Infections - clinical management of sepsis Flashcards

Question

antibiotic CHOICE:

Answer 1

- antibiotic vary from health board to " anti microb. resistance, circulating causative agent, local antibiotic guidlines consider; source of infec (chest, urine, abdominal) Patient charicteristics - allergies/ renal and hepatic func./ interacting medication Risk of anti mircob resistance > p been given any antibiotics recently immunisation status local/ national antimicrobial guile-lines > anti microbial stewarship - funamental role of pharmacist.

Answer 2

unkown source chest source abdominal source urine source

Answer 3

Renal func >20mls/min No penicillin allergy Drug & route - amoxicillin (IV) 1g TDS / Gentamycin (IV) 5mg/kg OD - dose banded Consider adding; Clarythromycin (IV) 500mg BD / Metronidazole (IV) 500mg OD - dose banded Penicillin allergy? Levofloxacin (IV/PO) 500mg BD Gentamycin (IV) 5mg/kg OD - dose banded Consider addinng; Metronidazole (IV) 500mg TDS No penicillin allergy but renal func/ <20mls/mis Tazocin (IV) 4.5mg (as CrCL <20ml/min) Clarythromycin (IV) 500mg BD

Answer 4

durg class - aminoglycoside acterial cover - Gram -ive bacilli Dose - 5mg/kg OD Route - IV - not absorbed through gut S.e - otoxicity - deafness nephrotoxicity - renal failure contraindications - blindness, renal impairmetn (<20ml/min), myasthenia gravis, allergy ti amunoglycoside Monitoring - NARROW therapeutic index drug > small changes in dose or clearnec of drug > >> change in therapeutic effect and drug levels clearer by kidney MUST monitor drug levels

Answer 5

Cock-croft and gault equation Monitor BEFORE using equation monitor x2 weekly whilst on this drug if CrCL stable deterioration in CrCL - daily monitoring maybe indicated

Answer 6

estimated creatinine clearance (eCrCL) = (140-age) x weight (kg) / serum creatinine X 1.04 female or 1.23 male what if patient obese ? ideal body weight can be used (IBW) adjusted body weight (ABW) if patient is >120% of IBW

Answer 7

- narrow therapeutic drug When? through level 18-24 hrs post dose, after first dose range <1mg/L How often? stable? (<1mg/L) twice weekly whilst on gentamycin WHEN Level >1mg/L (chelc renal func., if worsening <20-30ml/min > alternative Abx needs to be prescribed If level is high (> 1mg/L), hold drug for 12 hrs > retake the level 36 hrs post dose) if still >1mg/L > hold for another 12 hrs and retake level (48hrs post op) ADJUST DOSE

Answer 8

Risk of otoxicity and nephrotoxicity > VL risk of short courses very effective antibiotic bloods will be check to monitoring kindey function and level of antibiotics in blood report any hearning problems e.g. ringing / noises in ear, dizziness or balance problems

Answer 9

drug class - nitroimidazole Bacterial cover - anaerobic bacteria and protoxoa route - oral or IV dose - 400mgTDS/ 500mg TDS s.e - rare - peripheral neuropathy, pins and needles central neuropathy - dizziness, convulsions Blood dyscrasias (low PLT/ eosinophils) Contra-indications - allergic reaction monitor - cleared by kideny metobolised by liver Counselling - Topical ad: avoid sun light when using topically > wear sun cream Oral/ Iv use Avoid alcohol consumption whilst on metronidazole for at least 48 hrs after course disulfiram- like reaction > flushing/ throbbing headachje / N&V

Answer 10

drug class ; glycopeptide bacterial cover; aeorbic gra +ive anaerobic gram +ive - multi drug resistance staphycocci dose: loading dose > determined by patient actual body weight maintenance dose > determined by patients renal function (obese patients > IBW or AsBW) route; IV\ s.e; ototoxicity nephrotoxocity> monitor kidney function closley Infusion related reactions allergic reactions contra-indications; previous Hx of hearing loss Monitoring; narrow ther. index drug > small changes to drug >. large changes in ther. effects and drug levels clearer by kidney renal func + drug levels administration; given slowly over hrs > red man syndrome (if developed, stop)

Answer 11

Initial loading dose ius based on thepatients actual body weight

Answer 12

renal function

Answer 13

10-15mg/L - monitor x2 weekly

Answer 14

if <48 hrs since admission - community acquired pneumonia >48 hrs - hospital "

Answer 15

>20 mls/min RENAL FUNC No pen allergy: amoxicillin (IV) 1g TDS Gentamycin (IV) 5mg/kg OD Metronidazole (IV) 500mg TDS Pen allergic: Gentamycin (IV) 5mg/kg OD Metrodinazole (IV) 500mg TDS Teicoplanin (IV) 6mg/kg <20 mls/min RENAL FUNC. No pen allergy; tazocin (IV) 4.5g BD Non-severe pen allergy Meropenem (IV) 1g BD Severe pen allergy Teicoplanin (IV) 6mg/kg Vancomycin (IV) - dep on CrCL Caiplofloxacin (IV) - dep on CrcL

Answer 16

drug class - glycopeptide Bacterial cover - aerobic gram +ive anaerobic gram +ive dose - loading dose > det on ABW maint. dose > det by pateints weight & renal func. route (IV) s.e blood dyscrasias nephrtotoxicity > renal func monitor allergic reaction infusion related reaction hearing loss MONITOR therapeutic druh levels (only if patient on period over 7 days) Trough level, before 5th dose target is 15-60mg/L Blood count

Answer 17

30-80 > dose from table 1 every 48 hrs <30 > give dose from tabel 1 every 72 hrs

Answer 18

>20 mls/lin renal func Gentamycin (IV) 5mg/kg (w or w/o penicillin allergy) <20mls/min renal func. no pen allerg. Tazocin (IV) 4.5g BD non-severe pen allerg. Merepenem (IV) 1g BD severe pen allerg. Ciprofolaxin (IV) - dep on CrCL

Infections - clinical management of sepsis Flashcards

(43 cards)