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Antibiotics - bacterial Flashcards

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1
Q

4 types of antimicrobials?

A

bacterial
fungal
viral
other: mycobacterium, parasites

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2
Q

two ways to classify antibiotics by scope?

A

narrow spectrum: relatively small # of specific organisms will be sensitive to that agent (ex. penicillin)
broad spectrum: broad range of organisms will be sensitive to that agent (ex. piperacillin/tazobactam)

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3
Q

5 MOAs for antibiotics?

A
  1. inhibition of cell wall synthesis (penicillin, bacitracin, cephalosporin, vancomycin)
  2. disruption of cell membrane function (polymyxin)
  3. inhibition of protein synthesis (tetracycline, erythromycin, streptomycin, chloramphenicol)
  4. inhibition of nuclei acid synthesis (rifamycin, quinolones, metronidazole)
  5. action as antimetabolites (sulfonilamide, trimethoprim)
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4
Q

two ways to categorize abx by their killing capabilities?

A

bacteriostatic: keep at the # that is there
bactericidal: kill the bacteria off

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5
Q

two ways to categorize antimicrobials by pharmacodynamic profiles?

A

time dependent

concentration dependent

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6
Q

different categories of bugs?

A

gram (+): streptococci, staphylococci, enterococci
gram (=): enterobacteriaceae, pseudomonas
anaerobes: bacteroides fragilis

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7
Q

general bacterial classifications?

A

aerobe vs anaerobe

gram (+) vs gram (=)

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8
Q

shapes of bac?

A

cocci or rods

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9
Q

important aerobic gram (+) cocci?

A

staphylococci: s. aureus, coag-negative staph
streptococci: s. pneumoniae, group B strep, viridans strep
enterococci: e. faecalis, e. faecium

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10
Q

important aerobic gram (=)?

A

gram (=) rods: e. coli, k. pneumoniae, serratia, enterobacter, h. influenze, p. aeruginose
gram (=) cocci: m. catarrhalis, m. gonorrhoeae, n. meningitidis

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11
Q

important atypical respiratory aerobes? what makes them atypical?

A

legionella spp, mycoplasma pneumonia, chlamydia pneumoniae

lack a cell wall, intracellular organisms & can’t be seen w/gram staining process

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12
Q

where do true anaerobes generally live?

A

the gut!
bacteroides fragilis
clostridium difficile (causes diarrhea)

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13
Q

two oral anaerobes?

A

prevotella

peptostreptococcus

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14
Q

what is sensitivity in relation to abx?

A

the degree to which microbial organisms are killed or their proliferation is arrested by the drug

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15
Q

4 factors that determine sensitivity of microbes?

A
  1. reach microorganism
  2. bind to or enter the microorganism
  3. interfere w/vital microbial fxn
  4. remain chemically intact while acting upon the microorganism
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16
Q

how to test a bugs sensitivity to a drug?

A

done in vitro
dilution tests: minimum inhibitory concentration; minimum bactericidal concentration
disk-diffusion technique

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17
Q

7 ways to categorize abx via chemical structure?

A
  1. sulfonamides
  2. penicillins
  3. cephalosporins
  4. macrolides
  5. tetracyclines
  6. quinolones
  7. others
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18
Q

what is the main structure that inhibits cell wall synthesis?

A

beta-lactam ring structure

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19
Q

MOA of penicillin? two ways for bugs to have resistance?

A

MOA: B-lactam inhibits cell wall synthesis by binding to penicillin binding proteins
resistance via B-lactamases & altered PBPs

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20
Q

is penicillin time or dose dependent? bacteriostatic or bacteriocidal?

A

time dependent

bacteriocidal

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21
Q

4 different types of penicillins and penicillin congeners?

A

natural penicillin (penicillin G and penicillin VK)
aminopenicillins (amoxicillin, ampicillin)
penicillinase-resistance penicillins (methicillin, where we hear about MRSA)
extended spectrum PCNs + beta-lactamase inhibitor (piperacillin, tazobactram)

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22
Q

effective uses of penicillin? bioavailability? spectrum of use? given how?

A

often resistant b/c bacterial have evolved so only a few we can treat w/penicillin: gram (+) streptococci, oral anaerobes
drug of choice for N. meningitidis, syphilis
poor bioavailability, narrow spectrum of use
give per IV

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23
Q

penicillinase-resistant penicillin use?

A

naficillin
major drug used for MSSA
can be used to tx gram (+) strep and MSSA and oral anaerobes

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24
Q

two examples of aminopenicillins? aminopenicillins MOA? used to tx what?

