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Pharm for bacteria Flashcards

1
Q

What are anti-invectives effective against

A

Pathogens

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2
Q

How are anti-invectives classified

A

According to susceptible organism (antibiotic, antiviral, anti fungal, antiprorozoan)

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3
Q

What determines the mechanism of action for anti-invectives

A

Chemical structure

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4
Q

Bacteriocidal

A

Type of anti-infective that kills bacteria

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5
Q

Bacteriostatic

A

Type of anti-infective that prevents growth and reproduction of bacteria

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6
Q

Mechanisms of antibacterial agents

A

1) Drugs that damage bacterial cell wall
2) Drugs that damage cell membrane
3) Drugs that inhibit protein synthesis
4) Drugs that inhibit DNA replication or bacterial cell division

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7
Q

What type of drugs damage the bacterial cell wall

A

Beta-lactam antibiotics inhibit the synthesis of bacterial cell wall; tend tend to be bactericidal

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8
Q

What type of drugs damage the cell membrane

A

Bactericidal

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9
Q

What type of drugs inhibit protein synthesis

A

Drugs bind to bacterial ribosomal subunits or bind to transfer RNA; bacteriostatic

Drugs mimic folic acid

Tend to be bacteriostatic

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10
Q

What type of drugs inhibit DNA replication or bacterial cell division

A

Bacteriostatic

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11
Q

Structure of bacterial cell walls

A

Peptidoglycan molecules in their cell walls that protect them from the environment

Peptidoglycan molecules form a set of chains called penicillin-binding proteins (PBPs) because penicillins and related antibiotics bind to them.

We can target them because we don’t have peptidoglycan

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12
Q

What do penicillins target

A

Beta-lactam ring (central ring) structure of penicillin binds PBPs causing lysis of growing by damaging cell walls

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13
Q

How do some bacteria develop resistance to penicillin

A

They mutate so they lack the PBPs that are the target of penicillins.

or they secrete an enzyme (penicillinase or beta-lactamase) that splits penicillin’s beta-lactam ring, and inactivate it from working, often in response to penicillin.

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14
Q

What type of bacteria do we typically use penicillins for

A

Gram-positives

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15
Q

What are some types of infections that penicillin G potassium may be used for

A

Bacterial endocarditis with prosthetic heart valves, rheumatic fever, congenital heart disease, Group B strep, during labour

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16
Q

What is the mechanism of action for Penicillin G Potassium

A

Inhibits bacteria cell wall synthesis by biding PBPs

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17
Q

What are adverse effects of Penicillin G Potassium

A

Urticaria, allergies, anaphylaxis

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18
Q

What are the most common drugs to be allergic to

A

1) Penicillins 2) Sulfa’s

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19
Q

How many cephalosporins are there

A

20 cephalosporins in 5 generations

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20
Q

What generation of cephalosporins is the most resistant

A

1st Gen (more broad)

Reserve the 5th Gen (more specific)

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21
Q

Common adverse effects for cephalosporins

A

allergy, rash, GI complaints

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22
Q

What type of drugs do we typically use with pregnant women

A

Penicillin’s as we have a lot of data on them

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23
Q

What bacteria do cefotaxime (Claforan) target

A

They are third generation cephalosporins with a broad spectrum

They target gram-positives and gram-negatives

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24
Q

What type of infections could cefotaxime (Claforan) be used for

A

Infections of respiratory tract, urninary tract, genital infections, meningitis, septicaemia, endocarditis, bone and joint infections

infection prophylaxis in surgery patients

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25
Q

What is the mechanism of cation for cefotaxime (Claforan)

A

Inhibit bacterial wall synthesis by biding to specific PBPs

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26
Q

What are the adverse effects of cefotaxime (Claforan)

A

rash, diarrhea, allergic responses

Potential superinfection (caused by broad spectrum nature of drug)

Painm phlebitis at IM injection sites

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27
Q

What are serious adverse effects for cefotaxime (Clarforan)

A

Anaphylaxis and seizure

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28
Q

What type of bacteria do carbapenems target

A

Provide better activity against serious Gram-negative and multi resistant infections than most penicillins and cephalosporins

Given perentually (IV)

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29
Q

What drugs are typically used when there is multi drug resistance

A

Carbapenems

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30
Q

What are the 3 types of drugs that target the bacterial cell wall

A

1) Penicillins
2) Cephalosporins
3) Carbapenems

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31
Q

How does protein synthesis (translation) happen in bacteria

A

Similar tor humans and is carried out in ribsomone’s

Bacteria’s ribosomes have 30S and 50S subunits (humans have a 40S and 60S), they are slightly different so we can target

