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Antimicrobial Flashcards

1
Q

What are examples of penicillins?

A

penicillin G, ampicillin

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2
Q

What are examples of cephalosporins?

A

ceftriaxone, ceftaroline

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3
Q

What is an example of monoactam?

A

azotreonam

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4
Q

What is an example of carbapenams?

A

imipenam

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5
Q

What is an example of trycylic glycopeptide?

A

vancomycin

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6
Q

What is an example is cyclic lipopeptide?

A

daptomycin

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7
Q

What is an example of tetracyclines?

A

tetracyline

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8
Q

What are examples of macrolides?

A

azithromycin, erythromycin

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9
Q

What is an example of lincosomides?

A

clindamycin

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10
Q

What are examples of streptogramins?

A

quinopristin, dalfopristin

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11
Q

what are examples of aminoglycosides?

A

gentamicin, tobramycin

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12
Q

What is an example of sulfonamides?

A

sulfamethoxazole

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13
Q

What are examples of quinolones?

A

ciprofloxacin, levofloxacin

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14
Q

What drug has its own group?

A

trimethoprim

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15
Q

What is selective toxicity?

A

kill or damage a microbe without damage to the host

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16
Q

What is therapeutic index?

A
  • TI= LD50/ED50
  • ratio of the toxic dose to the effective dose

LD must be large; ED must be low

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17
Q

What does -cidal mean in antibiotics?

A

kill bacteria

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18
Q

What does -static mean in antibiotics?

A

stop abcteria from growing; does NOT kill

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19
Q

What drugs are bacteriostatic?

A
  • tetracyclines
  • erythromycin
  • chloramphenicol
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20
Q

What drugs are bacteriocidal?

A
  • penicillins
  • aminoglyocsides
  • cephalosporins
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21
Q

What is the exception that can be either -cidal or -static?

A

sulfonamides

surf between cidal and static

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22
Q

Where would bacteriostatic and bacteriocidal agents be located on a graph?

A

bacteriostatic agents would be located above bacteriocidal agents

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23
Q

What group of drugs are beta lactams?

A
  • penicillins
  • cephalosporins
  • monobactams
  • carbapenems
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24
Q

What drugs play a role in cell wall synthesis?

