Exam 2 (Antibiotics)

Question 1

• What is a nosocomial infection?

Answer 1

Any infection acquired in the hospital

Question 2

• What are the two biggest sources of HAI’s?

Answer 2

Surgical site infection & HAI PNE

Question 3

• What are some S/S suggesting a pre-existing infection?

Answer 3

• Fever
• chills
• night sweats
• AMS
• productive cough
• SOB
• rebound tenderness
• dysuria
• CVA tenderness
• suprapubic pain

Question 4

• When do surgical site infections present?

Answer 4

Within 30 days of surgery

Question 5

• What is involved in a deep incisional SSI?

Answer 5

Muscle and surrounding tissues

Question 6

• What is involved in an organ or space SSI?

Answer 6

Any area other than skin and muscle

Question 7

• What are the 3 most common types of bacteria?

Answer 7

• Staphylococcus
• streptococcus
• pseudomonas

Question 8

• What is a clean-contaminated wound?

Answer 8

• No evidence of infection
• do involve internal organ

Question 9

• What is a contaminated wound?

Answer 9

Involve internal organ with spillage of contents from the organ

Question 10

• What is a dirty wound type?

Answer 10

Known infection at time of surgery

Question 11

• What are some risks for SSI?

Answer 11

• Comorbidities
• elderly
• emergency or abdominal surgery
• surgery >2hrs

Question 12

• What is a 1A grading category of studies?

Answer 12

Strong recommended, moderate to high-quality evidence

Question 13

• What is a 1B grading category of studies?

Answer 13

Strong recommended, low-quality evidence

Question 14

• When are parental Abx administered?

Answer 14

With 1B grading category

Question 15

• When are IV Abx not needed?

Answer 15

• Wound irrigation,
• Do not apply Abx ointments to incisions (1B)
• soaking prosthetic devices

Question 16

• Glycemic control is what kind of evidence & what is the target?

Answer 16

• 1A
• <200 mg/dL

Question 17

• Intraop iodine irrigation in deep tissue is what kind of evidence?

Answer 17

2

Question 18

• What are some general principles for Abx prophylaxis?

Answer 18

• Shortest possible course effective (1 dose)
• newer Abx reserved for resistant infections
• if everything equal then oldest and cheapest first

Question 19

• What Abx are initiated within 2hrs of incision?

Answer 19

Vancomycin & fluoroquinolones

Question 20

• Which Abx is redosed after coming off bypass & which is not?

Answer 20

• Ancef is redosed
• Vanc is not

Question 21

• Which Abx are beta lactams?

Answer 21

PCN, cephalosporins & Carbapenems

Question 22

• Which Abx is an Aminoglycoside?

Answer 22

Gentamycin

Question 23

• How do penicillin-beta lactams work?

Answer 23

Inhibit bacterial cell wall synthesis

Question 24

• PCN’s are the drug of choice for?

Answer 24

• Streptococci
• meningococci
• pneumococci

Question 25

- PCN Beta lactams are usually used for what kind of infections?

Answer 25

Skin, catheter infections & URI’s

Question 26

- What are some adverse reactions to beta lactams?

Answer 26

- Skin rash - GI upset - vaginal candidiasis

Question 27

- Can cephalosporins be used on patients with a PCN allergy?

Answer 27

Yes, unless it is anaphylaxis

Question 28

- What is the difference between PCN & cephalosporins?

Answer 28

Cephalosporins are more stable against beta lactamases

Question 29

- Which cephalosporin generation can cross the BBB?

Answer 29

- Some of Gen 3 - Gen 4 & 5

Question 30

- Which cephalosporin generation does not work on Gram -?

Answer 30

Generation 1 (Cefazolin)

Question 31

- Which cephalosporin is the DOC for gonorrhea?

Answer 31

Ceftriaxone (Rocephin)

Question 32

- Which cephalosporin are generation 2?

Answer 32

- Cefuroxime (Zinacef) - Cefoxitin (Mefoxin) - Cefotetan (Cefotan)

Question 33

- Which cephalosporin treats resistance meningitis?

Answer 33

- Cefotaxime (Claforan) - It's Gen 3

Question 34

- Which cephalosporin drug is generation 4 & what is it good for?

