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NU 600

Exam 6 - Antiaspirants and Antibiotics

QuestionAnswer
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