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Pharm Exam 4 > Antibiotics 1-3 > Flashcards

Antibiotics 1-3 Flashcards

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1
Q

chemotherapy definition

A

treatment of a disease with the use of chemicals to kill or impair the growth of microorganisms or cancerous cells

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2
Q

selective toxicity definition

A

aimed at killing or impairing growth of the specific target organism without harming the host

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3
Q

empirical therapy definition

A

treatment of a symptomatic patient without further testing or confirmation of the organism

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4
Q

narrow spectrum definition

A

drug that has an effect on one type or species of organism

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5
Q

prophylactic therapy definition

A

treatment in the absence of infection in order to prevent disease

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6
Q

definitive therapy definition

A

treatment given when the pathogenic organism has been identified and appropriate drug identified

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7
Q

broad spectrum definition

A

drug that has an effect on a wide variety of organisms

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8
Q

preemtive therapy definition

A

treatment of high risk patients that have become infected but are asymptomatic (treating a patient who has symptoms and then treat his family even if they aren’t showing symptoms but illness is very contagious)

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9
Q

suppressive therapy definition

A

generally a low dose therapy used as a secondary prophylaxis

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10
Q

LPS - effect on antibiotic?

A

slows or prevents penetration of bulky, HMW antibiotics like erythromycin

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11
Q

hydrophillic pores - effect on antibiotics

A

can be utilized to help water soluble drugs like sulfonamides to enter cells

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12
Q

Nutrient receptor proteins on outer bacterial membrane - effect on antibiotics:

A

Agents that are structurally related to nutrients such as sideromycins can use these to enter cell

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13
Q

bacterial folate synthesis inh drugs:

A
  • sulfonamides
  • trimethoprim

(bacterial dihydrofolate inh)

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14
Q

RNA polymerase inh drugs:

A

rifampin

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15
Q

cell membrane inh drugs:

A

amphetericin
ketoconazole
polymyxin - binds phospholipids in cell membrane and distrupts structure like LPS

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16
Q

cell wall synthesis inh drugs:

A

1) Beta-lactam antibiotics:
- carbapenems
- cephalosporins
- monobactams
- penicillins
2) Others:
- bacitracn
- fosfomycin
- vancomycin

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17
Q

DNA gyrase inh drugs:

A

fluoroquinolones

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18
Q

Protein synthesis inh drugs:

A 
aminoglycosides
chloramphenicol
clindamycin
macrolides
mupiocin
streptogramins
tetracyclins
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19
Q

bactericidal drugs do what?

A

kill the bacteria

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20
Q

bacteriostatic drugs do what?

A

inhibits growth of the bacteria but does not kill the bacteria

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21
Q

WHat are the most common resisitant organisms? Mnemonic?

A

ESKAPE

  • Enterococcus faecium
  • Staphylococcus aureus
  • Klbsiella pneumoniae
  • Acinetobacter baumanni
  • Pseudomonas aeruginosa
  • Enterobacter species
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22
Q

Daptomycin

  • Tx use?
  • Resistance how?
A
  • for complicated skin infections, bacteremia and endocarditis
  • specific gene mutation (mprF) that results in a change in membrane charge = overall net positive (More lysine added) –> repels the antibiotic with positively charged daptomycin properties
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23
Q

Tetracycline

  • Tx use?
  • Resistance how?
A
  • broad spectrum antibiotic used to treat a variety of conditions such as acne, bronchitis, gonorrhea, and syphilis
  • expression of an efflux pump removes antibiotic from the cell (N gonorrhea, E Coli, S pneumo, P Aeruginosa
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24
Q

