CA Police Department Detail Codes(Ten Codes)

10-1
Receiving poor, unable to copy/relocate

10-2
Receiving good/signals clear

10-3
Stop transmitting

10-4
Message received/good copy, acknowledgement

10-5
Relay

10-6
Busy/stand-by

10-7
Out of service

10-7A
Out of service, administrative

10-7B
Out of service, break

10-7C
Out of service, court

10-7P
Out of service, personal

10-7S
Out of service, maintenance service

10-7OD
Off duty

10-7X
Out on portable

10-8
In service

10-9
Repeat

10-10
Out at home

10-11
Dog case

10-12
Visitor(s) present

10-13
Weather & road report

10-14
Report of prowler

10-15
Have prisoner in custody

10-15X
Female prisoner in custody

10-16
Pick-up

10-17
Meet complaintant

10-18
Complete assignment quickly

10-19
Enroute/return(ing) to station

10-20
Location

10-21
Telephone

10-22
Disregard/cancel

10-23
Stand-by

10-24
Assignment completed

10-25
Report in person to “___ “

10-26
Clear, no wants

10-27
Wanted

10-27V
Vehicle code warrant

10-27M
Misdemeanor warrant

10-27F
Felony warrant

10-28
Vehicle registration

10-29
Check for warrant(s)

10-30
Illegal use of radio

10-32
Drowning

10-33
Alarm sounding

10-35
Time check/current time

10-36
Confidential information

10-37
Identify operator

10-38
Stopping suspicious vehicle

10-39
Current status

10-40
Is “___” available for a call?

10-41
Beginning tour of duty

10-42
Call doctor

10-43
Call doctor/medical assistance

10-44
Request permission to leave

10-45
Condition of patient

10-45A
Condition good

10-45B
Condition serious

10-45C
Condition critical

10-45D
Condition deceased

10-48
Traffic standard repair

10-49
Proceed to “____”

10-50
Traffic accident

10-51 & 10-52
Drunk

10-53
Man down

10-54
Possible dead body

10-55
Coroner’s case

10-56
Suicide

10-56A
Suicide attempt

10-57
Hit & run

10-58
Direct(ing) traffic

10-59
Security check

10-61
Personnel in area

10-62
Meet citizen

10-63
Prepare to copy message

10-64
Message for local delivery

10-65
Net message assignment

10-66
Suspicious person/situation

10-67
Person yelling for help

10-68
Dispatch information

10-69
Message received

10-70
Prowler

10-71
Shooting

10-72
Stabbing

10-73
How do you copy

10-74
Negative

10-31
Crime in progress

10-32
Man with gun/weapon

10-33
Alarm sounding

10-34
Open door/window

10-97
Arrived at scene/on scene

10-98
Completed assignment

Pharmacology Gastrointestinal drugs from powerpoint

Antiulcer Drugs:
Include antacids, Histamine Antagonists,
Antacids:
Neutralize gastric acid

Histamine (H2) Receptor Antagonist:
Inhibit production of gastric acid
Mucosal Protectants:
Protect gastric mucosa by coating wall of stomach or ulcer crater
Gastric Acid (Proton Pump) Inhibitors:
Suppress gastric acid secretion at final step of production process
Helicobacter Pylori:
Bacteria associated with about 65% of all peptic ulcers
Laxative:
Used to treat constipation
Stool Softener:
Used to prevent constipation
Antiemetic:
Used to prevent or treat vomiting
Emetic:
Used to induce vomiting
Regurgitation:
backward flowing of solids or fluids to the mouth from the stomach
Dyspepsia:
Indigestion
Flatulence:
Excess gas
Heartburn:
Burning sensation under sternum often due to GERD
Gastroesophageal reflux disease(GERD):
Gastric contents re-enter esophagus; can cause esophageal erosion with risk of strictures
Erosive Esophagitis:
Inflammation of the esophagus with tissue damage; associated with increased risk of cancer
Diarrhea:
liquid consistency of stool; May be due to food poisoning, side effect of medications such as lactose intolerance, laxatives, antibiotics, etc. or symptoms of disease condition; culture for Clostridium difficle or other pathogens
Constipation:
hard, dry consistency of stool; May be due to inactivity, lack of fluid intake, or side effect of medications such as opioids for analgesia
ANTIEMETIC Drugs
ondansetron (Zofran), prochlorperazine (Compazine), promethazine (Phenergan), dimenhydrinate (Dramamine), scopolamine (Trans-derm Scop), trimethobenzamide (Tigan), droperidol (Inapsine), chlorpromazine (Thorazine)
ANTIEMETIC NC:
nasogastric tube for decompression (NG to LIS) should be assessed for patency prior to administering an antiemetic. Provide mouthcare after emesis; Eating dry crackers may reduce vomiting; Monitor fluid and electrolyte balance; If client is taking digoxin (Lanoxin) consider possible digitalis toxicity if severe anorexia, nausea and vomiting; Consider IICP if head injury and vomiting occurs without warning of nausea; Trans-derm Scop changed q 72 hours
ANTIULCER AGENTS:
Antacids, Histamine-Receptor Antagonists, Mucosal Protective Medications, Gastric Acid Pump Inhibitors
ANTACIDS Action:

Neutralize gastric acidity by a local effect, except sodium bicarbonate which is absorbed and can cause systemic electrolyte imbalance

Uses: Relief of heartburn, gas, and indigestion; treatment of peptic ulcers

ANTACIDS Adverse Effects:
Aluminum-based cause constipation; magnesium-based cause diarrhea; sodium-based increase risk of edema/ CHF Caution: Client with renal failure should not take magnesium-based antacids
ANTACIDS NC:
Simethicone reduces flatulence; Avoid long-term use of antacids; Liquid suspensions must be shaken well before administration; Chewable tablets should be chewed well and followed with 8 oz. of water
Antacid Mixtures:
Combination of aluminum and magnesium antacids minimize adverse GI reactions of each
ANTACIDS Common Drugs:
calcium carbonate (Tums), aluminum hydroxide (Amphojel, AlternaGel or Milk of Magnesia), aluminum hydroxide with magnesium hydroxide (Maalox), aluminum hydroxide with magnesium hydroxide and simethicone (Mylanta)
HISTAMINE-RECEPTOR ANTAGONIST Action:

Inhibits both daytime and nocturnal basal gastric acid secretion and inhibits gastric acid stimulated by food, stress, smoking, caffeine, and certain drugs by occupying H2 receptor sites on parietal cells

*Uses*: Active gastric and duodenal ulcers; Prevention of hyperacidity in hospitalized client

HISTAMINE-RECEPTOR ANTAGONIST NC:
Monitor gastric ph (normally below 5); Monitor CBC due to possible blood dyscrasias; Antacids decrease effectiveness; Evaluate improvement of symptoms Client teaching: Avoid substances that irritate stomach such as black pepper, alcohol, harsh spices, aspirin products
HISTAMINE-RECEPTOR ANTAGONIST Drugs:
cimetidine (Tagamet) , rantitidine (Zantac) famotidine (Pepcid)
MUCOSAL PROTECTION AGENTS Action:
Protect mucosal lining from acid, but do not inhibit acid production; coats surface of ulcer. *Uses*: Short-term treatment of active duodenal ulcer
MUCOSAL PROTECTION AGENTS: Drugs:

sucralfate (Carafate)

