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pharmacology > Antibiotic > Flashcards

Antibiotic Flashcards

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1
Q

What is the drug of choice for meningitis caused by listeria monocytogen?

A

Ampicillin

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2
Q

What is the drug used for severe staphylococcal infection like endocarditis and pneumonia ? What is the administration?

A

Nafcillin and oxacillin ( parenteral )

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3
Q

What is the drug of choice for therapy of meningitis caused by suspectible staphylococcus pneumonia? And what is the administration of the drug?

A

Penicillin G intravenously

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4
Q

What is the category of penicillin?

A

Natural penicillin,
anti-staphylococcal penicillin,
extended spectrum penicillin
and anti pseudomonal penicillin

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5
Q

Mechanism of action for beta lactams?

A

Inhibiting transpeptidase
Activate autolytic enzyme
Unactivate penicillin binding proteins

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6
Q

What is the drug that used for otitis media , bronchitis and sinusitis? What is the administration?

A

Amoxicillin orally

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7
Q

What drug is used for eradication of Helicobacter pylori and duodenal and gastric ulcers?

A

Amoxicillin

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8
Q

What drugs of penicillin are used for serious infection caused by pseudomonas areuginosa

A

Piperacillin, ticarcillin

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9
Q

Examples for natural penicillin

A

Penicillin G ,penicillin V

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10
Q

Examples for anti-staphylococcal penicillin

A

Nafcillin, oxacillin, and dicloxacillin

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11
Q

Examples for extended spectrum penicillin

A

Ampicillin and amoxicillin

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12
Q

Examples for anti pseudomonal penicillin

A

Carbenicillin, ticarcillin and piperacillin

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13
Q

The Oral absorption of penicillin varies according to

A

Particular penicillin used
PH of the patient’s stomach
presence of food and G.I. track

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14
Q

All the penicillin should be given without food, but What are the penicillin that should be taken with food?

A

Penicillin V and amoxicillin

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15
Q

What is the distribution of penicillin?

A

They are widely distributed in the body fluids, and It can across the placenta
The entrance to CSF is minimal except with inflammation of meninges

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16
Q

The metabolism of penicillin

A

Metabolized by hepatic enzymes
Dosage adjust might be needed

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17
Q

The elimination of penicillin

A

Renal through tubular secretion and glomerular filtration

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18
Q

All penicillins require dosage adjustments in renal failure.
What is the penicillin that does NOT need dose adjustment

A

Anti staphylococcal penicillins

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19
Q

The bacterial resistance to penicillin

A

1-Bacterial enzyme (beta lactamase/penicillinase)
2-decrease penetration to the target site
3-Inability to bind to penicillin binding protein
4-Lack for activation of autolytic enzymes

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20
Q

Beta lactamase are most common in what kind of bacteria

A

Gram-negative bacteria

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21
Q

What is the solution for bacterial resistance to penicillin with beta lactamase

A

Combined penicillins with beta lactamase inhibitors

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22
Q

What is the examples of combination of antibiotic with beta lactamase inhibitor?

A

1- agumentin ( amoxicillin + clavulanic acid)
2- unasyn ( ampicillin + sulbactam)
3- zosyn ( piperacillin + tazobactam)

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23
Q

What is the adverse effects of penicillin?

A

1-hypersensitivity
2-diarrhea
3- nephritis
4-neurotoxicity
5-hematologic toxicity

