Principles Ii, Exam Final

Front 1

Why are prophylactic abx a crucial part of the intraop regimen?

Back 1

prevent surgical site infections (SSI), incr hospital stay 7 days per infection, incr likelihood for ICU

Front 2

SSI Process Measures
-antibx choice, timing, hair removal, dicontinuation of antibx and perioperative ?hypo/normo/hyper-thermia?

Back 2

normothermia

Front 3

What are MIC and MBC?

Back 3

minimum inhibitory concentration and minimum bacteriocidal concentration

Front 4

What are the dimension of antibiotic spectrum?

Back 4

- narrow vs broad
- bacteriostatic vs bacteriocidal
- resistant vs susceptible

Front 5

What are the indications of abx therapy?

Back 5

prophylactic, empiric, therapeutic

Front 6

What is abx selection based on?

Back 6

indication, allergies, organism susceptibility (most important factor is cultures), drug toxicity, antibacterial effect (Bacteriocidal/static), renal and hepatic fcn, site of infection (drug distribution to intrathecal/intratracheal), mode/frequency of abx admin, anticipated synergy, cost

Front 7

Some abx work via inhibition of cell wall _____. Examples of abx that work this way include...

Back 7

cell wall synthesis,

PCNs, cephalosporins, vancomycin,

Front 8

Some abx inhibit bacterial DNA, such as....

Back 8

fluoroquinolones, flagyl

Front 9

Some abx inhibit _______, such as aminoglycosides, clindamycin, macrolides, and tetracyclines.

Back 9

protein synthesis

Front 10

Some abx act as _____, such as sulfonamides and trimethoprim.

Back 10

antimetabolites

Front 11

Some abx disrupt the _____, such as amphotericin B, ketoconazole and nystatin.

Back 11

cell membrane

Front 12

What is the mechanism of action for beta-lactams?

Back 12

bacteriocidal , inhibit cell wall synthesis

Front 13

PCN, cephalosporins, carbapenems (imipenem), and monobactams (aztreonam) are all examples of what abx group?

Back 13

beta lactams

Front 14

PCN covers mostly _____ streptococci and mouth anaerobes. It is not useful in.....

Back 14

gram positive,
not useful in PCNase (beta-lactamase) producing staph, enterococcus, cdiff

Front 15

What are the 2 main examples of PCN types?

Back 15

PCN G and V

Front 16

PCN-PCNase resistant PCNs cover most ______, and are useful against ____ producing staph aureus.

Back 16

streptococci, beta-lactamase producing staph aureus

Front 17

PCN-PCNase resistant PCNs are not useful against

Back 17

gram negs, enterococcus

Front 18

Nafcillin, oxacillin, and methicillin are all examples of what type of abx?

Back 18

PCN-PCNase resistant PCNs

Front 19

This group of abx are extended spectrum PCNs that cover most streptococci, some gram pos and basic gram negs

Back 19

PCN-aminopenicillins

Front 20

PCN-aminopenicillins are not effective against ______.

Back 20

beta lactamase producing organisms.

Front 21

For gram pos and gram neg beta-lactamase producing organisms, which PCN-aminopenicillins are best used?

Back 21

-ampicillin/sulbactam (Unasyn)
-amoxicillin/clavulanate (augmentin)

Front 22

Anti-pseudomonas PCNs are most effective against

Back 22

gram neg rods, esp pseudomonas!

Front 23

Anti-pseudomonas PCNs are less effective against gram pos ______ producing organisms

Back 23

PCNase

Front 24

What are some examples of PCN-anti-pseudomonas abx?

Back 24

-ticarcillin- pseudomonas
-piperacillin- enterobacter and gram pos cocci
-piperacilin/tazobactam (zosyn)- piperacillin resistant gram negs and gram pos PCNase producing organisms

Front 25

This is a chemically modified version of PCN, composed of a beta lactam ring that inhibits cell wall synthesis

Back 25

cephalosporins

Front 26

About 5-10% of pts have a cross sensitivity between PCN and

Back 26

cephalosporins

Front 27

What are the advantages of cephalosporins over PCNs?

Back 27

beta lactam ring is much more resistant to beta lactamase, broader spectrum of activity

Front 28

With progressing cephalosporin generations, coverage against ___ increases and coverage against ____ decreases.

Back 28

incr gram neg
decr gram pos

Front 29

First gen cephalosporins are effective against gram pos cocci except _____ and _____. Also effective against basic gram negs.