A
  • penicillins
  • cephalosporins
  • monobactams
  • carbapenems
  • vancomycin
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25
What drugs play a type of role in DNA to RNA synthesis?
* quinolones: DNA gyrase, replication * rifampin: RNA polymerase * metronidazole: damage DNA
26
What drugs play a role in protein synthesis?
* tetracyclines * aminoglycosides * chloramphenicol * macrolides (azithromycin, erythromycin)
27
What drugs play a role in the cell membrane?
* polymyxins * daptomycin
28
Which drugs play a role in the production of folic acid?
* trimethoprim * sulfonamides ## Footnote PABA -> DHFA -> THFA
29
What are the reasons why a patient may not respond to therapy?
* misdiagnosis * no infection * do not complete full length of therapy * patient self treatment of infection with antimicrobials that were not prescribed to them
30
What are some factors to consider when treating an infection?
* sensitivity of organism to drug * appropriate dosage * route of admin. * duration of therapy * special patient features
31
What is meant by "superinfection"?
when an antimcirobial migth disturb the ecologically balance leading to overgrowth of pathogenic microbes that are resistant to the antimicrobial agent
32
What is an example of something that can cause a superinfection?
C. Diff Albicans
33
What are the microorganisms that are most likely to cause a burn and traumatic/surgical wounds?
* staph * strep * pseudo. aeru
34
What are the microorganisms that are most likely to cause a skin infection?
* staph * strep * herpes
35
What are the microorganisms that are most likely to cause a wound infection?
* staph * E. coli * bact fragilis
36
What si the difference between the MIC and MBC?
* MIC: used more * MBC: can be toxic
37
What si the goal of MIC to get rid of infection?
3-5 times more
38
What is the first choice of treatment for syphilis?
benzathine + penicillin G
39
What is the first choice of treatment for tuberculosis?
rifampin + isoniazid + pyrazinamide + ethambutol
40
What is the first choice of treatment for pneumonia?
piperacillin/tazabactam + tobramycin
41
Most antimicrobia drugs are excreted by what organ?
kidneys
42
What is creatinine clearance rate?
* measure renal function * serve as guide to adjust dose ## Footnote dose based on patients renal function
43
For hepatic function, which drug do you need to reduce the dosage for?
chloramphenicol
44
For hepatic function, which drug do you need to use with caution and have NO dosage adjustment?
clindamycin
45
How does the change in dose affect neonates (chloramphenicol)?
* low conc. of UGT which conjugates chloramphenicol; cleared by kidneys * infants died from cardiovascular collapse, Gray Baby syndrome * give lower dose
46
How does the change in dose affect neonates (sulfonamides)?
* displace bilirubin from albumin in the blood which can deposit in the brain * contraindicated in neonates
47
How does the change in dose affect children?
* permanent dsicoloration of growing teeth of children * can cause intracranial hypertension in infants and children
48
How does the change in dose affect CHF patients?
ticarcillin disodium/calvulanate potassium can cause edema and arrythmia
49
What dosage needs to be increased for infants/young children?
gentamicin
50
What drug causes the risk of hepatitis to increase with age?
isoniazid
51
What are the contradicted drugs for pregnancy and nursing?
* metronidazole * sulfonamides * antifolate drugs * fluoroquinolones * tetracyclines
52
What is the best combination for synergy?
2 drugs from different classes or have different mechanism of action
53
What are the mechanisms of antimicrobial resistance in pathogenic microbes?
* decrease drug uptake * increase durg increase * decrease affinity for site of action
54
What are the gram positive microorganisms?
* staph * strep * E. faecalis * mono
55
What are the gram negative microorganisms?
* E. coli * kleb * pseudo * H. influenzae
56
Which microorganisms are anaerobes?
C. diff and bacterio fraglis
57
What are the gram positive characteristics in regards to a membrane?
* lactamase outside * thicker peptidoglycan wall
58
What are the gram negative characteristics in regards to a membrane?
* outer membrane with porin channel * thin peptidoglycan layer * lactamase inside
59
Penicillin targets what?
transpeptidase ## Footnote important for cross linking
60
Fosphomycin inhibits what enzyme?
pyruvyl transferase ## Footnote used in formation of NAM
61
Peptidoglycan is a target for what enzymes?
vancomycin and pentapeptide
62
What is the mechanism of action for penicillins and cephalosporins?
* inhibit peptidoglycan transpeptidase * penicillin binding proteins (PBP) * trigger autolysins
63
What are the chararcteristics of penicillin G?
* narrow spectrum * penicillinase-sensitive * used to treat trep and necrotize
64
What are the chararcteristics of dicloxacilin?
* narrow spectrum * penicillinase-resistant * used ot treat staph, skin infection and run of the mill
65
What are the chararcteristics of amooxicillin?
* broad spectrum * penicillinase sensitive * used ot treat H. influ, E. coli, mono, ear/URTI
66
What are the chararcteristics of ticarcillin?