Ribsomone’s are required for tRNA and mRNA to connect and disrupt translation and prevent reproduction

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32
Q

What type of bacteria are tetracyclines active against

A

Gram-pos and gram-neg

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33
Q

What type of infections can tetracylines be used for

A

typhus, cholera, Rocky Mountain spotted fever, Lyme disease, H.pylori ulcers, P.Acnes, Malaria, and chlamydia

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34
Q

How do tetracylines work

A

They inhibit protein synthesis at the 30S subunit by preventing rRNA from binding to mRNA/ribosome complex

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35
Q

How are tetracylines given

A

On an empty stomach, as nutrient cation binding interactions (Ca, Mg, Al)

Or

Parenterally (IV) because they are incompletely absorbed in the intestine

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36
Q

How are penicillins and celphasporines absorbed

A

Very well and fast

Eliminated in the kidneys

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37
Q

How are tetracylines absorbed

A

They are large molecules so they are absorbed slow and hang around in the bowels longer (interaction with natural bowel flora)

Resulting in more GI side effects

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38
Q

What is a side effect of giving tetracylines parenterally

A

Can be hepatotoxic and cause photosensitivity (chemical induced reaction to light causing rash)

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39
Q

What happens when a tetracylines is given when it is expired

A

can cause fatal toxicities

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40
Q

What is the mechanism of action for tetracylines

A

Inhibits bacterial protein synthesis by interfering with binding of tRNA to the mRNA - 30S ribosome complex

Terminates the growing of amino acid chain prematurely

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41
Q

Adverse effects for tetracylines

A

superinfections

nausea, vomiting, epigastric burning, diarrhea

discolouration of the teeth and issues with bone development in young kids (strong affinity to Ca2+)

Photosensitivity (may burn quicker or develop a rash)

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42
Q

What are serious adverse effects of tetracyclines

A

Hepatotoxicity, anaphylaxis, exfoliative dermatitis (very bad photosensitivity), intracranial hypertension also called pseudotumor cerebra (PTC)

43
Q

What type of drugs are macrolides used against

A

Gram-positives

Alternative drugs for patients allergic to penicillin

44
Q

What type of infections are macrolides/erythromycin (Eryc) used for

A

prophylaxis and treatment of susceptible bacterial infections including legionella, chlamydia, listeria, campylobacter, as well as upper and lower respiratory tract infections, and skin infections

45
Q

Mechanism of action for macrolides/erythromycin (Eryc)

A

Inhibits protein synthesis by preventing tRNA from binding to 50S subunit

Considered bacteriostatic but may be bactericidal in high doses

46
Q

How are macrolides metabolized and what are the effects of this

A

they are metabolized in the liver and can result in drug interactions (largely CYP 3A4)

47
Q

Adverse effects for macrolides/erythromycin (Eryc)

A

Nausea, vomiting, abdominal cramping, phlebitis, intensive pain at IV injection site

48
Q

What are some serious adverse effects of macrolides/erythromycin (Eryc)

A

Cholestatic hepatitis,

anaphylaxis

ototoxity (hearing loss, vertigo, dizziness)

Cariotoxicity including palpitations, chest pain, arrhythmias, OT prolongation

49
Q

What type of bacteria do aminoglycosides target

A

Gram-neg bacilli caused by aerobic or multi-resistant

A few gram-pos like some strains of MSRA

pseudomonas, enterobacteriaceae family, tuberculosis

50
Q

What us postanibiotic effect and what drug is it associated with

A

Activity of drug continues even after serum drug levels drop as drug remains in some tissues despite clearance by kidneys in aminoglycosides

51
Q

How are aminoglycosides administered

A

Must be given parenterally and are reversed for serious systemic infections

They are too big to be given orally

52
Q

Why might there be some serious adverse effects for aminoglycosides

A

May include nephrotoxicity, ototoxicity, and neuromuscular blockade, thus these drugs are only used when other drugs are not effective

They have a preferential tendency to want to go into organs we don’t want to hurt (endolymph in ear)

53
Q

Mechanism of action for Gentamicin (Garamycin)/aminoglycosides

A

Inhibits protein scythes by binding to the 30S ribosomal subunit, causing premature termination of translation.

