Selection Of Antimicrobials

Front 1

what is the systematic approach to selecting a anitmicrobial

Back 1

confirm presence of infection
identify pathogen
selection of presumptive therapy
monitor therapeutic response

Front 2

substance that causes fever

Back 2

pyrogens

Front 3

drug induced fever

Back 3

persistent fever in absence of infection which coincides with drug use disappears when drug is discontinued

Front 4

which counts are elevated in an infection

Back 4

granulocyte counts especially neutrophils often with immature forms

Front 5

predisposing factors to infection

Back 5

alterations in normal flora
disruption of natural barriers
age
immunosuppresion

Front 6

what things is immunosuppression secondary to

Back 6

malnutrition, underlying disease, hormones, drugs

Front 7

MIC

Back 7

minimum inhibitory concentration

Front 8

MBC

Back 8

minimum bacterial concentration

Front 9

susceptibility testing

Back 9

measure the concentration of drug to inhibit growth and kill the organism

Front 10

what susceptibility data should be considered

Back 10

local data

Front 11

bacteriostatic antibiotics

Back 11

inhibit protein synthesis and organisms are prevented from growing

Front 12

bacteriostatic antibiotics

Back 12

chloramphenicol
macrolides
sulfonamides
trimethoprin
clindamycin
nitrofurantoin
tetracyclines

Front 13

concentration dependent killing

Back 13

rate and extent of killing increases with increasing drug concentration

Front 14

examples of drugs with concentration dependent killing

Back 14

aminoglycosides
quinolones

Front 15

time dependent killing

Back 15

cidal activity continues as long as serum concentration are greater than the MBC

Front 16

examples of drugs with time dependent killing

Back 16

beta-lactams

Front 17

mixed infections

Back 17

multiple organisms may be present

Front 18

nosocomial infections

Back 18

infection due to procedure or hospital stay

Front 19

disadvantages of combined therapy

Back 19

additive toxicity(nephrotoxicity)
possible antagonism

Front 20

example of antagonism

Back 20

inactivation of aminoglycosides by penicillins

Front 21

post-antibiotic effect

Back 21

persistent suppression of growth after drug is gone

Front 22

antibacterials with PAE > 1.5hr against gram positives

Back 22

aminoglycosides
carbapenems
cephalosporins
clindamycin
macrolides
penicillin
sulfas
vanco

Front 23

antibacterials with PAE>1.5hr against gram negatives

Back 23

carbapenems
agents that inhibit protein synthesis of DNA synthesis

Front 24

clinical relevance of long PAE

Back 24

reduced dosing regimens
enhanced bactericidal activity
less toxicity
lower monitoring cost

Front 25

post antibiotic leukocyte enhancement

Back 25

increased susceptibility of bacteria to the phagocytic and bacteriocidal action of neutrophils

Front 26

synergism

Back 26

inhibitory/killing effect of 2 or more antimicorbials used together are significantly greater than expected from their effects when used individually

Front 27

synergistic effects of 2 or more antimicrobials on MIC and/or MBC

Back 27

synergism may be marked by a 4 fold or greater reduction in MIC or MBC

Front 28

possible synergistic mechanisms

Back 28

blockage of sequential steps in a metabolic sequence
inhibition of enzymatic inactivation
enhancement of antimicrobials agent uptake

Front 29

drugs with synergistic effect of blocking sequential steps in metabolic sequence

Back 29

TMP/sulfa

Front 30

drugs with synergistic effect of inhibition of enzymatic inactivation

Back 30

penicillins and cephalosporins

Front 31

drugs with synergistic effect of enhancment of antimicrobial agent uptake

Back 31

penicillin and aminoglycosides

Front 32

antagonism

Back 32

combined inhibitory or killing effects of 2 or more antimicrobials are significantly less than expected from their effects when used individually

Front 33

mechanisms of action of antagonism

Back 33

inhibition of cidal activity by static agents
induction of enzymatic inactivation
direct drug interaction

Front 34

when do you perform serum concentration monitoring

Back 34

when there is a relationship between drug concentration and efficacy, toxicity, etc

Front 35

what types of failure do you use monitoring for

Back 35

failure by drug selection, dosage, or route
failure by host factors
failure by microorganisms

Front 36

types of prophylaxis

Back 36

surgical
nonsurgical

Front 37

what types of surgical procedures require prophylaxis

Back 37

contaminated
clean-contaminated
procedures where post-op infection may be catastrophic
clean procedure which require placement of prosthetic material
immunocompromised patients

Front 38

clean procedure

Back 38

elective
primarily closed procedure
respiratory, GI, biliary, GU, or oropharyngeal tract not entered
no acute inflammation and no bread in technique

Front 39

expected rate of infection with clean procedure

Back 39

<2%

Front 40

clean contaminated

Back 40

urgent or emergency case that is otherwise clean
elective
controlled opening of respiratory, GI, biliary, or oropharyngeal tract
minimal spillage or minor break in techinique

Front 41

expected rate of infection for clean contaminated

Back 41

<10%

Front 42

contaminated

Back 42

acute nonpurulent inflammation
major technique break or major spill
penetrating trauma less than 4hr
chronic open wounds to be grafted or covered

Front 43

what is expected infection rate with contaminated procedure

Back 43

20%

Front 44

dirty

Back 44

purulence or abscess
preoperative perforation of respiratory, GI, biliary, or oropharyngeal tract
penetrating trauma more than 4hr

Front 45

expected rate of infection in dirty procedures

Back 45

40%

Front 46

main point for surgical prophylaxis

Back 46

must achieve greater than MIC of suspected pathogens and these concentrations must be present at the time of incision

Front 47

general principles for surgical prophylaxis

Back 47

should be active against common surgical pathogens
shortest possible course
least expensive if all else is equal

Front 48

common errors in surgical prophylaxis

Back 48

selecting wrong antibiotic
admin of first dose to early or too late
failure to repeat dose in prolonged cases
excessive duration
inappropriate use of broad spectrum antibiotics

Front 49

nonsurgical prophylaxis

Back 49

prevention and colonization or asymptomatic infection as well as the admin of drugs following colonization by or inoculation of pathogens but before the development of disease

Front 50

who is nonsurgical prophylaxis indicated for

Back 50

those at high risk for temporary exposure to selected virulent pathogens
patients at increased risk for developing infection because of underlying disease