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;
42 Cards in this Set
- Front
- Back
there is increasing evidence that antimicrobials are ___ and _____ used |
over, improperly
|
|
T/F choosing an antimic. is just matching a drug to a bug
|
F
|
|
4 steps of the systematic approach for AM selection
|
1. Confirm presence of infxn
2. ID the pathogen 3. select presumptive (empiric) therapy 4. monitor therapeutic response |
|
_____ are substances that cause fever
|
pyrogens
|
|
T/F you must have an infxn to have a fever
|
F
|
|
what is a drug induced fever
|
persistent fever in absence of infxn which coincides w/ drug use and disappears when drug is D/Ced
|
|
What is the normal range for body temp in C
|
36-37.8
|
|
3 ways to confirm presence of infxn
|
fever
drug induced fever WBC count |
|
normal WBC count range
|
4-10K/mm
|
|
bact. infxns are associated w/ increased ___ counts
|
granulocyte
|
|
what type of WBC is especially elevated in bact. infxn
|
neutrophils
|
|
what form of neutrophil becomes more common in bact. infxn? What is this called?
|
immature forms
shift to the left |
|
factors that predispose to infxn
|
-alterations in normal flora of host
-disruption of natural barriers -Age -immunosuppression from malnutrition, DZ, hormones, drugs |
|
what should you get before any AM therapy and should you do it sooner or later?
|
a culture!
soon! delay can cause false negative esp. if drugs are given (will mask infxn) |
|
what is MIC?
|
minimum inhibitory conc. - the smallest conc. that will inhibit growth
|
|
what is MBC?
|
min. bactericidal conc. - the smallest conc. that will kill the org.
|
|
T/F it is more important to consider national and regional susceptibility data than local
|
F!
|
|
T/F every AM kills the bug that it treats
|
F
|
|
what bacteriostatic AM is hard to get in the US b/c of it's toxic side effects?
|
chloramphenicol
|
|
what do bacteriostatic AMs do?
|
inhibit protein synth. which prevents orgs. from growing
|
|
what is conc. dependent killing and give 2 examples of AMs with it
|
rate and extent of killing increases with increasing drug conc.
-ex. aminoglycosides and quinolones (floxacins) |
|
what is time dependent killing and give an example
|
bactericidal activity continues as long as serum conc. are greater than MBC
-ex. beta-lactams |
|
do you get better killing with a time dependent killing AM if you increase AM conc. above MBC?
|
NOPE
|
|
combination therapy ____ the spectrum of coverage and is esp. useful in what two types of infxns?
|
broadens,
mixed and nosocomial infxns |
|
what are the disadvantages of combo therapy?
|
-additive toxicity --> nephrotoxicity
-possible antagonism among agents ex. aminoglycosides are inactivated by penicillin |
|
what is the post-antibiotic effect (PAE) and what is it's mechanism?
|
persistent suppression of growth after drug is gone
-mechanism unknown (may be lag phase of bact. growth) |
|
what is the clinical relevance of post-antibiotic effect?
|
-once daily dosing
-enhanced bactericidal activity -less toxicity* -lower monitoring costs |
|
what is post-antibiotic leukocyte enhancement (PALE)?
|
increased susceptibility of bact. to the phagocytic and bactericidal action of neutrophils
|
|
synergism can result in a __ fold or greater reduction in MIC/MBC of each drug when used in combo vs. alone
|
4
|
|
what are 3 mechanisms of synergism?
|
-blockade of sequential steps in a metabolic sequence ex. TMP/sulfa
-inhibition of enzymatic inactivation ex. penicillins and cephalosporings (unisyn) -enhancement of AM agent uptake ex. penicillin and aminoglycosides (break down cell wall and then kill) |
|
what are the mechanisms of antagonism
|
-inhibition of 'cidal' activity by 'static' agents
-induction of enzymatic inactivation ex. imipenem, cefoxitin, ampicillin -direct drug interaction |
|
What 2 AMs require serum conc. monitoring?
|
Aminoglycosides and Vanco
|
|
AMs are _____ in preventing infxns
|
effective
|
|
AM prophylaxis may be divided into ____ and ____
|
surgical and non-surg
|
|
surgical wound infxns increase the average hospital stay by __ days and inc. the bill by $_____
|
7.3,
$3152 |
|
surgical procedures that require AM prophylaxis include:
|
-contaminated and clean-contaminated operations
-ops in which postop infxn would be catastrophic i.e. open heart surg -clean procedures that involve prosthetics -any procedure in immunocompromised pt |
|
for surg. prophylaxis the AM must achieve conc. greater than ____ and must be present by _____
|
MIC
Time of incision |
|
T/F the surgical prophylaxis AM should have as broad of coverage as possible
|
F, should be active against common surgical wound pathogens
|
|
the _____ course of the ______ effective and _____ toxic AM should be used for surg. proph.
|
shortest possible;
most; least; |
|
What are some common errors in AM prophylaxis?
|
-selection of wrong AM
-admin. the 1st dose too late -failure to repeat doses during long procedures -excessive duration of proph. -inappropriate use of broad spectrum AM |
|
when do you administer nonsurgical prophylaxis
|
-indicated for those at high risk for temp. exposure to pathogens or b/c of underlying DZ
|
|
what is nonsurgical prophylaxis?
|
-prevention of colonization/asymptomatic infxn
-administration of drugs following colonization/inoculation BUT before development of DZ |