NC: Do not crush to dissolve; dissolves in water to form slurry

GASTRIC ACID INHIBITOR or PROTON PUMP INHIBITOR Action:

Blocks final step in gastric acid production to suppress gastric acid secretion

*Uses*: Treatment of active ulcers, GERD, and erosive esophagitis; prevention of peptic ulcer

NC: Reconstitute IV Protonix immediately before administration; Do Not Crush delayed-release capsules

GASTRIC ACID PUMP INHIBITOR Drugs:
omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix)
Antiemetic, cholinergic, & GI stimulant (without increasing acid secretion); used in treatment of ?
gastroparesis in DM; administered before meals
metoclopramide HCl (Reglan) (Urecholine) stimulates ?
smooth muscle of bowel or urinary bladder to promote emptying
GI ANTICHOLINERGICS Drugs:
atropine sulfate (Atropine), dicyclomine HCl (Bentyl), propantheline bromide (Pro-Banthine)
Action: anticholinergic action on smooth muscles of GI tract
HELICOBACTER PYLORI ULCERS:

Many peptic ulcers are caused by a bacteria that can be detected with a culture of the gastric lining or by other diagnostic tests Adequate treatment with antimicrobials can cure the peptic ulcer disease and prevent re occurrence,

Two weeks of 3 drug treatment cures up to 90% of patients: omeprazole (Prilosic) clarithromycin (Biaxin), Metronidazole (Flagyl) Treatment for other 10% includes additional drug treatment with: metronidazole (Flagyl), tetracycline or amoxicillin, colloidal bismuth subcitrate (Pepto-Bismol) Must complete entire treatment program to avoid resistant

STIMULANT LAXATIVES:
irritate intestinal mucosa NC: Dulcolax may be administered by mouth or per rectum (suppository)
STIMULANT LAXATIVES Drugs:
cascara sagrada, bisacodyl (Dulcolax), senna (Ex-Lax or Senokot)
BULK FORMING LAXATIVES:
absorbs water and stimulates peristalsis
NC: May cause abdominal distention and flatulence
BULK FORMING LAXATIVES Drugs:
polycarbophil (Fibercon), psyllium (Metamucil)
HYPEROSMOTIC LAXATIVES:
prevent reabsorption of water from stool; also prevents absorption of ammonia and promotes excretion of ammonia in hepatic encephalopathy NC: Report diarrhea for decrease in dose
HYPEROSMOTIC LAXATIVES Drugs:
Lactulose (Chronulac), polyethylene glycol/electrolyte (Go Lytely)
EMOLLIENTS OR LUBRICANTS:

Lubricant Laxatives soften fecal mass

NC: May impair absorption of fat-soluble vitamins; swallow carefully to avoid lipid pneumonia

EMOLLIENT LAXATIVES Drugs:
Mineral oil , Castor oil, Fleets Mineral Oil Enema
SALINE LAXATIVES:

draw water into intestinal contents

NC: Administer Fleets PhosphoSoda over ice due to salty taste; Shake Milk of Magnesia thoroughly prior to administration

LAXATIVES Common Drugs:
sodium phosphate (Fleets Phosphosoda), magnesium hydroxide (Milk of Magnesia) or MOM
STOOL SOFTENERS:
moisten stool; used to prevent constipation, especially when straining is contraindicated such as post myocardial infarction or pelvic surgery
STOOL SOFTENERS Drugs:
docusate calcium (Surfak), docusate sodium (Colace), docusate sodium and casanthranol (Pericolace) is stool softener and laxative
ANTIDIARRHEAL AGENTS:
Diarrhea is characterized by frequent defecation of loose, watery stools. Symptom, not a disease. May be caused by infection, intoxication, allergy, malabsorption, inflammation, tumors of GI tract, food poisoning, and by certain medications.Diarrhea is best defined by consistency of stool , Culture for Clostridium Difficle is done when unexplained, severe diarrhea. Fluid and electrolyte imbalance may occur if prolonged diarrhea (Fluid Volume Deficit and Metabolic Acidosis) Fecal transfer from a healthy person to a client with C-Diff has been successful in re-establishing normal intestinal flora Transfer via NG tube or enema
ANTIDIARRHEAL AGENTS NC:
Monitor potassium level; OTC antidiarrheals may be used without determining cause of diarrhea
ABSORBENT ANTIDIARRHEALS OTC’s drugs:
bismuth subsalicylate (Pepto-Bismol) kaolin mixture with pectin (Kaopectate), loperamide HCl (Imodium)
OPIATE-RELATED ANTIDIARRHEAL AGENTS Prescription Drugs:
diphenoxylate HCL with atropine (Lomotil) {Schedule V controlled drug} paregoric { Schedule II controlled drug}
ANTIDIARRHEAL AGENTS Probiotic:
Promotes Normal Flora Restoration, Lactobacillus acidophilus (Lactinex), Yogurt
ANTIINFLAMMATORY MEDICATIONS USED FOR INFLAMMATORY BOWEL DISEASES:
5-Acetylsalicylic Acid Medications (1st Line Treatment for Crohn’s Disease or Ulcerative Colitis, sulfasalazine (Azulfidine), mesalamine (Asacol or Rowasa), Anti-Inflammatory Corticosteroids (Acute Exacerbation), prednisone
Immune Modulating Agents:
azathioprine (Imuran)
Biologic Agents:
infiximab (Remicade)May not have normal immune response to infection. Monitor closely for signs of infection and reduce risk of infection through universal precautions
EMETIC:
induce vomiting for overdose of oral drugs or certain poisons. Contraindicated of unconscious or semi-conscious or if caustic substance such as lye or acid or petroleum-based substance such as gasoline or kerosene. Recent research questions appropriateness of use. Contact Poison Control Center immediately for instructions
EMETIC Drugs:
Ipecac Syrup followed with full glass of water causes vomiting within 30 minutes, Activated Charcoal may be used to absorb toxic agents from the GI tract without causing vomiting
Procoagulant for decreased production of clotting factors in liver failure-
Vitamin K or Aqua Mephyton, Liver failure causes other problems such as malnutrition, hypoglycemia, hepatomegaly, splenomegaly, ascites, epistaxis, hepatic encephalopathy with confusion, etc.
Ammonia-Lowering Agents to treat Hepatic Encephalopathy:
neomycin (Aminoglycoside antibiotic), kanamycin (Aminoglycoside antibiotic), lactulose/ Chronulac (Laxative)
Diuretics to treat ascites:
cironolactone/ Aldactone (Potassium-Sparing)
Immune Agents used to force virus into remission:
Interferon alfa-2b, recombinant
Immunosuppressive Agents used to prevent rejection of transplanted organs:
Cyclosporine, Tacrolimus (Prograf)
PANCREATIC ENZYME:
used to promote digestion and fat, protein, and CHO absorption
Action: Replaces exocrine secretions of pancreas in cystic fibrosis, chronic pancreatitis, etc.; acts directly in GI tractNC: Given with meal or snack (immediately prior to eating food)

PANCREATIC ENZYME Drug:
pancrelipase (Pancrease)
LACTOSE INTOLERANCE:
Lactose (milk sugar) requires the enzyme lactase for digestion. Symptoms include bloating, cramping, or diarrhea.
CELIAC DISEASE:
Also called nontropical sprue or gluten sensitivity Symptoms include diarrhea, weight loss, and malnutrition. Cause is unknown. Rx: Avoid all food manufactured with grains such as barley, oats, rye, and wheat. May also develop lactose intolerance. Corn, potato, and rice products do not create the malabsorption that occurs with grain products.

