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Anesthesia Pharmacology > Antibiotics > Flashcards

Antibiotics Flashcards

(94 cards)

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1
Q

What are methods in surgical technique that lead to less SSI?

A 
gentle traction
Effective hemostasis
removal of devitalized tissues
obliteration of deadspace
irrigation with saline
fine non-absorbed suture
closed suction drains
wound closure without tension
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2
Q

What patient conditions may lead to increased SSI?

A 
Extremes of age
malnourished
obesity
Diabetes
Recent operation
corticosteroid therapy
immunocompromised
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3
Q

What are perioperative factors that may increase SSI?

A 
Body temperature
FiO2
fluid management
blood glucose
blood transfusion
antimicrobial prophylaxis
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4
Q

What are the benefits of normothermia during surgery?

A

wound healing

less vasoconstriction

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5
Q

how does hypothermia lead to SSI?

A

decreased tissue perfusion
decreased super oxide radicals
induced anti-inflammatory profile
decreased collagen production

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6
Q

More oxygen leads to _______ wound healing

A

improved

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7
Q

At what FiO2 is decreased incidence of SSI seen?

A

0.8

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8
Q

Which fluid is better for preventing SSI, colloid or crystalloid?

A

no difference

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9
Q

Why is keeping the patient euvolemic important for preventing SSI?

A

prevents subq tissue from being hypervolemic

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10
Q

HOw does hyperglycemia affect infection?

A

increased morbidity and mortality
Deactivation of immunoglobulins
functional deficits in neurtophil function

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11
Q

SSI is decreased with _____ PRBC transfusion

A

auto

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12
Q

HOw should rbc’s be prepared to reduce risk of infection?

A

leukocyte reducted

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13
Q

What are the goals of surgical prophylaxis?

A 
prevent postoperative SSI
Prevent post-op M&M
reduce duration of healthcare
Reduce cost of healthcare
Produce no adverse effects
Have no adverse consequences
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14
Q

What are the normal flora of the skin?

A

Staph epidermidis

staph aureas

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15
Q

What is the ideal antibiotic therapy

A 
active against most likely pathogen
given in appropriate dosage
given at appropriate time
safe
administered for shortest period
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16
Q

when and how often are antimicrobials dosed?

A

1 hour before incision
must exceed minimum inhibitory concentration
Every 1-2 half lives, terminating within 24 hours

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17
Q

This type of proceure is elective, not emergency, nontraumatic, primarily closed, no breack in techinique. Respiratory , GI, biliary and GU tracts not entered

A

clean procedure

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18
Q

What is a contaminated procedure?

A

Nonpurilent inflammation, gross spillage from GI tract, entry ito GU or biliary tract i presence of infected bile or urine. penetrating trauma <4 hours old

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19
Q 
Purulent inflammation (e.g., abscess); preoperative perforation of respiratory, gastrointestinal, biliary or genitourinary tract; penetrating trauma > 4 hours old
l
A

dirty procedure

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20
Q

Urgent or emergency case that is otherwise clean; elective opening of respiratory, gastrointestinal, biliary or genitourinary tract with minimal spillage (e.g., appendectomy) not encountering infected urine or bile; minor technique break

A

clean contaminated

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21
Q

Nonpurulent inflammation; gross spillage from gastrointestinal tract; entry into biliary or genitourinary tract in the presence of infected bile or urine; major break in technique; penetrating trauma

A

contaminated procedure

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22
Q

Which antibiotic should be used for clean procedures?

A

cefazolin 1-2 grams IV

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23
Q

What antibiotic should be given for thoracic/orthopedic procedures?

A

cefuroxime 1.5 grams IV

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24
Q

What antibiotics should be given for bowel procedures?

A

cefoxitin 1-2 grams IV
cefazolin 1-2 gram + methonidazole 500mg
Ampicillin/subactam (unasyn) 3 grams