* broad spectrum * penicillin sensitive * used to treat pseudo aeru and nocosomial
67
What are the chararcteristics of piperacillin?
* undergo renal clearance * poor in absense of inflammation
68
What is the pharmacokinetics of penicillins?
conc. of drug acheived to treat meningitis, arthritis, endophthalmitis
69
What are the side effects of penicillins?
* NVD * superinfection of GI tract: C. diff * neurotoxicity: seizures, penicillin G inhibit GABA * penicillin allergy
70
What are the mechanisms of resistance of penicillins, carbapenems, monobactam, and cephalosporins?
* changes in PBP * tolerance: deficiency in autolytic enzymes * changes in the porins (gram -) * beta-lactamase
71
What are the drugs in cephalosporins?
1. cefazolin: 1st gen 2. cefoxitin: 2nd gen 3. ceftriaxone: 3rd gen 4. cefepime: 4th gen 5. ceftaroline: 5th gen
72
What is cefazolin used to treat?
used to treat pro mira, E. coli, kleb pneu, staph/strep (PEKS)
73
What is cefoxitin used to treat?
used to treat haem influ, enter aero, neiss hono, PEK (HEN PEK)
74
What is ceftriaxone used to treat?
used to treat 2nd gen and acine calco, citro dive, entero cloa, serra marce, and GRAM -, meningitis
75
What is cefepine used to treat?
used to treat 3rd gen, strep, pseudo aeru, citro freu, seriosu G- nonsocomial infec.
76
What are the chararcteristics of ceftaroline?
used to treat 4th gen (besides pseudo aeru), acute bacterial infec., pneum
77
What are the side effects of cephalosporins?
DO NOT give to patients with history of severe penicillin reaction
78
What are carbapenems used to treat?
used ot treat G-, pseudo aeru, mono, serious nosocomial infections
79
What are the pharmacokinetics of carbapenems?
* primarily renally cleared * imipenem hydrolyzed by dipeptidases
80
What are the side effects of carbapenems?
seizures, hypersensitivity reactions
81
What is the drug to give someone if they are allergic to penicillin?
aztreonam
82
What is monobactam used to treat?
used to treat G- (E. coli, kleb pneu, haemo influ, prot vulga, pseudo aeru)
83
What is the pharmacokinetic of monobactam?
renally cleared
84
What are he side effects of monobactam?
* GI upset * phlebitis, pain at injection * cross reactivity * hypersensitivity reactions; , 15 of beta lactam allergic patients
85
What is the main drug for tricyclic glycopeptide?
vancomycin
86
What is the main drug for monobactam?
aztreonam
87
What is the mechanism of action for trycyclic glycopeptide?
* inhibitor of peptidoglycan synthase * attaches to NAG and NAM; binds to D-ala-D-ala * inhibitor of pentapeptide precursor and membrane carrier
88
What is trycyclic glycopeptide used to treat?
G+, MRSA, MRSE, both streps, coryne dipth, both entero faec, serious multi-drug resistant infections, C. diff
89
What are the pharmacokinetics of trycyclic glycopeptides?
* renally cleared * can enter CSF with inflamed meninges
90
What are the side effects of trycyclic glycopeptides?
* ototoxicity: rare * nephrotoxicity: uncommon
91
What are the mechanisms of tricyclic glycopeptide?
* changes alanine to lactate * vancomytcine resistant enterococci
92
What is the drug for cyclic lipopeptide?
daptomycin
93
What is th mechanism of action for cyclic lipopeptides?
binds to cell membrane, forms pores
94
What is cyclic lipopeptide used to treat?
G+, MRSA, VRE
95
What are the pharmacokinetics of cyclic lipopeptides?
* renally cleared * pulmonary surfactant inactivates it * CANNOT be used for lung infections (ex: pneumonia)
96
What are the side effects of cyclic lipopeptide?
* myopathy * rhabdomyolysis
97
What is the mechanism of resistance of cyclic lipopeptides?
treatment failure -> increase in MIC
98
What are the drugs for tetracyclines?
tetracycline, minocycline, doxycycline
99
What is the mechanism of action for tetracyclines?
* inhibit protein synthesis * bind to 30S subunit * prevent attachment of bacteriostatic (TEC)
100
What are tetracyclines used to treat?
mycoplasma pneu, cutibact acnes, chlamydia, strep
101
What are the pharmacokinetics of tetracyclines?
* limited CNS penetration * doxycycline primarily fecally eliminated -> with renal failure
102
What are the side effcts tetracyclines?
* contraindicated during pregnancy * discoloration of teeth and inhibit bone * photosensitivity * superinfection -> C. diff, C. albicans
103
What is the mechanism of resistance for tetracyclines?
* plasmid-determined resistance: decrease influc and increase efflux * ribosomal change
104
What is the drug for glycylcyclines?
tigercycline
105
What is the mechanism of action for glycylcyclines?
* bind to bacterial 30S ribosomal subunit * bacteriostatic
106
What are the characteristics of glycylcyclines?
* broad spectrum * used to treat: G+, G-, MRSA, VRE, PRSP, skin infections
107
What are the side effects of glycylcyclines??
* increase mortality risk, limit use for multi-resistance * contraindicated in pregnancy, superinfection
108
What are the drugs for macrolides?
* erythromycin * azithromycin * clarithromycin
109
What is the mechanism of action for macrolides?
* inhibit protein synthesis * binds ot peptidyl-tRNA region on 50S subunit * bacteriostatic
110
What are the characteristics of macrolides?
