Antibiotics

Question 1

What are the names of the two areas where health acquired infection can occur?

Answer 1

Community and healthcare

Question 2

4 types of infection

by what

Answer 2

Bateria
Fungal
Viral
Parasitic

Question 3

9 general full body symptoms of infection

Answer 3

Pyrexia 
Headache 
Sore throat 
Abdominal pain 
Lethargy 
Joint/muscle pain 
Nausea / vomiting 
Diarrhoea 
Rash

Question 4

4 key structural features of bacteria

Answer 4

No nucleus
2x forms of DNA
Peptidoglycan cell wall
Ribosomal subunit different to that in eukaryotes (mammalian cells)

Question 5

Names and functions of the 2 forms of DNA in bacteria

Answer 5

Plasmid DNA - allows for self replication

Nucleoid - chromosomes, protein synthesis, RNA molecules

Question 6

What is the generic name for the treatment of parasitic infections?

Answer 6

Anti-protozoal

Question 7

Names of the 2 types of bacteria

staining

Answer 7

Gram positive

Gram negative

Question 8

What structural feature is it of gram negative bacteria that make them difficult to treat with abx?

Answer 8

Protective outer membrane

Question 9

What ideally is the first action that should be carried out before abx administration?

Answer 9

Bacteria cultures and sensitivities sent to the lab

Question 10

What 4 investigations/tests are used to guide abx use?

Answer 10

Blood tests
Urine samples
Swabs
Stool samples

Question 11

What 3 blood tests and results (i.e.higher/lower) would indicate infection?

Answer 11

White cell count - >11= bacterial infection, <5 = viral infection
Neutrophils - increased during bacterial infection
C-Reactive Protein - increased during infection/injury

Question 12

What do bactericidal antibiotics do and name 3 examples?

Answer 12

Kill bacteria.

Penacillin, cephalosporins, quinolones

Question 13

What do bacteriostatic antibiotics do and name 2 examples?

Answer 13

Inhibit bacterial growth.

Tetracyclines, macrolides

Question 14

What is the intention of bacteriostatic abx therapy? What may it detrimentally result in in terms of stopping infection?

Answer 14

Intends to suppress bacterial division so that body’s own immune system is able to eradicate infection.
Detrimentally, it is the reason infections may continue to occur despite abx treatment.

Question 15

Name 5 mechanisms of which abx ihibit bacteria

Answer 15

Peptidoglycan synthesis - cell wall 
Cell metabolism 
DNA/RNA metabolism
Degrade plasma membrane 
Protein synthesis

Question 16

What two mechanisms of abx mean they will only effect bacteria and why?

Answer 16

Peptidoglycan synthesis - because human cells have no cell wall
Protein synthesis - because bacteria have a different subunit to that of human ribosomes

Question 17

Name 5 classes of abx

Answer 17

Beta-lactams 
Macrolides 
Cephalosporins 
Penacillins 
Tetracyclines

Question 18

What is a key structural feature of beta-lactam abx and how may bacteria become resistant to them?

Answer 18

All abx with a beta-lactam ring
Bacteria may develop to synthesise beta-lactamase which hydrolyses the beta-lactam ring leaving abx ineffective and bacteria resistant.

Question 19

What might be included in abx to combat bacteria producing beta-lactamase to make them effective?

Answer 19

Beta-lactamase inhibitors

Question 20

Mechanism for how penicillin works?

bacteriostatic/cidal, inhibit what

Answer 20

Bactericidal

Inhibit peptidoglycan synthesis and DNA/RNA metabolism - preventing bacterial growth/division

Question 21

What spectrum of abx is penicillin and what gram of bacteria does it work on?

Answer 21

Broad spectrum

Works on gram -ve and +ve bacteria

Question 22

5 ADRs of penicillin

Answer 22

Rash 
Nausea/vomiting 
Pyrexia 
Diarrhoea 
GIT disturbance

Question 23

2 ADRs of penicillin given IV

Answer 23

Increase in sodium

Convulsions

Question 24

Mechanism for how cephalosporins work?

bacteriostatic/cidal, inhibit what

Answer 24

Bactericidal

Inhibit peptidoglycan synthesis

Question 25

What spectrum of abx are cephalosporins and what generation is most effective on which gram of bacteria?

Answer 25

Broad spectrum Old generation most effective on gram -ve New generation most effective on gram +ve

Question 26

4 ADRs of cephalosporins

Answer 26

GIT disturbance Caution in pts with penicillin allergy Rash Pyrexia

Question 27

Which abx (of the other 4) contain a beta-lactam ring?

Answer 27

Penicillin | Cephalosporins

Question 28

Mechanism for how macrolides work? | bacteriostatic/cidal, inhibit what

Answer 28

Bacteriostatic and bactericidal | Inhibit protein synthesis via irreversibly binding to ribosomal subunit, preventing replication or repair.

Question 29

What spectrum of abx are macrolides and what gram of bacteria are they most effective on?

Answer 29

Narrow spectrum | Works on gram +ve bacteria

Question 30

2 ADRs of macrolides

Answer 30

Liver damage | GIT disturbance

Question 31

Interaction of macrolides and resulting effect | CYP

Answer 31

CYP450 inhibitors - reduce drug metabolism leading to drug accumulation

Question 32

Mechanism for how tetracyclines work? | bacteriostatic/cidal, inhibit what

Answer 32

Bacteriostatic | Inhibit protein synthesis by binding irreversibly to ribosomal subunit preventing mRNA synthesis

Question 33

What spectrum of abx are tetracyclines and what gram of bacteria are they most effective on?

Answer 33

Broad spectrum | Work on gram -ve and +ve bacteria

Question 34

3 ADRs of tetracyclines

Answer 34

GIT disturbance Photosensitivity AVOID use in children as slows bone growth and alters colour of teeth

Question 35

What interacts with tetracyclines to form an insoluble compound?

Answer 35

Milk

Question 36

Name the two types of bacterial resistance

Answer 36

Natural innate resistance | Acquired resistance

Question 37

How does innate bacterial resistance develop?

Answer 37

Over time to the environment bacteria lives within

Question 38

How does acquired bacterial resistance develop?

Answer 38

Bacteria sharing their resistance between one another

Question 39

3 ways innate ways bacterial are resistant to abx

Answer 39

Impenetrable peptidoglycan wall/cell membrane No receptor on bacteria for abx to bind to Abx susceptible to enzymes produced by bacteria

Question 40

2 ways in which acquired antibiotic resistance occurs

Answer 40

Production of enzymes that inactivate abx | Changes to abx structure preventing binding of abx

Question 41

6 ways in which bacteria become resistant to abx

Answer 41

``` Selection of resistant bacteria Mutated to be resistance Transferred resistance Production of abx inactivating enzymes Impermeability of cell wall/membrane Altered structure abx unable to bind ```

Question 42

What ADR is seen in all abx?

Answer 42

GIT disturbance

Question 43

3 steps in the prescribing of abx

Answer 43

Send cultures and sensitivities before commencing abx. Indication and duration of abx use. Review need, dose or type of abx in 48hrs

Question 44

What are viruses and two features?

Answer 44

Intracellular parasites, have no metabolism, require host to replicate

Question 45

6 steps of monitoring/assessing infection

Answer 45

``` Obtain symptom onset /pt history White cell count Temperature CRP Erythrocyte sedimentation rate Exposure to infection Cultures ```