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NU 600
Exam 6 - Antiaspirants and Antibiotics
| Question | Answer |
|---|---|
| What are the functions of the pharyngeal or gagging reflex? | Block the respiratory pathway and expel foreign matter |
| "Reflux" comes from the Latin word ________, which means ________. | refluere; to flow back |
| "Aspirate" is derived from the Latin word ________ which means ________. | a spire; to breathe upon |
| Who described the relationship between aspiration of solid and liquid matter, and pulmonary sequelae in obstetric patients? What year did he discover this finding? | Mendelson (obstetrician) in 1946 |
| What is Mendelson's Syndrome? | Lung tissue damage as a result of aspiration of non-infective but highly acidic gastric secretions |
| How often to peristaltic waves occur? | 3-4/min |
| How much gastric volume enters the small bowel per minute? | 3% of gastric volume |
| What is the drawback of the entrogastric inhibitory nervous reflex? | Slows stomach emptying, predisposing the patient to reflux |
| What is the pH and volume of gastric contents? | pH <2.5; volume >25ml |
| What is Mendelson's Syndrome? | Instant and severe inflammatory response caused by damage to surfactant producing cells and capillary endothelial cells |
| What are the current fasting recommendations for healthy children and adults? | Clear liquids=2h, breast milk=4h, infant formula/nonhuman milk/light meal=6h |
| T/F: Fasting (does/does not) guarantee gastric emptying and positive anesthetic outcomes. | does not |
| What is the draw back to clear H20 prior to surgery? | Clear H20 2h pre-op promotes gastric emptying w/o a decrease in gastric pH |
| What is the older term for aspiration pneumonitis? | Mendelson's Syndrome |
| What can be used to assess gastric volume? | portable ultrasound |
| Gastric volume is also called ______. | chyme |
| Prolonged fasting in children leads to what three pre-op conditions? | Volume depletion, tachycardia, hypotension |
| How does intraoperative hypotension affect aspiration? | Decreased perfusion pressure to the brain and gut may contribute to vomiting |
| What does the Sellick's maneuver help prevent? | Prevents reflux and air from entering the stomach with PPV |
| What force is necessary to occlude the esophagus after loss of consciousness? | 30-40 newtons |
| What is the dose of steroids given as an early intervention after aspiration pneumonitis? | Methylprednisolone 30mg/kg or decadron 1mg/kg |
| When is NGT not appropriate to place? | Closed head trauma, esophageal varices, life-threatening circumstances |
| What is the gold standard for preventing aspiration? | Cuffed ETT |
| What can be used on the cuff to help prevent aspiration? | Water-soluble lubricant |
| What effect can lead to aspiration despite the use of a/an NGT/OGT? | Wicking effect |
| What alkalinizer is used in obstetrics to buffer gastric pH? What is the dose and when is it administered? | Bicitra 15-30ml PO given 20-30min before induction |
| What is a drawback to Bicitra? | It can induce N/V |
| Bicitra should not be administered with other types of medications? Why? | Antacids b/c they slow gastric emptying |
| What is routinely performed when Bicitra is administered? | RSI |
| How does Ach contribute to aspiration? | Facilitates gastric acid secretion, stimulates vestibular apparatus of the inner ear |
| What are systemic effects of scopolamine? | Dizziness, confusion, blurry vision, dilated pupils, paradoxical bradycardia, urinary retention |
| Bicitra is composed of what two types of ions? | Sodium and citrate |
| What does high doses of scopolamine cause? | Tachycardia (not good for patients w/CAD) |
| Who should not get scopolamine and why? | Pts with glaucoma b/c mydriasis may inhibit drg of aqueous humor |
| Give 3 examples of H2 receptor antagonists. | Cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac) |
| What does H2 receptor inhibition result in? | Inhibits H2 receptors in gastric parietal cells, blocking the secretion of gastric acid and hydrogen ions (reduces gastric volume and increases pH) |
| How is ranitidine metabolized? | P450 |
| Ranitidine interferes with the absorption of what other drugs? | Coumadin, antivirals, antibx, antifungals |
| Ranitidine is a (specific/nonspecific) histamine blocker. | Nonspecific |
| Where should ranitidine be used in caution? | When given in conjunction w/drugs that may cause histamine release (e.g. atracurium, MSO4) |
| H1 causes what effects? | Coronary artery constriction, bronchoconstriction, decreased AV node conduction |
| What are the effects of H2 stimulation? | H+ secretion by parietal cells, increased contractility and HR, coronary dilation, bronchial dilatation |
