Term
| For which types of surgeries is Cefazolin given? |
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Definition
| Gastroduodenal, Biliary, Uro, hyst or C-section, head and neck, cardiac, neuro, skin and vascular, ortho |
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Term
| What antibiotics are given for colorectal surgery? |
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Definition
| PO Neomycin and erythromycin pre-op, or cefoxitin or cefotetan IV |
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Term
| What antiobiotic beside cefazolin is given for head and neck surgery? |
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Definition
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Term
| What antibiotics are given for an appy? |
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Definition
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Term
| What is presumptive antibiotic therapy? |
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Definition
| Given when there is a strong possibility of an established infection. (acute cholecystitis or pancreatitis of less that 24 hour duration) |
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Term
| What is therepeutic antibitic therapy? |
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Definition
| Means there is an established infection such as finding a perforted appy or a gangrenous gallbladder. |
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Term
| Risk factors for surgical wound infections? |
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Definition
| microbiology of the surgical site, presence of an established infection, the risk of contaminating sterile tissue during surgery, and perioperative events. |
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Term
| Intrinsic patient risks that increase the risk of surgical wound infections? |
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Definition
| Diabetes, chronic immunosuppressed states (HIV, steroids, lymphomas), recent corticosteroid use, prolonged hospitalization, obesity, pre-existing infection. |
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Term
| Individual risks for surgical wound infections? |
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Definition
| >3 underlying medical diagnosis, abd operations >2 hours, contaminated or dirty procedures, ASA pre-op assessment score >=3 |
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Term
| Timing if antibiotics prior to surgery? |
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Definition
Give pre-op no sooner that 2 hours, if procedure .4 hrs, may need to repeat.
Bacteriocidal concentrations should be maintained during the procedure. Distal infections should be eradicated prio to procedure if possible. |
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Term
| How does Penicillin work? |
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Definition
| Beta-lactams interfere with the synthesis of peptidoglycan so the bacteria can't maintain the cell wall. |
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Term
| Adverse reactions with penicillins? |
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Definition
| hypersensitivity,^bleeding times with ticarcillin, mezocillin, pipercillin, superinfections(c-diff,fungus, pseudomonas), pseudomembranous colitis, electrolyte abnormalities |
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Term
| 1st generation cephalosporins? |
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Definition
| cefadroxil, cefazolin, cephalexin, cephadrin |
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Term
| 2nd generation cephalasporins? |
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Definition
| cefaclor, cefonacid, ceforinide, cefoxitin, cefuroxime, loracarbef, (cefamandol and cefotetan have MTT which can increase risk for bleeding) |
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Term
| 3rd generation cephalosporins? |
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Definition
| cefixime, cefoperazone(MTT), cefotaxime, cefpodaxime proxetil, ceftriaxone, ceftazadime |
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Term
| 4th generation cephalosporins? |
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Definition
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Term
| Mechanism of action of cephalosporins? |
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Definition
| Same as PCN--Beta-lactams interfere with the synthesis of peptidoglycan so the bacteria can't maintain the cell wall |
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Term
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Definition
| bleeding abnormalities with MTT side-chain. ceftriaxone may prolong PT, |
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Term
| Adverse reactions with cephalosporins? |
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Definition
| hypersensitivity, psuedomembranous colitis, renal function impairment, hepatic dysfunction w/cefoperazone |
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Term
| What is another beta-lactam with the most broad spectrum coverage? |
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Definition
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Term
| uses and cautions with imipenum? |
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Definition
| can be used as monotherapy for psuedomonas infections. Use w/caution with seizures, decrease dose w/renal impairment. |
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Term
| What is so special about meropenum? |
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Definition
| a beta lactam that is less likely to cause seizures than imipenum. |
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Term
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Definition
| beta-lactam that is good Gram -, not used for pseudomonas, can cause seizures like imipenum |
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Term
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Definition
a monobatam good gram-, can be used safely for pts w/PCN or cephalosprin allergy.
organisms develop a resistance and it is expensive. |
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Term
| Name the aminoglycosides? |
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Definition
| Amikacin, gentamycin, neomycin, netilmicin, streptomycin, tobramycin |
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Term
| mechanism of action of aminoglycosides? |
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Definition
alter bacterial cell proetin synthesis in the 30s subunit ribosome.
highly water soluble and are not absorbed when given orally. |
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Term
| warnings for aminoglcosides? |
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Definition
nephrotoxicity-decreased creatinine clearance, urine casts, decreased specific gravity, oliguria and proteinuria. Ototoxicity-r/t use for >10days or use with other ototoxic drugs. Neurotoxicity-skeletal weakness-inhibits prejunctional release of ACH. Treat with IV calcium.
