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78 Cards in this Set
- Front
- Back
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Which antibiotics are commonly used for anaerobic infections?
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Metronidazole, clindamycin, cefoxitin, cefotetan, imipenem, ticarcillin-clavulanic acid, Unasyn, Augmentin
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Which antibiotics are commonly used for gram-negative infections?
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Gentamycin and other aminoglycosides, ciprofloxacin, aztreonam, third-generation cephalosporins, TMP/SMZ
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Which antibiotic, if taken with alcohol, will produce a disulfiram-like reaction?
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Metronidazole
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What is the drug of choice for treating amoebic infections?
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Metronidazole
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Which antibiotic is associated with cholestasis
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Ceftriaxone (Rocephin)
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Which antibiotic cannot be given to children or pregnant women
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Ciprofloxacin (interferes with the growth plate)
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With which antibiotics must serum levels be determined?
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Aminoglycosides and vancomycin
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Is rash (only) in response to penicillins a contraindication to cephalosporins?
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No, but breathing problems, urticaria, and edema in response to penicillins are contraindications to the cephalosporins
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What is Augmentin made up of?
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Amoxicillin and clavulanic acid
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What is Unasyn made up of?
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Ampicillin and sulbactam
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Which medication is a first-generation cephalosporin used as surgical prophylaxis for skin flora?
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Cefazolin (Ancef)
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Which medication is a second-generation cephalosporin; used for mixed aerobic/anaerobic infections; effective against Bacteroides fragilis and anaerobic bacteria?
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Cefoxitin (Mefoxin)
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Which medication is a third-generation cephalosporin with strong activity against Pseudomonas?
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Ceftazidime (Ceftaz)
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Which medication has strong activity against gram-negative anaerobes, such as B. fragilis, and has adequate gram-positive activity?
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Clindamycin
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Which medication is an aminoglycoside used to treat gram-negative bacteria; nephrotoxic, ototoxic; blood peak/trough levels should be monitored?
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Gentamycin
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Describe Imipenem and cilastatin (Primaxin)
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Often used as a last resort against serious, multiresistant organisms. Usually combined with cilastin, which inhibits renal excretion of imipenem. Has a very wide spectrum
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Which medication is used for serious anaerobic infections (e.g. diverticulitis); also used to treat amebiasis; patient must abstain from alcohol use during therapy?
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Metronidazole (Flagyl)
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Which medication is an antistaphylococcal penicillin commonly used for cellulitis?
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Nafcillin (Nafcil)
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Which medication is used to treat MRSA; used orally to treat C. difficile pseudomembranous colitis (poorly absorbed from the gut); with IV administration, peak/trough levels should be monitored?
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Vancomycin
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Describe Percocet
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PO narcotic pain reliever with acetaminophen and oxycodone
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Which medication is a quinoline antibiotic with broad-spectrum activity, especially against gram-negative bacteria, including Pseudomonas?
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Ciprofloxacin (Cipro)
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Describe Aztreonam (Azactam)
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Monobactam with gram-negative spectrum
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Describe Amphotericin
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IV antifungal antibiotic associated with renal toxicity, hypokalemia
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Describe Fluconazole (Diflucan)
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Antifungal agent (IV or PO) not associated with renal toxicity
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Describe Nystatin
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PO and topical antifungal
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What are the side effects of steroids?
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Adrenal suppression, immunosuppression, weight gain with central obesity, cushingoid facies, acne, hirsutism, purple striae, hyperglycemia, sodium retention/hypokalemia, hypertension, osteopenia, myopathy, ischemic bone necrosis (avascular necrosis of the hip), GI perforations
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What are the uses of steroids?
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Immunosuppression (transplant), autoimmune diseases, hormone replacement (Addison's disease), spinal cord trauma
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Can steroids be stopped abruptly?
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No, steroids shoudl never be stopped abruptly; always taper
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Which patients need stress-dose steroids before surgery?
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Those who are on steroids, were on steroids in the past year, have suspected hypoadrenalism, or are about to undergo adrenalectomy
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What is the "stress dose" for steroids?
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100mg of hydrocortisone IV every 8 hours then taper (adults)
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Which vitamin helps counteract the deleterious effects of steroids on wound healing?
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Vitamin A
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Describe the action of heparin
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Heparin binds with and activates antithrombin III
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What are the uses of heparin?
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Prophylaxis/treatment--DVT, pulmonary embolism, stroke, atrial fibrillation, acute arterial occlusion, cardiopulmonary bypass
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What are the side effects of heparin?
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Bleeding complications; can cause thrombocytopenia
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What reverses the effects of heparin?
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Protamine IV (1:100, 1 mg of protamine to every 100 units of heparin)
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What laboratory test should be used to follow the effect of heparin
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aPTT--activated partial thromboplastin time
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What is the standard lab target for therapeutic heparinization?