| What is the effect of H3? | Inhibits synthesis and release of histamine (modulator of histamine release) |
| What is the normal pH of HCl? | <1.0 |
| Proton pump inhibitors are formally known as ___________. | ATP proton pump inhibitors |
| How much more acidic is HCl than arterial blood? | 3millionx more acidic |
| What are the generic and trade names for the PPIs? | Omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex) |
| What do PPIs bind to? | ATPase proton pump |
| What is the effect of PPI binding? | Increases gastric pH and decreases gastric fluid volume |
| PPI bind with the ATPase proton pump via what type of bonding? | Covalent bonding |
| What are SE of PPIs? | Increased risk for hip fx, N/V, abdominal pain, HA, dizziness, agitation, confusion |
| Which types of antiaspirants increase the risk for hip fractures? | Proton pump inhibitors |
| What effect do PPIs have on antifungals and BZDs? | Less absorption of antifungals (need low pH) and increased effect of BZDs |
| Malpractice claims for aspiration pneumonitis is at ______% of malpractice cases. | 3-3.5 |
| What type of anesthesia is associated with the highest amount of claims for aspiration pneumonitis? | GA |
| Damages from respiratory incidents have dropped by ______%. | 15 |
| Who received the Nobel Prize for Medicine in 1945 for his work on antimicrobial drugs? | Alexander Fleming |
| What does "antibiosis" mean? | against life |
| When was antibiosis first described and who observed it? | 1877 by Louis Pasteur and Robert Koch (observed that airborne bacillus inhibits bacillus anthracis) |
| Who coined the term "antibiotics" and when? | Selman Waksman, 1942 |
| What is the difference between a bacteriostatic and bactericidal agent? | Bacteriostatic provides minimum inhibitory [] to prevent growth, bactericidal kills organisms |
| What are 5 functions in a bacterial cell that can be targeted by antibiotics? | 1)cell wall formation 2)protein synthesis 3)DNA replication 4)RNA synthesis 5)synthesis of essential metabolites |
| Which antibiotics inhibit cell wall synthesis? | PCN, cephalosporins, bacitracin, vanco |
| Which antibx inhibit protein synthesis? | Chloamphenicol, erythromycin, tetracyclines, streptomycin |
| Which antibx inhibit nucleic acid replication and transcription? | Quinolones, rifampin |
| Which antibx causes injury to the plasma membrane? | Polymyxin B |
| Which antibx inhibits synthesis of essential metabolites? | Sulfanilamide, trimethoprim |
| What are the most widely used group of antibiotics and how do they function? | Beta-lactam antibiotics -- inhibit cell wall synthesis |
| What bacterial enzyme is interrupted by PCNs, cephalosporins, carbapenems, and other cell-wall influencing antibx? | Transpeptidase (antibx inhibit cross-linking and cell wall function) |
| What integral structure do penicillins share? | 4-sided ring (beta lactam ring) |
| Name the order of generation of cephalosporins and how they increase in effectiveness. | 1, 2, 3, 4th generation with 1st being the least and 4th being the most effective |
| Cephalosporins are derived from ______. | PCN |
| Cephalosporins are effective at combating gram (negative/positive) bacteria. | negative |
| Bacitracin is effective against gram _______ microbes. | positive |
| Which antibiotic is important as a "last line" antibiotic and is used in the treatment of s.aureus? | vancomycin |
| Inhibitors of cell-wall synthesis have a (broad/narrow) range of action. | narrow |
| Inhibitors of protein synthesis have a (broad/narrow) spectrum of action. | broad |
| Inhibitors of protein synthesis are associated with problems regarding what issue? | toxicity |
| Which antibiotic works by causing injury to the plasma membrane? | Polymyxin B |
| What types of microbes does Polymixin B treat? | gram negative |
| Where is polymyxin B seen in medical use? | Topical combined w/bacitracin and neomycin as a broad spectrum OTC preparation |
| What antibiotic inhibits nucleic acid synthesis? | Rifamycin |
| Which antibiotic is used as an antituberculosis agent? | Rifamycin |
| What cell function do quinolones and fluoroquinolones interrupt in treating infections? | Inhibit DNA gyrase |
| Which specialty commonly uses quinolones and fluoroquinolones and for what purpose? | GI and urology for urinary tract PPX and active infx |
| What is the urology preop abx of choice? | Cipro 400mg IV over 30min |
| What bacterial cell function do sulfonamides inhibit? | Folic acid synthesis |
| Sulfa drugs are (narrow/broad) spectrum antibx. | broad |
| Sulfa drugs act as ________ inhibitors. | competitive |
| What are eukaryotes? | Any organism with one or more cells that have visible nuclei and organelles |
| Fungi are classified as _________. | Eukaryotes |
| What do fungi have in their cell walls? | Unique sterols |
