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Respiratory II > Antibiotics > Flashcards

Antibiotics Flashcards

Based on the Introduction to Antibiotics Lecture (J. Kinder); not a complete overview

1
Q

What are prophylactic, preemptive, empiric, and definitive therapies?

A 
Prophylactic = Prevention of infection
Preemptive = treatment of an asymptomatic patient who is infected
Empiric = treatment without direct identification of the known agent, but treat for most likely
Definitive = treatment of a specific entity
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2
Q

What is the gold standard for differentiation of bacteria?

A

Gram stain

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3
Q

What is the minimum inhibitory concentration and name the various methods used to discern this value.

A

MIC - the minimum concentration of a drug required to halt growth.

Can be tested by dilution test, disk diffusion test, or optical diffusion.

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4
Q

Describe the disk diffusion test and dilution test.

A

Disk diffusion is performed by plating bacteria on the surface of an agar plate and placing Abx wafers on there and incubating.
Dilution test is performed by culturing bacteria in a broth medium and adding this medium to a serial dilution of Abx.

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5
Q

Describe narrow, extended, and broad-spectrum antibiotics.

A

Narrow-spectrum - effective against a single species or a narrow group
Extended-spectrum - effective against gm + and some gm - bacteria
Broad-spectrum - effective against a wide variety of gm + and gm - bacteria

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6
Q

Describe bacteriostatic and bacteriocidal and the two types of bacteriocidal activity.

A

Bacteriostatic - inhibits growth and replication of bacteria, limiting the spread of infection
Bacteriocidal - either concentration-dependent or time-dependent killing

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7
Q

Name the two factors which have contributed to the development of antimicrobial resistance. Describe the 6 mechanisms of antimicrobial resistance.

A

Evolution and clinical practices have the biggest influence on antimicrobial resistance.

6 mechanisms:

  1. Decreased entry of the Abx into the cell
  2. Increased export of the Abx into the cell
  3. Release of enzymes which degrade the Abx
  4. Alteration of enzymes which convert prodrugs
  5. Alteration of drug targets
  6. Development of alternative pathway, which is not susceptible

Think of the antibiotic resistance methods as the response of a wealthy man to a serial burglar. First he puts new locks on the doors. When the locks don’t keep him out, he buys a gun. The burglar gets a bullet proof vest, and the man buys a doberman. Fourth when the burglar starts using steak, the wealthy man changes his alarm system. The burglar cuts the power, and the man buys a new safe. Finally, the wealthy man decides to move out of crime city.

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8
Q

What is a Beta-lactam? Describe an important mechanism of resistance? What five classes of drugs does this moiety function in?

A

Beta-lactam is a structure which covalently binds a Penicillin Binding Protein (PBP) inhibiting the final step of cell wall synthesis.
A major method of resistance is the production of beta-lactamases.
Key role in penicillins, cephalosporins, carbapenams, monobactams, and glycopeptides.

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9
Q

What are the four classes of beta-lactamases?

A

Class A - broad spectrum activity
Class B - Zn-dependent enzymes degrade everything except aztreonam
Class C - degrades cephalosporins
Class D - degrades cloxacillin

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10
Q

What are the various classes of protein synthesis inhibitors and which ribosomal subunit do they inhibit?

A

The 30S subunit is inhibited by tetracyclines and aminoglycosides. The 50S subunit is inhibited by macrolides, clindamycin, and chloramphenicol.

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11
Q

What is the CURB-65 assessment for severity of illness and what is the meaning of the score?

A 
CURB-65 stands for
confusion
uremia (BUN > 19)
respiratory rate (>30)
blood pressure ( <90/60)
Each positive factor increases likelihood of mortality. 0-1 is an outpatient matter. 2 = admission. 3 or greater = ICU
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12
Q

What is the empiric approach for antibiotics in an outpatient setting?

A

If the patient was previously healthy, use a macrolide (axithromycin) or tetracycline (doxycycline).

If the patient is susceptible to drug resistant pneumococcus, use a fluorquinolone (cipro-, levo-, and moxifloxacin) or a beta-lactam (amoxicillin-clavulanate) and a macrolide (azithromycin)

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13
Q

What is the empiric approach for antibiotics in an inpatient, Non-ICU setting and an ICU setting?