Metronidizole

  • Tx use?
  • Resistance how?
A
  • abdominal infections, vaginitis, C Difficile, and brain abscess
  • metronidazole needs to be reduced to generate reactive oxidative species. Mutation in rdxA gene reduces/decreases activiation
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25
Aminoglycosides (streptomycin) - Tx use? - Resistance?
- used with other drugs to tx endocarditis, tularemia, plague, and tuberculosis - aminoglycoside-modifying enzymes chemically modify the antibiotic and alter binding of drug to its target
26
Amoxicillin - tx use? - resistance?
- broad spectrum antibiotic | - Beta-lactamase breaks beta lactam ring of amoxicillin (and other penicillins and cephalosporins)
27
Trimethoprim and sulfonamides - Tx use? - resistance?
- commonly used in combo to tx UTI | - these guys inh folate synthesis so the organism expresses drug insensitive enzymes and can still make the folate
28
Vancomycin - tx use - resistance?
- tx bloodstream infections, endocarditis, and meningitis | - substitution on the peptidoglycan stem so that the drug can no longer bind the target
29
- How to recognize penicillin type drugs? | - MOA?
- name ends in -illin | - cell wall synthesis inhibitors
30
- How to recognize cephalosporin type drugs? | - MOA?
- name begins with cef- | - cell wall synthesis inhibitors
31
- beta-lactamase inhibitor drug? | - MOA?
- clavulanic acid - given with other beta-lactam drugs to help with cell wall synthesis inh - prevents bacteria from breaking down the acting beta-lactam
32
- monobactam drug? | - MOA?
- aztreonam | - cell wall synth inh
33
- glycopeptides drug? | - MOA?
- vancomycin | - cell wall synthesis inh
34
- polypeptide type drug? | - MOA?
- bacitracin | - cell wall synthesis inh
35
- How to recognize carbapenem type drugs? | - MOA?
- drug name ends in -enem | - cell wall synth inh
36
- phosphoenolpyruvate type drug? | - MOA?
- fosfomycin | - cell wall synthesis inh - (blocs early step - UDP-N-acetylmuramic acid)
37
- Lipopeptide type drugs? | - MOA?
- daptomycin | - targets the membrane - bacteria cant control depolarization=death
38
- detergent type drug? | - MOA?
- polymyxin B | - targets the membrane - binds phospholipids in cell membrane and distrupts structure like LPS
39
- how to recognize the tetracyclines drugs? | - MOA?
- name ends -cycline | - protein synthesis inh
40
- aminoglycoside type drugs? | - MOA?
- amikacin - gentamincin - kanamycin - neomycin - streptomycin - tobramycin -protein synthesis inh
41
- macrolide type drugs? | - MOA?
- clarythromycin - azithromycin - erythromycin -protein synthesis inh
42
- How to recognize sulfonamide type drugs? | - MOA?
- sulfadiazine - sulfamethizole - sulfamethoxazole - name begins with sulfa- - folate synth inhibitors - mimics PABA and competes for binding in dihydrofolic acid
43
- trimethoprim type drugs? | - MOA?
- pyrimethamine - trimethoprim -folate synth inh
44
- How to recognize fluoroquinolone type drugs? | - MOA?
- usually end in or have -floxacin somewhere in the name | - gyrase inhibitors
45
- Metronidazole type drugs? | - MOA?
- metronidazole | - DNA damage???
46
MOA/What enzymes to cell wall synthesis inh drugs target?
PBPs - penicillin-binding proteins | many different types
47
- What type drugs belong to the beta-lactams? | - How do these drugs fight bugs (bactericidal/static)?
- penicillins - cephalosporins - monobactams - carbapenems -bactericidal
48
Which penicillins are resistant to bacterial beta-lactamases?
methicillin nafcillin oxacillin
49
``` penicillin compounds (beta lactam antibiotics) to know for this exam? -drug derived from nature or synthetic? ```