| Where do pathogenic fungi often reside? | Outside the body |
| Which antiviral inhibits viral assembly? | Indinavir |
| Which antiviral drug inhibits viral attachment? | Zanamivir |
| What is antimicrobial resistance? | Relative or complete lack of effect of antimicrobial activity against a previously susceptible microbe |
| What are 4 mechanisms of antibx resistance? | 1)Enzymatic destruction 2)Prevention of penetration 3)Alteration of target site 4)Rapid ejection |
| What are 2 factors that promote antimicrobial resistance? | 1)suboptimal levels of antimicrobial 2)microbes carrying resistant genes |
| What drug resistant strain of bacteria has been found in people who ate beef fed with antibx? | salmonella typhi |
| What is the most frequent nosocomial pathogen? | MRSA |
| What are a few proposals to combat antimicrobial resistance? | Speed development of new antibx; track resistance data; restrict antimicrobial use; direct observed dosing; use narrow spectrum; use cocktails (e.g. cipro+flagyl) |
| Most antibx depend on (active transport/passive diffusion) to penetrate to the site of infxn. | passive diffusion |
| How does protein binding affect antibx? | May not penetrate to the infected site |
| Besides protein binding, how else are antibx limited in their function? | Not all cross BBB unless there is active infxn and all BBB pores are open |
| What three antibx are safe for use in pregnancy? | PCN, cephalosporin, erythromycin |
| What two antibx can cross the placental barrier? What are the effects of each antibx regarding fetal development? | Aminoglycosides (hearing issues); tetracycline (dentition and bone issues) |
| What harm can occur to the pregnant woman taking tetracycline? | Fatty liver, pancreatic and renal harm |
| How do beta-lactam PCNs function to inhibit microbial infections? | Inhibit cell wall synthesis by interfering w/transpeptidase |
| What purpose does transpeptidase serve in microbial function? | Cross-linking and cell-wall integrity |
| Identify 3 key points in the pharmacokinetics of PCNs. | Rapid and complete absorption (IV); low []s in intraocular fluid, prostatic, and CSF (1%); elimination primarily by glomerular filtration |
| T/F: Cephalosporins are not related to PCNs. | False |
| Which has a greater spectrum of activity: cephalosporins or PCNs? | cephalosporins |
| What do 1st gen cephalosporins exhibit intense activity against? | gram positive (some gram negative activity) |
| What are two examples of gram positive microbes? | e.coli, s.aureus |
| Ancef penetrates into most tissues with what exception? | CNS |
| Cefazolin exhibits (safe/dangerous) therapeutic levels and (low/high) toxicities. | safe; low |
| What is the dosing for Ancef? | 1-2gm q8h; redosed q4h for long cases (surgeon specific); 1-2gm cutoff is 80kg |
| Which antibiotic has proven to be effective against skin and soft tissue infections from s.aureus? | Cefazolin |
| Cefazolin is a (1/2/3/4) generation cephalosporin. | 1st |
| Give an example of a 2nd generation cephalosporin. In what setting is it widely used? | Cefoxitin; colorectal PPX |
| Give 2 examples of 3rd gen cephalosporins. In what setting are they used? | Cefoxamine; ceftriaxone--used for serious infx in immunocompromised |
| What is the cross sensitivity of 1st gen cephalosporins to PCN? 2nd gen? | 5-10% for 1st; <5% for 2nd |
| What types of microbes is cefoxitin used for treating? | Mixed anaerobes |
| What is the only 4th gen cephalosporin and what is it used to treat? | Cefipime; MRSA, enterobacter, gram negative bacilli |
| How should cephalosporins be administered to a patient with PCN allergy? | 1st give 1cc test dose, wait 10min, then give the remaining 9cc slowly |
| What type of reaction can be caused by fast administration of any medication? | Local histamine release |
| Clindamycin is part of what antibx family? | Lincosamide |
| Clindamycin is similar to what antibx in its spectrum? | Erythromycin |
| What function of the microbe does clindamycin interrupt? | Inhibits protein synthesis at the ribosomal level |
| What are two issues regarding the pharmacokinetics of clindamycin? | Highly protein bound w/hepatic metabolism |
| Which antibx is associated with cardiac arrest when given IVP quickly? | Clindamycin |
| How should clindamycin be prepared and in what application is it seen in? | Should be diluted in at least 10cc; used in oral surgery (abdominal, gut) |
| Which antibx is recommended for patients with endocarditis? | Clindamycin |
| What are different applications for the use of clindamycin? | Penetrating wounds, conditions involving: abdomen/gut and GYN |
| Which antibx is recommended for endocarditis and oral surgery PPX in susceptible patients? | Clindamycin |
| What are the SE of clindamcyin? | Diarrhea, rash, pseudomembranous colitis (potentially lethal) |
