MMI review

Question 1

cautions w antibiotic therapy

Answer 1

specificity, resistance, superinfections

Question 2

specificity

Answer 2

narrow-spectrum antibiotics needed

Question 3

resistance

Answer 3

mutations in drugs, nosocomial infections

Question 4

superinfections

Answer 4

broad spectrum antibiotics; CNS active meds

Question 5

3 pathways of resistance

Answer 5

1. bacteria spread among people
2. bacteria to bacteria communication
3. biochemical mechanisms

Question 6

1. Bacteria spread among people

Answer 6

mutations occur 1/10 mill

Question 7

2. Bacteria to bacteria communication

Answer 7

bacteria exposed to tx creates resistance genes, r-plasmid=site for resistant genes
transfer via conjugation (transferring plasmids)

Question 8

Transformation

Answer 8

absorbing resistance gene plasmid. transponson- jumping genes, carrries DNA info between bacteria

Question 9

3. Biochemical mechanisms

Answer 9

enzymes- essential enzyme pathway desensitization
receptor site alteration
decreased drug intake

Question 10

resistant pathogens

Answer 10

staphylococcus aureus: MRSA

enterococci: VRE
mycobacterium: tuberculosis

Question 11

what causes an infection

Answer 11

pathogenicity: organisms ability to evade body defenses (bacteria, virus, fungus, parasite
entry into the body past endogenous defenses

Question 12

mechanisms of entering body past endogenous defenses

Answer 12

1: strength in numbers
2: toxin production

Question 13

common world wide pathogens

Answer 13

TB, cholera, E-coli, enterococci, staph. aureus, acinetobacter

Question 14

Viral infections

Answer 14

more contagious ex. flu, cold, laryngitis, croup. symptom management with antivirals & best protection with vaccination

Question 15

Bacterial infections

Answer 15

less common, less contagious, respond to antibiotics

ex. strep, pneumonia

Question 16

Gram Neg bacteria

Answer 16

thin peptidoglycan, has 2 membranes and looks pink. lipid-a endotoxin
ex. E-coli, salmonella, pseudomonas

Question 17

Gram Pos bacteria

Answer 17

thick peptidoglycan, looks purple

Question 18

narrow spectrum antibiotics

Answer 18

more specific, less resistance, requires ID of organisms ex. vancomycin, penicillin

Question 19

broad spectrum antibiotics

Answer 19

less specific, more resistance potential, doesn’t require ID of organism ex. carbapenems

Question 20

antibiotic emperic tx

Answer 20

based on suspected bacteria, broad spectrum, started ASAP

Question 21

antibiotic focal tx

Answer 21

need culture and sensitivity results= focused treatment, initiated once results are known
narrow spectrum

Question 22

tx protocols: 3 steps

Answer 22

1: treat according to clinical presentation & patient history ( emperic therapy)
2: use bugs and drugs resource
3: confirm with culture & sensitivity (focal therapy)

Question 23

4 classes of antimicrobial MOA

Answer 23

1. cell wall synthesis inhibitors
2. protein synthesis inhibitors
3. nucleic acid inhibitors
4. antimetabolites

Question 24

cell wall synthesis inhibitors

Answer 24

penicillins, cephalosporins, bacitracin, vancomycin

Question 25

penicillins

Answer 25

contains beta-lactam ring

targets Gram + = best efficacy

Question 26

narrow penicillins

Answer 26

Pen G (IV), Pen V (PO), cloxacillin

Question 27

broad penicillins

Answer 27

ampicillin

Question 28

very broad penicillins

Answer 28

pipercillin, carbenicillin, ticaricillin

Question 29

pharyngitis tx

Answer 29

Pen V (PO)

Question 30

otitis media tx

Answer 30

amoxicillin

Question 31

PUD tx

Answer 31

amoxicillin, metronidazole, clarithromycin (tetracycline if allergic)

Question 32

clavulanic acid and tazobactam

Answer 32

b-lactam inhibitor

combined with amoxicillin, ticarcillin, pipercillin

Question 33

co-amoxiclav

Answer 33

amoxicillin + clavulanic acid (augmentin)

Question 34

co-ticarclav

Answer 34

ticarcillin + clavulanic acid (timentin)

Question 35

pip-taz

Answer 35

pipercillin + tazobactam (tazosin, zosyn)

Question 36

cephalosporins

Answer 36

largest antibiotic class, contains b-lactam ring, bactericidal

Question 37

cephalosporins efficacy

Answer 37

treats Gram + & - bacteria = broad
1st choice for skin infections ex. cefazolin, cephalexin, cefuroxime
higher generations can cross BBB ex. ceftriaxone, ceftazidime, ceftaroline

Question 38

carbapenems

Answer 38

potent, IV only. resistance growing.
b-lactam structure, bactericidal
ex. imipenem, meropenem

Question 39

carbapenems efficacy

Answer 39

very broad spectrum, serious & mixed infections ex. meningitis, aspiration pnuemonia

Question 40

bacitracin efficacy & tx

Answer 40

efficacy: G+, broad, topical, ear or eye prep
tx: conjunctivitis, skin/soft tissue topical infections (prophylactic)

Question 41

vancomycin

Answer 41

glycopeptide
1st choice for MRSA
2nd tx for C.difficile

Question 42

VRSA

Answer 42

MRSA strains resistant to vancomycin

ex. tigecycline (IV), daptomycin

Question 43

tetracyclines

Answer 43

-ycline suffix
broad spectrum: Gram + & -, bacteriostatic
ex. tetracycline,doxycyline, tigecycline

Question 44

tetracyclines tx

Answer 44

treatment for lyme disease, cholera, h-pylori, chlamydia, acne
causes bone deformations

Question 45

macrolides

Answer 45

-mycin suffix 
Gram + mostly, some - 
bactericidal or bacteriostatic 
PO very effective, 1st choice for community aquired adult pneumonia, last tx for gonorrhea (w/ cephalosporin)
ex. erythromycin, azithromycin

Question 46

aminoglycosides

Answer 46

treats gram - mostly
ex. gentamicin, streptomycin, tobramycin
tx for: high risk infections, except conjuctivitis
narrow TI