pharm-ABX

Question 1

scip infection module

1. used to be called ___?
2. what are the Scip modules?
3. what is scip?
4. scip goal?

Answer 1

1. Sip (surgical infection prevention)
2. –scip infection (1-7)
   
   • -scip venous thromboembolus (VTE) (1-2)
   • -scip cardiac prevention (1)
   • -scip respiratory (used in aicu core measure set)
3. national quality partnership of organizations focused on improving surgical care by reducing post op complications
4. scip goal: reduce post op morbidity & mortality by 25% by 2010

Question 2

1. surgical infections make up __ to ___% of nosocomial infections
2. when are antibiotics ideally given?
3. what situations warrant pre op abx?

Answer 2

1. 14-25%
2. before incision in surgery, at induction or after cord clamping, prior to tournicate inflation.
3. when “dirty” or trauma cases present, valve concerns, endocarditis succeptable, insertion of implants, joints etc.

Question 3

concerns with abx:

Answer 3

cross sensitivities, side effects, renal concerns, interactions with other drugs

Question 4

PCNs

1. structure:
2. MOA
3. what are they not effective against?
4. what are penicillinase resistant pcns? (name them): what does MRSA have to do with these?
5. what abx has cross sensitivity? when should they not be given if ??allergy to pcn is present?

Answer 4

PCN:

1. thiazolinide ring connected to B-lactam ring and side chain
2. interferes with synthesis of peptidoglycan (bacterial wall)
3. PCN-v & g are active against gram + cocci (strep), not effective against staph aureus
4. Nafcillin, methicilin, dicloxacillin (MRSA is methicillin resistant)
5. cephalosporins; dont give if anaphylaxis or anaphylactoid…possibly give if cutaneous reaction only (if necessary)

Question 5

examples of pcns:

Answer 5

amoxicilin
ampicilin
dicloxacillin
nafcillin
pcn VK, G
piperacillin

Question 6

cephalosporins:

1. structure:
2. action
3. what do resistant bacteria do to B-lactam ring?

Answer 6

cephalosporins:

1. semisynthetic B-lactam (related to PCN but fused to dihydrothiazine ring)
2. inhibits cell wall synthesis
3. b-lactam resistant cleaves B-lactam ring of abx making it impotent

Question 7

cephalosporins:

1. first gen; example
2. second gen:
3. third gen:
4. fourth gen;

Answer 7

1. good against gram + including strep and mrsa: cefazolin
2. good against gram + and gram -
3. greatest gram - activity, some activity against pseudomonas
4. most resistant against cephalosporin resistant bacteria

Question 8

examples of cephalosporins:

Answer 8

brand-(chemical name)
keflex (cephalexin)
ancef, kefzol (cefazolin)
(generic) (cefotetan)
mefoxin (cefoxitin)
claforan (cefotaxime)

Question 9

aminoglycosides:

1. chem structure
2. action
3. what bacteria
4. metablism/ excretion

Answer 9

1. contain 1 or 2 amino sugars linked by glycosidic bond to aminocycitol nucleus
2. inhibit protein synthesis by binding irreversibly to 30S ribosomal subunits
3. mostly gram - some gram +
4. not metabolized; excreted unchanged by kidneys (nephrotoxic)

Question 10

1. what side effects of aminoglycosieds?
2. what toxicity is increased in what populations?
3. what meds increase this toxicity?
4. what should be assessed prior to giving?
5. cross sensitivity to what?
6. what do they potentiate in terms of anesthesia?

Answer 10

1. nephro and ototoxic
2. > nephrotoxic in elderly, dehydrated, renal impaired
3. increased nephrotoxicity with lasix, ethacrynic acid and vanco
4. assess renal fxn prior
5. other aminoglycocides (allergy/hypersensitivity)
6. NDMBs

Question 11

1. how do aminoglycosides potentiate NDMB
2. which aminoglycosides are worst?
3. does abx dose matter?
4. what neuro muscular blockers are most succeptible?
5. who is most succeptible?