Answer 34

- Cefepime. - Most resistant to hydrolysis by lactamases. - Good for multi-resistant organisms & crosses BBB

Question 35

- Which Abx should not be used for Pts with bleeding issues?

Answer 35

Cephalosporins

Question 36

- Which antibiotics can used for a Pt with a true anaphylaxis reaction to PCN?

Answer 36

Vancomycin or Clindamycin

Question 37

Which beta-lactam Abx have good activity against Gram (-) & enterobacter

Answer 37

- Carbapenems Examples: - Ertapenem (Invanz) - Meropenem (Merrem) - Imipenem (Primaxin)

Question 38

- What are carbapenem ABX used for?

Answer 38

- Intra-abdominal - Resistant UTI - PNE

Question 39

- What do you need to check before giving carbapenem IM?

Answer 39

- LA allergies - If Pt is on Depakote

Question 40

- When does Vancomycin work?

Answer 40

Only if bacteria is actively dividing

Question 41

- Vancomycin is most valuable in treating?

Answer 41

- Bloodstream infections - Endocarditis caused by MRSA

Question 42

- How do aminoglycosides work?

Answer 42

Inhibit ribosomal proteins and cause mRNA to misread

Question 43

- Which Abx is synergistic with aminoglycosides?

Answer 43

Beta lactams or Vancomycin

Question 44

- What are the adverse effects of aminoglycosides?

Answer 44

- Ototoxicity - nephrotoxicity & - curare-like effect leading to longer NMBD effects

Question 45

- Which receptors are adversely affected by Gentamycin?

Answer 45

nACHr

Question 46

- How do fluoroquinolones work?

Answer 46

Inhibit DNA protein synthesis

Question 47

- What are examples of fluoroquinolones?

Answer 47

Ciprofloxacin & Levofloxacin

Question 48

- Which Abx is used for GU cases?

Answer 48

Levofloxacin

Question 49

- Fluoroquinolones are excellent for?

Answer 49

- Gram (–) organisms (UTI - bacterial diarrhea - bone/joint infections)

Question 50

Per SCIP Abx prophylaxis is there to?

Answer 50

Reduce Abx resistance

Question 50

- What are the adverse reactions of Fluoroquinolones?

Answer 50

- N/V/D - prolonged QT - cartilage damage - tendon rupture

Question 51

- Which Abx is an anaerobic antibacterial?

Answer 51

Metronidazole (Flagyl)

Question 52

- Flagyl is indicated for?

Answer 52

- Intra-abdominal infections - Vaginitis - C-diff - superinfections

Question 53

- What are the adverse reactions of Metronidazole?

Answer 53

- Nausea - peripheral neuropathy (w/ prolonged use) - disulfiram-like effect

Question 54

- Which Abx should a patient not drink alcohol with?

Answer 54

Flagyl

Question 55

- Which surgeries require the use of 2 Abx & what is the 2nd Abx?

Answer 55

- Small intestine obstruction - Colorectal & clean-contaminated head & neck surgeries including cancer. - 2nd Abx is Flagyl

Question 56

- How is Ancef dosed in adults?

Answer 56

By weight: - If < 80kg= 1g - If 81-119kg= 2g - If > 120kg= 3g

Question 57

- What is the usual adult dose for Vancomycin?

Answer 57

15 mg/kg

Question 58

- What is the goal of SCIP?

Answer 58

Decrease morbidity & mortality rate of SSI

Question 59

- What is the SCIP protocol for foleys?

Answer 59

Removed on or before POD 2 unless reason document to extend

Question 60

- What SCIP measures for SCD’s?

Answer 60

- Place on Pt if surgery >1hr - Appropriate post-op orders & given by RN within 24hrs after surgery

Question 61

- What 1st temp must a patient have in PACU?

Answer 61

36℃ within 15mins after leaving OR

Question 62

When are Abx D/c'ed in SCIP?

Answer 62

- Within 24hrs - Within 48hrs for cardiovascular surgeries

Question 63

Which Abx affect the neuromuscular junction?

Answer 63

Aminoglycosides

Question 64

Who is at an increased risk for SSI?

Answer 64

- Diabetics - Cancer Pts

Question 65

Which bacteria is most likely to cause a HAI?

Answer 65

C-diff

Question 66

What are some signs of an acute infection?

Answer 66

- Hyperglycemia - Leukocytosis