A

ampicillin, amoxicillin
MOA: binds to PBPs and inhibits synthesis of cell wall
used to tx respiratory infxn (not as common anymore),, sinusitis, otitis, lower respiratory tract infxns, endocarditis from enterococcus
can be used to tx gram (+) strep and enterococci; some gram (=)s, oral anaerobes

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25
ex of extended-spectrum penicillins? | spectrum? bugs it can treat? how to use?
piperacillin broad spectrum, severe infections gram (+) strep, staph, possibly eneterococci gram (=)- excellent- pseudomonas aeruginosa given in combo w/B-lactamase inhibitor so it can act on those bugs which produce the B-lactamase
26
MOA of B-lactamase inhibitors?
increase treatment capacity against MSSA and enterobactieraceae and anaerobes
27
bugs pencillin/B-lactamase inhibitor can be used on?
gram (+) strep, MSSA, maybe enterococci gram (=) P. aeurginosa all anaerobes
28
possible adverse rxns with penicillins?
allergic reaction: anaphylaxis, rash, urticaria, fever 5-20% report allergy, <20% who think they have an allergy actually have an allergy diarrhea
29
type I allergic reaction? common to see in what type of abx?
IgE occur w/in 1 hr of dose urticarial rash, pruritis, flushing, angioedema of face or laryngeal tissues, wheezing, hypotension anaphylaxis common to see w/B-lactam drugs; ~5% cross reactivity w/cephalosporins if true allergy
30
4 less common adverse penicillin rxns?
hematologic: anemia, thrombocytopenia hepatitis w/nafcillin/oxacillin interstitial nephritis: nafcillin/oxacillin seizures: high doses, renal failure
31
SEs of amoxicillin and clavulanate/augmentin?
notable increased SEs from clavulanic acid, clavulanate alone has very little antimicrobial activity but causes copious GI distress and diarrhea
32
what is the most severe cause of abx induced diarrhea?
pseudomembranous colitis (c. difficile colitis)
33
most of the abx are cleared in which way?
most are cleared renally
34
what is the only major interaction w/amoxicillin?
acacia
35
MOA of cephalosporins?
binds to beta-lactam ring of cell wall and inhibits organisms ability to form new cell walls
36
between 1st, 2nd, 3rd and 4th generation cephalosporins, which have the greatest activity against gram (+)s, against gram (=)s?
1st and 2nd have greatest activity against gram (+)s | 3rd and 4th have greatest activity against gram (=)s
37
what bug do cephalosporins NEVER cover??
enterococcus
38
1st generation cephalosporins use? what bugs does it cover?
indications: UTIS, skin infxns, some respiratory and prophylaxis surgically used against gram (+) strep, MSSA; gram (=) e. coli, klebsiella; oral anaerobes can be used as an alternative to penicillin allergic pts
39
2nd generation cephalosporins use? what bugs does it cover?
indicated in some respiration and GI infections gram (+) strep, MSSA gram (=)- good coverage overall oral anaerobes + b. fragilis
40
3rd generation cephalosporin use? bugs it covers?
``` use: respiratory infxns, serious infxns gram (+) strep, MSSA gram (=): very good, p. aeruginosa oral anaerobes some are able to cross BBB ```
41
4th generation cephalosporin use? what bugs?
serious hospital infxns gram (+) strep and MSSA gram (=): excellent, p. aeruginosa oral anaerobes only
42
what can 5th generation cephalosporins cover?
MRSA strep pneumonia covers GNR, but not pseudomonas
43
exceptions of cephalosporins that are not cleared renally?
ceftriaxone so don't need to adjust for reduced renal fxn
44
ADRs of cephalosporins?
allergic rxns: anaphylaxis, rash, urticaria, fever, 3-7% cross resistance with penicillin allergy diarrhea less common: anemia, thrombocytopenia, seizures when given at high doses
45
two other beta-lactam drugs? MOA? what can provide bugs w/resistance?
monobactams and carbapenems MOA: inhibit cell wall synthesis resistance via B-lactamases, outer membrane protein mutations very broad spectrum, sever infxns in hospital
46
macrolides use? bugs it covers?
erythromycin, azithromycin good coverage of respiratory infections, chlamydia, syphilis, gonorrhea, sinusitis, bronchitis, COPD gram (+) strep, MSSA, pneumococci gram (=) minimal w/h. flu oral anaerobes useful in treating atypical respiratory pathogens such as legionella, chlamydia, mycoplasma
47
ADRs of macrolides?
GI: n/v, diarrhea b/c cause direct (+) motility of gut; erythro is worse than clarithro which is worse than azithro phlebitis with IV erythro less common: prolonged QT interval hepatotoxicity
48
what enzyme do macrolides inhibit?
CYP450-3A4
49
4 major interactions with azithromycin?
all possibly prolong the QT segment | cesium, ephedra, oleander, sida cordifolia
50
MOA of tetracyclines?
inhibit protein synthesis by binding to the 30s ribosomal subunit (inhibits translation) bacteriostatic
51
what can tetracyclines be used to tx?
