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ID unit 1 > antimicrobials > Flashcards

antimicrobials Flashcards

1
Q

bacteriostatic vs bacteriocidal

A

bacteriostatic: stops bacteria from reproducing. Bactericidal: kills bacteria

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2
Q

MIC vs MBC

A

Minimum inhibitory concentration: concentration to stop growth. Minimum bactericidal concentration: concentration which kills 99%

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3
Q

List the cell wall synthesis inhibitors

A

beta lactams (penicillins, cephalosporins, carbapenems, monobactams), vancomycin, bacitracin, and cycloserine

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4
Q

PenicillinsMOA, excretion and adverse rxns

A

Inhibit cell wall synthesis (bactericidal). Renal excretion. Adverse rxn: anaphylaxis type I, rash type III and convulsions (high dose)

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5
Q

Penicillin G and V: route and spectrum/uses

A

Pen G: IV/ IM (poor oral). Pen V: good PO. Both: gram +/- cocci, gram + bacilli, most anaerobes

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6
Q

List the penicillinase-resistant penicillins

A

Methicillin, oxacillin (dicloxacillin, cloxacillin)

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7
Q

List the extended spectrum penicillins

A

amoxicillin, ampicillin

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8
Q

list the antipseudomonal penicillins

A

piperacillin (ticarcillin, mezlocillin, carbenicillin)

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9
Q

List the penicillin + beta-lactamase inhibitor combos

A

Amoxicillin/ clavulanate, piperacillin/ tazobactam, (ampicillin/sulbactam, ticarcillin/clavulanate)

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10
Q

penicillinase resistant penicillins spectrum/uses

A

Beta-lactamase producing Staph aureus

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11
Q

Extended spectrum penicillins uses

A

gram neg enterobacteria (H flu, e coli)

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12
Q

antipseudomonal penicillins uses

A

pseudomonas, bacteroides

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13
Q

List first generation cephalosporins

A

cephalexin, cefazolin (cephradine, cefadroxil, cephapirin)

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14
Q

list 2nd generation cephalosporins

A

cefuroxime, cefaclor (cefotetan, cefoxitin, cefprozil, lorcarbef, cefmetazole, cefonicid)

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15
Q

List 3rd generation cephalosporins

A

ceftriaxone, ceftazidime, cefdinir, cefepime (cefotaxime, cefoperazone, cefixime, cefpodoxime, ceftizoxim)

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16
Q

cephalosporins MOA, adverse rxns

A

Inhibit cell wall synthesis (bactericidal). Allergy less severe than penicillins

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17
Q

first gen cephalosporins uses

A

Gram pos cocci, gram neg cocci and rods (e coli, klebsiella proteus)

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18
Q

Second gen cephalosporins uses

A

gram + cocci, gram - cocci/rods, extended gram - (H flu and enterobacter) and some anaerobes

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19
Q

third gen cephalosporins uses

A

More gram -, less gram +, plus moderate antipseudomonal. Also distributes well in CSF

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20
Q

List carbapenems

A

imipenem/cilastatin, ertapenem (meropenem)

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21
Q

list monobactams

A

aztreonam

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22
Q

Monobactams uses

A

aerobic gram neg only

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23
Q

Carbapenems uses

A

wide spectrum- used for resistant organisms and cephalosporinases

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24
Q

Vancomycin uses

A

narrow gram pos cocci

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25
Q

List the protein synthesis inhibitors

A

aminoglycosidea, macrolides, tetracyclines, chloramphenical, clindamycin, streptogramins and linezolid

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26
Q

List aminoglycosides

A

tobramycin, gentamicin (neomycin, streptomycin, netilmicin, paromomycin)

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27
Q

List tetracyclines

A

tetracycline, doxycycline, minocycline

28
Q

List the macrolides

A

erythromycin, clarithromycin, azithromycin

29
Q

aminoglycosides MOA, route, adverse toxicity

A

Inhibits 30s ribosomal subunit (bactericidal). IV/IM (poor oral). High toxicity- vestibular and auditory toxicity, nephrotoxicity

30
Q

aminoglycosides uses

A

gram negative aerobes (e coli, pseudomonas). Limited gram pos. TB

31
Q

tetracycline MOA, adverse rxns

A

Inhibits 30S ribosomal subunit (bacteriostatic). Causes abnormal bone and tooth development (don’t use if <8 yrs), superinfections (fungal)

32
Q

Tetracycline uses

A

Broad spectrum gram pos and neg. Rickettsia, chlamydia, mycoplasma, spirochetes

33
Q

Macrolides MOA, adverse rxns

A

Inhibits 50S ribosomal subunit (bacteriostatic/cidal). Drug interactions due to inhibition of P450.

34
Q

Macrolides uses

A

gram pos and some gram neg bacilli. Community acquired pneumonia, (Chlamydia, mycoplasma legionella)

35
Q

Chloramphenical MOA, adverse rxns

A

Inhibits 50S ribosomal subunit (bacteriostatic), bone marrow toxicity, gray baby syndrome.