| What effect does clindamycin have on NMBs? | Potentiates NMBs -- the blockade does not respond to Ca++ or anticholinesterase agents |
| Which antibx has been associated w/cardiac arrest when given as a rapid infusion? | Clindamycin |
| Vancomycin is a type of ________ antibiotic that is effective against gram _________ organisms. | glycopeptide; positive |
| What type of microbes is vancomycin effective against? | Gram positive that are actively dividing |
| The action of vancomycin is (fast/slow). | slow |
| How does vancomycin serve to inhibit microbial growth? | Prevents cross-linking, which damages cell membranes |
| Vancomcyin is a bactericidal against what strain(s) of bacteria? | Staph, including methicillin resistant strains |
| Which microbial strains have shown resistance to vancomycin? | E.fecalus and s.aureus |
| Ho do e.fecalus and s.aureus achieve resistance to vancomycin? | Alteration of the organisms' peptidoglycan binding site |
| Vancomcyin is _____% protein bound and (does/does not) penetrate CSF. | 30; does |
| What is the T1/2 of vancomycin? | 6h |
| True/False: Vancomycin can be used to treat brain abscesses. | True (penetrates CSF) |
| Vancomycin can be used to treat severe infections of 4 systems? | lung, heart, bone, soft tissue |
| Vancomycin is used when patients are allergic to what two antibx families? | PCN and cephalosporin |
| True/False: Vancomycin can be used to treat MRSA. | True |
| What can occur with rapid administration of vancomycin? | "Red Man" syndrome |
| What is "Red Man" syndrome? | Extreme flushing, tachycardia, and low BP associated w/rapid vanco infusion |
| What is the cause of Red Man syndrome? | Direct mast cell reaction to the drug (histamine release) |
| Red Man syndrome occurs in up to ____% of patients rec'ing vancomycin. | 14 |
| True/False: If Red Man syndrome occurs with a vanco infusion, the infusion should be stopped and dc'd. | False=stop the drug, restart slowly and titrate to the end of the infusion |
| Which antibx is associated with ototoxicity with excessive plasma levels? | Vancomycin |
| Vancomycin given in combination with __________ increases the risk for toxicity. | aminoglycosides |
| Give an example of an aminoglyoside. | Gentamycin |
| What is the most common offending microbe? How much to post-op infx cost in the US per year? | S.aureus=most common; cost $1.5 billion/yr |
| What are risk factors for post-op infection? | 1)Surgery >2h 2)abdominal surgery 3)contaminated wounds (trauma/gunshot/MVA) 4)3+ co-morbidities or diagnoses |
| What are CDC recommendations for the administration of vancomycin? | Infused 60-120min prior to surgery (peak plasma at 120min); administer TID |
| Vancomycin has (high/low) oral absorption. | low |
| The liver exhibits a (large/small) degree of clindamycin metabolism. | Large (only 10% excreted unchanged in urine) |
| What is the most common adverse drug reaction with clindamycin? | diarrhea |
| What types of bacteria are fluoroquinolones active against? | Gram negative and positive |
| Drugs that are fluoroquinolones have what ending in their name? | -floxacin (e.g. ciprofloxacin, levofloxacin) |
| What are the 2 mechanisms of action of fluoroquinolones? | Inhibit DNA gyrase (prevents normal transcription/replication); inhibit bacterial topoisomerase IV (interferes w/separation of replicated chromosomal DNA to daughter cells) |
| Which class of antibx are the drug of choice for treating UTI? What surgical suite are they often seen in? | Fluoroquinolones; urology |
| Although rare, which antibx class is associated with QT prolongation? | Fluoroquinolones |
| Flagyl is a _______ bactericidal agent. | nitroimidazole |
| What types of microbes is flagyl effective against? | Anaerobic protozoal parasites and anaerobic bacteria |
| Which antibx functions as a prodrug? | Flagyl |
| Oxygen (inhibits/enhances) the activity of metronidazole. | inhibits --> the drug has selective toxicity for anaerobic microorganisms |
| Which antibx is often used in the operative setting for PPX in elective colorectal surgery? | Flagyl |
| What are 5 uses for metronidazole therapy? | Anaerobeic infx; mixed intraabdominal infx, vaginitis, c.diff, brain abscess |
| What can occur if flagyl is taken with ETOH? | Disulfiram-like effect |
| What are the disulfiram-like effects that occur when ETOH is taken with flagyl? | Severe nausea and vomiting |
| How does disulfiram (Antabuse) work to achieve its undesirable effects? | Inhibits aldehyde dehydrogenase, which leads to decreased breakdown and increased accumulation of acetaldehyde when drinking ETOH |
| What antibx was discovered to be an effective treatment for chronic alcoholism? | Disulfiram |
Created by:
philip.truong
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