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finals > prescribing > Flashcards

prescribing Flashcards

1
Q

which abx work by binding to cell wall and inhibiting cell wall synthesis

A

beta lactams: penicillins and cephalosporins and carbapenems
glycopeptides also active against penicillin binding proteins

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2
Q

which abx work by inhibiting nucleic acid synthesis or function

A

metronidazole and rifampicin

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3
Q

which abx work by inhibiting DNA gyrase

A

fluroquinolones

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4
Q

which abx work by inhibiting ribosomal acitvity and protein synthesis

A

aminoglycosides, tetracyclines, lincosamides, macrolides, chloramphenicol

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5
Q

which abx wotk by inhibiting folate synthesis and carbon unit metabolism

A

sulphonamides and trimethoprim

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6
Q

baceriostatic

A

prevent growth of bacteria
abx that inhibit protein synthesis or DNA repication or metabolism
need a minimum inhibitory concentration

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7
Q

bactericidal

A

kills bacteria
abx that inhibit cell wall synthesis
needs a minimum bactericidal concentration

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8
Q

how to bacteria become resistant to abx

A

change abx target
destroy or inactivate abx with an enzyme-beta lactamase, penicillinase
prevent abx access-changing channel
remove abx from bacteria-using pump

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9
Q

how are bacteria abx resistance

A

intrinsic: equally resistant in population
acquired: spontaneous gene mutation, horizontal gene transfer( conjugation, transduction, transformation)

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10
Q

important gram positive resistant organisms

A

MRSA: staph aureus resistant to beta lactams and methicillin
VRE: enterococci resistant to vancomycin

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11
Q

important gram negative resistant organisms

A

ESBL: extended spectrum beta lactamase
AMpC beta lactamase resistance: broad spectrum penicilllin ,cephalosporin and monobactam resistnce

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12
Q

what to use for resistant gram negative bacteria

A

carbapenems
however also becoming resistant

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13
Q

what are beta lactams

A

penicillins, cephalosporins, carbapenems,

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14
Q

which bacteria have a bigger cell wall

A

gram positive

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15
Q

common causes skin infections

A

staph aureus, group a strep

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16
Q

common causes chest infections

A

strep pneumoniae

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17
Q

common cause throat infections

A

group a strep

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18
Q

common causes urine infection

A

e.coli, klebsiella sp, proteus sp

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19
Q

common causes gallbladder infections

A

e.coli, klebsiella sp, proteus sp

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20
Q

common causes abdo infections

A

e.coli, klebsiella sp, proteus sp

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21
Q

common causes infective diarrhoea

A

shigella, salmonella

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22
Q

why do beta lacatms work against gram positibe

A

target cell wall, gram positive have thick cell wall

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23
Q

when are vancomycin and teicoplanin useful

A

gram positive
MRSA
penicillin allergy

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24
Q

give e.g. macrolides

A

clarithromycin and erythromycin

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25
Q

what are macrolides used for

A

gram positives and atypical pneumonia (legionella, mycoplasma)

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26
Q

give e.g. lincosamides

A

clindamycin

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27
Q

use of lincosamides

A

gram positives-s.aureus, GAS, anaerobes
cellulitis if penicillin allergy
necrotising fascitis-as turns off toxins made by gram posive bugs

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28
Q

give e.g. tetracyclines

A

doxycycline

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29
Q

use doxycycline

A

broad spectrum but mainly gram positibe
cellulitis if penicillin allergy
chest infections

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30
Q

use of ciprofloxacin

A

gram negative > gram positibe
UTIs, gallbladder infections, abdo infections

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31
Q

uses of trimethoprim

A

broad spectrum but mainly gram negatives
UTIs

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32
Q

uses nitrofurantoin

A

gram negatives
UTIs

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33
Q

what beta lactams can be used for gram negatives

A

amoxicillin-clavulanate
piperacillin-tazobactam
meropenem
cefuroxime
ceftriaxone
cefotaxime

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34
Q

done first 4 recorded lectures (antivirals not useful)

A
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35
Q

difference between inhaler and nebuliser

A

inhaler=powder
nebuliser=aerosol

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36
Q

categories of bronchodilators

A

adrenergic (sympathetic)=cause bronchodilation
anti-cholinergic (parasympathetic)=block bronchoconstriction

37
Q

how do B2 adrenoreceptor agomists work

A

cause smooth muscle relaxation and bronchodilation
inhibit histamine release from lung mast cells

38
Q

saba

A

salbutamol

39
Q

laba

A

salmeterol, formoterol

40
Q

how do muscarinic receptor antagonists work

A

block muscarinic receptors on airway smooth muscle, glands and nerves to prevent muscle contraction, gland secretion and enhance NT release

41
Q

e.g. muscarinic receptor antagonists

A

atropine
ipatropium bromide

42
Q

what effect do glucocorticoids have on airway

A

anti-inflammatory
suppress production chemotactic mediators
reduce adhesion molecule expression
inhibit inflammatory cell survival

43
Q

ICS e.g.