68T First Aid for Heat Stroke

Thermoregulation
establishes a set point which may be changed up or down corresponding to hyperthermia or hypothermia

What is the center for thermoregulation control?
anterior hypothalamus

hyperthermia
increase in core body temperature above the normal

What are the four major categories of hyperthermia?
Pyrogenic
Inadequate heat dissipation
exercise hyperthermia
pathologic and pharmacologic

What are the four types of heat dissipation?
evaporation
radiation
convection
conduction

Heat Stress
temp < 106, heavy but controlled panting

heat exhaustion
Temp 106.1-108, uncontrolled panting, dyspnea,

heat cramps
Na+ depletion, muscle cramps

heat stroke
temp > 108. dark mm, vomiting, comatose or dull mentation, weakness

heat prostration
vomiting, tachycardia, hypotension

What is the clinical representation of heat injury?
105 or great rectal temp.
weakness, collapse
rapid pulse
panting
bright red mm
shock
neurological abnormalities
petechaie, ecchymoses
melena, discolored urine

When should cooling be discontinued?
when rectal temp at 103.

EMR Chp 1

Enhanced 911 systems allow the caller’s information to be received electronically to the
Dispatch center

The medical director is a physician who assumes the ultimate responsibility for the:
Medical oversight of the EMS system, patient outcome, protocols

You have received orders to administer oxygen to the patient. This would be called:
On-line medical direction

The procedures that an Emergency Medical Responder can provide as care for a patient are called
Scope of practice

Emergency Medical Responders are trained in the care and management of ill and injured patients. An Emergency Medical Responder should not be involved in the process ofL
Traffic control

The first priority of an Emergency Medical Responder should be:
Scene safety

The personal protective equipment for the Emergency Medical Responder should include:
A mask, eye protection, gloves

As an Emergency Medical Responder, when you are helping a person you should:
Be honest and realistic

The Emergency Medical Responder acts as a designated agent of the:
Medical director

The personal protective equipment that minimizes contact with infectious bodily fluids includes:
Gloves, gowns, eye protection

A designated 911 emergency dispatch center is called a:
Public safety answering point

When the medical director’s specific instructions on providing care for a specific medical condition or injury is/are called:
Standing orders

An Emergency Medical Responder provides emergency care:
Until EMTs or paramedics take over care

You are on your way home when you see a child fall off the curb. You stop to help and find that the child is bleeding from his right knee. Since you have no access to your medical director, you get your first aid kit from your truck and follow the protocols for controlling the bleeding and bandaging the injury. What type of medical direction are you adhering to?
Off-line medical direction

You respond to a motor vehicle crash with your crew and will have to provide care to patients from a different culture. This culture is foreign to many of your beliefs. Which of the following can you legally consider when making decisions about the care you provide?
The patients’ unique medical needs

You have attending an Emergency Medical Responder course, and your friend asks you, “What are the duties of an Emergency Medical Responder?” You know that your patient-related duties include all of the following EXCEPT:
Administering medication to ill and injured patients

During your conversation with your friend, he asks you what other levels of EMS personnel there are. you explain that there are Emergency Medical Responders, EMT-Basics, and advanced-level providers such as:
Paramedics and EMT-Intermediates

Your friend asks, “How do you know what you can and cannot do when caring for a patient?” You explain that there is a set of responsibilities and ethical considerations that define the extent of care you provide called:
Scope of practice

During the conversation, you are asked what you do if you can not contact Medical Control. You explain that you can follow protocols or standing orders under a medical direction called:
Off-line medical direction

The National Registry of Emergency Medical Technicians recognizes all of the following EMS levels EXCEPT:
EMT-Dispatcher

Medical direction obtained by speaking directly with the medical director is called:
On-line medical direction

The first concern at the scene of an emergency is:
Scene safety

When moving or lifting a patient, you should:
Use good body mechanics

Pharmacology wk#2 Test#1

What is minimum effective concentration (MEC)?
The lowest plasma concentration required to cause measurable response.

what is onset of action?
Onset of action is when plasma concentration reaches the minimum effective concentration. Length of time before med starts to work.

What does peak mean?
Peak is the highest plasma concentration. This is when drug will have strongest effect.

When is the greatest risk for toxic or adverse reaction?
at the peak plasma concentration

What is duration of action?
Duration of action is the time period when plasma concentration is above MEC.

What is therapeutic index?
The ratio between the toxic dose and the effective dose. Ratio between LD50 (lethal dose in 50% of the population) and ED50 (effective dose in 50% of the population)

The closer the therapeutic index is to ___ the more narrow the therapeutic index.
1

What should you do if there is a narrow TI/range?
monitor plasma drug levels and drug effects. The goal is to keep plasma levels within therapeutic range, but below toxic levels.

What is half life?
the time it takes, after absorption, for 50% of the drug to be eliminated.

How many half lives does it take to eliminate 98% of the drug?
It takes approximately 4-5 half lives.

What helps to determine duration of action?
half life (it helps determine how much time separates each dose)

Dose approximately every_____ in order to maintain steady state blood levels (an equilibrium between drug transfer in and out of plasma).
half life ( it takes 4-5 half lives to reach steady state blood levels.

What is a loading dose?
This means to give a higher than maintenance dose in order to rapidly reach steady state blood levels.

Nursing implications for peak and trough drug levels
wait until steady state is reached (after at least 4 doses given). Give drug on time and document. Draw blood at proper time. For peak draw blood at peak of drug action. For trough draw blood immediately before next dose of drug.

Drug receptor interaction theory?
drugs interact with receptor in lock and key fashion. Only certain keys fit certain locks.

Rate interaction theory?
The rate of binding determines the type and intensity of response. A drug with a greater affinity or greater concentration will attach to more receptors, and more often, resulting in a more intense response.

What does agonist mean?
combines with receptor and produces a response (activates receptors). When drugs act as agonist, they simply bind to receptors and mimic the actions of the body’s own regulatory molecules.

What does antagonist mean?
combines with receptor and inhibits action of agonist (prevents receptor activation).

What does competitive antagonist mean?
has a higher affinity for receptor. If an agonist and a competitive antagonist have equal affinity for a particular receptor, then the receptor will be occupied by whichever agent agonist or antagonist is present in the highest concentration.

What does noncompetitive antagonist mean?
it cannot be overcome by higher concentrations of agonist. Because the binding of noncompetitive antagonist is irreversible, inhibition by these agents cannot be overcome, no matter how much agonist may be available.

The combined effect of 2 similar drugs that act at the same receptor is called?
addition (additive)

The effect of one drug increased by the second is called?
potentiation. 1+1+2
This can work in many ways.
1. increased concentration at the receptor.
2. increased concentration at the receptor
3. decreased metabolism
4. slow excretion

What does synergism mean?
combined effect greater than each drug given alone. 1+1=3

What is inhibition? Inhibitory?
Interactions that result in reduced drug effects.
1. any decrease in effect
2. decrease in absorption (1st drug decreases absorption of 2nd drug).
3. decrease concentration at receptor
4. increase metabolism
5. increase excretion

What does side effect (secondary effect) mean?
any effect other than the primary therapeutic effect.

