wall precursors
D-Ala terminus inhibiting crosslinking

248
Q

Vancomycin spectrum

A

Gram +: enterococcus
MRSA
C. Diff

249
Q

what do we try to reserve vancomycin for?

A

MRSA treatment

250
Q

Vancomycin adverse effects

A

nephrotoxicity
ototoxicity
red man syndrome

251
Q

vancomycin infusion time

A

1 hr
avoids red man syndrome

252
Q

is vancomycin a beta lactam

253
Q

what drug is an alternative for penacillin allergies

A

vancomycin, macrolides

254
Q

aminoglycosides

A

gentamicin
neomycin
amikacin

255
Q

what drug is related to bowel prep or irrigation?

256
Q

aminoglycosides MOA

A

inhibit bacterial protein synthesis (30S subunit)

257
Q

Are aminoglycosides bactericidal or bacteriostatic?

A

bactericidal

258
Q

Aminoglycosides adverse effects

A

ototoxicity
nephrotoxicity
prolong neuromuscular blockade (NDMR)

259
Q

macrolides

A

erythromycin
clarithromycin
azithromycin

260
Q

macrolides MOA

A

inhibit protein synthesis (50S subunit)

261
Q

macrolides spectrum

A

G+, pneumococci

262
Q

macrolides adverse effects

A

GI effects, inhibit CYP 450

263
Q

tetracyclines

A

Tetracycline, Doxycycline
Minocycline

264
Q

tetracyclines MOA

A

inhibit protein synthesis (30S subunit)
inhibit adding next amino acid

265
Q

Are tetracyclines bacteriostatic or bactericidal?

A

bacteriostatic

266
Q

tetracyclines spectrum

A

Gram (+), mycoplasma, H. pylori, Chlamydia

267
Q

tetracyclines adverse effects

A

GI altered flora

268
Q

tetracyclines contraindications

A

pregnancy
causes bone deformities and teeth issue in fetus

269
Q

clindamycin MOA

A

inhibit protein synthesis (50S subunit)

270
Q

Is clindamycin bacteriostatic or bactericidal?

A

bactericidal

271
Q

clinda spectrum

A

most gram pos
most anaerobes

272
Q

Clindamycin adverse effects

A

C. diff, GI effects

273
Q

oxazolidinones

274
Q

oxazolidinones MOA

A

prevents formation of ribosome complex
23s ribosomal rna on 50s subunit

275
Q

oxazolidinones spectrum

A

G+ (MRSA, VRE, VRSA)
vanc resistant enterococci

276
Q

what do we reserve linexolid for

A

MRSA
vanc-resistant MRSA

277
Q

oxazolidinones adverse effects

A

MAO activity (degrades catecholamines - HTN response)
hematological (anemia, thrombocytopenia)
neuropathy

278
Q

DNA synthesis inhibitors

A

Quinolones

279
Q

quinolones

A

Ciprofloxacin
Levofloxacin
Ofloxacin
lomefloxacin
perfloxacine

280
Q

quinolones MOA

A

inhibit topoisomerase II (DNA gyrase)
inhibit topoisomerase IV

281
Q

quinolones spectrum

A

Broad (G+ and G-)
do not cover anaerobes

282
Q

Quinolones adverse effects

A

glycemia
QT prolongation
growing cartilage (CI for preg/peds)
tendonitics
enhance NMB

283
Q

quinolones CI for what pts

A

pregnant
peds

284
Q

antimetabolites (antifolates)

A

sulfonamides

285
Q

sulfonamides MOA

A

inhibit folate synthesis
(inhibit purine/DNA synthesis)

286
Q

sulfonamides spectrum

A

gram positives

287
Q

sulfonamides adverse effects

A

megaloblastic anemia,
leukopenia
granulocytopenia
vasculitis
cross reactivity

288
Q

metronidazole use

A

add when worried about anaerobes

289
Q

when to use metronidazole

A

abdominal
absesses
mixed infection

290
Q

mupirocin use

A

MRSA nasal colonization

291
Q

polymixins use

A

bactericidal for abdominal procedures

292
Q

when should the antibiotic be administered?

A

60 min prior to incision

293
Q

when should vanc and quinolone be administered

A

120 min prior to incision

294
Q

when should you give cefazolin?

A

30 mins prior

295
Q

when do you redose abx

A

sx longer than 4 hrs
major blood loss

296
Q

how long do you mx prophylaxis of abx

A

duration of sx
not greater than 24 hrs

297
Q

what is commonly used when there is a PCN allergy

A

vancomycin, clindamycin, erythromycin

298
Q

what abx do you give for b lactam allergy

A

vancomycin
clindamycin

299
Q

abx that impact NMJ (slower reversal)

A

aminoglycosides
quinolones
polymyxins
tetracyclines
clindamycin

300
Q

reversal of abx NMB prolongation

A

calcium
neostigmine (not polymixin)

301
Q

pt allergic to penicillin: what do you avoid?

A

penicillin
cefaclor
cefadroxil
cefatrizine
cefprozil
cephalexin
cephradine

302
Q

can you use cefazolin w/penicillin allergy

303
Q

what drugs should you avoid in pregnancy in third trimester

A

TMP/SMX
- displace bilirubin from albumin

304
Q

what drug should you avoid in all trimesters?

A

doxycycline
tetracycline
quinolones

305
Q

SCIP

A

quality measures to medicare for public display

Sp: Pharm 1 (9 decks)

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