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24
Q

Cephalosporin are from a fungus called

A

Cephalosporium acremonium

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25
What is the second choice for many infections
Cephalosporins
26
Cephalosporins works for what kind of bacteria?
Gram-positive and gram-negative
27
What kind of administration used for urinary infection while taking cephalosporins (cefaclor)
Oral
28
The generation of cephalosporin based primarily on
Spectrum of antibacterial activity The basis of anti-microbial activity (including beta lactamase stability and pharmacological properties)
29
What is the changes if we go from the first to fourth generation of cephalosporins
1-The spectrum of activity against gram negative organisms and the stability against beta lactamase INCREASE 2- same or REDUCED spectrum of activity against gram positive organisms and pharmacokinetics differences
30
Which generation of cephalosporins has good activity against gram positive and against most gram negative
The fifth generation
31
Which generation of cephalosporins have activities against anaerobic bacteria
The second and the fifth
32
Which cephalosporin drugs have anti pseudomonal activity
1- ceftazidine 3rd 2- cefepime 4th 3- ceftolozane 5th
33
The most potent anti pseudomonal from cephalosporins is
Ceftolozane 5th “which derived from ceftazidine 3rd”
34
The only cephalosporins that is used against MRSA
ceftoraline 5th
35
The absorption of cephalosporins
Good on oral administration Unaffected by food (except: cephradine and cefaclor for which it may be delayed)
36
The distribution of cephalosporins
Well distributed into most body tissue like: Bone, pleural fluid, pericardial fluid and synovial fluid
37
Which cephalosporins does NOT need dose adjustment
Ceftriaxone and cefoperazone
38
The adverse effects of cephalosporins
Allergic manifestation: to those who had an anaphylaxis response to penicillin Bleeding : due to anti vit.k effect
39
The reason behind developing carbanpenems and monobactams
To deal with beta lactamase producing gram negative resistance penicillin
40
Example for carbapenem
Imipenem ( broad spectrum antibiotic) Ertapenem Meropenem
41
What is been used with imipenem to block its breakdown by the kidneys
Cilastatin
42
What kind of administration that is used with carbapenem
IV “ NOT absorbed orally”
43
The adverse effect of carbapenem
Seizures
44
Examples for Monobactam
Aztreonam which is active against gram-negative aerobic bacteria Resistant most beta lactamase
45
Aminoglycosides divided into
Systematic and topical
46
Systematic aminoglycoside are
Streptomycin Gentamicin kanamycin amikacin tobramycin
47
Topical aminoglycoside are
Neomycin Framycetin
48
Does the aminoglycosides considered to be bactericide or bacteriostatic
Bactericides
49
Based on the mechanism of action, in what category does aminoglycosides belong to?
Interferes with proteins synthesis, 30 ribosomal subunit
50
Aminoglycosides used to treat what kind of bacteria
Aerobic, gram-negative bacteria
51
What is the adverse effect of aminoglycosides?
Ototoxicity , nephrotoxicity
52
What is the distribution of aminoglycosides
Distribute only extracellularly Do not penetrate brain or CSF no not absorbed orally
53
What is the mechanism of action of aminoglycosides
They are positively charged bind to the negative charge of the bacterial membrane and disturb it + interfere with protein synthesis
54
The antibacterial spectrum of aminoglycosides is / or what kind of bacteria does the aminoglycosides work against
Gram-negative aerobic bacilli Gram-positive cocci NOT NOT effective against G+ve bacilli, G-ve cocci nor anaerobes
55
What is the pharmacokinetics of aminoglycosides
1-Highly polar=poor Oral 2-Administrated parenterally or applied locally 3-Poorly protein bound 4-No significant metabolism 5-Excreted unchanged in urine 6-Dosage adjustments is needed
56
Clinical use for aminoglycosides
1-gram-negative bacillary infection (Septicemia, pelvic and abdominal sepsis) 2-bacterial endocarditis 3-pneumonias, tuberculosis 4-brucellosis 5-topical- neomycin 6-Infection of conjunctiva or external ear
57
Share toxicity of aminoglycosides
Ototoxicity, nephrotoxicity, neuromuscular blockage, skin rash
58
Which aminoglycosides are more likely to produce neuromuscular blockade
Streptomycin and neomycin
59
Which aminoglycosides are least likely to produce neuromuscular blockade
Tobramyosin
60
Which aminoglycosides are more likely to produce nephrotoxicity
Gentamicin, amikacin and tobramycin
61
Is the nephrotoxicity caused by aminoglycosides are reversible?
Reversible of drug promptly discontinue
62
Precautions and contraindication for aminoglycoside
1-pregnancy : fetal ototoxicity 2-with other ototoxic drugs: furosemide, minocycline 3-with nephrotoxic drugs: vancomycin, cisplatin 4- elderly patient 5-those with kidney disease 6-muscle relaxant 7-do not mix with any other truck in the same syringe
63
What is the most commonly used aminoglycosides?