What is an adverse drug reaction?
Noxious, unwanted or unintended reaction occurring at ” normal doses”.

What is a severe adverse effect?
toxicity (may be due to excessive dosing)

What does toxicity mean?
an adverse drug reaction caused by excessive dosing. In everyday parlance the term toxicity has come to mean any severe ADR, regardless of the dose that caused it.

Acceptable adverse reaction
risk vs benefit is acceptable (nausea w/opioids). doesn’t require stopping the drug.

Unacceptable adverse reaction
causes higher risk vs benefit (anaphylactic reaction). requires stopping the drug.

Adverse drug event
considered reportable to FDA or monitoring agencies.

What does hypersensitivity mean?
Any excessive reaction

What does idosyncratic effect mean?
uncommon response, may be due to genetic predisposition.

What is an allergy?
Histamine mediated immune response. requires sensitization. it’s a state of hypersensitivity.

Allergic reactions
severity may vary from uncomfortable hive,s and itching to life threatening anaphylaxis.

Anaphylaxis is?
abrupt onset, massive histamine release.

S/S of anaphylactic reaction
edema at injection site, erythema, anxiety, restlessness, coughing, sneezing, itching (throat, mouth, palms, soles of feet), bronchospasm (wheezing), laryngospasm (stridor, airway compromised), vascular collapse (hypotension, tachycardia).

Anaphylaxis treatment
Epinephrine- 1mg IV or ET.
less severe reaction: 0.3-0.5mg.
IM (SQ also recommended)
Airway management: intubation PRN, O2.
Antihistamine: diphenhydramine (benadryl) IV.
Corticosteroids: methylprednisolone(IV)
Fluid resuscitation: increasing blood volume will increase BP. Vasopressores (dopamine) and cardiac monitoring.

What is serum sickness?
Type III hypersensitivity reaction.
S/S: Skin rashes, edema, fever, joint pains. **anaphylaxis may follow if untreated**
Tx: stop drug, corticosteroids, anti inflammatory drugs (NSAIDS), antihistamines.

What is erythema multiformae?
delayed hypersensitivity reaction.
S/S: circular, edematous lesions, **target lesions, or bulls eye lesions**, necrosis of lesions may occur. (lesions are not typical hives. they have a dip in the middle of the hive)
Tx: stop the drug, corticosteroids (debatable), lesions may become necrotic (wound care)

What is Stevens Johnson syndrome?
A more severe form of erythema multiformae.
S/S: target lesions that involve mucous membranes as well as skin, lesions erode (painful), joint pains, fever, malaise.
Tx: stop drug, symptom management, corticosteroids, antibiotics, wound care.
Death may result from infection of lesions.

What is toxic epidermal necrolysis?
A more sever form of erythema multiformae where the skin sloughs.
Tx: stop drug, antibiotics, corticosteroids, wound care, isolation if needed.

Other skin reactions
Drug eruptions- drug rash, a fine rash with small bumps.
Eczema- pruritis, edema
Contact dermatitis- skin irritation because of direct contact w/drug.

What is photosensitivity?
skin reactions- rash, sunburns easily.
Tx: avoid sun exposure, wear proper clothing, sunscreen. teach clients to avoid sunburn. Some drugs increase sensitivity to sun and cause sunburn.

What is pseudomembranous colitis?
overgrowth of clostridium dificile in gut.
S/S: worsening diarrhea that is bloody and contains mucus. Tx: stop drug, hydrate.

What is ototoxicity?
toxicity to the eighth cranial nerve. S/S: tinnitus, vertigo, hearing loss. Tx: stop drug, hearing loss may be irreversible. Prevent: monitor, teach people to report symptoms.
Drugs: aspirin, loop diuretics (furosemide, lasix)

What is Encephalopathy?
Brain dysfunction. S/S: reduced LOC, seizures, risk greater with pre-existing neurologic disease or injury. Tx: stop drug, manage symptoms.

What are paradoxical reactions?
opposite of expected therapeutic effects.
Children- excitement with some sedatives.
Elderly- similar reactions (agitation w/sedative)

What is extrapyramidal reactions?
AKA parkinsonian symptoms. S/S: disturbances in motor function, tremor, gait distrubances, rigidity (looks like parkinson’s disease). Psychotropic and antiemetic agents worst. Tx: stop drug, reduce dose, anticholinergic agents.

What are the cardiovascular reactions?
arrhytmias (dysrhytmias)- irregularities in cardiac rhythm. “Arrhythmogenc” drugs- may directly interfere w/cardiac conduction OR Sensitize myocardium to Epi/NorEpi, Stimulatns (acti like Epi), some anesthetics. Tx: stop drug, cardiac monitoring, treat dysrhythmias.

What is myocardial toxicity?
direct damage to myocardial tissue. Causes: cardiomyopathy- can lead to congestive HF. Drugs (lead, some antineoplastics, illicit drugs). Tx: stop drug, monitor cardiac functions, symptom management.

What does cardiac vasoconstriction do?
causes reduced circulation to the myocardium, myocardial infarction if severe. Tx: stop drug, manage symptoms. Drugs-cocaine, meth.

what is a blood dyscrasia?
dysfunction of the blood forming organs.

What happens with a hematologic reaction such as bone marrow depression?
1.reduced WBC- neutropenia, rick of infection.
2.reduced RBC- anemia, fatigue, lower O2 carrying capacity.
3. reduced platelets- risk of bleeding

Hematologic reaction: Severe aplastic anemia
lack of production of all cells. Tx: 1.Reduced White Cells-Prevent infection, isolation, Neupogen (neutrophil colony stimulating factor) 2.Reduced Red Cells – Oxygen, Transfusion, Epogen (stimulate RBC production) 3.Reduced Platelets – Safety, Platelet Transfusion, Oprevelkin (stimulate platelets)

Hematologic reaction: Hemolytic anemia
direct red blood cell destruction. this can cause renal failure if heme molecules clump in glomerulus. Tx: stop drug, corticosteroids,

Hepatotoxicity: Toxic Hepatitis
look like viral form(elevated enzymes- ALT, AST, jaundice). Tx: stop drug, corticosteroids. Drugs: acetaminophen, antilipemic drugs.

What is Carcinogenicity?
the ability to cause cancer. dose related risk (higer dose, higher risk). Drugs: antineoplastics, anabolic steroids. Prevent: minimize exposure.

