Sepsis highlights

Question 1

Why is moxifloxacin not an option for UTIs?

(objective)

Answer 1

Because it’s a respiratory fluoroquinolone & it does not reach the urethra

Question 2

Which uses endotoxins, G+ or G-?

Answer 2

G negative (-)

Question 3

List 3 proinflammatory mediators released by activated macrophages

Answer 3

TNF-α, IL-1 and IL-6

Question 4

List 3 anti-inflammatory mediators [inhibit the production of the proinflammatory cytokines and down regulate some inflammatory cells]

(“know these”)

Answer 4

IL-1RA, IL-4, and IL-10

Question 5

What should you do for Resuscitation?

Answer 5

1) 30 mL/kg of IV crystalloid fluid within the first 3 hours
-Target MAP of 65 mm Hg

Question 6

List 5 colloids

Answer 6

1) Human plasma
2) Dextrose 5%
3) NaCl 0.9%
4) Lactated ringers
5) Plasma-Lyte 148

Question 7

1) What is commonly referred to as D5W?
2) What is commonly called normal saline?
3) Name a colloid

Answer 7

1) Dextrose 5%
2) Sodium chloride 0.9%
3) Albumin 5%

Question 8

What is the second line fluid therapy Tx?

Answer 8

Colloid (i.e., albumin)

Question 9

There should be administration of empiric broad-spectrum therapy with one or more IV antimicrobials within ___________ of recognition of sepsis or septic shock to treat most likely pathogens

Answer 9

1 hour

Question 10

Which one of the five drugs suggested for community-acquired respiratory tract infections does not cause QT-prolongation?

(objective)

Answer 10

Ceftriaxone

Question 11

Which drug is administered with cilastin and why?

(objective)

Answer 11

Imipenem (to protect kidneys)

Question 12

Why is ertapenem not used for hospital-acquired empiric therapy for intra-abdominal infections?

(objective)

Answer 12

Doesn’t work for P. aeruginosa

Question 13

You must premedicate when administering amphotericin B deoxycholate; what are your options?

(this is an exam question)

Answer 13

1) APAP or NSAID
2) Diphenhydramine or hydrocortisone
3) Meperidine (Demerol / opioid) to decrease duration of rigors
4) Fluid boluses to decrease risk of nephrotoxicity

Question 14

Besides antibiotics, what should be initiated in all patients admitted to the ICU with sepsis?

Answer 14

Venous thromboembolism (VTE) prophylaxis with daily subcutaneous LMWH
(extend dose if cl/cr <30)

Question 15

Nystatin suspension (ie, 100,000 units/mL) can be used to Tx what?

Answer 15

Oral candidiasis (thrush) in adults

Question 16

What are 2 meds used to Tx thrush?

Answer 16

1) Nystatin suspension (ie, 100,000 units/mL)
2) Clotrimazole troche

Question 17

What may you Tx ringworm in?

Answer 17

Cream formulation of Clotrimazole troche for 2-3 days