36
Q

Chloramphenicol uses

A

broad spectrum gram pos and neg cocci and anaerobes (H flu, Neisseria meningitis, Chlamydia, mycoplasma, rickettsia)

37
Q

Clindamycin MOA, adverse rxns

A

inhibits 50S ribosomal subunit. Severe diarrhea, pseudomembranous colitis

38
Q

Clindamycin uses

A

narrow spectrum gram pos cocci (penicillin alternative), anaerobes, acne (topical)

39
Q

List the streptogramins

A

quinupristin/ dalfopristin

40
Q

streptogramins MOA

A

inhibits 50S

41
Q

streptogramins uses

A

gram pos and some gram neg. Life threatening VREF

42
Q

List the oxazolidinones

A

linezolid

43
Q

linezolid MOA and uses

A

inhibits 50S. Gram pos and severe VREF, MSSA, MRSA and strep

44
Q

Which antibiotics undergo hepatic elimination

A

CRIMES: clindamycin/ chloramphenicol, rifampin, isoniazid, metronidazole, erythromycins, sulfonamides/ streptogramins

45
Q

List the inhibitors of folic acid metabolism

A

sulfonamides: trimethoprim/ sulfamethoxazole (intermediate acting) (sulfadiazine, sulfamethizole, sulfisoxazole, mafenide)

46
Q

sulfonamides MOA

A

PABA analogues which Inhibit dihydropteroate synthase (of folic acid synthesis pathway). Selective toxicity b/c humans dont have DHPS or synthesize folic acid. Bacteriostatic

47
Q

Trimethoprim MOA

A

Inhibit dihydrofolate reductase (of folic acid synthesis pathway). Selective toxicity b/c humans don’t synthesize folic acid. Used in synergy with sulfamethoxazole

48
Q

sulfonamides pharmacokinetics

A

bacteriostatic with delayed onset of action (5-6hrs). Good oral absorption, widely distributes in tissues (including CSF).

49
Q

sulfonamides metabolism/excretion

A

Hepatic metabolism by acetylation at N4- metabolite is inactive but less soluble. Increasing pH will increase renal excretion and decrease renal crystalluria (improve solubility)

50
Q

sulfonamides toxicity

A

renal crystalluria precipitates, hemolytic anemia in pts with G6PD deficiency, hypersensitivity/ Stevens-Johnson syndrome, kernicterus (bilirubin deposition in brain of neonates), DDIs such as displacement of anticoagulants from plasma proteins

51
Q

Sulfonamide uses

A

Broad spectrum (not used alone very much though): UTI (TMP/SMX), toxoplasmosis (sulfadiazine + pyrimethamine), nocardiosis (sulfa + AMP, erythro or streptomycin), chloroquine resistant malaria (sulfadoxine + pyrimethamine), pneymocystis carinii in AIDS, otitis media, prophylaxis of burn wounds (pseudomonas aeruginosa), sinusitis/ acute bacterial bronchitis (SMX/TMP), MRSA

52
Q

sulfonamides mechanism of resistance

A
  1. acquired: increased production of PABA, altered DHPTS, bacterial permeability. 2. escape: bacteria obtain methionine, homocysteine, serine, purines, thymine from pus. 3. Natural: organisms with no folic acid requirement are not susceptible
53
Q

Why is surgical drainage important

A

Prevent escape mechanism of antibiotic resistance

54
Q

Fluoroquinolones MOA

A

DNA gyrase inhibitor- bactericidal. Selective toxicity b/c humans don’t have gyrase

55
Q

list fluoroquinolones

A

ciprofloxacin (2nd gen), levofloxacin (3rd gen), moxifloxacin (4th gen) (cinoxacin, enoxacin, nalidixic acid, gemifloxacin, norfloxacin, ofloxacin)

56
Q

fluoroquinolones pharmacokinetics and toxicity/ DDI

A

orally available, broadly distributed. Toxicity: impair cartilage development/ causes erosion in children under 12, also contraindicated in pregnant women, hepatic damage DDI: inhibition of theophylline metabolism, increased risk of seizures with NSAIDs, antacids reduce oral absorption

57
Q

Fluoroquinolone uses and resistance

A

gram neg and some gram pos. UTI, respiratory tract, soft tissue, some anaerobes, mycobacteria, prostatitis, STDs, GI tract infections.Resistance through shift in metabolic processes from acetate to lactate

58
Q

List nitroimidazoles

A

Nitrofurantoin and metronidazole

59
Q

Metronidazole MOA and uses

A

Degrades DNA- bactericidal. Anaerobic and protozoal infections (giardia, trichomoniasis, amebiasis), pseudomembranous colitis

60
Q

nitrofurantoin MOA and uses

A

Degrades DNA- bacteriostatic. Gram negative bacteria. Prevention and treatment of UTI

61
Q

Polymyxins MOA, uses, toxicity

A

Bactericidal- interacts with membrane phospholipids and lyses cells. Gram neg Pseudomonas meningitis (polymyxin B) and p. aeruginosa/ acinetobacter (polymyxin E). Highly nephrotoxic

62
Q

Daptomycin MOA, uses, toxicity

A

Bactericidal- loss of membrane potential, inhibits protein/RNA/DNA synthesis. gram pos: MRSA, VISA, VRSA, VRE. Toxicity: rare eosinophilic pneumonia

63
Q

bactericidal vs bacteriostatic for severe infections

A

bactericidal is best

64
Q

List the bactericidal agents

A

penicillins, cephalosporins, vancomycin, aminoglycosides, fluroquinolones, rifampin, polymyxins, daptomycin

65
Q

List bacteriostatic agents

A

sulfonamides, trimethoprim, tetracyclines, macrolides, clindamycin, chloramphenicol

ID unit 1 (12 decks)

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