What is Teratogenicity?
ability to cause birth defects. most risk in 1st trimester- as most organ systems are differentiating at this time. Teach: avoid drugs throughout pregnancy- only with approval of Dr. Agents: many alcohol, antineoplastics, anticonvulsants, etc.

pharm ch 2: Application of Pharmacology in Nursing Practice

Seven aspects of drug therapy
1) pre-administration assessment
2) dosage and administration
3) evaluating and promoting therapeutic effects
4) minimizing adverse effects
5) minimizing adverse interactions
6) making PRN decisions
7) managing toxicity

Three goals of ASSESSMENT
1) collecting baseline data
2) identifying high-risk patients
3) assessing the pts capacity for self-care.

low doses of Aspirin
relieve pain

high doses of Aspirin
relieve inflammation

Morphine doses
Oral = higher doses
injected = lower doses

to make an evaluation you must know:
-the rationale for treatment
-nature and time course of intended response

Nifedipine
-given for HTN and ANGINA PECTORIS
-used for two cardiovascular disorders

adherence
extent to which a pts behavior coincides with medical advice

carbamazepine
anti-seizure drug

PRN most common for:
hypnotics (sleeping pills)

rifampin
drug for TB – creates a harmless red-orange color to urine, sweat, saliva and tears

phenelzine
antidepressant – can cause dangerous elevations in BP if taken with certain drugs (amphetamines) or certain foods (figs, avocados, most cheeses)

nursing process
1) assessment
2) analysis
3) planning
4) implementation
5) evaluation

4 goals of preadmnistration assessment
1) collection of baseline data needed to evaluate therapeutic responses
2) collection of baseline data needed to evaluate adverse effects
3) identification of high risk patients
4) assessment of the pts capacity for self care

drug hx should include:
-rx drugs
-OTC drugs
-herbal remedies
-drugs taken for non-med purposes (alcohol, nicotine, caffeine, illicit drugs)

idiosyncratic reactions
reactions unique to the individual

contraindication
preexisting condition that precludes use of a particular drug under all but the most desperate circumstances
(allergic reaction to penicillin = contraindication to penicillin unless pt has a life threatening infection that can’t be controlled by another antibiotic)

precaution
preexisting condition that significantly increases the risk of an adverse reaction to a particular drug but not to a degree that is life threatening.

4 groups of nursing interventions
1) drug administration
2) interventions to enhance therapeutic effects
3) interventions to minimize adverse effects and interactions
4) pt education (encompasses info in first 3 groups)

pt education should include:
-pts capacity to learn
-technique of admin
-dosage size
-duration of treatment
-method of drug storage
-measures to promote therapeutic effects
-measures to minimize adverse effects

4 major components of implementation
1) drug admin
2) pt education
3) interventions to promote therapeutic effects
4) interventions to minimize adverse reactions

evaluation
evaluate for:
1) therapeutic response
2) adverse drug reactions/interactions
3) adherence to prescribed regimen
4) satisfaction w/ treatment

amphetamine
adverse effect (AE) = CNS stimulation

aspirin
AE – gastric erosion

atropine
AE – urinary retention

bethanechol
AE – stimulation of GI smooth muscle

clonidine
AE – impotence

cyclophosphamide
AE – reduction in WBC count

digoxin
AE – dysrhythmias

furosemid
AE – excessive urine production

gentamicin
AE – damage to 8th CN

glucocorticoids
AE – thinning of skin

haloperidol
AE – involuntary movements

nitroglycerin
AE – hypotension

propranolol
AE – bradycardia

warfarin
AE – spontaneous bleeding

Surgical Recall 69 – Hand Surgery

Bones of the hand?
Phalanges
Metacarpal bones
Carpal bones

What is the tip of the finger joint?
Distal InterPhalangeal joint (DIP)

What is the middle finger joint?
Proximal InterPhalangeal joint (PIP)

What is the knuckle joint?
Metacarpal Phalangeal joint (MP)

What are the intrinsic hand muscles?
Lumbricals
Interosseous muscles

What is adduction and abduction of the fingers?
ADDuction is to the midline
ABDuction is away from the midline

What are the trauma zones of the hand?
Zone 1 – beyond PIP
Zone 2 – MP to PIP
Zone 3 – Thumb crease to MP
Zone 4 – Lower half of the palm
Zone 5 – Palmer crease and proximal

Where is “no man’s land”? Significance?
Zone 2 – distal palmer crease to just beyond the PIP joint
Flexor tendon injuries here have a poor prognosis – expert is needed to repair

What is the ulnar nerve distribution?
Half of ring finger and medial

What is the radial nerve distribution?
Back of hand, half of ring finger and lateral, NOT including tips of fingers
Lateral part of thumb

What is the median nerve distribution?
Palmer side of hand, half of ring finger and lateral.
Tips of fingers on the back

How can radial nerve motor function be tested?
– Wrist and MCP extension
– Abduction and extension of thumbs

How can the ulnar nerve motor function be tested?
– Spread fingers apart against resistance
– Check ability to cross index and middle fingers

How can the median nerve function be tested?
– Touch the thumb to the pinky (distal median nerve)
– Squeeze examier’s finger (proximal median nerve)

How can the flexor digitorum profundus apparatus be tested?
Check isolated flexion of the finger DIP joint

How can the flexor digitrum superficialis apparatus be tested?
Check isolated flexion of the figer at the MP joint

Where do the digital arteries run?
On medial and lateral sides of the digit

What hand lacerations should be left unsutured?
Human and animal bites

Should a clamp ever be used to stop a laceration bleeder on the hand?
NO
Use pressure then tourniquet for a definitive repair if bleeding does not cease
Nerves run with blood vessels

What is a felon?
Infection of the tip of the finger pad
Treat with incision and drainage

What is a paronychia?
Infection of the side of the finger nail
Treat by incision and drainage

What is tenosynovitis?
Tendon sheath infection

What are Kanavel’s signs?
Signs of tenosynovitis
– Affected finger held in flexion
– Pain over volar aspect of affected tendon on palpation
– Swelling of affected finger (fusiform)
– Pain on passive extension

Most common bacteria in tenosynovitis and paronychia?
Staph aureus

How do you treat bites (human and animal)?
Debridement and irrigation
Administration of antibiotics
Leave wound open

Unique bacteria in human bites?
Eikenella corrodens

Unique bateria in dog and cat bites?
Pasteurella multicoida

What is the most common hand/wrist tumor?
Ganglion cyst

What is an extremely painful type of subungual tumor?
Glomus tumor
(subungual – under the nail)

What is a “boxer’s fracture”?
Fracture of the fourth or fifth metacarpal

What is a “drop finger” injury?
Laceration of the extensor tendon over the MP injury

What is the classic deformity resulting from laceration of the extensor tendon over the DIP joint?
Mallet finger

What is the classic deformity resulting from laceration of the extensor tendon over the PIP joint?
Boutonniere deformity

What fracture causes pain in the “anatomic snuffbox”?
Schapoid fracture
Visible 2 weeks later on Xray (NOT initially)
Can cause avascular necrosis
Place in cast if clinically suspected

What is the “safe position” of hand splinting?
In a C-shape, with hand slightly extended and fingers/thumb slightly flexed

What is Dupuytren’s contracture?
Fibrosis of palmar fascia, causing contracture of an inability to extend digits

What is Gamekeeper’s thumb?
Injury to the ulnar collateral ligament of the thumb

How should a subungal hematoma be treated?
Release pressure by burning a hole in the nail

What is carpal tunnel syndrome?
Compression of the median nerve in the carpal tunnel

What is the most common cause of carpal tunnel syndrome?
Synovitis

What are less common causes of carpal tunnel syndrome?
Median artery (persistent)
Edema of pregnancy
Diabetes
Idiopathic
Acromegaly
Neoplasm (i.e. ganlioneuroma)