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25
What class of antimicrobial is ampicillin and amoxicillin?
penicillinase with gram (-) activity
26
What class of antimicrobial is methicillin, oxacillin and nafcillin?
Pinicillinase-resistant
27
What class of antimicrobial is ampicilln-sulbactam
penicillin with beta lactamase inhibitor
28
What class of antimicrobial is imipenem?
carbapenem
29
What class of antimicrobial is gentamicin, tobramycin?
aminoglycosides
30
What class of antimicrobial is erythromycin, clrithomycin?
macrolide
31
What class of antimicrobial is clindamycin
lincomycins
32
What class of antimicrobial is vancomycin?
glycopeptide derivative
33
What class of antimicrobial is ciprofloxacin, levofloxacin?
fluroquinolones
34
Cephazolin belongs to which cephalosporin class?
1st generation
35
Cefuroxime (and cefaclor) belongs to which cephalosporin class?
2nd generation
36
ceftizoxime belongs to which cephalosporin class?
3rd generation
37
Cefclidine and cefepime belongs to which cephalosporin class?
4th generation
38
As the generation of cephalosporin increases, there is increased coverage for gram _____, while some coverage for gram ____ is lost
negative | positive
39
Which abx may be used if pt is allergic to penecillin?
``` Vancomycin 1gram (15 mg/kg) clindamycin (600-900 mg) ```
40
What abx may be used to add gram negative coverage?
gentamicin ciprofloxacin levofloxacin aztreonam
41
What are the possible benefits of adding vancomycin to the mix?
prevention of MRSA prosthetic heart valve and vascular graft recent broad spectrum therapy --studies show no benefit to using vanc. -muse be cautious due to increased incidence of VRE
42
Repeat dosing shows no benefit in procedures +/- ___ hours but significant benefit in those > ____ hours
4, 7
43
How long are antibiotics given post closure?
``` 24 hours (most) 48 hours (cardiac) ```
44
REpeat dosing for Cefazolin
2-5 hour
45
Repeat dosing for cefoxitin
2-3 hour
46
Repeat dosing for cefuroxime
3-4 hours
47
Repeat dosing for Ampicillin/sulbactam
2-4 hours
48
Repeat dosing for Nafcillin
2 hours (used for neurosugery
49
Repeat dosing for Vancomycin
6-12 hours
50
Repeat dosing for clindamycin
3-6 hours
51
Repeat dosing for metronidazole
6-8
52
What organisms do you need to treat for in neurosurgery? How do you treat it?
staph aureus, s. epidermatis Cefazolin (1-2g) Nafcillin(1-2g) Vancomycin (1-2g)
53
Head and neck procedures are clean or clean-contaminated t or f?
true
54
What organisms are in head and neck?
Mouth: streptococci, S. epidermidis Nose: Staph and strep
55
What are recommendations for head and neck surgery?
Clean: Not clear Clean-contaminated: Cefazolin (1-3g) Clindamycin (600-900mg) + gentamicin(1.5/mg/kg)
56
Cardiac Sx is clean contaminated. T/F
F. Clean | Low risk but catastrophic complications
57
Organisms associated with cardiac Sx.
S. aureus and coagulase-neg staph | Gram (-) bacilli with saphenous vein harvest
58
Recommendations for cardiac Sx
Cefuroxime is agent of choice | Vancomycin and clindamycin are alternatives
59
Organisms associated with noncardiac thoracic Sx
same as cardiac | S. aureus and coagulase-neg staph
60
recommendations for noncardiac thoracic Sx
Cefazolin (1-2 grams) Cefuroxime (1.5 grams) Vancomycin* (1 gram [10-15 mg/kg]) Clindamycin** (600-900 mg)
61
organisms associated with Colorectal Sx
Gram-neg bacilli, anaerobes, enterococci
62
recommendations for Colorectal Sx
``` Oral regimen -Neomycin + erythromycin -Neomycin + metronidazole Intravenous regimen -Cefazolin (1-2 g) + metronidazole (0.5 g) -Cefoxitin or cefotetan (1-2 g) -Ampicillin-sulbactam (3 g) ```
63
what are recommendations for colorectal Sx for PCN and Cephalosporin allergic pts
``` Clindamycin (600-900 mg) plus -Gentamicin (1.5 mg/kg) or -Ciprofloxacin (400 mg) or -Levofloxacin (750 mg) or -Moxifloxacin (400 mg) Metronidazole + aztreonam (1-2 g) + gentamicin ```
64
Organisms associated With GI-Appendectomy
Aerobic / anaerobic gram-neg enteric
65
Recommendatinos for GI-appendectomy
