Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
90 Cards in this Set
- Front
- Back
|
Which antibiotics are commonly used for anaerobic infections? |
- Metronidazole - Clindamycin - Cefoxitin - Cefotetan - Imipenem - Ticarcillin-Clavulanic Acid - Unasyn (Ampicillin-Sulbactam) - Augmentin (Amoxicillin-Clavulanic Acid) |
|
|
Which antibiotics are commonly used for Gram negative infections? |
- Gentamicin and other aminoglycosides - Ciprofloxacin - Aztreonam - 3rd gen cephalosporins (ceftriaxone, cefotaxime, ceftazadime) - Sulfamethoxazole-Trimethoprim (Bactrim) |
|
|
Which antibiotic, if taken with alcohol will produce a disulfiram-like reaction? |
Metronidazole (Flagyl) |
|
|
What is the drug of choice for treating amoebic infections? |
Metronidazole (Flagyl) |
|
|
Which antibiotic is associated with cholestasis? |
Ceftriaxone (Rocephelin) |
|
|
Which antibiotic cannot be given to children or pregnant women? |
Ciprofloxacin (interferes with the growth plate) |
|
|
With which common antibiotics must serum levels be determined? |
- Aminoglycosides - Vancomycin |
|
|
Is rash (only) in response to penicillins a contraindication to cephalosporins? |
No, but breathing problems, urticaria, and edema in response to penicillins ARE contraindications to cephalosporins |
|
|
What is Augmentin? |
Amoxicillin and Clavulanate |
|
|
What is Unasyn? |
Ampicillin and Sulbactam |
|
|
What is Cefazolin? Use? |
First-generation cephalosporin, surgical prophylaxis for skin flora |
|
|
What is Cefoxitin? Use? |
Second-generation cephalosporin: - Used for mixed aerobic/anaerobic infections - Effective against Bacteroides fragilis and anerobic bacteria |
|
|
What is Ceftazidime? Use? |
Third-generation cephalosporin: - Strong activity against Pseudomonas |
|
|
What is Clindamycin used for? |
- Strong activity against G- anaerobes (eg, B. fragilis) - Adequate G+ activity |
|
|
What is Gentamicin? Use? |
Aminoglycoside - Treat G- bacteria - Nephrotoxic, ototoxic, blood peak/trough levels should be monitored |
|
|
What is Imipenem and Cilastatin (Primaxin)? |
- Often used as a last resort against serious, multi-resistant organisms - Usually combined with cilastin, which inhibits renal excretion of imipenem - Has a very wide spectrum |
|
|
What is Metronidazole used for? |
- Serious anaerobic infections (eg, diverticulitis) - Amebiasis - Must abstain from alcohol use during therapy |
|
|
What is Nafcillin? Use? |
Anti-staphylococcal penicillin - Commonly used for cellulitis |
|
|
What is Vancomycin used for? |
- MRSA - C. difficile pseudomembranous colitis (poorly absorbed from gut) - With IV admin, peak/trough levels should be monitored |
|
|
What is Ciprofloxacin? Use? |
Quinolone antibiotic - Broad-spectrum activity, especially against G- bacteria (including pseudomonas) |
|
|
What is Aztreonam? Use? |
Monobactam - G- spectrum |
|
|
What is Amphotericin? Use? |
IV antifungal antibiotic associated with renal toxicity, hypokalemia |
|
|
What is Fluconazole? Use? |
Antifungal agent (IV or PO) not associated with renal toxicity |
|
|
What is Nystatin? Use? |
PO and topical antifungal |
|
|
What are the steroid side effects? |
- Adrenal suppression - Immunosuppression - Weight gain with central obesity - Cushingoid facies - Acne - Hirsutism - Purple striae - Hyperglycemia - Sodium retenion / hypokalemia - HTN - Osteopenia - Myopathy - Ischemic bone necrosis (avascular necrosis of hip) - GI perforations |
|
|
What are the uses of steroids? |
- Immunosuppression (transplant) - Autoimmune diseases - Hormone replacement (Addison's disease) - Spinal cord trauma - COPD |
|
|
Can steroids be stopped abruptly? |