- penicillin G (natural) - penicillin V (natural) - amoxicillin (synthetic) - methicillin (synthetic resistant to beta-lactamases)
50
Spectrum of penicillin drugs? MOA for penicillins?
- the natural agents has limited spectrum - the synthetics have broader spectrum - inh PBPs!!
51
- Key adverse effect for penicillin compounds? | - Secondary infections?
* *-hypersensitivity - rash, itching, respiratory issues, anaphylaxis - CNS effects - confusion - blood- hemolytic anemia, thrombocytopenia -secondary infections=vaginal candidiasis
52
If patient has anaphylactic adverse reaction to penicillin drug then what drug type to give/not give?
- Dont give other beta-lactams bc cross reactivity | - -> so no cefalosporins, carbapenems, monobactams or other penicillins
53
Narrow spectrum beta-lactam antibiotics? -sensitive organisms?
- penicillin G - penicillin V -sreptococci, pneumococci, meningococci, treponema pallidum
54
Very-narrow spectrum beta-lactam antibiotics? -sensitive organisms?
- methicillin - nafcillin - oxacillin - ONLY ONE THAT IS BETA LACTAMASE RESISTANT - staph (but NOT multi-drug resistant stap)
55
Broad spectrum beta-lactam antibiotics? -sensitive organsims?
- ampicillin - amoxicillin -gram+ cocci, E Coli, Haemophilus Influenzae, listeria monocytogenes, borrelia burgdorferi, H pylori
56
Extended spectrum beta-lactam antibiotics? -sensitive organisms?
- peperacillin - ticarcillin - aziocillin -gram - rods, antipseudomonal
57
- How to protect drugs to beta-lactamase expressing bacteria? - What is a common combo?
- Give clavulanic acid type drugs | - Common: amoxicillin and clabulanic acid (Augmentin)
58
When are cephalosporins used? How react to beta-lactamases?
- used especially if penicillins are not tolerated by patient - Usually more RESISTANT to beta-lactamases compared to susceptible penicillins
59
Spectrum of activity for cephalosporins based on generation?
-4th generation broadest and 1st generation narrowest effect
60
1st generation cefalosporins effective against gram what?
Only gram + cocci | -MOST narrow
61
2nd generation cephalosporins effective against gram what?
-gram + and some gram-
62
3nd generation cephalosporins effective against gram what?
gram+ and gram - cocci, and many gram- rods
63
4nd generation cephalosporins effective against gram what?
-BROADEST spectrum for gram + and gram -
64
Key adverse effects for cephalosporins?
-(similar to penicillins:) - ****hypersensitivity stuff - metabolism-disulfiram-effect = avoid alcohol - blood=bleeding disorders
65
MOA for cephalosporins?
-inh penicillin binding proteins (PBPs)
66
1st generation cephalosporin drugs? -sensitive organisms for fun?
- cefazolin - cephalexin -gram + cocci
67
2nd generation cephalosporin drugs? -sensitive organisms for fun?
- cefotetan - cefaclor - cefuroxime -gram+ cocci and some gram- organisms
68
3rd generation cephalosporin drugs? -sensitive organisms for fun?
- ceftriaxone - cefotaxime - cefdinir - ceflixime -gram+ and gram neg cocci, gram - rods
69
4th generation cephalosporin drugs? -sensitive organisms for fun?
- cefepime | - broadest spectrum of gram + and -
70
Which generation of cephalosporins are resistant to beta-lactamases?
-4th gen = cefepime
71
WHich cefalo's are able to enter the CNS?
-All 4th gen enter while 1st gen do not
72
Which class of cephalo's is used for surgical prophylaxis?
1st generation - cefazolin - cephalexin
73
what is the monobactam type drug? - resistant/susceptible to beta-lactamases? - MOA? -spectrum of activity for fun?
- aztreonam - RESISTANT TO B-lactamases - bind and inh PBPs - cell wall synth inh -limitied to Gram -