use with cuation in parkinson's and myasthenia gravis. |
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Term
| Cautions with aminoglycosides and NMB? |
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Definition
| aminoglycosides can potentiate NMB agents. The reappearance of the neuromuscular blockade is a possibility if aminoglycosides are given in the early post-op period. The effects of lidocaine can be enhanced in the presence of NMB and aminoglycosides. The neostigmine(reversal drug) and Ca-induced antagonism of NMB may be incomplete and transient. |
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Term
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Definition
| erythromycin, clarithromycin, azithromycin. Used against gram+ and atypical organisms such as chlamidia pneumonia, legionella, mycobacterium, community aquired pneumonias |
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Term
| Adverse reactions to macrolides? |
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Definition
| GI intolerance(^peristalsis), ototoxicity w/IV erythomycin, prolonged QT, inhibits hepatic enzymes so may cause drug interactions, obstructive jaundice in peds w/erythomcin estalate |
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Term
| Clindamycin-type of drug, uses and precautions? |
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Definition
| lincomycin antibiotic, used for dental prophylaxis for pts w/PCN allergy. Can cause severe psuedomembranous colitis. Decrease dose w/severe liver disease |
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Term
| Warning with chloramphenicol? |
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Definition
| may cause aplastic anemia (gray baby) and is only used for severe infections such as typhoid fever and salmonellosis |
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Term
| half-life and dosing of macrolides (e-mycin, clarithromycin, azithromycin) |
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Definition
| Clarithromycin has longer half-life than e-mycin and is given BID (also has less GI intolerance) azithromycin has the longest half-life and can ge given 1X/QD-useful in treating MAC inpatients with HIV |
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Term
| Vancomycin-type and uses? |
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Definition
| a glycopeptide antibiotic that impairs cell wall synthesis. Reserved for treatment of resistant species. Given IV for systemic infrctions,but can be given orally for C-diff colitis. |
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Term
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Definition
Give slowly over 1 hr to avoid histimine release-Redman's syndrome!
Can also cause nephrotoxicity, ototoxicity, allergic reactions, and can potentiate the NMB effects of succinylcholine |
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Term
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Definition
| Used for vanco, multi-drug, and methicillin-resistant infections.Some bugs are now becoming resistant to linezolid! Do not use with myelosuppresive drugs, avoid w/intakes of tyramine, pseudomembranous colitis or superinfections have been reported with use. |
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Term
| Quinupristin/dalfopristin-type, uses, and adverse reactions? |
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Definition
first water-soluble streptogramin antibiotic combination for IV use. Used for vanco-resistant enterococcus, complicated skin infections (staph), used with methicillin resistance.
Adverse reactions:infusion site reactions, rash, N/V, HA, diarrhea |
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Term
| Sulfonamides-type and uses? |
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Definition
| inhibit synthesis of folic acid by bacteria. Treats UTI, otitis media, SMX/TMP used to tx PCP in AIDS pts.MRSA skin infections. |
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Term
| Sulfonamides adverse reactions? |
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Definition
| allergic reactions(Steven-Johnsons syn), drug fever, photosensitivity, hepatic dysfunction, blod dyscrasias(hemolytic anemia in pts w/G6PD deficiency), crystaluria, do not use with infants or near term pregnancies-jaundice, drug interactions w/warfarin |
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Term
| Metronidazole-uses and side effects? |
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Definition
| used for C-diff colitis. Side effects N/V, disulfiram reaction to treat alcoholism (causes severe N/V), neuropathy and pancreatitis |
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Term
| Name the tetracyclines? Uses? |
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Definition
| doxycycline, minocycline, demeclomycin. treats rickettsial dx, doxycycline unstilled in chest tubes of malignant pleural effusions, demeclomycin used in the treatment of SIADH (hyponatremia), minocycline treats acne. |
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Term
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Definition
ciprofloxacin, gatifloxacin, levoflacin, o,spar, and trovafloxacin.
Broad spectrum antibiotics that inhibit bacterial DNA gyrase.Can cause CNS toxicity, mild to seizures, photosesitivity, N/V, drug interactions, pediatric cartilage damage |
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Term
| Polymyxins? Uses and precautions? |
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Definition
| Usually used topically. Can potentiate NMB and cuase muscle weakness resembling NMBlockade, happens especially in patients with renal impairment-calcium and neostigmine are not reliable to antagonize these effects. nephrotoxicity is a significant risk. |
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Term
| What 2 drug types least affect the NMJ? |
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Definition
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Term
| Drugs for the treatment of TB? |
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Definition
| isoniazid, rifampin, pyrazinamide, ethambutal. American Thoracic Society recommends 3 drug regimen of isoniazid, rifampin, and pyrazinamide |
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Term
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Definition
| primary agent for tx of TB. Only known agent to be effective for prophylaxis of TB.Mechanism of action is unknown |
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Term
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Definition
| adverswe effects can be minimized w/prophylaxis treatment of pyridoxine (B6), drug depletes B6, so when given will inhibit peripheral neuritis and anemia. May precipitate seizures in pts w/epilepsy, may cause euphoria and psychosis, hepatic necrosis(rapid acetylators have ^risk) esp. when older |
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Term
| drug interactions with isoniazid? |
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Definition
| isoniazid significantly increases the defluorination of volitile anesthetics, r/t inducung hepatic enzymes. Rapid acetylators can reach fluoride levels that can lead to nephrotoxicity. |
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