Thyroid (myxedema)
Rheumatoid arthritis
Amyloid
Pneumatic drill usage
SLE

MEDIAN TRAPS

Symptoms of carpal tunnel syndrome?
Pain and numbness in the median nerve distribution

What are the signs of carpal tunnel syndrome?
Tinel’s sign (percussion over median nerve)
Phalen’s test (flexion of wrist)
Thenar atrophy
Wartenberg’s sign (hand resting on a surface – pinky finger rests in abduction compared to the other 4 digits)

What is the workup for CTS?
EMG
Nerve conduction study

What is the initial treatment for CTS?
Nonoperative – rest, wrist splint, NSAIDs

What are indications for surgery with CTS?
Refractory symptoms, theanr atrophy, thenar weakness

What is the surgical treatment for CTS?
Release transverse carpal ligament

Surgery – General Abdominal Surgery

What are common premedications and their doses?
Acepromazine: 0.02-0.05 mg/kg

What are common induction agents and their doses?
Propofol: 4-6 mg/kg
Propofol at 2 mg/kg and diazepam at 0.25 mg/kg
Ketamine at 5 mg/kg plus Valium at 0.25 mg/kg or combined Ket/Val at 1 ml/10 ikg

What are common medications for fractious cats and their doses?
Medetomidine at 0.02 mg/kg
Butorphanol at 0.2 mg/kg
Ketamine at 5 mg/kg

What is commonly used for maintenance of anesthesia?
isoflurane and sevoflurane

What is the most common antibiotic?
cefazolin (1/2 hour prior to start of surgery and every 2 hours intra-op)

How long should the incision be for exploratory laparotomy?
at least 10 to 15 cm margins (from the xiphoid process to the pubis)

What type of sponges should be used during a laparotomy surgery?
laparotomy sponges only – do not use 4×4 sponges

What are the three layers to go through when entering the abdomen?
(1) the skin, (2) subcutaneous tissue and (3) linea alba/rectus abdominis

What are the four parts of the linea alba/rectus abdominis (superficial to deep)?
(1) linea alba, (2) external rectus sheath, (3) rectus abdominis and (4) internal rectus sheath

What part of the rectus sheath holds the strength?
the external rectus sheath

What part of the rectus sheath is usually intimate with the peritoneum?
the internal rectus sheath

What type of cutting is most commonly used for incising through the skin?
slide cutting

Why do you not want to undermine, dissect or remove SQ fat to find the linea alba?
it increases the risk of post-operative seroma or infection

What can be applied by the surgeon to increase slide cutting efficiency and precision?
force vectors

Where do you make incisions for the following procedures?
-exploratory laparotomy?
-dog OHE?
-cat OHE?
-cystotomy?
-gastrotomy?
– exploratory: xyphoid to pubis
– dog OHE: cranial third of the caudal abdomen
– cat OHE: middle (cranial) third of the caudal abdomen
– cystotomy: umbilicus to pubis
– gastrotomy: xyphoid to pubis

How can you provide adequate hemostasis when making incisions into the abdominal wall?
by cauterizing, ligating or applying pressure to small bleeding vessels before proceeding to the next layer

When making abdominal incisions, what needs to be done differently in the male dog?
need to curve the skin incision to the right (or left) to avoid the prepuce

In male dogs, what vessels do you need to ligate or cauterize that is different from the other animals?
branches of the superficial caudal epigastric artery and vein

How do you enter the abdomen through the linea alba?
palpate interior surface of linea for adhesions; tent the abdominal wall at or cranially to the umbilicus with tissue forceps to protect underlying organs; make a sharp reverse stab incision into the linea alba with the scalpel blade horizontal; use dissecting scissors to extend the incision cranially and caudally

What is an exploratory laparotomy?
a methodical examination of the abdominal organs

When would you perform an exploratory laparotomy?
organ biopsy; therapeutic reasons; emergencies; severe trauma

Why does the falciform ligament need to be removed? How can it be removed?
need to get it out of the way to better see the viscera and allow for better abdominal closure; can remove by excising with cautery or scissors/blunt traction with hemostats only from its attachment at the midline in small patients

What type of retractors are used for exploratory laparatomy?
balfour

Why should you place moistened lap sponges along the subcutaneous tissue before placing retractors?
to prevent direct contact of viscera with skin; prevent dessication of exposed tissue and prevent contamination of exposed tissue

How should exploration of the abdomen be performed?
systematically

What can be found in the cranial abdomen?
liver, gall bladder and common bile duct, stomach, diaphragm, left pancreatic duct and cranial abdominal lymph nodes

Explain the duct system found in the cranial abdomen?
the cystic duct from the gall bladder receives hepatic ducts from each liver lobe; this bile duct empties into the duodenum on the major duodenal papilla

The omental bursa needs to be opened to view which structures?
the dorsal surface of the stomach, the left pancreatic limb and the cranial abdominal lymph nodes

What is found in the right gutter?
the right adrenal gland, the right kidney, the right ureter and the right ovary and uterine horn (or stump)

What acts as a natural internal retractor?
the duodenum and mesoduodenum

Why can the right adrenal gland be difficult to see?
because it is covered by the caudate process of the caudate hepatic lobe

Where is the epiploic foramen?
cranailly in the root of the mesoduodenum and it lies medial to the caudate process of the liver bounded by the portal vein ventrally, and the vena cava/celiac artery dorsally

What can often be visualized in the area of the epiploic foramen?
portosystemic shunts

What is a common location for entrapped bowel in equine colic patients?
the epiploic foramen

What is found in the left gutter?
spleen, left adrenal gland, left kidney, ureter and ovary and uterine horn or stump

What is found in the caudal abdomen?
the bladder, the sublumbar lymph nodes, the prostate gland and the uterine body or stump

What is the ventral ligament and can it be transected?
a reflection of the peritoneum and it can be reflected

Why can the right and left ligaments of the bladder not be cut into?
they contain the ureters, hypogastric nerves and primary blood supply to the bladder

Why is biopsy rather than complete excision of masses in the bladder usually performed?
because the masses are typically located at the trigon making it difficult to excise

What type of pattern do you close the bladder with?
a single or double layer appositional or inverting pattern using absorbable suture

What is found in the central abdomen?
the omentum, intestines, mesenteric lymph nodes and the pancreas

Can the mesenteric lymph nodes be removed?
no as this will damage mesenteric vessels and kill the small intestine

What should you do in case of ileus?
milk luminal contents distally to prevent absorption of enterotoxins

What are all tissue biopsies submitted in for histological examination?
10% buffered formalin

What is an incisional biopsy?
a biopsy of a selected portion of a lesion with some adjacent normal tissue

What is a wedge biopsy?
a biopsy where a wedge of tissue is taken from the organ/lesion

What is an excisional biopsy?
a biopsy of an entire lesion including a significant margin of normal appearing tissue

What is a punch biopsy?
a circular sample taken with a Baker’s punch

Define transect
cut through

Define incise
to cut into

Define excise
to cut out

Define proximal
relative term used to describe a structure closer to the heart

Define distal
relative term used to describe a structure farther from the heart

What is a percutaneous liver biopsy good for? Which patients should it be cautioned in? How can the sample be taken?
diffuse liver disease; patients with coagulation concerns; make a small incision through the skin on the left side of the xiphoid and insert the biopsy needle in a craniodorsal direction aiming to the left of the midline