54
Q

Adverse effects of Gentamicin (Garamycin)/aminoglycosides

A

Nausea, vomiting, rash, fatigue

55
Q

Serious adverse effects of Gentamicin (Garamycin)/aminoglycosides

A

Ototoxicity, nephrotoxicity, neuromuscular blockage, neurotoxicity

56
Q

What type of bacteria do lincosamides (Clindamycin)/aminoglycosides target

A

Anaerobic infections (live in bowels typically) and gram positive organisms

57
Q

What type of infections do lincosamides (Clindamycin)aminoglycosides target

A

Oral infections (especially when PCN allergic), Septicemia, skin and soft tissue infections, GI infections, abscess (skin, ovarian), pelvic inflammatory disease

58
Q

What is the mechanism of action for lincosamides (Clindamycin)aminoglycosides

A

Work by biding to the 50S ribosomal subunit of bacteria

This agent disrupts protein synthesis by interfering with the protein synthesis by transpeptidation reaction, which thereby inhibits early chain elongation

59
Q

Adverse effects for lincosamides (Clindamycin)aminoglycosides

A

GI related (Nausea, vomiting, diarrhea): diarrhea quite common given broad spectrum activity

Poor taste in mouth (take with lots of water, stay up right 20 mins after admin) try cold and tarte combo

60
Q

Serious adverse effects for lincosamides (Clindamycin)

A

Most common antibiotic to cause C. Diff diarrhea especially with high doses

61
Q

What are the steps in bacterial DNA replication

A

1) DNA gyrase relaxes supercoil
2) DNA helocase unwinds stands of helix
3) DNA polymerase replicates DNA strands
4) Topoisomerase IV separates newly replicated strands into daughter cells

62
Q

Drugs can block bacterial DNA replication in three ways

A

1) Inhibit synthesis of precursor bases or nucleotides

2) Interact with or bind to DNA, preventing uncoiling or relaxation

3) Bind to enzymes of replication, stopping the formation of new DNA strands

63
Q

How many gernerations are there for fluoroquinolones

A

4 with activity on all Gram-negs and some gram-positives

64
Q

What type of infections are Fluoroquinolones used to treat

A

Uriniary tract infections, GI, respiratory and skin infections

65
Q

Ciprofloxacin (Cipro)/Fluoroquinolones mode of action

A

Inhibits bacterial topoisomerase IV and DNA gyrase, preventing DNA replication

66
Q

Adverse effects for Ciprofloxacin (Cipro)/Fluoroquinolones

A

Nausea, vomiting, diarrhea

phototoxicity, headache, dizziness

tendonitis

67
Q

Serious Adverse effects for Ciprofloxacin (Cipro)/Fluoroquinolones

A

Pseudomembranous colitis (wide scale inflammation of intestines)

Seizures, toxic psychosis

68
Q

What type of treatment is used for pneumonia

A

need parenteral administration (IV)

may be toxicity in other tissues bc doses are too high when taken orally

69
Q

What types infections are sulfonamides/trimethoprim-sulfamethoxazole used to treat

A

UTI prophylaxis and UTI
Prophylaxis and treatment of p. carinii and shigella
Acute episodes during chronic bronchitis
Off-label for other indications depending on sensitivity of microbe

70
Q

Mechanisms of action for sulfonamides/trimethoprim-sulfamethoxazole

A

Both drugs inhibit different steps of folate synthesis (necessary for thymine metabolism), thereby inhibiting DNA replication

71
Q

Adverse effects for sulfonamides/trimethoprim-sulfamethoxazole

A

Nausea, vomiting

Skin rash, pruritus

Fever

Photosensitivity

72
Q

Severe adverse effects for sulfonamides/trimethoprim-sulfamethoxazole

A

Anaphylaxis, allergic myocarditis

Stevens-Jognson syndrome (exfoliated dermatitis, life threatening AKA skin is dying), epidermal necrolysis

Agranulocytosis, aplastic anemia

73
Q

What infections is vancomycin (Vancocin) used for

A

Severe gram-postive infections resistant to safer antibiotics

Off-label uses for meningitis and antibiotic-induced pseudomembranous colitis

74
Q

Mode of action for vancomycin (Vancocin)

A

Inhibits synthesis of bacterial cell wall

Increases permeability of bacterial cell membrane

Alters RNA synthesis

75
Q

How is vancomycin (Vancocin) administered

A

Not well absorbed (molecule size is too big) so often given parenterally unless bowel issues give oral

Need to give slow

76
Q

What are adverse effects for vancomycin (Vancocin)

A

“red man” syndrome: flushing, hypotension, tachycardia, rash on upper body

Nausea, rash, fever, chills

77
Q

What are serious adverse effects for vancomycin (Vancocin)

A

Confusion, seizures, and hallucinations

Extravasation leading to tissue necrosis (infusion site reactions)

Ototoxicity and Nephrotoxicity

Anaphylaxis

78
Q

What type of infections are Metronidazole (Flagyl) used for

A

Anaerobic infection and protozoal infections

79
Q

Mechanism of action for Metronidazole (Flagyl)

A

Reductive activation by intracellular transport proteins that exist only in obligate anaerobes

Metronidazole in the cellular environment, its nitro group acts as an electron sink shutting down ATO production

Formation of intermediate compounds and free radials occurs that are toxic to the cell, energy production is interfered with.