* used to treat chlamydia, H. influenzae, M. catarrhalis, URTI, pneumonia, otis media * broad spectrum
111
What are the side effects of macrolides?
* prolong the QTc interval * rash * hepatits * embryotoxic
112
What is the mechanism of resistance of macrolides?
methylation of the 23 rRNA binding site, prevents binding
113
What is the drug interaction of macrolides?
erythtromycin> clarithromycin, inhibit CYP3A4
114
What are the characteristics of chloramphenicol?
* binds to 50S subunit * bacteriostatic * bactericidal for meningitis
115
What is chloramphenicol used to treat?
haemo influen, neiss meningi, strep, rickett rickett
116
What are the side effects of chloramphenicol?
* anemia * gray baby syndrome
117
What are the drugs for lincosamides?
* clindamycin * Ca-mrsa * CDAD
118
What is the mechanism of action of lincosamides?
binds to 50S ribosome subunit, bacteriostatic
119
What are lincosamides used to treat?
Ca-mrsa, B lactam allergy, strep, clostri perfri, lung abscess
120
What are the side effects of lincosamides?
CDAD, diarrhea, rash, fever, neutropenia
121
What is the mechanism of resistance for linosamides?
methylation of the 23rRNA binding site, prevents binding
122
What are the drugs for streptogramins?
quinopristin, dalfopristin
123
What is the mechanism of action for streptogramins?
binds to 50S subunit, bactericidal
124
What are streptogramins used to treat?
primary G+, entero faec (VRE), MRSA, strep, PRSP, osteo, endo
125
What are the side effects of streptogramins?
arthralgias, myaglias, pain, phlebitis at infusion site
126
What is the mechanism of resistance for streptogramins?
ribosomal methylase, acetyltransferase
127
What are the drugs for aminoglycosides?
gentamicin, amikacin, tobramycin
128
What is the mechanism of action for aminoglycosides?
* inhibit protein synthesis, bind to 30s subunit * bactericidal * conc. depend. killing * synergistic with beta-lactams
129
What are aminoglycosides used to treat?
* primary for aerobic G-, pseudo aeru, both entero, serra marce, prot vulga, kleb pneu, listeria mono, serious G- nosocomial infections * combined with beta lactam
130
What is the pharmacokinetics of aminoglycosides?
* primarily renally cleared * polar -> decrease distribution
131
What are the side effects of aminoglycosides?
nephrotoxicity, ototoxicity, neuromuscular blackade, teratogen, myelosuppression
132
What is the mechanism of resistance of aminoglycosides?
* decrease in porin permeation and ribosomal binding * enzymatic inactivation: acetyltransferase and phosphotransferase
133
What is the drug for macrocylic antibiotic?
fidaxomicin
134
What is the mechanism of action for macrocylic antibiotic?
binds to sigma unit of RNA polymerase, inhibits protein synthesis
135
What is macrocylic antibiotics used for?
C. diff, CDAD
136
What are the side effectsof macrocylic antibiotic?
abdominal pain, GI hemorrhage, BMS
137
What is pharmacokinetic of macrocylic antibiotic?
very little systemic absorption, high fecal conc.
138
What is the drug for sulfonamides?
sulfamethoxazole
139
What is the mechanism of action for sulfonamides?
* inhibition of dihydropteroate synthase * decrease biosynthesis of DNA, RNA, AA, bacteriostatic
140
What are sulfonamides used to treat?
* broad spectrum * strep, both haem, nocard astero, E. coli, kleb granu, chlamydia, UTI
141
Dihydropteroate synthase is inhibited by?
sulfonamides
142
Dihydrofolate reductase is inhibited by?
trimethoprim
143
What are the side effects of sulfonamides?
rash, sulfa allergy, SJS, TEN, kernicterus (newborn encephalopathy)
144
What are sulfonamides used to treat?
conjunctivitis, burns, Ag sulfadiazine
145
What are the pharmacokinetics of sulfonamides?
* renally cleared * NAT and UGT substrate * inhibit CYP2C9 -> increase warfarin AUC
146
What are the mechanism of resistance for sulfonamides?
* DO NOT biosynthesize folic acid * increase PABA production * dihydropteroate synthase, low affinity for sulfa * decrease sulfa permeability
147
What are the mechanisms of action for trimethoprim/sulfamethoxazole?
* DHFRI, DHPSI, synergism * bacteriostatic, can be bactericial in blood; can be both in urine
148
What is trimethoprim/sulfamethoxazole used to treat?
MRSA, E. coli, UTI, prostatitis
149
What are the side effects of trimethoprim/sulfamethoxazole?
BMS, rash, hemolytic anemia
150
What is the mechanism of resistance of trimethoprim/sulfamethoxazole??
decrease DHFR afiinity, decrease cell permeation, DHFR overproduction
151
What are the drugs for quinolones (floxacin)?
ciprofloxacin, levofloxacin, moxifloxacin
152
What are the mechanisms of action for quinolones (floxacin)??
inhibit topoisomerase 2, inhibit DNA replication
153
What are the mechanisms of action for quinolones (floxacin)??
inhibit topoisomerase 2, inhibit DNA replication
154
What are the side effects of quinolones?
tendonitis, myasthenia gravis
155
What are the drug interactions of quinolones?
* celation, Al, Mg, Fe, Ca * inhibit CYP1A2, increase caffeine
156
What is the mechanism of resistance of quinolones?
* increase efflux * decrease influx * mutation in topoisomerase 2 or 3, decrease binding

Pharmacology (5 decks)

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