What is the guillotine method of biopsy used to obtain? How is this done?
a periphery sample of the liver; absorbable suture material is placed around the protruding margin of a liver lobe and pulled tight – hold the liver and with a sharp blade, cut the hepatic tissue approximately 5 mm distal to the ligature

When can a biopsy punch be done? How do you provide hemostasis afterwards?
when the lesion is more centrally located; place a small plug of gelatin hemostatic sponge within the biopsy site to provide hemostasis

What type of biopsies can be done for a lymph node?
a Tru-Cut needle biopsy or an incisional biopsy

What type of biopsies can be done for the spleen?
– FNA – diffuse pathology
– Focal lesions (FNA, Tru-Cut, punch biopsy and excisional biopsy)
– Diffuse lesions – partial or total splenectomy

What type of biopsies can be done for the kidney?
– percutaneous biopsy (Tru-cut)
– wedge biopsy

What type of sutures should be placed in the stomach after doing a biopsy?
a stay suture

How is a stomach and/or an intestinal biopsy done?
a 3-5 mm elliptical incision into the lumen either transversely or longitudinally is made; usually closed with interrupted appositional sutures of 3-0 or 4-0 monofilament absorbable suture

What is the “leak test” for GI organs?
saline is injected into the biopsied segment while the area is occluded digitally or with Doyon forceps

When is lavaging the abdomen indicated for? What do you use?
peritonitis, diffuse intra-operative contamination and GI surgery; warmed balanced electrolyte solutions (without antiseptics or antibiotics) and then remove the lavage fluid by suction

What is the holding layer that must be included when closing the abdomen?
the external rectus sheath

What pattern can be used when closing the linea alba?
a simple interrupted or a simple continuous pattern

Why is a subcuticular pattern used when closing the skin?
eliminates dead space and provides apposition of skin to decrease tension on the skin; client does not need to return to have stitches removed; animal does not have any sutures to chew on; reduces scarring

What types of needles are there and what are they used for?
taper needle – preferable for hollow organs and soft tissues that are easily penetrated
cutting needle – used for hard tissues (skin, ligaments, etc)
reverse cutting needle – a midway for solid tissues

What rate should fluids be at post-op?
5 ml/kg/hr

What is a paracostal celiotomy (or paralumbar incision) used to expose? What position is the animal in? How is the incision made?
kidneys and adrenals; lateral recumbency; incision is made from the ventral vertebral column to near the ventral midline – the incision is centered halfway between the wing of the ilium and the last rib – the incision is extended through the internal abdominal oblique – the peritoneal and transversalis fascia is exposed – the peritoneum is tented and incised with a reverse stab incision

using your knowledge 29

in coronary bypass surgery, a section of the vein is used to replace occluded coronary arteries. Over time, the vein wall becomes more like an arterial wall. Describe the change that would occur in the vein wall.
the tunica media would become thicker, containing more smooth muscle and elastic fibers

the smooth muscle fibers within the wall of an artery do not receive their nutrients from the blood within the lumen of the artery. why not?
arterial wall is too thick for nutrients from blood to diffuse to the smooth muscle fibers

blood flow within the capillaries is slower than within arterial or venous vessels. explain why this is important
blood flow must be slow to allow time for nutrients and wastes to diffuse across the capillary wall

blood flow to the skeletal muscles increases with exercise. explain how the autonomic nervous system mediates the increase in blood flow to skeletal muscles
the autonomic nervous system dilates arterial vessels within skeletal muscles to increase blood flow

explain how blood flow to the kidneys is decreased with exercise?
kidneys obtain 25% of the cardiac output at rest. To provide an increased blood flow to skeletal muscles to supply them with nutrients during exercise, the body decreases blood flow to other areas, including the kidneys

explain why the differences in the amount of elastic fibers and smooth muscle fibers in the tunica media of elastic arteries and muscular arteries is important to their function
experience greater pressure fluctuations than muscular arteries. They allow stretching and recoiling. Smooth muscle fiber abundance can be constricted or dilated to control blood flow

why does the tunica interna of the vasoconstricted section of the arteriole exhibit folds?
it is constricted. The tunica interna folds during constriction

capillaries within the brain have tight junctions, whereas capillaries within the anterior pituitary and other endocrine glands contain fenestrations, intercellular clefts, and vesicles for transcytosis. Explain how these structural differences are important to the function of the brain and the anterior pituitary
exhibit more tight junctions, contributing to the blood-brain barrier. That controls what substances enter the nervous tissue. Blood vessels of anterior pituitary have fenestrations, intercellular clefts, and vesicles for transcytosis to allow hormones traveling from other areas of the body to enter anterior pituitary and effect changes in secretion and allow hormones secreted by anterior pituitary cells to enter blood vessels and to be carried to target cells in the body

compare the strength of arterial and capillary walls
arterial walls contain smooth muscle and more elastic and collagen fibers and are much stronger than capillary walls. The arterial walls must carry blood and higher pressure than capillaries

Marfan syndrome is an inherited genetic disorder that results in malformed elastic fibers that are weak. What effect would this have on the aorta?
the aorta wouldn’t be able to recoil to move blood efficiently. Areas that don’t recoil may weaken from aneurysms

Drugs to Memorize — Antibiotics

Name 5 mechanisms for antibiotics.
1) inhibit cell wall synthesis
2) inhibit protein synthesis
3) inhibit folic acid synthesis
4) inhibit DNA / RNA synthesis
5) distinct mechanisms

Name 4 categories of cell wall inhibitors.
1) penicillins
2) cephalosporins
3) carbapenems
4) other

Name 9 categories of protein synthesis inhibitors
1) aminoglycosides
2) macrolides
3) tetracyclines
4) chloramphenicol
5) lincosamides
6) ketolides
7) mupirocin
8) linezolid
9) streptogramins

Name 2 classes of folic acid synthesis inhibitors
1) sulfonamides
2) trimethoprim

Name 3 classes of DNA / RNA synthesis inhibitors
1) fluoroquinolones
2) lipopeptides
3) metronidazole

Name 3 drugs with distinct mechanisms
1) nitazoxanide
2) tinidazole
3) rifaximin

Name 4 sub-classes of penicillins
1) natural penicillins
2) penicillinase-resistant penicillin
3) aminopenicillin
4) antipseudomonal penicillin

What two sub-classes of penicillins are effective exclusively on G+ bacteria?
natural and penicillinase-resistant penicillins

Which is oral and which is iv — penicillin G and penicillin v?
penicillin G — “gold standard” = iv
penicillin v — oral

Name an aminopenicillin?
ampicillin or amoxicillin

Name an antipseudomonal penicillin?
ticarcillin or piperacillin

Are the penicillins bacteriocidal or bacteriostatic?
bacteriocidal

How do pencillins work to kill bacteria?
bind to transpeptidase enzyme (PBP) and blocks cross-linkage of NAM and NAG in bacterial cell wall

What is the main resistance mechanisms for penicillins?
Beta-lactamases

What are two possible drug interactions to keep in mind with penicillins?
1) lowers effectiveness of birth control
2) ineffective if combined with drugs that are bacteriostatic; bacteria must be replicating for penicillins to work