Back 29

enterococci and MRSA

Front 30

First gen cephalosporins such as cefazolin and cephalexin (keflex) are no effective in treating ____.

Back 30

anaerobes

Front 31

Second generation cephalosporins are effective against

Back 31

- gram pos cocci
- improved gram neg coverage (h flu, enterobacter, proteus, neisseria)
-some anaerobes (cefotetan, cefoxitin)

Front 32

There are no 2nd gen cephalosporins effective against

Back 32

pseudomonas

Front 33

Cefotetan, Cefoxitin (Mefoxin) and Cefuroxime are all examples of

Back 33

2nd gen cephalosporins

Front 34

Cefuroxime is more effective than cefazolin in prophylaxis against

Back 34

MRSA wound infection

Front 35

Some 2nd gen cephalosporins may cause this side effect

Back 35

incr bleeding
-inhibits vit. K clotting factor

Front 36

______ are broad spectrum abx, resistant to most cephalosporinase. Also further diminished response to gram pos and staph aureus, with improved coverage to gram negs including pseudomonas.

Back 36

3rd gen cephalosporins

Front 37

3rd gen cephalosporins such as ceftriaxone, ceftazidime and cefotaxime are able to penetrate

Back 37

penetrate CSF

Front 38

4th gen cephalosporins, such as cefepime, are similar to 3rd gen but have better coverage against ____ and _____, which are resistant to 3rd gen.

Back 38

pseudomonas and enterobacter

Front 39

Carbapenems and monobactams are both

Back 39

beta lactam drugs

Front 40

These abx are excellent for most gram pos and gram negs, (but not MRSA), and also cover anaerobes (but not cdiff). There is a potential for cross allergy w PCN.

Back 40

carbapenems (imipenem, meropenem-can cause sz & LFT increase)

Front 41

These abx are excellent for gram negs including P aeruginosa, but have no gram pos or anaerobic coverage. They demonstrate little renal toxicity.

Back 41

monobactams (aztreonam)

Front 42

This abx works by inhibiting cell wall synthesis. It is excellent for gram pos coverage including MRSA and enterococci, but provides no gram neg coverage.

Back 42

vancomycin
-great for hardware placements

Front 43

This abx is given orally to treat cdiff colitis.

Back 43

vancomycin

Front 44

This vancomycin adverse rxn results from rapid IV admin.

Back 44

red man syndrome
-it is not an allergy rx d/t cytokine release
V/s: htn, tachycardia; tx: supportive (fluids & pressors)

Front 45

These 2 types of abx inhibit bacterial DNA

Back 45

fluoroquinolines and metronidazole

Front 46

This class of abx is bacteriocidal, mostly effective against gram negs (e coli, klebsiella, peudomonas, neisseria, moraxella, enterobacter). It has poor activity against strep, and is commonly used to treat UTI.

Back 46

2nd gen fluoroquinolones

ciprofloxacin and norfloxacin

Front 47

This class of abx has more gram pos coverage than ealy ones (against staph, strep and enterococcus), as well as gram neg coverage (inculding pseudomonas). It can also cover atypical bacteria such as legionella and chlamydia, but is not good for anaerobes.

Back 47

3rd gen fluoroquinolones

Front 48

This 3rd gen fluoroquinolone is excellent against gram negs and has improved staph coverage.

Back 48

levofloxacin

Front 49

4th gen fluoroquinolones have the same properties as 3rd gens but have improved coverage of _______ and decr activity against _______.

Back 49

improved pneumococcus
decr pseudomonas

Front 50

An example of a 4th gen fluoroquinolone that doesnt cover pseudomonas is

Back 50

gatifloxacin

Front 51

This type of abx is bacteriocidal, covers all anaerobes and protozoa (trichomonas, giardia, amoeba), but has no effect on aerobic organisms.

Back 51

metronidazole (Flagyl)

Front 52

A disulfiram-like reaction (abd cramps, vomiting, flushing, headache) can occur while taking flagyl if the pt ....

Back 52

drinks alcohol!

Front 53

______ are inhibitors of protein synthesis, are bacteriostatic, and an example is clindamycin.

Back 53

lincosamides

Front 54

______ are inhibitors of protein synthesis, are bacteriocidal, and examples are gentamycin, amikacin, tobramycin and streptomycin.

Back 54

aminoglycosides

Front 55

______ are inhibitors of protein synthesis,are bacteriostatic, and examples are erythromycin, azithromycin, and clarithromycin.

Back 55

macrolides

Front 56

_____ are inhibitors of protein synthesis, are bacteriostatic, and examples are minocycline, tetracycline, and doxycycline.

