SUR 126 unit 3

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jb124
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177379
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SUR 126 unit 3
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2012-10-13 21:45:02
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Antibiotics Diagnostic agents
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Antibiotics/Diagnostic agents
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  1. what are antibiotics used for?
    to prevent and treat infections caused by pathogenic microorganisms
  2. antimicrobial agents
    • antivirals
    • antibacterials
    • antiprotozoals
    • antifungals
    • antiparasitics
    • drugs such as sulfa and mercury
  3. only antimicrobial agents routinely used in surgery
    antibacterials (antibiotics)
  4. what does antibiotic mean?
    Greek for (anti) "against" and (bios) "life"
  5. what are antibiotics?
    natural chemicals produced by microorganisms that inhibit the growth of other microorganisms
  6. how many antibiotics are prescribed in the US for prophylaxis?
    between 30% and 50%
  7. what organization developed a national quality partnership called Surgical Care Improvement Project (SCIP)?
    The Joint Commission
  8. one of the goals of SCIP?
    increase compliance for measures related to use of antibiotics such as the selection, time discontinued, identification fo th person responsible for actions and verifying antibiotic names, administration times and documentation
  9. what organization developed Surgical Patient Checklist?
    WHO
  10. three sections of the Surgical Patient Checklist
    • before induction of anesthesia
    • before skin incision
    • before patient leaves OR
  11. what are SSIs caused by?
    introduction of pathogenic microorganisms into a susceptible host
  12. infectious microbe comes from patient's own bacteria
    endogenous
  13. infectious microbe comes from outside the patient
    exogenous
  14. common methods used to identify pathogens
    • culture and sensitivity
    • Gram staining
  15. process of growing microbes in culture to determine the infecting pathogen and exposure of the pathogen to various antibiotics to determine which agent will best inhibit the pathogen's growth
    culture and sensitivity
  16. rapid identification test that assists the physician in prescribing an initial course of antibiotic therapy
    Gram stain
  17. study of shapes
    morphology
  18. acting against pathogenic microorganisms without harming host cells
    selective toxicity
  19. one-celled organisms that do not have a fully developed nucleus
    bacteria
  20. organisms with partially developed nucleus
    prokaryotes
  21. multicellular organisms (fungi, plants, and animals)
    eukaryotes
  22. tiny structures in a cell that assemble or synthesize proteins from amino acids
    ribosomes
  23. goal of antibiotic administration
    to assist the patient's immune system to subdue the infection
  24. antimicrobial classifications
    • bactericidal
    • bacteriostatic
  25. agents that kill bacteria
    bactericidal agents
  26. agents that inhibit bacterial growth
    bacteriostatic agents
  27. examples of bactericidal agents
    • aminoglycosides
    • cephalosporins
    • penicillins
  28. examples of bacteriostatic agents
    • erythromycins
    • tetracyclines
  29. antibiotic with wide range of activity, usually effective against both gram-negative and gram-positive bacteria
    broad-spectrum
  30. antibiotics with small range of activity, effective against only one category, gram-positive or gram-negative
    narrow-spectrum
  31. antibiotics effective against just one species of microorganisms
    limited-spectrum
  32. ability of some strains of pathogenic microbes to prevent or overcome activity of antimicrobial agents
    antibiotic resistance
  33. 4 major categories of antibiotic resistance mechanisms
    • microorganism may manufacture microbial enzymes that inactivate the antibiotic
    • cell membrane may be altered to prevent antibiotic from entering the cell
    • target area may be altered so the agent is no longer effective
    • microorganism may add substance to the antibiotic which inhibits ability to reach its desired binding site
  34. antibiotics that interfere with protein synthesis by binding to bacterial ribosomes and active only against aerobic, gram-negative bacteria and only some gram-positive (Staph)
    aminoglycosides
  35. major adverse effects of aminoglycosides
    nephrotoxicity and ototoxicity
  36. most common administration routes for aminoglycosides
    • IM and IV
    • may be given orally when reducing bacteria in the bowel prior to colorectal surgery
  37. infections for which aminoglycosides are indicated?
