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Antimicrobials Flashcards

(90 cards)

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1
Q

What does a gram (+) stain look like

A

purple, single lipid bilayer with thick pept. cell wall

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2
Q

What does a gram (-) stain look like

A

red, double lipid bilayer with thin pept. cell wall

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3
Q

Cocci

A

spherical

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4
Q

Bacilli

A

rod

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5
Q

Aerobic

A

oxygen loving

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6
Q

Anaerobic

A

oxygen hating

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7
Q

Blood brain barrier- factors influencing drug penetration

A
  • Protective mechanism = stops entry into brain
  • Single layer tile-like endothelial cells fused by tight junctions
  • Resistant to hydrophilic drugs
  • Gain entry = high lipophilicity, increased inflammation of BBB, low molecular weight, decreased binding (free serum overall)
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8
Q

Bacteriostatic

A

stops growth of bacteria and limits spread of infection during immune system attack

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9
Q

Bacteriocidal

A

kills bacteria

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10
Q

Bacteriostatic list

A

CLM, TTTT, SSSS
Clindamycin*
Linezoid
Macrolides*

Tetracycline
Tigecycline
Trimethoprim

Sulfonamides
Spectinomycin
Synercid

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11
Q

Bacteriocidal list

A

A B C D
FVM

Aminoglycosides
Beta-lactam
Cephalosporines
Daptomycin
Fluroquinolies
Vancomycin
Metronidazole
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12
Q

Gram (+) pearls

A
  • Staphylococcus
  • Streptococus
  • Enterococcus
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13
Q

Gram (-) pearls

A 
Haemophilius influenza (easy to treat)
FENCE bugs (easy/hard)
SPACE bugs (hard to treat)
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14
Q

FENCE bugs

A

Proteus mirabilis
E. Coli
Klebsiella PNA

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15
Q

SPACE bugs

A
  • Serratia
  • Pseudomonas
  • Acinetobacter
  • Citerobacter
  • Enterobacter
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16
Q

Organism susceptibility

A

a guide for choosing antimicrobial therapy once a pathogen is cultured. Includes MIC, MBC, antibiogram

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17
Q

Concentration dependent killing

A

significant increase in rate of bacterial killing as the concentration of abx increases (cmax) à more rapid killing

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18
Q

Two meds that use concentration dependent killing are?

A

o Aminoglycosides

o Fluoroquinolones

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19
Q

Time dependent killing

A

increasing the concentration of antibiotic does not increase the rate of kill. It is based on clinical efficacy via percentage of time that blood concentration of the drug remain above the MIC (fT >MIC)

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20
Q

Post antibiotic effect

A

persistent suppression of microbial growth that occurs after levels of abx have fallen below the MIC

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21
Q

Narrow Spectrum

A

single/limited group of microorganisms

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22
Q

Extended Spectrum

A

gram (+) organisms and significant number of gram (-) organisms

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23
Q

Broad Spectrum

A

wide variety of microbial species (precipitates superinfections)

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24
Q

Combination therapy

A

combo of abx/synergism with a disadvantage of interfering with mechanisms of action, overuse, and cost