No, steroids should never be stopped abruptly; always taper |
|
|
Which patients need stress-dose steroids before surgery? |
- Those who are on steroids - Those who were on steroids in past year - Those who have suspected hypoadrenalism - Those who are about to undergo adrenalectomy |
|
|
What is the "stress dose" for steroids? |
100 mg of hydrocortisone IV every 8 hours and then taper (adults) |
|
|
Which vitamin helps counteract the deleterious effects of steroids on wound healing? |
Vitamin A |
|
|
Describe the action of heparin? |
Heparin binds with and activates antithrombin III |
|
|
What are the uses of heparin? |
Prophylaxis/treatment: - DVT - PE - Stroke - A Fib - Acute arterial occlusion - Cardiopulmonary bypass |
|
|
What are the side effects of heparin? |
- Bleeding complications - Can cause thrombocytopenia |
|
|
What reverses the effects of heparin? |
Protamine IV (1:100, 1 mg of protamine to every 100U of heparin) |
|
|
What lab test should be used follow effect of heparin? |
aPTT - activated partial thromboplastin time |
|
|
What is the standard lab target for therapeutic heparinization? |
1.5-2.5x control or measured antifactor X level |
|
|
Who is at risk for a protamine anaphylactic reaction? |
Patients with type 1 DM, s/p prostate surgery |
|
|
What is the half-life of heparin? |
~90 minutes (1-2 hours) |
|
|
How long before surgery should heparin be discontinued? |
4-6 hours pre-op |
|
|
Does heparin dissolve clots? |
No, it stops the progression of clot formation and allows the body's own fibrinolytic system to dissolve the clot |
|
|
What is LMWH? |
Low Molecular Weight Heparin |
|
|
What lab test do you need to follow with LMWH? |
None, except in children, pts with obesity, and those with renal failure, which is the major advantage (check factor X levels) |
|
|
Action of Warfarin? |
Inhibits vitamin K-dependent clotting factors II, VII, IX, and X (ie 2, 7, 9, 10), produced in liver |
|
|
What are the uses of warfarin? |
Long-term anticoagulation (PO) |
|
|
What are the risks of warfarin? |
- Bleeding complications - Teratogenic in pregnancy - Skin necrosis - Dermatitis |
|
|
What lab test should be used to follow the effects of warfarin? |
PT (prothrombin time) as reported as INR |
|
|
What is INR? |
International Normalized Ratio |
|
|
What is the classic therapeutic INR? |
INR of 2-3 |
|
|
What is the half-life of effect? |
40 hours; thus, it takes about 2 days to observe a change in the PT |
|
|
What reverses the cessation of warfarin? |
- Cessation - Vitamin K - FFP (in emergencies) |
|
|
How long before surgery should wararin be discontinued? When can it be restarted? |
From 3-5 days pre-op and IV heparin should be begun; heparin should be discontinued from 4-6 hours pre-op and can be restarted post-op; Coumadin can be restarted in a few days |
|
|
How can warfarin cause skin necrosis when first started? |
Initially depressed protein C and S result in HYPERcoagulable state! Avoid by using heparin concomitantly when starting |
|
|
What is Sucralfate (Carafate)? Use? |
Treats peptic ulcers by forming an acid-resistant barrier; binds to ulcer craters; needs acid to activate and thus should NOT be used with H2 blockers |
|
|
What is Cimetidine (Tagamet)? Use? |
H2 blocker - treats ulcers/gastritis |
|
|
What is Ranitidine (Zantac)? Use? |
H2 blocker - treats ulcers/gastritis |
|
|
What is Ondansetron (Zofran) used for? Mechanism? |
Serotonin receptor blocker: - Anti-nausea - Anti-emetic |
|
|
What is the mechanism of PPI? |
Proton Pump Inhibitor - Gastric-acid secretion inhibitor - Inhibits K+/H+ ATPase
Eg, Omeprazole |
|
|
What is Promethazine (Phenergan)? Use? |
