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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
what are macrolides used for
gram positives and atypical pneumonia (legionella, mycoplasma)
26
give e.g. lincosamides
clindamycin
27
use of lincosamides
gram positives-s.aureus, GAS, anaerobes cellulitis if penicillin allergy necrotising fascitis-as turns off toxins made by gram posive bugs
28
give e.g. tetracyclines
doxycycline
29
use doxycycline
broad spectrum but mainly gram positibe cellulitis if penicillin allergy chest infections
30
use of ciprofloxacin
gram negative > gram positibe UTIs, gallbladder infections, abdo infections
31
uses of trimethoprim
broad spectrum but mainly gram negatives UTIs
32
uses nitrofurantoin
gram negatives UTIs
33
what beta lactams can be used for gram negatives
amoxicillin-clavulanate piperacillin-tazobactam meropenem cefuroxime ceftriaxone cefotaxime
34
done first 4 recorded lectures (antivirals not useful)
35
difference between inhaler and nebuliser
inhaler=powder nebuliser=aerosol
36
categories of bronchodilators
adrenergic (sympathetic)=cause bronchodilation anti-cholinergic (parasympathetic)=block bronchoconstriction
37
how do B2 adrenoreceptor agomists work
cause smooth muscle relaxation and bronchodilation inhibit histamine release from lung mast cells
38
saba
salbutamol
39
laba
salmeterol, formoterol
40
how do muscarinic receptor antagonists work
block muscarinic receptors on airway smooth muscle, glands and nerves to prevent muscle contraction, gland secretion and enhance NT release
41
e.g. muscarinic receptor antagonists
atropine ipatropium bromide
42
what effect do glucocorticoids have on airway
anti-inflammatory suppress production chemotactic mediators reduce adhesion molecule expression inhibit inflammatory cell survival
43
ICS e.g.
beclomethasone dipropionate budesonide ciclesonide mometasone furoate
44
side effects ICS
loss of bone density adrenal suppression catacacts, glaucoma
45
ASA grading
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
Pre-optimisation before theatre
bp monitoring urinary catheter central venous access inotropic support CO monitoring maximise o2 delivery to supranormal levels
47
premedication before theatre
analgesia, sedatives, antiemetics, antacids
48
drugs omitted pre-op for elective surgery
ACEi 24-72h angiotensin receptor anatgonists 24-72h anti tnf 2w platelet i 7-10d doacs 3-4d
49
nsaids mechanism of action
inhibit cox enzyme therefore reduce prostaglandins, prostacyclin and thromboxanes
50
nsaids adverse effects
gastric (peptic ulceration), coag, resp (can precipitate severe asthma), renal (can cause renal failure if bleeding or bp low), cardiac
51
COX1
constitutive form present in tissues inhibition leads to gi se
52
cox2
inducible form present at sites of inflammation inhibition probably responsible for anti inflammatory properties of nsaids
53
cox 2 inhibitor
parecoxib-dynastat
54
when to avoid nsaids
renal impairment hyperkalaemia hypovolaemia circulatory failure severe liver dysfunction cardiac disease, MI, CVA
55
when to use nsaids with caution
>65 dm arteriopathy cardiac/hepatobilliary/major vascular surgery orthopaedics 48hr post op
56
intraoperative drugs
oxygen fluids blood products abx anaesthesia anagesia muscle relaxants
57
anaesthetic agents
inhalational most common IV often used for induction
58
desflurane
inhalational-fluorinated hydrocarbon v bad for environment rapid recovery possible reduction in post op cognitive dysfunt
59
TIVA
total intravenous anaesthesia no bad greenhosue gas effects
60
muscle relaxation for anaethesia types
depolarising (non-competative)-suxamethonium non-depolarising (competative)-rocuronium, atracurium
61
sugammadex
reversal of neuromuscular block due to rocuronium or vecuronium rescue reversal dose 16mg/kg time 1.5 mins only use in emergency
62
post op drugs
analgesia fluids blood products inotropes/vasopressors anti-emetics, anti-coag, abx
63
regional anaesthesia for pain
regional blocks epidural: local anaesthetic +/- opioid, continuous infusion
64
what weight should fluids be based on
IBW (M=H in cm-88, F+ h in cm - 92
65
blood vol in adults
70ml/kg
66
blood vol children
80ml/kg
67
blood vol neonates
90ml/kg
68
constituents of ECF
more sodium Na=140, K=4, Ca=2, Mg=1, Cl=105
69
constituents ICF
more potassium Na=10, K=150, Ca=3, Mg=30, Cl=3
70
colloids
large molecules in liquid medium e.g. blood, albumin
71
crystalloids
salty water e.g. saline, hartmanns, 5% desxtrose
72
water requied per kg
25-30ml
73
Na required per kg
1-2mmols
74
K required per kg
1 mmols
75
energy required per kg
30kcal
76
glucose required to prevent ketoacidosis
50-100g per day
77
loss of fluid
sensibble=visible insensible=not e.g. sweat, 3rd spacing
78
signs severe dehydration
2+: lethargy, loc, sunken eyes, poor or cant drink, skin trugor >2s
79
obs suggesting fluid resus
BP<100, HR>90, CRT>2s, cold peripheries, RR>20, NEWS >/=5, leg lifting
80
principles of fluid resus
calculate deficit ongoing requirements monitor results USE FLOW CHART ON FLUID CHART
81
check before prescribign paracetamol
liver impairment severe cachexia (<50kg max 500mg qds)
82
check before nsaids
renal and platelet count CI: GI bleeding, ulcer hx, asthma other meds: warfarin, digoxin, steroids
83
bioavailability IV infusions
approx 100%
84
vancomicin infusion
500mg in 100mls normal saline over 2hrs
85
amiodarone infusion
in emergency: 300mg in 100mls over 30 mins once stable 900mg over 24hrs
86
propofol infusion
total IV anaesthesia monitor depth using EEG
87
heparin infusion
emergency anticoag 1000 international units per ml, 3000 units usually enough for 24h
88
noradrenaline infusion
septic shock 4/8/16mg in 50ml via central line at 0.01-1 microgram/kg/min
89
patient controlled morphine infusion
50mg morphine in 50mls bolus 1mg, 5 min lockout, max 12mg/hr

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