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Phase 1 - S2 Infection > Session 4 - Antimicrobials > Flashcards

Session 4 - Antimicrobials Flashcards

1
Q

What are the ideal features of antimicrobial agents

A
  • selective toxicity
  • few adverse effects
  • reach site of infection
  • can be given orally or through IV
  • long half life
  • doesn’t interfere with other drugs
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2
Q

What are the 4 mechanisms of action of antimicrobials

A
  • inhibiting cell wall synthesis
  • inhibiting protein synthesis
  • inhibiting cell membrane function
  • nucleic acid synthesis
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3
Q

What 2 classes of antimicrobials inhibit cell wall synthesis

A

Beta-lactams

Glycopeptides

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4
Q

What class of antimicrobials inhibit cell membrane function

A

Polymixins

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5
Q

What class of antibacterials prevent protein synthesis

A
  • tetracyclines
  • aminoglycosides
  • macrolides
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6
Q

What class of antibacterials prevent nucleic acid synthesis

A

Quinolones

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7
Q

How does penicillin prevent cell wall synthesis

A

Binds to the penicillin binding proteins which forms the cross in bridges between the side groups of the peptidoglycan preventing the cross bridges forming

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8
Q

How does vancomycin prevent the synthesis of bacteria cell wall

A

Prevents cross linkages but binding to the cell wall preventing the penicillin binding protein from binding

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9
Q

Under which antibacterial class is vancomycin in

A

Glycopeptides

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10
Q

Under which antibacterial class does penicillin fall under

A

Beta-lactams

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11
Q

What are bacteria cell walls made up of

A

Peptidoglycan (chains of amino acids and peptides)

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12
Q

What are the 3 types of resistance

A
  • intrinsic
  • acquired
  • adaptive
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13
Q

What is intrinsic resistance

A

Where there is target for the drug so it cant enter the bacteria
This is usually permanent

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14
Q

What is acquired resistance

A

Where the organism acquires new genetic material or mutates

Usually permanent

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15
Q

What is adaptive resistance

A

Where the organism responds to the stress of antimicrobials and so high levels of antimicrobials allow the microbe to become resistant
This is reversible as you can take away the stress

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16
Q

What are the 3 mechanisms of resistance

A
  • drug inactivating enzymes
  • altered target
  • altered uptake
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17
Q

What are the 2 genetic mechanisms for antibiotic resistance

A
  • gene mutation

- gene transfer

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18
Q

What is transduction gene transfer

A

Where bacteriophage viruses insert the gene into the bacteria

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19
Q

What is transformation gene transfer

A

Where free DNA can enter at porins in the bacteria cell wall

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20
Q

How can you measure antibiotic activity

A

By disc testing to see what much the organism grows

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21
Q

what are the 4 classifications of antimicrobial agents

A
  • chemical structure
  • target site
  • spectrum
  • bactericidal or bacteriostatic
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22
Q

what are bactericidal agents

A

antimicrobials that kill bacteria

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23
Q

what are bacteriostatic agents

A

antimicrobials which inhibit bacteria growth

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24
Q

how do antimicrobials prevent nucleic acid synthesis

A

by inhibiting the actions of 2 nuclear enzymes inhibiting DNA replication

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25
Q

how does altering the target for antimicrobials cause resistance

A

it means the target enzyme for the antimicrobial has a lower affinity for it

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26
Q

give 2 examples of drug inactivating enzymes which cause antimicrobial resistance

A

B-lactamases

aminoglycoside enzymes

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27
Q

what uptake can be altered to cause antimicrobial resistance

A
  • a decreased permeability

- increased efflux

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28
Q

how do antimicrobials usually enter through the cell wall

A

through holes called porins

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29
Q

what is conjugation gene transfer

A

when genetic information from one bacteria is directly passed to another

30
Q

what is the empiric choice of antibiotics

A

where an antibiotic is given despite the causative bacteria being unknown

31
Q

outline disc testing

A

where antibiotics are placed on bacteria growing on agar jelly. the larger the circle becomes around the antibiotic, the more bacteria have been killed and so the more effective it is

32
Q

what is a quantitative way of assessing antibiotics

A

minimum inhibitory concentration test

33
Q

outline the minimum inhibitory concentration test

A

you put a concentration of bacteria into each test tube, but the concentration is double diluted by each tube. you then compare which concentrations allow the growth of bacteria