increased resistance limits their use respiratory, intracellular infxns, acne and rosacea, chlamydia, SSTI gram (+) strep, MSSA gram (=) h. flu, rickettsiae, other gram (=)s often resistance oral anaerobes atypical respiratory pathogens such as legionella, clamydia pneumonia, mycoplasma pneumonia
52
ADRs of tetracyclines?
``` photosensitivity nausea diarrhea tooth discoloration in children (C/I in children less than 8 and PG) less common: esophagitis, leukocytosis ```
53
what can tetracyclines not be given with? can be used in what populations?
do not give with Ca2+ supplements as it causes chelation of calcium ions can be used in those who are PNC allergic can be used in renal failure
54
MOA of sulfonamids?
inhibits folic acid synthesis via enzyme inhibition | bacteriostatic
55
can combine sulfamethoxazoe w/what other abx? what will this combo cover? what can this combo be used to tx?
can be combined with trimethoprim/bactrim variable wide activity when used in combo gram (+) strep, MSSA, CAMRSA gram (+) most enterobacteriaceae oral anaerobes indications: UTI, otitis media, sinusitis, bronchitis, pneumocystitis prophylaxis, community acquired MRSA, SSTI there is however increasing resistance
56
ADRs of bactrim? what drug does it specifically act with to increase its effects?
allergic rxns, rash, fever, photosensitivity, urticaria, GI effects, neutropenia, thrombocytopenia (folate deficiency) rare: Steven Johnsons Syndrome (severe rash) increases effects of warfarin!
57
MOA of fluroroquinolones? resistance mechanisms?
MOA: inhibits bacterial DNA gyrase, inhibiting DNA replication and transcription, bactericidal resistance: mutations at target sites, efflux pumps
58
bugs fluoroquinolones can act against?
potent broad-spectrum agent, most gram (=): p. aerugonisa | atypical pathogens: community acquired pneumonia- legionella, clamydia pneu, mycoplasma pneu
59
indications for fluoroquinolones? problems?
UTI, pyleo, upper and lower respiratory tract infxns, SSTI, joint infxns increasing resistance increase evidence of adverse rxns
60
ADRs of fluoroquinolones?
GI: nausea CNS: h/a, dizziness, insomnia less common: cartilage toxicity, AVOID use in children and PG, CNS: confusion, seizures; prolonged cardiac QT interval
61
interactions w/fluoroquinolones? need to be taken away from what items?
any drug that can prolong the QT interval like the macrolides cesium, ephedra, grapefruit, sidea cordifolia, sweet orange need to take away from calcium, iron, antacids, enteral feeding
62
MOA of anti-anaerobes (metronidazole and clindamycin)? resistance how?
metronidazole: inhibits nucleic acid synthesis clindamycin: ribosomal protein synthesis inhibitor resistance: rare w/metron, mutations in ribosomes w/clinda
63
use metronidazole against what?
only anaerobes! indications: vaginitis, h.pylori in PUD, c. difficle, associated diarrhea, intra-abdominal abscess, lung abscess, peritonitis
64
use clindamycin against what?
gram (+) and anaerobes NO GRAM (=)s indications: SSTI, anaerobic infxns, topical available for acne vulgaris, bacterial vaginosis
65
ADRs of metronidazole?
nausea, diarrhea, metallic taste | drug interaction: disulfiram rxn: flushing, sweating, nausea w/EtOH, can persist a few days after
66
ADRs of clindamycin?
diarrhea, nausea, c. difficile
67
indication of nitrofurantoin/macrobid? MOA?
indication: lower UTIs but NOT for pyelonephritis, considered safe before 38 wks gestation MOA: disrupts both DNA and RNA of bacteria which are sensitive to the drug
68
SEs of nitrofurantoin/macrobid?
n/v, diarrhea less common: fever, chills, pulmonary fibrosis not recommended for pyelonephritis and not effective in significant renal impairment
69
additional abx classes for hospital severe infxns? MOA? what bugs can they be used against?
aminoglycosides MOA: bactercidial, inhibit protein synthesis can be used against gram (=0 such as pseudomonas auerginosa
70
6 abx that can be used effectively to treat MRSA?
``` IV vancomycin daptomycin telavancin ceftaroline tigecycline linezolid ```
71
3 abx to use for community acquired MRSA (CAMRSA)
clindamycin tetracycline bactrim
72
6 drugs that cover pseudomonas?
``` aminoglycosides ciprofloxacin, levofloxacin ceftazidime, defepime, ceftolozane/tazobactam piperacillin, ticarcillin aztreonam imimpenem, meropenem, doripenem ```
73
what abx provide true anaerobic coverage?
``` metronidazole B-lactam/B-lactamase inhibitors carbapenems moxifloxacin clindamycin cefoxitin/cefotetan ```
74
topical abx?
mupirocin/bactroban bacitracin polysporin OTC (combo of bacitracin and polymyxin) neosporin OTC (combo of bacitracin along with neomycin and polymyxin B
75
probiotic strains which have been proven to prevent c. difficile?
lactobacillus combos or single agent regiments

Pharm I (18 decks)

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