A

beclomethasone dipropionate
budesonide
ciclesonide
mometasone furoate

44
Q

side effects ICS

A

loss of bone density
adrenal suppression
catacacts, glaucoma

45
Q

ASA grading

A

1-normal healthy
2-mild systemic disease
3-severe systemic disease
4-severe systemic disease, constant threat to life
5-moribund patient, not expected to survive over 24 hrs with/without surgery
6-declared brain dead, organ retrieval
ADD E IN EMERGENCY

46
Q

Pre-optimisation before theatre

A

bp monitoring
urinary catheter
central venous access
inotropic support
CO monitoring
maximise o2 delivery to supranormal levels

47
Q

premedication before theatre

A

analgesia, sedatives, antiemetics, antacids

48
Q

drugs omitted pre-op for elective surgery

A

ACEi 24-72h
angiotensin receptor anatgonists 24-72h
anti tnf 2w
platelet i 7-10d
doacs 3-4d

49
Q

nsaids mechanism of action

A

inhibit cox enzyme
therefore reduce prostaglandins, prostacyclin and thromboxanes

50
Q

nsaids adverse effects

A

gastric (peptic ulceration), coag, resp (can precipitate severe asthma), renal (can cause renal failure if bleeding or bp low), cardiac

51
Q

COX1

A

constitutive form
present in tissues
inhibition leads to gi se

52
Q

cox2

A

inducible form
present at sites of inflammation
inhibition probably responsible for anti inflammatory properties of nsaids

53
Q

cox 2 inhibitor

A

parecoxib-dynastat

54
Q

when to avoid nsaids

A

renal impairment
hyperkalaemia
hypovolaemia
circulatory failure
severe liver dysfunction
cardiac disease, MI, CVA

55
Q

when to use nsaids with caution

A

> 65
dm
arteriopathy
cardiac/hepatobilliary/major vascular surgery
orthopaedics 48hr post op

56
Q

intraoperative drugs

A

oxygen
fluids
blood products
abx
anaesthesia
anagesia
muscle relaxants

57
Q

anaesthetic agents

A

inhalational most common
IV often used for induction

58
Q

desflurane

A

inhalational-fluorinated hydrocarbon
v bad for environment
rapid recovery
possible reduction in post op cognitive dysfunt

59
Q

TIVA

A

total intravenous anaesthesia
no bad greenhosue gas effects

60
Q

muscle relaxation for anaethesia types

A

depolarising (non-competative)-suxamethonium
non-depolarising (competative)-rocuronium, atracurium

61
Q

sugammadex

A

reversal of neuromuscular block due to rocuronium or vecuronium
rescue reversal dose 16mg/kg
time 1.5 mins
only use in emergency

62
Q

post op drugs

A

analgesia
fluids
blood products
inotropes/vasopressors
anti-emetics, anti-coag, abx

63
Q

regional anaesthesia for pain

A

regional blocks
epidural: local anaesthetic +/- opioid, continuous infusion

64
Q

what weight should fluids be based on

A

IBW (M=H in cm-88, F+ h in cm - 92

65
Q

blood vol in adults

A

70ml/kg

66
Q

blood vol children

A

80ml/kg

67
Q

blood vol neonates

A

90ml/kg

68
Q

constituents of ECF

A

more sodium
Na=140, K=4, Ca=2, Mg=1, Cl=105

69
Q

constituents ICF

A

more potassium
Na=10, K=150, Ca=3, Mg=30, Cl=3

70
Q

colloids

A

large molecules in liquid medium e.g. blood, albumin

71
Q

crystalloids

A

salty water e.g. saline, hartmanns, 5% desxtrose

72
Q

water requied per kg

A

25-30ml

73
Q

Na required per kg

A

1-2mmols

74
Q

K required per kg

A

1 mmols

75
Q

energy required per kg

A

30kcal

76
Q

glucose required to prevent ketoacidosis

A

50-100g per day

77
Q

loss of fluid

A

sensibble=visible
insensible=not e.g. sweat, 3rd spacing

78
Q

signs severe dehydration

A

2+: lethargy, loc, sunken eyes, poor or cant drink, skin trugor >2s

79
Q

obs suggesting fluid resus

A

BP<100, HR>90, CRT>2s, cold peripheries, RR>20, NEWS >/=5, leg lifting

80
Q

principles of fluid resus

A

calculate deficit
ongoing requirements
monitor results
USE FLOW CHART ON FLUID CHART

81
Q

check before prescribign paracetamol

A

liver impairment
severe cachexia (<50kg max 500mg qds)

82
Q

check before nsaids

A

renal and platelet count
CI: GI bleeding, ulcer hx, asthma
other meds: warfarin, digoxin, steroids

83
Q

bioavailability IV infusions

A

approx 100%

84
Q

vancomicin infusion

A

500mg in 100mls normal saline over 2hrs

85
Q

amiodarone infusion

A

in emergency: 300mg in 100mls over 30 mins
once stable 900mg over 24hrs

86
Q

propofol infusion

A

total IV anaesthesia
monitor depth using EEG

87
Q

heparin infusion

A

emergency anticoag
1000 international units per ml, 3000 units usually enough for 24h

88
Q

noradrenaline infusion

A

septic shock
4/8/16mg in 50ml via central line at 0.01-1 microgram/kg/min

89
Q

patient controlled morphine infusion

A

50mg morphine in 50mls
bolus 1mg, 5 min lockout, max 12mg/hr

finals (31 decks)

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