Acute anti-nausea agent; used post-op |
|
|
What is Metoclopramide (Reglan) used for? Mechanism? |
- Increases gastric emptying with increase in LES pressure - Dopamine antagonist - Used in diabetic gastroparesis and to help move feeding tubes past pylorus |
|
|
What is Haloperidol (Haldol) used for? Mechanism? |
Sedative/anti-psychotic - Side effects = extra-pyramidal symptoms, QT prolongation |
|
|
What are the contents of "albumin"? |
- 5% albumin OR - 25% albumin - draws extravascular fluid into intravascular space by oncotic pressure |
|
|
What is the mechanism/use of Albuterol? |
Inhaled beta-2 agonist - Bronchodilator |
|
|
What is Octreotide? |
Somatostatin analog |
|
|
Mechanism of Famotidine (Pepcid)? |
H2 blocker |
|
|
Mechanism of Aspirin? |
Irreversibly inhibits platelets by irreversibly inhibiting cyclooxygenase |
|
|
Mechanism of Furosemide (Lasix)? |
Loop diuretic - watch for hypokalemia |
|
|
Use of Dantrolene (Dantrium)? |
Treats malignant hyperthermia |
|
|
Mechanism of Misoprostol (Cytotec)? Use? |
- Prostaglandin E1 analog - Gastroduodenal mucosal protection |
|
|
What is an antibiotic option for colon/appendectomy coverage if the pt is allergic to PCN? |
1. IV ciprofloxacin (Cipro) AND 2. IV clindamycin or IV flagyl |
|
|
If the pt does not respond to a dose of furosemide, should the dose be repeated, increased, or decreased? |
Dose should be doubled if there is no response to initial dose |
|
|
What med is used to treat promethazine-induced dystonia? |
Diphenhydramine hydrochloride IV (Benadryl) |
|
|
What med is classically associated with mesenteric ischemia? |
Digitalis |
|
|
What type of anti-HTN med is contraindicated in pts with renal artery stenosis? |
ACE Inhibitors |
|
|
Does acetaminophen inhibit platelets? |
No |
|
|
What meds are used to stop seizures? |
Benzodiazepines (eg, Lorazepam/Ativan, Phenytoin/Dilantin) |
|
|
What is an example of a pre-op antibiotic used for vascular prosthetic grafts? |
Ancef/Cefazolin (G+ coverage) |
|
|
What is an example of a pre-op antibiotic used for an appendectomy? |
Cefoxitin, Unasyn (anaerobic coverage) |
|
|
What is an example of a pre-op antibiotic used for colon surgery? |
Cefoxitin, Unasyn (anaerobic coverage) |
|
|
What are common post-op IV narcotics? |
- Morphine (most common) - Meperidine (demerol) - Fentanyl - Percocet - Dilaudid |
|
|
What is Percocet? |
PO narcotic pain reliever with acetaminophen and oxycodone |
|
|
What is Demerol's (Meperidine) claim to fame? |
Used commonly with acute pancreatitis / biliary pathology because classically morphine may cause sphyincter of Oddi spasm/constriction |
|
|
What are the side effects of narcotics? |
- Respiratory depression - Hypotension - Itching - Bradycardia - Nausea |
|
|
What is the danger of prolonged use of Demerol? |
Accumulation of metabolite normperidine (especially with renal/hepatic dysfunction), which may result in oversedation, hallucinations, and seizures! |
|
|
What med reverses the effects of narcotic overdose? |
Naloxone (Narcan), 0.4 mg IV |
|
|
Narcotic used to decrease post-operative shivering? |
Demerol |
|
|
What reverses the effects of benzodiazepines? |
Flumazenil (Romazicon), 0.2 mg IV |
|
|
What is Toradol? |
Ketorolac = IV NSAID |
|
|
What are the risks of Toradol (Ketorolac)? |
- GI bleed - Renal injury - Platelet dysfunction |
|
|
Why give patients IV Cipro if they are eating a regular diet? |
No reason - 500 mg of Cipro PO gives the same serum level as 400 mg Cipro IV! And PO is much cheaper! |
|
|
What is clonidine "rebound"? |
Abruptly stopping clonidine can cause the pt to have severe "rebound" HTN (also seen with beta-blockers) |