A

For a non-ICU inpatient setting administer fluorquinolone IV or PO (levofloxacin) OR give a beta-lactam IV (ceftriaxone) with a macrolide IV (azithromycin)

For an ICU inpatient setting administer a beta-lactam (ceftriaxone) with EITHER a macrolide (azithromycin) or fluorquinolone (levofloxacin).

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14
Q

What are risk factors indicating possible pseudomonas infection in CAP?

A

Structural lung disease, corticosteroid therapy (COPD), or recent Abx therapy.

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15
Q

What is the treatment regimen for a suspected pseudomonas infection?

A

Treat with piperacillin-tazobactam or cefepime and a fluorquinolone (??-floxacin)

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16
Q

What is the treatment regimen for MRSA?

A

Give IV vancomycin or linezolid

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17
Q

What do you give a patient with Panton-Valentine leucocidin necrotizing pneumonia?

A

Clindamycin or linezolid

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18
Q

What is EBSL? Which bacteria is this most common in, and how can it be treated?

A

Extended spectrum beta-lactamases is a protein which is encoded by a plasmid. It commonly occurs in klebsiella and enterobacter, but these bacteria remain susceptible to carbapenems.

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19
Q

What are the prototype aminopenicillins?

A

Amoxicillin and ampicillin

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20
Q

What is the MOA for aminopenisillins (lol)?

A

Covalently bind PBPs to inhibit the final transpeptidation of cell wall synthesis

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21
Q

What are the adverse effects of aminopenicillins?

A

GI disturbances, allergic reaction, and nephrotoxicity (1%)

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22
Q

What is the spectrum of activity for aminopenicillins?

A

Gm (+) and H. Influenzae, Proteus, and E. Coli

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23
Q

What are the notable resistances to aminopenicillins?

A

MRSA, DRSP, VRE, Pseudomonas, Klebsiella

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24
Q

What is the prototype anti-pseudomonal penicillin?

A

Piperacillin. Normally this is combined with Tazobactam.

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25
Q

What is the MOA of piperacillin?

A

Covalently bind PBPs to inhibit the final transpeptidation of cell wall synthesis

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26
Q

What are the adverse effects of piperacillin?

A

GI disturbances, nephrotoxicity (1%), and allergic reactions.

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27
Q

What is the spectrum of activity of piperacillin?

A

Gm (+) and H. Influenzae, Proteus, E. Coli, and Pseudomonas

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28
Q

What are the notable resistance to piperacillin?

A

Pseudomonas has increasing resistance, mildly concerned.

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29
Q

What are the prototype 3rd Gen cephalosporins?

A

Ceftriaxone and ceftazidime

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30
Q

What is the MOA for cephalosporins?

A

Covalently bind PBPs to inhibit the final transpeptidation of cell wall synthesis

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31
Q

What are the adverse effects of cephalosporins?

A

Penicillin cross-reactivity, diarrhea, and alcohol intolerance

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32
Q

What is the spectrum of activity for 3rd Gen cephalosporins.

A

3rd Gen cephalosporins cover little Gm (+), but are effective against enterbacteriaceae: klebsiella, proteus, heamophilus, serratia, and enterobacter. Ceftriaxone is ineffective against pseudomonas, but effective in treating borrelia and neisserial infections. Ceftazidime is effective against pseudomonas.

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33
Q

What are the notable resistances to 3rd Gen Cephalosporins?

A

Increasing resistance from pseudomonas. Klebsiella and enterobacter can be resistant through ESBL plasmid/chromosome.

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34
Q

What is the prototype 4th Gen Cephalosporins?

A

Cefepime

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35
Q

What is the spectrum of activity for 4th Gen Cephalosporins?

A

Little Gm (+), but all enterobacteriaceae: klebsiella, serratia, heamophilus, proteus, enterobacter, and PSEUDOMONAS.

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36
Q

What is the notable resistance to 4th Gen Cephalosporins?

A

Klebsiella and enterobacter receive resistance through ESBL.

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37
Q

What is the pnemonic for obligate intracellular bacteria?