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25
Synergy
combination drugs, better coverage together than alone
26
Resistance
genetic alterations, altered expression of protein
27
Genetic alterations
DNA/protein mutations à xfer drug resistence
28
Altered expression of proteins
modification of target sites, decreased accumulation (efflux pumps), and enzymatic inactivation (B-lactamases, acetyltransferases, esterases)
29
Superinfections
broad spectrum/combo of agents can lead to alterations of the normal microbial flora
30
the two big super infections are
C Diff | Yeast
31
What drug uses enzymatic inactivation as their MoR?
beta lactams
32
What drug uses modification of target site for their MoR?
Vancomycin
33
What drug uses: enzymatic inactivation Efflux pump and ribsomal protective proteins as its MoR?
tetracycline
34
What drug uses: alteration in amino glycoside uptake modifying enzymes alterations in ribosomal binding site for its MoR
aminoglycosides
35
What drug uses: decreased accumulation/efflux pump modification of target site (mef/erm) for its MoR ?
macrolides
36
What drug uses: altered target sites efflux pump for its MoR?
clindamycin
37
What drug uses: alterations in ribosomal binding sites enzymatic inactivation and efflux pump for its MoR?
synercid
38
What drug uses alterations in ribosomal binding sites for its MoR?
linezoid
39
What drug uses alterations in target sites and DNA active cell wall permeability and efflux pump for its MoR
fluoroquinolones
40
What drug uses impaired oxygen scavenging and alter ferrodoxin levels for its MoR?
metronidazole
41
What drug uses increased PABA production and point mutations as its MoR?
TMP-SMX
42
4 sites of action of antimicrobials
* Inhibitors of cell wall synthesis * Inhibitor of protein synthesis * Inhibitors of nucleic acid function or synthesis * Inhibitors of metabolism
43
which class are inhibitors of cell wall synthesis
``` beta lactams (PCMC) vancomycin ```
44
which classes are inhibitors of protein synthesis
tetracyclines aminoglycosides macrolides
45
which classes are inhibitors of nucleic acid formation or synthesis
Fluoroquinolones
46
which class is inhibitors of metabolism
TMP-SMX
47
Patient factors influencing selection of agents
``` Immune system Renal dysfunction and Hepatic dysfunction – (may need dose decrease) Poor perfusion (may need dose increase) Age Pregnancy Lactation ```
48
Beta Lactams
Beta Lactamase Enzymes Ethanol intolerance Cephalosporin MTT side chain, hypoprothrombinemia (low vit K) Neuro/Hem/GI Interstitial Nephritis Hypersensitivity (rash, anaphylaxis, death), Antibody production against penicillins
49
Cephalosporins can't cover what bug?
Enterococcus
50
Cephalosporin generation 1
gram (+) aerobes, limited with few gram (-) aerobes
51
Cephalosporin generation 2
- gram (+) aerobes, more active with gram (-) aerobes, 3 work on anaerobes (cefoxitin, cefotetan, cefmetazole)
52
Cephalosporin generation 3
less active against gram (+) greater against gram (-) aerobes
53
Cephalosporin generation 4
am (+) aerobes (ceftriaxone), gram (-) aerobes including pseudomonas aeruginosa and beta lactamase producing enterobacter sp.
54
Cephalosporin generation 5
best gram (+) coverage, CAP (MRSA), infections of skin/subcut tissue
55
which cephalosporins work on anaerobes?
cefoxitin cefotetan cefmetazole
56
T/F vancomycin treats gram (+) only
true
57
Vancomycin AEs/Contras
* Red-Man Syndromes (rate of infusion) * Nephrotoxicity * Ototoxicity * Neutropenia/Thrombocytopenia * Thombophlebitis
58
Tetracyclines AEs/Contras
•Effects on calcified tissue/bone and teeth deposition in pregnant women/children under 8 GI- N/V/D, pseduomembranous colitis • Hypersensitivity- rash, pruritis, anaphylaxis, angioedema, urticaria • Photosensitivity • Hepatotoxicity •
59
Aminoglycosides AEs/Contras