Back 56

tetracyclines.

Front 57

Chlorampenicol works by

Back 57

inhibition of bacterial protein synthesis

Front 58

This type of lincosamide covers most gram pos except enterococcus, and most anaerobes except cdiff. , but only limited coverage against gram neg aerobes.

Back 58

clindamycin

Front 59

______ are inhibitors of protein synthesis,are bacteriostatic, and examples are erythromycin, azithromycin, and clarithromycin.

Back 59

macrolides

Front 60

What are the potential adverse reactions to clindamycin

Back 60

-hypotension
- cdiff/pseudomembranous colitis
- SJS
- prolong NMB

Front 61

This type of ABX covers most gram negs including pseudomonas, some gramp pos (staphylococci, enterococci), but doesnt cover other gram pos or anaerobes

Back 61

aminoglycosides

Front 62

Gentamycin, tobramycin, and streptomycin are all examples of which kind of abx

Back 62

aminoglycosides

Front 63

What is the choice aminoglycoside to use in a bacteria resistant against gent and tobramycin?

Back 63

amikacin

Front 64

What are the adverse effects involved in aminoglycoside admin?

Back 64

- nephrotoxicity, ototoxicity
- potentiate non-depol. NMBs

Front 65

_____ such as erythromycin, cover organisms covered by natural PCN (most gram pos), gram neg except campylobacter and pateurella, and atypical bacteria (legionella, chlamydia, mycoplasma).

Back 65

macrolides

Front 66

This type of abx is well absorbed in the GI tract, and demonstrates poor activity w anaerobes.

Back 66

macrolides

Front 67

What adverse effects are associated w macrolide abx? (erythromycin)

Back 67

GI upset
Hepatic P450 inhibition
QT prolongation (can also be w/ zofran & roperidol)
painful infusion

Front 68

Antimetabolite abx such as trimethoprim sulfamethoxazole (TMP-SMX) work by

Back 68

synergistically inhibit bacterial folic acid synthesis

Front 69

Antimetabolite abx (bactrim) cover gram pos cocci, staph, strep, and gram negs. There is no ____ coverage. It is commonly prescribed for ____.

Back 69

anaerobic coverage,

pneumocytis carini

Front 70

What are the potential adverse effects of antimetabolite abx (bactrim)?

Back 70

-bone marrow suppression, Stevens Johnson Syndrome, fever, rash, photosensitivity, incr bilirubin, jaundice

Front 71

What considerations are made in prophylactic abx admin?

Back 71

-which drug
-dose
-timing
-speed of admin
-redosing
-duration

Front 72

Oral flora: Streptococcus Viridans is usual concern for ___ prophylaxis for ___

Back 72

dental prophylaxis for endocarditis

Front 73

SSi wound examples:
Clean
Clean-contaminated
Contaminated
Dirty or infected

Back 73

Clean- open wound; brain trauma
Clean-Cont- mouth or GI tract
Contaminated- dry gangrene, cardiac massage
Dirty or Infected- penetrating trauma

Front 74

Most important factor in selecting antibx is ...

Back 74

organ susceptibility

Front 75

Bacterial endocarditis pathogen S. aureous is caused by a high risk patient undergoing a procedure with active ___ infection

Back 75

staphylococcal

Front 76

Pts who have received antibiotics for surgical prophylaxis do not need additional prophylaxis for ___

Back 76

endocarditis

Front 77

No need for antibiotics agains endocarditis for __ or __ procedures

Back 77

GU or GI

Front 78

Examples of cardiac conditions w/ a high risk of endocarditis for which prophylaxis is recommended prior to some dental and respiratory tract procedures and procedures involving infected skin or musculoskeletal tissue...

Back 78

-prosthetic cardiac valve
-previous episode of infec. endocard.
-CHD, unrepaired cyanotic CHD
-Completely repaired CHD w/ prosthetic material or device
-repaired CHD w/ residual defects
-cardiac transplantation

Front 79

Antibx regimens for prophylaxis ag. bact. endocarditis:
Amoxicillin: 2 mg PO __ hour before procedure or
PCN allergy: Clindamycin 600 mg PO __ hour before proecure or
PCN allergy: Azithromycin 500mg PO 1 hour before procedure or
pt unable to take oral med: ampicillin 2 gm/IV 1 hour before procedure or
Cefazolin 1 gm im/iv ___ min. push prior to procedure

Back 79

1 hour
1 hour
5 min. push