74
Key adverse effects of monobactam type drgus?
-aztreonam * **-Hypersensitivity: rash, itching - -> *NOT AS SEVERE OF A RXN AS WITH CEFS OR CILLINS
75
What do monobactams generally treat?
- aztreonam | - serious infections like pneumonia, meningitis, and sepsis
76
MOA for carbapenems?
-inh PBPs!
77
- Carbapenem drug list? | - Spectrum of activity for fuN?
- doripenem - imipenem - ertapenem - meropenem - NAME ENDS IN -PENEM -gram - and gram + (BROAD)
78
``` Special way to administer imipenem? -what class drug? ```
- beta-lactam antibiotic -carbapenenm (ENDS IN -ENEM) | - must be given with cilastatin to prevent inactivation in the kidney
79
Carbapenems - resistant/susceptible to b-lactamases?
-RESISTANT to beta-lactamases BUT SUSCEPTIBLE TO CARBAMENEMASES* DRUG NAME ENDS IN -PENEM!!
80
Key adverse reaction of carbapenems?
* ***-GI - nausea, vomit, diarrhea - hypersentitivity stuff - cardiovasc=hypotension - CNS=confusion, tremors, seizures
81
What does Cilastatis do?
Prevents break down of imipenem in the kidney | carbapenem type-beta lactam
82
What is the MOA for glycopeptide antibiotics? Name the drugs?
- just vancomycin | - binds the D-ala-D-... pentapeptide and hides it from the linker enzymes (steric inhibitor)
83
Glycopeptide drugs: - name them? - tissue penetration? - key adverse effect? --Spectrum of activity for fuN?
- vancomycin - good tissue penetration except CNS * *-skin- flushing** (red neck or red-man syndrome) - ototoxicity (permanent hearing loss) only gram+ bacteria - good against MRSA, enterococci, and C dif
84
Polypeptide drugs - name? - use how? - MOA? - key adverse reaction?
- bacitracin - topical and ophthalmic ointments * -blocks incorportation of amino acids and nucleic acids into the cell wall (cell wall synthesis inh) - hypersensitivity but its rare
85
Phosphoenolpyruvate type - drug name? - MOA? - adverse rxn?
- fosfomycin - blocks an early step in cell wall synthesis by preventing synthesis of UDP-N-acetylmuramic acid - hypersensitivity but its rare
86
Common reason for phosphoenolpyruvate type?
- fosfomycin | - UTIs in females
87
Protein synthesis inh drug types:
*aminoglycosides - 30S block attachment chloramphenicol - 50S - blcok peptide formation clindamycin - 50S - elongation *macrolides -50s - block translocation/elongation mupiocin streptogramins *tetracyclins - 30S - block binding of tRNA
88
Protein synthesis inh | -bacteriostatic/or cidal?
-mostly static but some cidal
89
general MOA for all protein synth inh?
-disrupt *translation* by targeting the molecular machinery - ribsosme 50S and 30S (70S total)
90
whcih antibiotics inhibit 30S subunit?
tetracyclines - prevents binding of charged tRNA molecule | aminoglycosides
91
which antibiotics inh 50S subunit?
- chloramphenicol-blocks peptide formation | - macrolides (prevent translocation)
92
Name group of aminoglycosides:
- streptomycin - gentamicin - kanamycin - amikacin - tobramycin - neomycin
93
spectrum of activity -aminoglycosides? cidal or statis?
Broad - cidal effect!
94
Aminoglycosides are used to treat and how?
-treat serious gram- infections in combo with beta-lactams
95
MOA- aminoglycosides?
bind 30S == prevent translation (messes with attachment)
96
Key adverse effects -aminoglycosides
* nephrotox - renal tubular necrosis * ototox- dizziness, ringing, fullness - skin- hypersensitivity
97
Macrolides - name the drugs? - MOA? - static or cidal?
- erythromycin - clarythromycin - azithromycin -binds to 50S = inh translocation (prevents elongation) - low concentration=statis - high concentration=cidal
98