Gentamicin
64
Why is the gentamicin or most commonly use?
More potent Broader spectrum Low-cost, reliability of use, long experience Acts synergistically with ampicillin, penicillin G, ticarcillin, ceftriaxone and Vancomycin
65
the prototypes of Glycopeptide antibiotics are :
Vancomycin, teicoplanin
66
What is the mechanism of action of vancomycin?
Inhibits cross-linking of peptidoglycan which cause the destruction of bacterial cell wall
67
Why does Vancomycin considered important?
Because of its effectiveness against multiple drug resistant organism Such as MRSA and enterococci
68
Vancomycin is effective against
Gram-positive organism and MRSA
69
Spectrum of activity of vancomycin
1- Effective against gram-positive, streptococci, staphylococci and pneumococci 2- effective against Neisseria spp. (only G- can work against) 3- endocarditis caused by MRSA 4- Used for treating enterocolitis associated with clostridium difficle ( since it’s not absorbed from the G.I.)
70
Adverse effects of vancomycin
Fever, chills, phlebitis -at the infusion site- Flashing (red man syndrome) due to histamine release Ototoxicity , nephrotoxicity
71
What is the administration bacitracin?
Locally or IM against resistance staphs Orally for treating diarrhea especially against clostridium difficle
72
What is the antibiotic that used in disaffecting the gut before an operation?
Bacitracin
73
What is the mechanism of action of bacitracin?
Inhibits the biosynthesis of peptidoglycan by inhibition of dephosphorylation of phospholipid
74
What is the mechanism of action of polymyxin B?
- Forms of complex with membrane phospholipids and disrupt cell membranes - Bactericidal but restricted to gram negative bacteria - use locally for local infection of wounds with gram-positive antibacterial, bacitracin - used Orally for the treatment of G.I. infection - IM or intrathecal injection for systematic infections
75
What is the mechanism of action of the fluoroquinolones?
Bacteriocidal agent They block bacterial DNA synthesis by inhibiting bacterial DNA gyrase and topoisomerase
76
Bacterial resistance against fluoroquinolones
Point mutations in the binding site of the target enzyme Change in the permeability of the organism Resistance to one fluoroquinolones confers cross resistance to all members of the class
77
Generation of fluoroquinolones
1st -> nalidixic acid-> G-ve NOT pseudomonas species 2ed-> norfloxacin, ciprofloxacin, ofloxacin -> G-ve +pseudomonas species + G+ve + some atypicals 3ed -> levofloxacin moxifloxacin -> 2ed+ extended coverage of atypicals + G+ve 4th-> trovafloxacin -> 3ed + anaerobic coverage (withdrawn due to liver toxicity)
78
What is the pharmacokinetics of fluroquinolone?
- Well absorbed orally almost equal to intervenous administration - The absorption impaired by divalent cations ( Mg, Ca, AL ) -Adjustments required in patient with creatinine clearance <50 - Limited CSF penetration
79
Clinical use for fluoroquinolone
1-urinary track infection (G-ve bacteria) 2-travelers’ diarrhea —>ciprofloxacin 3-tuberculosis 4-prostatitis 5-anthrax 6- Respiratory infection caused by pseudomonas aeruginosa (cystic fibrosis ,otitis)
80
Adverse effects of fluoroquinolone
1-Generally considered safe 2-GIT —> nausea, vomiting, diarrhea 3-CNS —>confusion, insomnia, dizziness, anxiety, seizures 4-CVS—> arrhythmia 5-Damage growing cartilage and bone 6-Phototoxicity (avoid excessive sun exposure) 7-Hypoglycemia (levofloxacin)
81
Contraindication of fluroqoinolone
Children -18 Pregnancy Lactation Epilepsy Arrhythmia —Drug drug interaction between ciprofloxacin and theophylline (through inhibition of CYP 450 metabolizing enzyme)
82
Classification of macrolides
Narrow spectrum erythromycin Broad spectrum Clarithromycin Roxithromycin Azithromycin
83
What is the mechanism of action of macrolide?
Bacteriostatic agent that inhibits protein synthesis by binding to the 50 S ribosomal subunit
84
Macrolide work against what kind of bacteria?
Gram-positive and gram-negative bacteria
85
Therapeutic uses for macrolide
Staphylococcal infection Streptococcal infection Helicobacter pylori infection Chlamydial infection - diphtheria - Syphilis - Mycoplasma pneumonia
86
Pharmacokinetics of macrolide
—Erythromycin base is destroyed by stomach acid, so it must be administrated with enteric coating — Food interferes with absorption (the broad-spectrum macrolides are fairly acid resistance) Distribution : erythromycin are widely distributed in the body
87
Adverse effects of macrolides
- Hypersensitivity ( fever, skin rash) - Gastrointestinal effect ( nausea, vomiting, diarrhea ) - Hepatitis with cholestatic jaundice
88
Macrolides are excreted through
Azithromycin and erythromycin are excreted through bile Clarithromycin through kidney
89
Under what category of pregnancy drug is the macrolides?
Erythromycin and Azimyocin are category B Clarithromycin is category C

pharmacology (5 decks)

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