Lecture 1 Flashcards by hannah miller

semisynthetics

abx which have been chemically altered (eg. Penicillin V)

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synthetics

abx that are completely man-made (eg. cephalosporin)

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spectrum

describes “breadth of activity” of abx

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normal flora

humans are colonized with many species of org’s soon after birth, these org’s usually DONT cause disease (symbiotic relationship)
may prevent overgrowth of pathogens

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cardinal signs of local infection

redness (rubor), swelling (tumor), heat (color), pain (dolor

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symptoms of systemic infection

leukocytosis (inc WBC), fever (>101F), altered structure or loss of function, pure cultures of pathogens from infn site

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pathogen

org with inc ability to cause infn (e.g.. strep pneumonia, staph aureus, etc)

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virulence

microbial factors that inc likelihood of infn (eg. adhesions, toxins, etc)
high virulence - few org –> infn
low virulence - many org’s –> infn

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antimicrobials vs abx

antimicrobials are broader, includes elements and may be anti-vitals, anti-fungals, etc
abx are found in nature and are equivalent to antibacterials

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bacteriostatic

inhibits bacterial growth allowing the body’s immune system to act

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bacteriocidal

results in bacterial cell death by cell wall lysis, altered memb permeability, etc

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narrow spectrum abx

preferred, minimizes the development of resistance

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natural resistance

native to an org

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acquired resistance

usually associated with abx use, develops after exposure

can occur if pt does not complete their course of therapy

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prophylactic abx

used to prevent infn (eg. peri-sx abx is MC, others are heart valve dx, neutropenia, recurrent UTIs and transplant recipients)

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Penicillin

inhibits GRAM + CELL WALL SYN
allows inc water to go into cell causing lysis and death (bacteriocidal)
resistance to this medication by penicillinase/B-lactamase has been around the longest
time-dependent killing
anaphylaxis: 0.2% of 10,000 courses
fatality rate: 0.001% in 100,000 courses

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Penicillinase Inhibitors

Clavulanic acid (Augmentin is the only PI that is PO), Tazobactam, Sulbactam and Avibactam (newest)

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Cephalosporin xxx

structurally related to PCN
small amount of cross-sensitization with PCN allergy pt's
1st gen: mainly gram +
2nd and 3rd gen: less gram +, inc gram -
4th gen: best gram -

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Macrolides

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inhibits PROTEIN SYN, static in usual dose and cidal in higher dose
eg. erythromycin, clarithromycin and azithromycin xxx
side effects of GI upset, cramping and diarrhea

Tetracyclines

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1st broad spectrum abx, inhibits PROTEIN SYN
SE’s: photosensitivity, stains developing teeth
can bind cations (antacids and milk) inhibiting absorption xxx
avoid if <8 yo or preg xxx

Aminoglycosides

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inhibits PROTEIN SYN (static or cidal depending on dose) 
used for gram - infn 
used with PCN/cephalosporins
exhibit post-abx effect (PAE)
renally eliminated 
SE: nephrology and oto toxicity
poor CNS penetration

quinolones/fluoroquinolones

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broad spectrum, inhibits BACTERIAL DNA SYN (cidal)
good oral abs (PO and IV)
renally eliminated (except Moxi- which is hepatic)
good tissue penetration
SE: inhibit cartilage syn, achilles tendon rupture, skin rash, antacids inhibit abs

chloramphenicol xxx

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broad spectrum, limiting toxicity is BM suppression

little use, reserved for bad pt’s in ICU who are resistance to many

Aztreonam/Azactam xxx

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used in pt’s with PCN allergy

Vancomycin/Vancocin xxx

used for MRSA and C diff from other broad spectrums, poor oral abs

Metronidazole/Flagyl xxx

used for anaerobic/protozoal infn

Sulfonamides

not true abx, bacteriostatic or cidal dep on dose inhibits folate son required for microorganism growth UTIs are major use xxx used in combo with trimethoprim IV/PO (TMP/SMX) xxx

urinary antiseptics

minimal [] in blood/tissue, commonly used for UTIs e.g. Nitrofurantoin (Furadantin, Macrodantin, Macrobid) - dose dep, taken orally, pulmonary toxicity with long use in elderly, may discolor urine to dark, contraindicated for CrCl <60 (won't work, but will not harm) xxx

TB tx

first line ex's are most effective and least toxic isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), ethambutol (ETH) used in combo to prevent resistance

systemic antifungals xxx

flucanozole (diflucan) - IV/PO, old and cheap

HIV tx target - reverse transcriptase

nucleoside reversal transcriptase inhibitors (NRTIs) and non-nucleoside RTIs (NNRTIs)

HIV tx target - Protease

protease inhibitors (PIs)

HIV tx target - Fusion inhibitors

Newest category

significant bacteriuria

numbers of bacteria in voided urine that exceed numbers commonly seen due to contamination of urethra

cystitis

term to describe the syndrome involving dysuria, freq, urgency, and occasionally suprapubic tenderness

uncomplicated UTI

infection in a structurally and neurologically normal urinary tract

complicated UTI

infection in a urinary tract with abnormalities (men, preg women, kids)

relapse vs reinfection

relapse is recurrence of bacteriuria with the SAME org, while reinfection is recurrence with a DIFF org

symptoms of UTIs

in adults: dysuria, inc freq/urgency, maybe flank pain, suprapubic heaviness/pain in elderly: often asymptomatic

Diagnostic techniques of UTIs

urine microscopic exam, dipstick leukocyte esterase, dipstick urine nitrite, urine culture (GOLD STANDARD)

dipstick leukocyte esterase

sensitive to 10 WBC/mm, these enzymes are normally intracellular but once WBCs move into urine they lyse releasing the enzymes

distick urine nitrite

false - for bacteria < 100-1000 false + is rare gram - org use nitrate and covert to nitrite so this can be measured (high is abnormal)

significant bacteriuria

>10^5 bacteria/mL in asymptomatic patients on 2 consecutive specimens

antimicrobial resistance

sig inc over last decade, most significant for TMP/SMX, before 1990 E coli resistance was <5% data suggests inc clinical failures

nitrofurantoin

renewed interest secondary to inc resistance | less active than T/S and FQ

Fosfomycin

long half life, used for non adherent pt's | single dose tx of cystitis, inferior to 1st line agents though mainly for pt's susceptible to E coli and E faecalis

Lecture 1 Flashcards

(46 cards)