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1.5-2.5 times control or measured antifactor X level
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Who is at risk for a protamine anaphylactic reaction?
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Patients with type 1 diabetes mellitus, s/p prostate surgery
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What is the half-life of heparin?
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Approximately 90 minutes (1-2 hours)
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How long before surgery should heparin be discontinued?
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From 4-6 hours preoperatively
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Does heparin dissolve clots?
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No; it stops the progression of clot formation and allows the body's own fibrinolytic systems to dissolve the clot
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What laboratory test do you need to follow LMWH (low molecular weight heparin)?
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None, except in children, patients with obesity, and those with renal failure, which is the major advantage of LMWH (check factor X levels)
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Describe the action of warfarin (coumadin)
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Inhibits vitamin K-dependent factors II, VII, IX, X, which are produced in the liver
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What are the uses of coumadin?
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Long-term anticoagulation (PO)
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What are the associated risks with coumadin?
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Bleeding complications, teratogenic in pregnancy, skin necrosis, dermatitis
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What laboratory test should be used to follow the effect of coumadin?
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PT (prothrombin time) as reported as INR
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What is the classic therapeutic INR when on coumadin?
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INR of 2-3
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What is the half-life of effect of coumadin?
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40 hours; thus, it takes about 2 days to observe a change in the PT
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What reverses the action of coumadin?
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Cessation, vitamin K, fresh-frozen plasma (in emergencies)
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How long before surgery should coumadin be discontinued?
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From 3-5 days preoperatively and IV heparin should be begun; heparin should be discontinued from 4 to 6 hours preoperatively and can be restarted postoperatively; Coumadin can be restarted in a few days
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Describe sucralfate (Carafate)
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Treats peptic ulcers by forming an acid-resistant barrier; binds to ulcer craters; needs acid to activate and thus should not be used with H2 blockers
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Describe cimetidine (Tagamet)
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H2 blocker (ulcers/gastritis)
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Describe Odansetron (Zofran)
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Anti-nausea, anti-emetic
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Describe promethazine (Phenergan)
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Acute antinausea agent; used postoperatively
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Describe metoclopramide (Reglan)
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Increases gastric emptying with increase in LES pressure; dopamine antagonist; used in diabetic gastroparesis and to help move feeding tubes past the pylorus
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Describe albumin
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5% albumin--expands plasma volume. 25% albumin--draws extravascular fluid into intravascular space by oncotic pressure
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Describe octreotide
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Somatostatin analog
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Describe furosemide (lasix)
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Loop diuretic (watch for hypokalemia)
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What is the antibiotic option for colon/appendectomy coverage if the patient is allergic to penicillin
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1. IV ciprofloxacin AND 2. Clindamycin or IV Flagyl
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If the patient does not respond to a dose of furosemide, should the dose be repeated, increased, or decreased?
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The dose should be doubled if there is no response to the initial dose
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What medication is used to treat promethazine-induced dystonia?
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Benadryl
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Which medication is classically associated with mesenteric ischemia?
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Digitalis
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What type of antihypertensive medication is contraindicated in patients with renal artery stenosis?
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ACE inhibitors
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Does tylenol inhibit platelets?
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No
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What medication are used to stop seizures?
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Benzodiazepines--Lorazepam(Ativan), phenytoin (Dilantin)
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List the preop antibiotic for vascular prosthetic graft
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Ancef (gram positive coverage)
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List the preop antibiotics for appendectomy
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Cefoxitin, cefotetan, Unasyn (anaerobic coverage)
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List the preop antibiotics for colon surgery
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Cefoxitin, cefotetan, Unasyn (anaerobic coverage)
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What are common postoperative IV narcotics?
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Morphine, meperidine (Demerol), fentanyl, Percocet, Dilaudid
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What is Demerol's claim to fame?
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It is used commonly with acute pancreatitis/biliary pathology because classically morphine may cause sphincter of Oddi spasm/constriction
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What are the side effects of narcotics?
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Respiratory depression, hypotension, itching, bradycardia, nausea
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What is the danger of prolonged use of Demerol?
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Accumulation of metabolite mormeperidine (especially with renal/hepatic dysfunction), which may result in oversedation, hallucinations, and seizures
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Which narcotic is used to decrease postoperative shivering?
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Demerol
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What reverses the effects of benzodiazepines?
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Flumazenil (Romazicon), 0.2mg IV
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What is Toradol?
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Ketorolac IV NSAID
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What are the risks of Toradol?
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GI bleed, renal injury, platelet dysfunction
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Why give a patient IV Cipro when he is eating a regular diet?
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No reason--500mg Cipro PO gives the same serum level as 400mg Cipro IV. PO is much cheaper
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What is clonidine rebound?
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If you stop clonidine, the patient will often have severe rebound hypertension
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