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Misc > Antimicrobial chemotherapy > Flashcards

Antimicrobial chemotherapy Flashcards

1
Q

Which type of antibiotics inhibit cell wall synthesis by disrupting peptidoglycan synthesis using enzymes known as penicillin-binding proteins?

A

β-lactams

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2
Q

What are the two groups of β-lactam antibiotics?

A

Penicillins and cephalosporins

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3
Q

Which type of antibiotics inhibit cell wall synthesis by inhibiting the assembly of a peptidoglycan precursor?

A

Glycopeptides

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4
Q

What are the two groups of glycopeptide antibiotics?

A

Vancomycin and teicoplanin

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5
Q

Glycopeptides only affect gram …………….. organisms

A

Positive, they are unable to penetrate the gram negative cell wall

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6
Q

Name the four groups of antibiotics which act by inhibition of protein synthesis

A
  1. Aminoglycosides
  2. Macrolides and tetracyclines
  3. Oxazolidinones
  4. Cyclic Lipopeptide
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7
Q

Aminoglycosides (eg(a)…………….) are especially useful in the treatment of serious gram (b)………….. infection

A

(a) Gentamicin

(b) Negative

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8
Q

(a)…………………… antibiotics are useful alternatives to penicillins in treatment of gram (b)………………….. infections in patients who are penicillin allergic

A

(a) Macrolide

(b) Positive

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9
Q

(a)………………………, an Oxazolidinone, has good activity against (b)………………….. and is held in reserve for treatment of serious infection

A

(a) Linezolid

(b) MRSA

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10
Q

(a)…………………, a cyclic lipopeptide, has good activity against (b)……………………….. and is used in serious infections on specialist advice

A

(a) Daptomycin

(b) Gram positives in general and MRSA in particular

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11
Q

Name the two groups of antibiotics which act by inhibition of nucleic acid synthesis

A
  1. Trimethoprim and sulphamethoxazole

2. Fluoroquinolones

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12
Q

……………………… is less likely than other broad spectrum agents such as cephalosporins to cause Clostridium difficile infections

A

Co-trimoxazole, this drug is a combination of Trimethoprim and Sulphamethoxazole

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13
Q

……………………… is commonly used in the treatment of UTIs

A

Trimethoprim

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14
Q

(a)………………….. is an example of a fluoroquinolone and are particularly effective against gram negative organisms, including Pseudomonas, but cannot be used in children due to (b)…………………………….

A

(a) Ciprofloxacin

(b) Danger of interference with cartilage growth

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15
Q

Term for the minimum concentration of antimicrobial needed to inhibit visible growth of a given organism

A

Minimal inhibitory concentration(MIC)

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16
Q

Term for the minimum concentration of antimicrobial needed to kill a given organism

A

Minimal bactericidal concentration

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17
Q

What are the two important mechanisms of resistance to β-lactam antibiotics?

A
  1. β-lactamase production

2. Alteration of penicillin binding protein target site

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18
Q

…………………….. is β-lactamase resistant and can be used to treat β-lactamase producing Staph. aureus

A

Flucloxacillin

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19
Q

MRSA are resistant to…………

A

All penicillins and cephalosporins

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20
Q

………………….. is the best known example of a β-lactam combined with a β-lactamase inhibitor

A

Co-amoxiclav, which consists of amoxicillin plus clavulanic acid

21
Q

Until recently resistance to (a)………………. among gram positive organisms was virtually unknown so it could be relied on for the treatment of serious gram positive infections. However (b)……………….. have appeared recently and is a major concern among microbiologists

A

(a) Vancomycin

(b) Vancomycin resistant enterococci

22
Q

(a)…………………… is an important side effect of antibiotic therapy, restricted use of (b)……………….. helps minimise this. It is treated with (c)………………….. and discontinuation of current antibiotic treatment if clinically appropriate

A

(a) Clostridium difficile infection(CDI)
(b) broad spectrum antibiotics, 4 Cs( Cephalosporins, ciprofloxacin, clindamycin and co-amoxiclav)
(c) Oral metronidazole or oral vancomycin

23
Q

Which two antibiotics should have their levels monitored to avoid toxicity?

A

Vancomycin, gentamicin

24
Q

…………………. bind to ergosterol, which is present in fungal cell wall and results in an increase in its permeability. Unfortunately they also bind to other sterols (eg cholesterol) in mammalian cell membranes and this is the reason for their toxicity

A

Polyenes

25
Q

Two commonly used polyenes are:

(a) …………….. which is used intra-venously for serious yeast and other fungal infections, it is extremely toxic however
(b) …………… is used topically or in oral suspension for serious fungal infection

A

(a) Amphotericin B

(b) Nystatin

26
Q

…………….. is used to treat yeast infection (not filamentous fungal infection)

A

Fluconazole

27
Q

(a)……………. and (b)……………… are used to treat aspergillosis

A

(a) Voriconazole
(b) Itraconazole
Aspergillosis is the name given to a wide variety of diseases caused by infection by fungi of the genus Aspergillus. The majority of cases occur in people with underlying illnesses such as tuberculosis or COPD, but with otherwise healthy immune systems.