What is often prescribed along with amoxicillin?
B-lactamase inhibitor, clavulanic acid

What is often prescribed along with ticarcillin?
B-lactamase inhibitor, clavulanic acid

What is often prescribed along with piperacillin?
B-lactamase inhibitor, tazobactam

What is route for antipseudomonal penicillins?
iv

What kind of bacteria are cephalosporins used for?
G- bacteria especially Klebsiella

What is the best antibiotic for Klebsiella?
cephalosporins

Name 2 carbapenems
imipenem and meropenem

What is the route for carbapenems?
iv

Name a specific cephalosporin
cefazolin, ceftriaxone

Cephalosporins are bacteriocidal or bacteriostatic?
bacteriocidal

Carbapenems are bacteriocidal or bacteriostatic?
bacteriocidal

Imipenem is often given along with what other drug?
cilastatin, which inhibits enzyme that degrades imipenem

What kind of drug is methicillin?
penicillinase-resistant penicillin

What is the mechanism for vancomycin?
cell wall inhibition

What bacteria is vancomycin used for?
Gram positive bacteria

Is vancomycin bacteriostatic or bacteriocidal?
bacteriocidal

How specifically does vancomycin work?
binds to D-ala-D-ala portion of cell walls, blocking cell wall polymerization and cross-linking

What bug is the drug cycloserine used for?
mycobacterium TB

Is cycloserine bacteriocidal or bacteriostatic?
bacteriocidal

What is the drug polymixin B used for?
Gram- bacteria except for Proteus

Is polymixin B bacteriocidal or bacteriostatic?
bacteriocidal

How specifically does polymixin B work?
detergent that disrupts lipoproteins in bacterial cell walls, increasing membrane permeability

Name 2 aminoglycosides
amikacin, gentamicin

What is mechanism for aminoglycosides?
binds to bacterial 30s subunit; interferes with formation of complex. and causes ribosome to separate from the mRNA

What tissue(s) is toxicity to aminoglycosides seen?
eyes and kidneys

What are resistance mechanisms for aminoglycosides?
alterations in receptor proteins on ribosomes; enzymatic alteration of AGs by the bacteria

What bacteria are aminoglycosides used to treat?
G-

What is route for aminoglycosides?
IV

Name 2 macrolides
erythromycin, clarithromycin and azithromycin

What is important to remember about erythromycin?
CYP450 inhibitor and can prolong the QT interval

What is mechanism for macrolides?
binds to 50S subunit and prevents translocation of incoming AA from the A site to the P site

What adverse effect(s) are associated with erythromycin?
GI distress and therefore should be taken with food; CYP inhibition

What is the resistance mechanism for macrolides?
methylation of the 50S subunit or enzymatic ability to destroy the drug

What is important to remember about tetracyclines?
can be inhibited by chelation with milk; take on an empty stomach

What kind of bacteria are tetracyclines used for?
G- and G+

Name 2 tetracyclines
-tetracycline
-doxycyclin

Are tetracyclines bacteriocidal or bacteriostatic?
bacteriostatic

What is the mechanism of action for tetracyclines?
inhibit protein synthesis through reversible binding to 30S subunit; prevents binding of new incoming AAs

Which tetracyline is best for patients with renal dysfunction?
doxycycline

What is resistance mechanism for tetracyclines?
efflux / pumped out of the cell (in G+)

What is the drug chloramphenicol used for?
anaerobic bacteria

Is chloramphenicol bacteriocidal or bacteriostatic?
bacteriostatic

What is complication is patients with hepatic disease on chloramphenicol?
gray color, “gray baby”

Clindamycin is what kind of drug?
lincosamide

What is mechanism of action for chloramphenicol?
binds to 50S subunit and blocks linkage of incoming AAs; interferes with peptidyl transferase

Name an important lincosamide
clindamycin

Clindamycin is used to treat what kind of bacteria?
anaerobic

What is the route for clindamycin?
topical

Is clindamycin bacteriocidal or bacteriostatic?
bacteriostatic

What is the mechanism of action for clindamycin?
binds to 50S subunit and prevents translocation of the incoming AA from the A site to the P site

What is 1 example of a ketolide?
telithromycin

What are ketolides / telithromycin used to treat?
MDR streptococci

What is mechanism of action for telithromycin?
binds to 2 location on the 50S subunit; resistant to mutations

What is the route for mupirocin?
topical

What is brand name for mupirocin?
Bactroban

What is mechanism of action for mupirocin?
inhibits the tRNA that transports isoleucine

What is mechanism of action for linezolid?
binds to 50S subunit and prevents formation of the 70S complex

What is the target organism of streptogramins?
VRA and MRSA

Name an example of a streptogramin
quinupristin / dalfopristin (given together)

What is the mechanism for quinupristin / dalfopristin?
quin — blocks late phases of protein synthesis
dalf — inhibits early phases of protein synthesis

Name 2 drug classes of folic acid synthesis inhibitors?
1) sulfonamides
2) trimethoprim

Name an example of a sulfonamide?
sulfamethoxazole — they all begin with “sulfa”

Are sulfonamides bacteriostatic or bacteriocidal?
bacteriostatic

Is trimethoprim bacteriostatic or bacteriocidal?
bacteriostatic

What is the mechanism of action for sulfonamides?
interfere with the 1st step of folic acid synthesis — compete with para-aminobenzoic acid and inhibit dihydropteroate synthetase

What is the mechanism of action for trimethoprim?
interfere with the 2nd step of folic acid synthesis — inhibits dihydrofolate reductase (DHFR)

Trimethoprim — take with or without food?
without — food may inhibit absorption

Name 2 fluoroquinolones
ciprofloxacin, moxifloxacin (ends in -floxacin)

Are fluoroquinolones bacteriocidal or bacteriostatic?
bacteriocidal

What is mechanism for fluoroquinolones?
inhibits DNA gyrase and DNA topoisomerase and therefore prevents DNA from replicating

Name 1 lipopeptide
daptomycin

Is daptomycin bacteriocidal or bacteriostatic?
bacteriocidal

What is the mechanism of action for lipopeptides / daptomycin?
rapidly depolarizes the cell membrane

What is another name for metronidazole?
Flagyl

What is the target of metronidazole?
anaerobic bacteria especially in meningitis

What is the mechanism of action for metronidazole?
the enzyme pyruvate ferridoxin oxidoreductase generates ferredoxin which reacts with the drug and generates toxins

What is the target for nitazoxanide?
inhibits electron transfer reaction

What is ADE associated with metronidazole?
mutagenic and possibly carcinogenic

What is mechanism of action for tinidazole?
damages DNA and inhibits DNA synthesis

What is the name of a drug that inhibits mRNA synthesis by binding to RNA polymerase?
rifaximin

Name 3 anti-mycobacterials?
rifampin, isoniazid and ethambutol

What is mechanism for rifampin?
inhibits the bacterial RNA polymerase

What is the mechanism for isoniazid?
inhibits components of the mycobacterial cell wall

What is the mechanism for clofazimine?
inhibits RNA polymerase

Why are there many drug interactions associated with rifampin?
rifampin induces drug metabolism and binds to plasma proteins