A

live in cells when it’s Really Cold

R = Rickettsia
C = Chlamydia
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38
Q

What is the pnemonic for facultative intracellular bacteria?

A

Some Nasty Bugs May Live FacultativeLY

S = Salmonella
N = Neisseria
B = Brucella
M = Mycobacterium
L = Listeria
F = Francisella
L = Legionella
Y = Yersinia
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39
Q

What are the prototype carbapenems?

A

Meropenem and ertapenem

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40
Q

What is the MOA of carbapenems?

A

Covalently bind PBPs to inhibit the final transpeptidation of cell wall synthesis

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41
Q

What are the adverse effects of carbapenems?

A

Diarrhea, seizures, and hypersensitivity

42
Q

What is the spectrum of activity for carbapenems?

A

Cover almost all aerobic and anaerobic Gm (+/-) except intracellular bacteria. Effective against the nosocomials pseudomonas and acinetobacter.

43
Q

What is the notable resistance to carbapenem?

A

The nosocomial Stenotrophomonas Maltophilia is resistant to carbepenems.

44
Q

What are the three significant combination therapies incorporating Beta-Lactamase inhibitors?

A

ampicillin + sulbactam
amoxicillin + clavulanic acid
piperacillin + tazobactam

45
Q

When are combination therapies utilising beta-lactamases indicated?

A

When the infection is deep-seated and consisting of these organisms. SPICE.

Serratia
Pseudomonas
Indole positive (Proteus vulgaris and providencia)
Citrobacter
Enterobacter
46
Q

What is the protoype glycopeptide?

A

Vancomycin

47
Q

What is the MOA of Vancomycin?

A

Binds to D-Ala-D-Ala, a precursor of cell wall synthesis

48
Q

What are the adverse effects of Vancomycin?

A

Macular rash and Redman Sydrome (Flushing, hypotension, and tachycardia)

49
Q

What is the spectrum of activity of Vancomycin?

A

All Gm (+) including MRSA and MRSE

50
Q

What are the notable resistances to vancomycin?

A

All gm (-) and mycobacterium

51
Q

What are the prototype fluoroquinolones?

A

Levofloxacin, ciprofloxacin, and moxifloxacin

52
Q

What is the MOA for the fluorquinolones?

A

Fluorquinolones bind to and inhibit DNA gyrase and tropoisomerase IV.

53
Q

What are the adverse effects of fluoroquinolones?

A

Rash, GI/CNS disturbances, and tendon rupture (contraindicated in children)

54
Q

What is the spectrum of activity for fluoroquinolones?

A

Mostly Gm (-) bacteria: E. coli, salmonella, shigella, enterobacter, campylobacter, pseudomonas, neisseria, S. aureus (Not MRSA), and some streptococcal species.

55
Q

What is the notable resistance to fluorquinolones?

A

Mutations in DNA gyrase and tropoisomerase IV

56
Q

What is the prototype aminoglycoside?

A

Gentamicin

57
Q

What is the MOA of gentamicin?

A

Inhibit 30S ribosomal subunit

58
Q

What are the adverse effects of gentamicin?

A

Ototoxicity, nephrotoxicity, and neuromuscular block

59
Q

What is the spectrum of activity for gentamicin?

A

Most Gm (-)

60
Q

What is the notable resistance of gentamicin?

A

Most Gm (+)

61
Q

What is the prototype tetracycline?

A

Doxycycline

62
Q

What is the MOA of doxycycline?

A

Inhibition of the 30S ribsomal subunit

63
Q

What is the spectrum of activity for doxycycline?

A

Almost all aerobic and anerobic gm (+). Some gm (-): rickettsia, chlamydia, mycoplasma, legionella, borrelia, and coxiella.

64
Q

What are the adverse effects of doxycycline?

A

GI disturbances, C. Difficile superinfection, photosensitivity, and yellowing of the teeth.

65
Q

What is the notable resistance to doxycycline?

A

Pseudomonas and proteus possess intrinsic resistance

66
Q

What is the prototype macrolide?

A

Azithromycin

67
Q

What is the MOA of azithromycin?