Cefoxitin (1-2 g) Ampicillin-sulbactam (3 g) Cefazolin (1-2 g) + metronidazole (0.5 g)
66
Recommendations for GI-appendectomy-PCN allergic
Clinamycin + gentamicin (cipro, Levo)
67
Organisms associated with esophageal and gastroduodenal Sx
E. coli, staph, strep, enterococci
68
Recommendations for esophageal/gastroduodenal Sx
cefazolin (1-2 g)
69
Recommendations for esophageal/gastroduodenal Sx-PCN or cephalosporin allergy
Clindamycin + | -Ciprofloxacin, Levofloxacin, gentamicin
70
Organisms-GI-Biliary tract
E.coli, Klebsiella, enterococci
71
recommendations for GI-Biliary tract
Cefazolin (1-2g) | (may ask for cefoxitin just in case they puncture the gut
72
recommendations for GI-Biliary tract-PCN or cephalosporin allergy
Clindamycin + | -Ciprofloxacin, Levofloxacin, gentamicin
73
Recommendation-clean orthopedic procedures
None
74
organisms-orthopedic
S. epidermidis, S. aureus, gram- neg bacilli
75
which orthopedic procedures should antibiotic be used for
Hip repair, joint replacement, fixation
76
What are recommendations if you ar going to give prophylaxis for orthopedic procedures?
``` Cefazolin (1-2 g) Vancomycin (1 g) Other options -Antimicrobials in bone cement -Ultraclean O.R. ```
77
how often does endometritis happen in cesarean?
85% | -prolonged labor and ruptured membranes
78
Organisms-cesarean delivery
Vaginal tract: strep, staph, enterococci | Wound: S. Aureus, staphylococci
79
recommendation-cesarean delivery
Single dose of cefazolin before incision -Historically post clamping Clindamycin+gentamicin
80
Organisms-hysterectormy
Post op differs from Pre-op | polymicrobial
81
recommendation-hysterectomy
Cefazolin, Cefoxitin, Ampicillin-Sulbactam Clindamycin or Vancomycin + aminoglycoside, aztreonam or fluoroquinolone Metronidazole + aminoglycoside or fluroquinolone
82
Organism-GU
E. coli
83
Procedures indicating prophylaxis for GU Sx
any transurethral Sx or catheter placement
84
Recommendations for GU
Clean procedures—cefazolin Clean contaminated—see bowel prophylaxis Aminoglycoside + metronidazole or clindamycin
85
Infections associated with vascular Sx are associated with extensive morbidity and mortality. T or F
T
86
Organisms associated with vascular Sx
S. aureus, S. epidermidis, gram-neg bacilli
87
Recommendations-vascular Sx
Cefazolin (1-2 g) | Vancomycin (1g ) ± gentamicin (2 mg/kg)
88
Which procedures are at a high risk for SBE?
Prosthetic heart valves -Biprosthetic and homograft valves Prior history of IE Complex cyanotic congenital heart dz -Transposition of great vessels, single ventricle, Tetralogy of Fallot Surgically constructed systemic and pulmonary conduits
89
Which procedures are at a moderate risk for SBE?
``` Other congenital cardiac malformation -Bicuspid aortic valve Acquired valvular dysfunction -AS, MS or valve repair Hypertrophic Obstructive Cardiomyopathy Mitral valve prolapse -With regurgitation on auscultation -Thickened leaflets on echo ```
90
Which procedures are at a low risk for SBE?
``` Physiologic or innocent murmurs Isolated secundum ASD Repair of ASD,VSD or PDA MVP without regurgitation Aortic valve sclerosis Physiologic MR on echo Mild TR CAD, rheumatic fever, pacemaker, stent ```
91
What are AHA guidelines for SBE prophylaxis?
Situations in which the risk of IE is considered by most authorities to be high Antimicrobial prophylaxis is generally accepted as advisable Conditions in which risk of IE is considered moderate
92
ABX for SBE prophylaxis
``` Ampicillin (2 g) Gentamicin (1.5 mg/kg; 120 mg max)-For GI and GU PCN allergy -Clindamycin (600 mg) -Cefazolin (1 g) -Vancomycin (1 g) ± Gentamicin for GI and GU ```
93
What can occur if vancomycin is given too fast? What are the symptoms? How should vanco be given?
Redman syndrome Pruritus, flushing, erythema of head and torso Arterial hypotension Give over 1 hour
94
What happens if gentamycin is given too quickly? How fast should it be given?
Ototoxicity | give aminoglycosides over 20-30 minutes

Anesthesia Pharmacology (25 decks)

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