• Nephrotoxicity o Nonoliguric azotemia (proximal tubule damage) o Risk for elderly, underlying renal dysfuction with long therapy • Ototoxicity o 8th CN damage with irreversible vestibular/auditory toxicity o Vestibular- dizziness, vertigo, ataxia (S,G,T) o Auditory- tinnitus, decreased hearing (A,G)
60
Macrolides AEs/Contras
``` • QTc prolongation • GI o N/V/D, dyspepsia o Erythro most common • Cholestatic hepatitis • Thrombophlebitis • Ototoxicity • Allergy ```
61
Clindaymycin AEs/Contras
* most associated w/ Cdiff * GI symptoms * Allergy * Hepatotoxicity
62
which medication causes c diff the most
clindamycin
63
linezolid- Zyvox
o ADE= thrombocytopenia with tx >2wks, headaches, thrombocytopenia, reversible optic/peripheral neuropathy o caution w/ SSRIs- serotonin syndrome, MOI
64
• Tigecycline (Tygacil)-
o D/N/V o Acute pancreatitis o Tooth discoloration
65
Fluoroquinolones
* covers atypical pathogens * not recommended in pediatrics d/t tendon rupture, * difference between newer and older agents and gram positive coverage, * CNS issues * Hepatotoxicity * QTc prolongation…watch with other prolonging agents * GI issues * Must take 2 hours before or 4hrs after chelation with calcium, iron, aluminum, Mg meds
66
T/F Fluroroquinolones have post antibiotic effect
True
67
o TMP-SMX-
``` • GI issues • Hematologic- leucopenia, thrombocytopenia, eosinophilia (should stop therapy) • Dermatologic- sulfa allergy o Steven Johnson Syndrome o Photosensitivity o Rash • CNS- aseptic meningitis, sz, headaches • Crystalluria ```
68
Metronidazole
* GI issues * CNS (caution with preexisting CNS disorders) * Disulfiram reaction with ETOH
69
Synercid
* venous irritation * GI symptoms * Rash * Myalgias * Hyperbilirubinemia * Interaction warning= CYP3A4 inhibitor (Ca2+ blockers, cyclosporine, warfarin, HIV meds, statins, diazepam)
70
o Endemic Mycoses:
* Histoplasmosis * Coccidiodomycosis * Blastomycosis
71
o Opportunistic Mycoses:
* Cryptococcosis * Candidiasis * Aspergillosis * Zygomycosis
72
3 types of polyenes
Ampho B Lipid Ampho B Nystatin
73
Ampho B
* Fungicidal/Fungistatic * Does NOT penetrate CSF * AEs- * Infusion related (fever, chills)-premed * Nephrotoxicity-give fluids before and after * Elevated liver enzymes * Hypokalemia * Hypomag
74
o Lipid-based Ampho B
* Advantages- higher tissue conc, decreased infusion related reactions, marked decreased in nephrotoxicity, increased daily dose * Good for people with renal insufficiency
75
o Nystatin
* Topical only | * Candida suppression
76
• Pyrimidines (Flucytosine)
* Combined with Ampho B * Penetrates CSF * AEs- * Neutropenia * Thrombocytopenia * Bone marrow depression * Hepatic dysfuction * GI symptoms
77
what are the 4 azoles
Itraconazole Fluconazole Voriconazole Posaconazole
78
Azoles
* AEs- * GI-N/V abd pain, elevated LFTs * Prolonged QTc * Visual disturbances (voriconazole) * Rash * Nephrotoxicity
79
what are the 3 echincandins
Caspofungin Micafungin Anidulafungin
80
echincandins
* AEs- overall tolerated well * N/V * Flushing * Elevated LFTs * Infusion reaction * Phlebitis * Hypokalemia
81
• Griseofluvin
``` o Used for dermatophytosis o AEs • Serum sickness • Hepatitis o Drug Interactions • Warfarin • Phenobarb ```
82
• Terbinafine
o AEs • GI upset • Headache
83
• Topical Agents
o Miconazole o Clotrimazole • OTC • Used for vulvovaginal candida or dematophytic infections
84
T/F • Viruses obligate intracellular parasites- invade host cells
True
85
• Acyclovir
o Treats HSV and VZV o renal toxicity w/ IV o neuro toxicities o high doses of valtrex can cause HUS, thrombocytopenia, seizures, hallucinations, confusion
86
o Amantadine and Rimantadine-
• use for Influenza A only, high levels of resistance
87
o Oseltamivir and Zanamivir-
* Activity against Influenza A and B | * Should be administered w/i 30 hours of symptom onset – and not after 48hrs
88
what bacteria are not covered by carbapenems?
MRSA VRE Cdiff
89
Monobactams only work against?
gram (-) aerobes
90
Vanc only works against?
gram (+) aerobes

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