A

Inhibition of the 50S subunit

68
Q

What are the adverse effects of axithromycin?

A

GI disturbances, hepatotoxicity, arrhythmias, and prolongation of QT interval, digoxin, and warfarin

69
Q

What is the spectrum of activity of azithromycin?

A

Broad, but shallow spectrum: S. pneumoniae, H. influenzae, Mycoplasma, Legionella, and Chlamydia

70
Q

What is the notable resistance of azithromycin?

A

Anything not listed in spectrum of activity

71
Q

What is the prototype lincosamide?

A

Clindomycin

72
Q

What is the MOA of clindomycin?

A

Inhibits the 50S ribosomal subunit

73
Q

What are the adverse effects of clindomycin?

A

Diarrhea, pseudomembranous colitis due to C. difficile, and rashes

74
Q

What is the spectrum of activity for clindomycin?

A

Almost ALL streptococcal spp. and anaerobes

75
Q

What is the notable resistance to clindomycin?

A

All gm (-) aerobic bacilli

76
Q

What is the prototype oxazolidinone?

A

Linezolid

77
Q

What is the MOA for linezolid?

A

Inhibits the 50S ribosomal subunit

78
Q

What are the adverse effects of linezolid?

A

Myelosuppression, headaches, and rash

79
Q

What is the spectrum of activity of linezolid?

A

All Gm (+)

80
Q

What is the notable resistance to linezolid?

A

All gm (-) and ribosomal mutations

81
Q

What is the prototype antiviral?

A

Oseltamivir

82
Q

What is the MOA of oseltamivir?

A

Neuraminidase inhibitor. Prevents the release of viral progeny from infected host cell.

83
Q

What are the adverse effects of oseltamivir?

A

Headaches, fever, and GI disturbances

84
Q

What is the spectrum of activity of oseltamivir?

A

Influenzae Type A and B

85
Q

What would confer resistance to oseltamivir?

A

Neurminidase mutations

86
Q

What are the prototype antifungals?

A

Fluconazole, Itraconazole, and voriconazole

87
Q

What is the MOA of antifungals?

A

Ergosterol = Fungal Cholesterol. Azole agents inhibit the fungal P450 enzymes which produce ergosterol.

88
Q

What are the adverse effects of antifungals?

A

GI disturbances and Abnormal liver enzymes.

Voriconazole can cause photosensitivity and visual disturbances.

89
Q

What is the spectrum of activity of antifungals?

A

Aspergillus is covered by itraconazole and voriconazole.

Candidas, histoplasma, blastoides, and coccidioides are covered by all three.

90
Q

What is the DOC for S. pneumoniae and DRSP?

A 
Non-resistant = Amoxicillin
DRSP = dependent on susceptibility
91
Q

What is the DOC for non-beta-lactamase producing and beta-lactamase producing H. influenzae?

A 
Non-beta-lactamase = amoxicillin
Beta-lactamase = amoxicillin + clavulanic acid
92
Q

What are the two drugs of choice for mycoplasma pneumoniae?

A

Azithromycin and doxycycline

93
Q

What are the two drugs of choice for chlamydophiila pneumoniae?

A

Azithromycin and doxycycline

94
Q

What is the DOC of C. psittaci?

A

Doxycycline

95
Q

What is the DOC for legionella?

A

Fluoroquinolones, axithromycin, and doxycycline

96
Q

What is the DOC for enterobacteraceae (klebsiella, proteus, enterobacter, and E coli)?

A

3rd and 4th Gen cephalosporins. If ESBL producing, use carbapenem.

97
Q

What is the DOC for pseudomonas?

A

An anti-pseudomonnal beeta-lactam (ceftazidime, cefepime, carbepenems, or piperacillin) and a fluoroquinolone or aminoglycoside.

98
Q

What is the DOC for aspiration pneumonia?

A

Causative agent would be anaerobic: prevotella, fusobacterium, peptostreptococcus, or bacteroides.

Administer beta-lactame + inhibitor or clindamycin

99
Q

What is the DOC for MRSA?

A

Vancomycin or linezolid

100
Q

What is the DOC for bordetella pertussis?

A

Azithromycin

Respiratory II (4 decks)

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