Answer 11

1. inhibit calcium influx into motor nerve terminals decreasing amount of Ach released
2. neomycin and netilimycin are worst
3. high dose abx is worse
4. vecuronium is more affected than atracurium
5. mostly in patients with neuromuscular disease,possibly increased by anesthetic agents or nm blockers

Question 12

aminoglycoside examples:

end in mycin or micin

Answer 12

gent
tobra
amikacin
neomycin
streptomycin

Question 13

macrolide abx:

1. action:
2. active against:
3. examples:
4. s/e

Answer 13

1. inhibit protein synthesis by binding with 50S ribosome
2. gram + (staph, strep), mycoplasma, legionella
3. erythromycin, azithromycin, clarithromycin,
4. erythro and clarithro can inhibit c-p450 reduing metabolic clearance of versed

Question 14

clindamycin

1. class
2. similar to:
3. interaction with neuro muscular blockers?

Answer 14

1. miscellaneous (related to macrolide)
2. clindamycin resembles erythromycin but is more active
3. yes, like aminoglycosieds- potentiates nm blockers

Question 15

miscellaneous abx:
vancomycin
1. class?
2. action?
3. works on what bacteria?
4. side effects from rapid infusion?
5. what other side effects (from normal infusion)?

Answer 15

1. glycopeptide
2. inhibits cell wall formation and alters cytoplasmic membrane
3. active against gram + (especially staph/MRSA)
4. profound hypotension and cardiac arrest; also redman syndrome: hypotension, flushed skin to face and trunk (from histhamine release)
5. neprho and ototoxic

Question 16

1. according to DMC guidelines, when should asp pneumonia be treated with abx?
2. what bacteria doesnt have to be covered with abx?

Answer 16

1. when symptomatic for infection and illness is severe

2. B. fragilis

Question 17

dmc guidelines:
nosocomial pneumonia:
1. how long should abx regimen last?
2. unless it is what organism?
3. if what is found in aspirant, it may be co_ _ _ _ _ _ _ _ ion in the airways? should it be treated?

Answer 17

1. 7 days (not the old 14-21 day regimen)
2. pseudomonas aeruginosa
3. candida albicans or other candida; colonization; should not be treated

Question 18

dmc guidelines:
sepsis in IVDAs
1. IVDA persons with suspected infection should be started on___?
2. should they be on abx without gram- coverage?

Answer 18

1. vanco

2. no

Question 19

allergic to PCN? what is chance of pcn to cephalosporin cross sensitivity:

1. how much for 1st gen (%)
2. how much for 2nd gen(%)
3. how much for 3rd gen (%)
4. so what is the “rule of thumb”

Answer 19

1. first gen has 0.5 to 1% chance
2. second gen has 0.2% chance
3. third gen has -0.8% chance
4. therefore the further from gen 1, the less the chance of cross sensitivity of PCN to ceph’s

Question 20

ciprofloxin should NOT be substituted for ___ to treat gram - in pcn allergic patient?

Answer 20

cefepime

Question 21

1. what is the % of cross sensitivity in PCN and carbopenims?
2. why the range?
3. what should you do?

Answer 21

1. between 1-40%
2. data has not been well defined
3. use with caution

Question 22

1. what is CA-MRSA?
2. how frequent
3. what is it succeptible to? do you have to use vanco?

Answer 22

1. community acquired MRSA
2. TMP/SMX (?augmentin) and doxycycline
3. no

Question 23

catheter tip infections:

1. when should tip be cultured?
2. does absence of bacteria on tip mean no infection? why?
3. if blood culture is negative but tip is positive, do they need abx for line sepsis?

Answer 23

1. when there is suspicion of line sepsis
2. No.; testing only does outside of catheter, there may be bacteria on inside of it.
3. no, only for bacteremia (different abx)