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78 Cards in this Set

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