    • respiratory tract
    • bones and joints
    • CNS
    • skin
    • soft tissue
  38. aminoglycoside drugs
    • amikacin
    • gentamicin
    • streptomycin
    • tobramycin
    • neomycin
    • kanamycin
  39. broad-spectrum antibiotics, bactericidal, targeting cell-wall synthesis
    cephalosporins
  40. which antibiotic agents have 5 generations based on ranges of activity?
    cephalosporins
  41. 1st generation cephalosporins
    active against many gram-positive and some gram-negative microbes
  42. 2nd generation cephalosporins
    effective on wider variety of gram-negative but fewer gram-positive organisms
  43. 3rd generation cephalosporins
    • wider range against gram-negative than 2nd generations, but less effective on gram-positive organisms
    • may be used in treating some hospital-acquired infections
  44. 4th generation cephalosporins
    • expanded spectrum on both gram-positive and gram-negative microorganisms
    • many can cross blood-brain barrier
    • effective against meningitis
  45. 5th generation cephalosporins
    • not yet approved by FDA
    • appear to be less susceptible to development of resistance
  46. 1st generation cephalosporin drugs
    • Ancef
    • Keflex
    • Keflin
  47. 2nd generation cephalosporin drugs
    • Mefoxin
    • Zefazone
    • Zinacef
    • Ceclor
  48. 3rd generation cephalosporin drugs
    • Suprax
    • Rocephin
  49. 4th generation cephalosporin drugs
    Maxipime
  50. 5th generation cephalosporin drugs
    ceftobiprole
  51. broad-spectrum agents that inhibit bacterial protein synthesis by binding to prokaryotic ribosomal subunit
    macrolides
  52. macrolide actions
    • bacteriostatic for most bacteria
    • bacteriocidal for several gram-positive bacteria
  53. macrolide drugs
    • erythromycin
    • azithromycin
  54. first of the true antibiotics
    penicillin
  55. penicillin actions
    bacteriocidal
  56. 4 basic categories of penicillins
    • natural penicillins
    • penicillinase-resistant penicillins
    • amino-penicillins
    • broad-spectrum penicillins
  57. first broad-spectrum antibiotics
    tetracyclines
  58. tetracycline actions
    bacteriostatic against many gram-positive and gram-negative bacteria
  59. tetracycline drugs
    • vibramycin
    • aureomycin
  60. new class of synthetic antibiotics that inhibits bacterial protein synthesis by different mechanism of action from other agents
    oxazolidinones
  61. oxazolidinone action
    • bacteriostatic against enterococci and staphylococci
    • bactericidal against majority of streptococci
  62. antibiotics that have a relatively low toxicity and broad spectrum of activity
    fluoroquinolones
  63. set of antibiotics that are formulated for ophthalmic use
    fluoroquinolones
  64. antimicrobials more commonly known as sulfa drugs
    sulfonamides
  65. synthetic analogue of natural antibiotic lincomycin
    clindamycin
  66. clindamycin is active against?
    gram-positive and anaerobic bacteria
  67. what is clindamycin used for?
    • to treat infections in patients who are allergic to penicillin
    • to treat serious respiratory, pelvic and intra-abdominal infections
  68. infections caused by several different microbes
    polymicrobic infections
  69. synthetic antibiotic that is bactericidal against anaerobic gram-positive and gram-negative bicilli, used for colorectal procedures
    metronidazole (Flagyl)
  70. antibiotic with similar properties to penicillin and effective against staphylococci and streptococci
    bacitracin
  71. antibiotic used to treat infections caused by MRSA
    vancomycin
  72. vancomycin actions
    bactericidal only against gram-positive bacteria
  73. substance does not permit the x-rays to pass through
    radiopaque
  74. how is a diagnostic radiologic test with radiopaque media performed?
    contrast medium is injected into the circulatory system or instilled into a body cavity, then a radiograph is taken
  75. solutions that color or mark tissue for identification
    dyes
  76. what are dyes used for?
    to mark skin incisions, delineate normal tissue planes, or enhance visualization of certain anatomic structures
  77. used in surgery to help visually identify abnormal cells, most frequently in procedures on the cervix
    staining agents
  78. chemicals in solution that react differently with abnormal cells from the way they react with normal cells
    staining agents
  79. high-density pharmacological agents used to visualize low-contrast body tissues that include vascular structures, urinary bladder, kidneys, GI tract and biliary tree
    contrast media
  80. what takes place if the patient has a history of iodine allergy with need of radiologic tests during surgery?