80
Q

Adverse effects for Metronidazole (Flagyl)

A

GI related (Nausea, vomitin, diarrhea)

Metallic taste in mouth

Thrombophlebitis common with IV administration

81
Q

Serious adverse effects for Metronidazole (Flagyl)

A

Seizure threshold is lowered

Disulfiram like reaction with alcohol (MUST avoid combination)

Leukopenia with high dose/long term use

82
Q

What is the most important question to ask in the health history when picking an antibiotic

A

Allergies

83
Q

Common UTIs

A

Urethritis, Cystitis
Prostatitis in males
Pyelonephritis

84
Q

Common therapies for UTIs

A

Nitrofurans
Sulfonamides
Fluoroquinolones

85
Q

How are UTI drugs administered

A

Drugs specific for UTIs are given by oral route and only each effective concentrations in kidney

Food improves absorption by 30-40% so meals are important for effective absorption

86
Q

What is Nitrofurantoin/Macrobid, Macrodantin used for

A

Uncomplicated acute cystitis, usually prophylaxis of recurrent UTIs

Rapid absorption and renal eliminate, concentrating drug in the bladder

87
Q

What is the mechanism of action for Nitrofurantoin/Macrobid, Macrodantin

A

Intermediates attack bacterial ribosomal proteins, prevent DNA and RNA synthesis, and prevent protein synthesis, also inhibits cell wall synthesis

88
Q

Are Nitrofurantoin/Macrobid, Macrodantin effective for systemic infections like pyelonephritis (kidney infection)

A

NO

89
Q

What is a note worthy serious adverse effect for Nitrofurantoin/Macrobid, Macrodantin

A

Acute and chronic pulmonary toxicity (++ in renal impairment)

90
Q

What is tuberculosis cause by

A

Mycobacterium tuberculosis, spread by airborne droplets

91
Q

How does mycobacterium tuberculosis cause infection

A

Immune system response leads to formation of tubercles in lungs that surround mycobacteria

Mycobacteria can remain dormant for awhile

92
Q

What are the two major goals of therapy

A
  1. Eliminate all tubercle mycobacteria
  2. Avoid emergence of resistant strains
93
Q

What are the two phases of pharmacotherapy for TB

A
  1. Initial phase - active cells are killed
  2. Continuation phase - dormant mycobacteria are killed (may last 6-12 months)
94
Q

What is necessary for patients that are at high risk for TB

A

Directly observed therapy (DOT), its a pill

95
Q

what is Isoniazid used to retreat

A

M. tuberculosis prophylaxis and treatment

96
Q

What is the mechanism of action for Isoniazid

A

Inhibits the synthesis of mycelia acid, a critical component of mycobacterial cell wall

97
Q

Is Isoniazid bactericidal or bacteriostatic

A

Bactericidal for rapidly dividing organisms

bacteriostatic for dormant mycobacteria

98
Q

Adverse effects for Isoniazid

A

Numbness of hands and feet

99
Q

Serious adverse effects for Isoniazid

A

Tend to have drug interactions

Neurotoxicity related to decrease in vitamin B6

Blood dyscrasias

100
Q

Assessment for Isoniazid

A

Understand the importance of drug-drug interactions, may need to change other drugs like BP meds.

101
Q

What is Leprosy used to treat

A

Chronic infection caused by Mycobacterium leprae

Targets the nervous tissues, leading to nerve thickening, skin lesions, loss of sensation disfiguration

Infection is thought to be spread via respiratory route

102
Q

What are the two types of disease associated with Leprosy

A
  1. Lepromatous - slow, progressive form of disease requiring 2-5 years of therapy
  2. Tuberculoid - less progressive with long remissions, requiring 2-3 years of therapy
103
Q

What is the main drug used to treat Leprosy

A

Dapsone

104
Q

What is the mode of action for Dapsone

A

Inhibits folic acid metabolism

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