28
Q

……………… is used for fungal infection of skin and nails

A

Terbinafine

29
Q

……………………… are used for serious Candida and Aspergillus infections, usually on specialist advice

A

Echinocandins

30
Q

……………………. is active against herpes simplex virus and varicella zoster virus

A

Aciclovir

31
Q

The first treatment for HIV was ……………….. Many other drugs are currently under evaluation so this is a quickly changing area of medial practice

A

Zidovudine

32
Q 
The original naturally occurring substance discovered by Fleming and largely acts against gram
positive organisms (though meningococci, which are Gram negative, are an important exception). It is still the best choice for intravenous treatment of serious pneumococcal, meningococcal and Strep pyogenes (Group A) infection
A

Benzyl penicillin (Penicillin G)

33
Q

has much better oral absorption orally than benzylpenicillin, and originally better gram negative activity, although 20-30% of coliform organisms are now resistant due to β-lactamase production. It covers streptococci (including enterococci) and some coliforms.

A

Amoxicillin, ampicillin

34
Q

combines amoxicillin with the β-lactamase enzyme
inhibitor clavulanic acid, thus extending the spectrum to cover
β-lactamase producing coliforms.

A

Co-amoxiclav

35
Q

Resistant to the actions of staphylococcal β-lactamase and is therefore first choice treatment for staphylococcal infections. Methicillin is a similar agent which is used to represent flucloxacillin in laboratory testing - resistant strains are therefore termed methicillin resistant Staph aureus (MRSA).

A

Flucloxacillin

36
Q

is a broad spectrum penicillin with extended gram negative cover. It has useful activity against Enterococcus faecalis
and unlike all of the above it is active against Pseudomonas species.
It also has anti-anaerobic activity so it has a good spectrum of action to cover serious intra-abdominal infection. It is now commonly used in combination with the β-lactamase inhibitor tazobactam, the combined preparation has the commercial name Tazocin but is commonly referred to as “pip/taz” in everyday use

A

Piperacillin

37
Q

these are close relatives of the penicillins in a sub group called carbapenems. These drugs have the widest spectrum of all and are active against most bacteria, including
anaerobes.

A

Imipenem, meropenem

38
Q

This is a permanently expanding and confusing group of antibiotics,
often divided somewhat arbitrarily into generations, more or less in chronological order of first appearance. Among them,
activity against gram negative organisms increases from first generation drugs through second generation to third generation drugs. Only third generation has any activity against Pseudomonas species.

A

Cephalosporins

39
Q

These are noted for their action against gram negative organisms including pseudomonas, with very little resistance seen in the UK. Most
staphylococci are also sensitive but not streptococci

A

Aminoglycosides (parenteral use only) Gentamicin is the
cheapest and most commonly used, but serum levels must be monitored
because of potential toxicity

40
Q

Activity against only gram positive organisms, both aerobic and anaerobic

A

Glycopeptides:- Vancomycin and teicoplanin (parenteral use only)
Vancomycin levels must be monitored because of potential toxicity

41
Q

mainly against gram positive

organisms and they are often used as an alternative to penicillin in patients with penicillin hypersensitivity

A

Macrolides:- Clarithromycin or Erythromycin
Azithromycin is a newer macrolide which is useful for single dose
treatment of Chlamydia infection

42
Q

The newer ones have a much wider spectrum of action and are active against nearly all gram negative organisms including pseudomonas.
This group provides virtually the only possibility for oral therapy in the
treatment of pseudomonas infections

A

Quinolones:- ciprofloxacin

43
Q

is effective against anaerobes, both gram positive and gram negative.
Resistance amongst anaerobes is virtually unknown, while it has
no useful activity against aerobes. It is widely used in any situation which may involved anaerobic infection e.g. intra-abdominal
sepsis

A

Metronidazole

44
Q

is used only as an anti-staphylococcal drug.
Staphylococcus aureus can develop resistance very readily to this agent and thus it should always be used in combination with other anti-staphylococcal drugs such as flucloxacillin. It diffuses well into bone and tissues and so is useful in staphylococcal osteomyelitis and pneumonia

A

Fusidic acid

45
Q

is used in the treatment of urinary infections. (a)……………………..and sulfamethoxazole together are marketed as the
combined drug (b)………………….., which is used for a few specialised
conditions and sometimes for treatment of chest infections on the grounds that it does not predispose to Clostridium difficile
infection.

A

(a) Trimethoprim

(b) Co-trimoxazole

46
Q

are broad spectrum agents which inhibit bacterial
protein synthesis and have a few limited applications nowadays. They are useful for some genital tract (chlamydia) and respiratory
tract infection

A

Tetracyclines

They should not be given to pregnant women or children under 12 yearsof age as they are deposited in teeth and bone.

47
Q

is the only lincosamide antibiotic in common use
and has good activity against gram positive organisms such as staphylococci and streptococci. It also has good activity against anaerobes

A

Clindamycin
The advantages of clindamycin are that it has very good tissue penetration – e.g. into bone – and can be taken orally. The disadvantage is that it is a common cause of pseudo-membranous
colitis

48
Q 
The following agents are used only in the treatment of lower urinary
tract infection (cystitis):
A
  1. Nalidixic acid:- gram-negative aerobes(coliforms) only

2. Nitrofurantoin:- effective against most gram negative and also some gram positive organisms, unlike Nalidixic acid

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