selected topics Flashcards
What is the definition of Antimicrobial Stewardship (AMS)?
To optimize clinical outcomes while minimizing the unintended consequences of antimicrobial use including toxicity, selection of pathogenic organisms, and resistance.
AMS includes coordinated interventions designed to improve and measure the appropriate use of antibiotics.
What is Antimicrobial Resistance (AMR)?
A global threat with deaths attributed to resistant infections projected to exceed 10 million annually.
Commonly resistant pathogens include Gram-negative bacteria like Pseudomonas aeruginosa.
What percentage of Pseudomonas aeruginosa isolates in the U.S. are categorized as multidrug resistant (MDR)?
15-20%
MDR refers to non-susceptibility to at least one antibiotic in three or more antibiotic classes.
What is the range of antimicrobial use in hospitals that is often inappropriate?
30-50%
A majority of antimicrobials used for respiratory infections in adults in the emergency department are inappropriate.
What are some adverse effects associated with antimicrobials?
- Allergic reactions
- Drug interactions
- Side effects
- C. difficile infection
1 out of 5 ED visits due to an adverse event is related to antimicrobials.
What are the key components of a protocolized approach to sepsis management?
- Early Goal Directed Therapy (EGDT)
- Quick Sequential Organ Failure Assessment (qSOFA)
- National Early Warning Score (NEWS)
- Systemic Inflammatory Response Syndrome (SIRS)
These tools help in the early diagnosis and treatment of sepsis.
What is the definition of sepsis according to the Surviving Sepsis Campaign?
Life-threatening organ dysfunction caused by a dysregulated host response to infection.
What is septic shock?
Persistent hypotension requiring vasopressors to maintain mean arterial pressure despite elevated lactate (>2 mmol/L).
What are the two main mechanisms the body uses to increase cardiac output (CO) during hypovolemic shock?
- Increase heart rate and force of heart contractions
- Increase circulating volume
These mechanisms involve catecholamines and hormone release such as aldosterone and vasopressin.
What is the significance of the ‘Golden hour’ in sepsis management?
The first hour of treatment where specific interventions should be initiated to improve outcomes.
What are the components of the Sepsis Hour-1 Bundle?
- Oxygen
- Cultures
- IV fluids
- Antimicrobials
The bundle emphasizes rapid assessment and treatment to improve patient outcomes.
What is the role of pharmacists in sepsis management?
- Champion for AMS
- Develop AMS program
- Educate healthcare team about AMS
- Educate patients about proper use of antibiotics.
What is the WHO’s definition of acute poisoning?
An acute exposure to a toxic agent that may require medical intervention.
What is the DEFG approach in managing poisoned patients?
- D: Decontamination
- E: Enhanced elimination
- F: Focused antidote therapy
- G: Get help from a poison control center or toxicologist.
What is a toxidrome?
A collection of symptoms that occur with particular classes of toxic agents.
Fill in the blank: The treatment for anticholinergic toxidrome includes _______.
Physostigmine (reserved for patients with severe agitation/delirium).
What are common signs of opioid toxidrome?
- Bradycardia
- Decreased bowel sounds
- Decreased respirations
- Hypotension
- Miosis
- Sedation.
What is the initial step in the emergency evaluation of a poisoned patient?
Initial stabilization: Airway, breathing, circulation (ABC).
What is the contraindication for gastric lavage?
Craniofacial abnormalities, concomitant head trauma, unprotected airway.
What is the recommended dosing for activated charcoal in adults?
Adult Dosing: 25-100 g within 60 minutes of ingestion.
What is the recommended volume of aliquots for gastric lavage?
200-300 mL
Aliquots should be instilled until there is clearing of aspirated fluid.
What is the primary purpose of gastric lavage?
Remove toxins or prevent further absorption
What is the dosage range for activated charcoal in patients older than 12 years?
25-100 g
When should activated charcoal be administered?
Within 60 min of ingestion
What is the mechanism of action of activated charcoal?
Adsorbent that works by binding the toxin to reduce systemic absorption
Which agents is activated charcoal not recommended for?
- Alcohols
- Acids
- Hydrocarbons
- Carbamates
What is the toxic dose of paracetamol (acetaminophen) for acute ingestion?
150 mg/kg or greater than 7 g in adults
What constitutes chronic toxicity of paracetamol?
150 mg/kg/day (6 g/day) ingested for 2 days or longer
What is the primary detoxification method for paracetamol?
Glucuronide and sulfate conjugates
What toxic intermediate is produced from paracetamol metabolism?
N-acetyl-para-benzoquinone imine (NAPQI)
What happens to glutathione in paracetamol overdose?
Depleted, leading to hepatotoxicity and cell death
What is the role of acetylcysteine in paracetamol toxicity?
Replenishes cysteine for glutathione synthesis
What are the signs and symptoms in Phase I of paracetamol toxicity?
- Minimal or no signs of distress
- Nausea
- Vomiting
- Diaphoresis
- Anorexia
What occurs during Phase II of paracetamol toxicity?
- Initial hepatocyte damage
- Right upper quadrant pain
- Elevated liver transaminases
- Elevated total bilirubin concentrations
- Prolonged prothrombin time
What peak effects are observed in Phase III of paracetamol toxicity?
- Lactic acidosis
- Acute renal failure
- Acute pancreatitis
- Fulminant hepatic failure
What characterizes Phase IV of paracetamol toxicity?
Recovery phase if the patient survives Phase III
What is the loading dose for the 21-hour IV protocol of N-acetylcysteine?
Up to 15 g in 200 mL dextrose 5% water over 60 minutes
What is the loading dose for the 72-hour oral NAC protocol?
140 mg/kg loading dose orally
What adverse effects are associated with oral N-acetylcysteine?
Nausea, vomiting
What adverse effects are associated with intravenous N-acetylcysteine?
- Anaphylactoid reactions
- Hyponatremia
- Hypervolemia
- Seizures
What is the purpose of the Rumack-Matthew Nomogram?
Stratify patients at high risk for hepatotoxicity after a single ingestion
What is the serum acetaminophen concentration considered safe?
10 to 20 mcg/mL
What category did the patient fall into based on the Rumack-Matthew nomogram?
Probable risk category
What is the role of pharmacists in the management of antidotes?
Develop standardized protocols for emergency administration of antidotes
True or False: Gastric lavage is recommended for all toxic ingestions.
False