34
Q

give an example of a drug with is an antibacterial and antiprotozoal agent

A

metronidazole

35
Q

give 2 examples of antiviral agents

A
  • aciclovir

- oseltamivir (tamiful)

36
Q

what is azole

A

an antifungal agent which inhibits cell membrane synthesis

37
Q

what is polyene

A

an antifungal which inhibits cell membrane function

38
Q

what is trimethoprim used to treat

A

UTIs

39
Q

what is trimethoprim sometimes combined with

A

sulphamethoxazole

40
Q

how does trimethoprim work

A

inhibits folic acid synthesis preventing DNA replication

41
Q

what is the most common type of quinolone

A

ciprofloxacin

42
Q

what type of bacteria are quinolones very active against

A

gram negative

atypical pathogens

43
Q

give 4 examples of penicillin antimicrobials

A
  • penicillin
  • amoxicillin
  • flucloxacillin
  • b-lactamase inhibitors
44
Q

what is flucloxacillin especially active against

A

staphylococci and streptococci

45
Q

what is amoxicillin active against

A

gram negatives

46
Q

what is penicillin active against

A

streptococci

47
Q

what antimicrobial is used in meningitis

A

ceftriaxone as it can enter the CSF

48
Q

give an example of a glycopeptide antimicrobial

A

vancomycin

49
Q

what is vancomycin used for

A

gram positive bacteria

50
Q

why must you be careful when taking vancomycin

A

it has some toxic affects so there must be therapeutic drug monitoring to compare concentration of antimicrobial in the blood to known levels

51
Q

give an example of a tetracycline

A
  • tetracycline

- doxycycline

52
Q

why shouldn’t tetracyclines be given to children under 12

A

it stains bones and teeth yellow

53
Q

what is antimicrobial stewardship

A

making sure that there is the appropriate use of antimicrobials for optimal clinical outcomes, reduced toxicity, side effects, costs of health care and limiting selection for resistance

54
Q

true or false - antimicrobial resistance increases with use

A

true.

55
Q

give 3 consequences of antimicrobial resistance

A
  • treatment failure
  • prophylaxis failure
  • economic costs
56
Q

what is antimicrobial prophylaxis

A

prevention of infection by the use of antimicrobials

57
Q

what is multi-drug resistance

A

where the bacteria are not susceptible to 3 or more categories of antimicrobials

58
Q

what is extensive drug resistance

A

where the bacteria are not susceptible to at least one drug in all but 2 antimicrobial categories

59
Q

what is pan drug resistance

A

where bacteria are not susceptible to any agents in all the antimicrobial categories

60
Q

what 3 types of evidence is there to show that antibacterials cause resistance

A
  • laboratory evidence
  • ecological studies
  • individual level data
61
Q

what are ecological studies

A

studies relating the levels of antibacterial use in a population with levels of resistance

62
Q

what is individual level data

A

relating prior antibacterial use in an individual with subsequent presence of bacterial resistance

63
Q

what is involved in an antimicrobial stewardship programme

A
  • multidisciplinary team
  • surveillance using process and outcome measures
  • interventions
64
Q

who is involved in the stewardship multidisciplinary team

A
  • microbiologist
  • infection control nurse
  • hospital epidemiologist
  • antimicrobial pharmacist
65
Q

what are the 3 intervention types of stewardship programmes

A
  • persuasive
  • restrictive
  • structural
66
Q

what is persuasive intervention

A

giving physicians advise on prescribing antimicrobials and feedback on how they were prescribed

67
Q

what is restrictive intervention

A

putting a limit on how antimicrobials can be prescribed e.g. having approval by an infection specialist to be able to prescribe an antimicrobial

68
Q

what are process measures

A

surveillance of antimicrobial use (doses, appropriateness and classes) overtime in the same institution

69
Q

what are outcome measures

A

surveillance of patient outcomes, the emergence of resistance and c.Diff infection rate

70
Q

which intervention is most effective

A

initially restrictive but over time there is no significant difference

71
Q

what are the unintended consequences of interventions

A
  • risk of mortality

- risk of readmission

Phase 1 - S2 Infection (16 decks)

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