Macrolides - name the drugs? - key adverse effects? -spectrum of drugs for fun?
- erythromycin - clarythromycin - azithromycin * **-GI- cramps, nausea, vomit, diarrhea - hypersensitivity -skin - CYP450 inh - impaired drug metabolism -gram + mostly and some gram -
99
tetracycline antibiotics: - name the drugs: - spectrum and static/cidal?
- tetracycline - minocycline - tigecycline - doxycycline -BROAD and static
100
tetracycline antibiotics: - MOA? - key adverse effects?
-bind 30S = block translation - prevent elongation? block tRNA binding? - *nutrient interaction - bind Ca =growth of calcified tissue (bone/teeth) - (dont use with pregos) * ecological effects - disrupt normal flora * Skin-*photosensitivity* - GI - chelator of divalent ions
101
Clindamycin - type of antibiotic? MOA? - spectrum - tx of what?
- protein synth inh - binds 50S = prevents elongation - narrow spectrum - used for soft tissue infections by staph or strep - used to treat community acquired MRSA
102
Clindamycin - type/MOA? - key adverse effects?
- protein synth inh - binds 50S = prevents elongation - **GI - nausea, vomit, diarrhea, ***C dif infection*** - hypersensitivity - skin
103
Chloramphenicol - drug type? MOA? - Tx use?
- protein synthesis inh - binds 50S - prevents elongation | - rare use - typhus, Rocky mountain spotted fever, eye infections
104
Chloramphenicol | -Adverse effect:
* *-Blood: suppresses RBC production * **Gray baby syndrome: infants lack glucuronic acid conjugation (phase 2 of elimination) = gray color, vomit, shock, vascular collapse - GI - Superinf=oral and vaginal candidiasis
105
Gray baby syndrome with which drug?
chloramphenicol | infants lack glucuronic acid conjugation = gray color, vomit, shock, vascular collapse
106
RBC production suppressed by which drug?
chloramphenicol Linezolid = myelosuppression too on bigger scale -Trimethoprim and pyrimethamine - bone marrow suppression - bacterial dihydrofolate inh
107
oxazolidinones - drug names - drug type/MOA?
- linezolid | - protein synth inh -- binds p-site of 50S = prevents initial formation of tRNA with ribosiome
108
oxazolidinones - drug name: - tx use? - adverse effect?
- linezolid - used for penicillin, methicillin, vancomycin resistant strains - **blood = myelosuppresion (anemias, leukopenia - GI - drug interactions -inh MAO
109
antibiotics used for resistant organisms?
linezolid - oxazolidinone
110
Sulfonamides - name the drugs? - type of antibiotic/MOA? - spectruM ?
- sulfadiazine - sulfamethoxazole - sulfamethizole - DNA synthesis inh - antifolate - similar structure to PABA=compete with PABA for enzyme and block dihydrofolic acid = no purines= no DNA - broad
111
Sulfonamides - - MOA? - key adverse?
- sulfadiazine - sulfamethoxazole - sulfamethizole -DNA synthesis inh - antifolate - similar structure to PABA=compete with PABA for enzyme and block dihydrofolic acid = no purines= no DNA - SKIN**-hypersensitivity, photosensitivity, Stevens johnson - GI - urinary tract - **cystalluria**, hematuria, obstruction = obstruction but can be used for UTIs
112
Trimethoprim- - name drugs - MOA/type of drug?
- trimethoprim - pyrimethamine -DNA synth inh-antifolate-inh of BACTERIAL dihydrofolate reductase = impaired DNA syntehsis
113
Trimethoprim - name the drugs - spectrum? - Key AE?
-trimethoprim -pyrimethamine (bacterial dihydrofolate inh) -Gram - bacteria - **BLOOD - bone marrow suppression, megaloblastic leukopenia, - GI
114
What is one key issue for sulfa and trimethoprim drugs?
-resistance - bacteria can change drug uptake or reduce binding
115
Why use trimethoprim and sulfamethoxazole together?