    • surgeon should be alerted prior to patient transport to OR
    • usually given Benadryl or prednisone
  81. IV ROCM onset of action
    immediate
  82. IV ROCM excreted by what organ and within what time frame?
    kidneys, usually within 24 hours
  83. water-soluble, iodine-based radiographic contrast medium containing approximately 45% iodine
    omnipaque
  84. omnipaque strengths
    • 140
    • 180
    • 240
    • 300
    • 350
  85. omnipaque available in glass vials in sizes:
    10 mL to 250 mL
  86. omnipaque absorption
    • absorbed from the site of administration into the bloodstream
    • excreted by kidneys virtually unchanged
  87. meaning into lumbar subarachnoid space
    intrathecal
  88. how is omnipaque injected?
    intrathecally or intravascularly
  89. omnipaque is used for what types of procedures?
    • angiography
    • retrograde urography
    • cholangiography
  90. hypaque supplied in glass vials in sizes:
    50 mL and 100 mL
  91. common uses for hypaque
    • excretory urography
    • angiography
    • cerebral angiography
    • peripheral arteriography
    • central venography
    • renal venography
    • cholangiography
  92. hypaque administration
    • not intended for intrathecal administration
    • oral and also directly into the bladder via catheter
  93. visipaque concentrations
    270 and 320 mg/mL
  94. visipaque available in glass and plastic vials in sizes:
    • 50 mL
    • 100 mL
    • 150 mL
    • 200 mL
  95. types of procedures in which visipaque is used
    • cardiography
    • peripheral, visceral and cerebral arteriography
    • contrast-enhanced CT of head and body
    • cholangiography
    • excretory urography
    • peripheral venography
  96. isovue administration
    intravascular, intrathecal and body cavity administration
  97. isovue concentrations
    • 200 mg/mL
    • 250 mg/mL
    • 300 mg/mL
    • 370 mg/mL
  98. what types of procedures is isovue used for?
    • lumbar and thoracocervical myelography
    • cerebral angiography
    • peripheral arteriography
    • venography
  99. isovue supplied in sizes of:
    • 20, 30, 50, 75 and 100 mL vials
    • 75, 100, 150, 175 and 200 mL bottles
  100. for operative cholangiograms, how is contrast media prepared?
    • usually diluted with equal parts normal saline solution
    • attach 30-cc syringe with saline and 30-cc syringe with contrast  media to 3-way stop-cock adapter which is attached to cholangiogram catheter
    • saline injected first to verify placement, then media injected and radiograph taken
  101. dyes used in surgery
    • methylene blue
    • isosulfan blue
    • indigo carmine
    • gentian violet
  102. methylene blue dye used in what types of procedures?
    • cystoscopy (detect bladder injury)
    • tubal dye studies (verify patency of fallopian tubes
    • bladder surgery or exploration (detect bladder injury)
  103. isosulfan blue (lymphazurin) used in what types of procedures?
    delineation of lymphatic vessels for sentinel lymph node biopsy
  104. procedure for injecting isosulfan blue
    3-5 mL injected 5 minutes before skin preparation, allowing 5 minutes' time before first incision is made, allowing medication to be carried through the lymphatic system
  105. indigo carmine used in what types of procedures?
    • kidney or bladder procedures (detect injury to urinary structures)
    • verify kidney function during any procedure (colored urine excreted)
  106. purple dye most frequently used in surgery to mark incision lines
    gentian violet
  107. uses of gentian violet
    • mark skin incisions
    • plastic and reconstructive procedures
    • label containers of medications
  108. gentian violet also belongs to what category of medications?
    antifungal
  109. what is gentian violet used to treat?
    topically, it treats fungal infections inside the mouth, vagina and skin
  110. help identify abnormal tissue for biopsy or excision
    staining agents
  111. strong iodine mixture used to perform Schiller's test on cervix
    Lugol's solution
  112. what does Lugol's solution treat?
    • overactive thyroid gland function
    • iodine deficiency
    • protects thyroid from effects of radiation from radiation therapy treatments
  113. how is Schiller's test with Lugol's solution performed?
    • Lugol's solution applied topically to external cervical os
    • abnormal cells do not take up brown stain as readily as normal cells, demonstrating area of cervix to be biopsied
  114. stain commonly known as vinegar and used to help identify cervical dysplasia
    acetic acid
  115. staining agent used when laser is used to excise dysplasia
    acetic acid

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