TMP-SMX together has synnergistic effects - great for UTI and prostatitis - pneumonia, shigella, systemic salmonealla
116
Fluoroquinolones - name the drugs? - type of drug/MOA? - spectrum?
- ciproflaxin - levoflacin - norfloxacin - ofloxacin - gatifloxacin - gemifloxacin - moxifloxacin - DNA synth inh - bind DNA gyrase (topoiso 2 and 4) = prevent unwinding of DNA - broad! Gram + and -
117
Fluoroquinolones - name the drugs? - tx use?
- ciproflaxin - levoflacin - norfloxacin - ofloxacin - gatifloxacin - gemifloxacin - moxifloxacin -anthrax, urinary, GI, respiratory gonorrhea
118
Fluoroquinolones - drugs? - key AE?
- ciproflaxin - levoflacin - norfloxacin - ofloxacin - gatifloxacin - gemifloxacin - moxifloxacin - **GI usual - **Drug nutrient int - bind divalent cations - ** cardio - QT prolongation
119
Group 1 fluoroquinolones - drugs? - activity against?
- norfloxacin | - least active
120
Group 2 fluoroquinolones - drugs? - activity against?
- ciproflaxin - levoflaxin - ofloxacin - best against gram - - ok against some gram +
121
Group 3 fluoroquinolones - drugs? - activity against?
- gatifloxacin - gemifloxacin - moxifloxacin -best for Gram +
122
How to recognize fluoroquinolone drugs?
-end in -oxacin
123
Metronidazole - type of drug/MOA? - key AE?
-DNA damage - prodrug activated by bacterial enzymes = bind to DNA and cause damage to whole lot of stuff - **GI usual * *metabolism - disulfiram effect
124
Disulfiram interacting drugs?
- metronidazole | - cefalosporins
125
Metronidazole | -tx use?
- anaerobic bactiera, protozoa | - abdominal infections, vaginitis, **C dif**, and brain abscess
126
Lipopeptides - name drugs - type/MOA?
- daptomycin - Cell membrane inhibitors - bind to membrane and causes depol of membrane = bactericidal - insertion into membrane needs Ca
127
Lipopeptides - name drug? - Key AE? - tx use?
- daptomycin - **Musculoskeletal - myopathy, rhabdomyolysis - skin and soft tissue inf & bacteremia and endocarditis
128
Daptomycin is similar to what other drug? why?
like vancomycin bc both good against Gram +
129
Detergents - name drugs? - type/MOA? - spectrum?
- polymyxin B (used with bacitracin) - cell membrane targeter - bind phospholipids in the cell membrane and disrupt structures (punch holes) - specificially LPS -Gram - bacteria
130
Detergents - name drgus? - key AE?
- polymycin B - binds phospholipids in cell membrane and distrupts structure like LPS - rare when topical
131
Resistance mechanisms- | -penicillins and cephalosporins
1) beta-lactamases 2) alteration in PBP bidning to drug 3) alteration in porin fucntion
132
Resistance mechanisms- | -aminoglycosides
1) expression of enzymes that alter chemical structure of the drug
133
Resistance mechanisms- | -macrolides
1) transport of drug out of cell (drug efflux) | 2) alteration of drug binding to 50S
134
Resistance mechanisms- | -tetracyclines
1) transport out of cell (drug efflux)
135
Resistance mechanisms- | -sulfonamides
1) less sensitive drug target 2) increased synthesis of PABA 3) scavenge or use outside folic acid source
136
Resistance mechanisms- | fluoroquinolones
1) less sensitive drug target | 2) drug efflux (transport out of cell)
137
Resistance mechanisms- | -chloramphenicol
1) expression of inactivating enzymes
138
musculoskeletal AE-which drug?
daptomycin - a polypeptide drug | MOA = insterts into membrane and bacteria cant control depol
139
Which drug causes C Dif infection? | What are options to treat C Dif infection?
-Clindamycin side effect on GI system - vancomycin - metronidazole

Pharm Exam 4 (10 decks)

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