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1
Q

-Patients getting prescribed antibiotics for viral colds
-Some bacteria can survive for a long time on objects
-Wrong drug used for treatment
-patient Started abx too late
-treatment was Too low of does
-patient Didn’t take long enough
-Drug can’t get to the infection

these are scenarios that contribute to ________

A

resistance

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2
Q

When HIV progresses and more and more helper T cells are destroyed = __________ immunity occurs

A

When HIV progresses and more and more helper T cells are destroyed = compromised cell-mediated immunity occurs
(occurs when the body’s ability to mount an effective immune response using T cells is impaired. T cells are crucial for recognizing and attacking foreign invaders like viruses, bacteria, and cancer cells)

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3
Q

Redman syndrome - From rapid infusion, infuse slow and long
- Flushing
- Rash
- Pruritis
- Urticaria
- Tachycardia
- Hypotension

associated with which penicillin or vancomycin?

A

vancomycin

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4
Q

antimicrobial

MOA: inhibit cell wall synthesis

class: beta lactam antibiotics (3)

class: glycopeptide antibiotic (1)

A

class: beta lactam antibiotics
- penicillin (6)
- cephalosporins (9)
- carbapenems (2)

class: glycopeptide antibiotic
- vancomycin

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5
Q

Start ART ASAP after HIV diagnosis?

Goal = cure?

A

yes

no
Goal = decrease viral load to undetectable level

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6
Q

penicillin (general) side effects
(3)

  • hint all skin related
A
  • Urticaria - hives
  • Pruritis
  • Angioedema – swelling
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7
Q

what drug would we use to prevent an infection in patients that have a high risk of infection due to:
-Surgical procedures
-Dental procedures for patients at risk of endocarditis
- Immuno compromised patients from HIV or chemo

A

Prophylactic antibiotic

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8
Q

Does exposure = active infection?

is the risk of infection for HC workers high or low?

A

Does exposure = active infection?
NO

is the risk of infection for HC workers high or low?
Varies by type of exposure

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9
Q

Selective toxicity -
Toxic to ______ while sparing ________

A

Selective toxicity
Toxic to a specific cell while sparing other normal cells in close proximity

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10
Q

If a bacterium produces the enzyme beta lactamase will these abx work against them?

  • Penicillin
  • Cephalosporins
  • Carbapenems
  • Vancomycin
A

NO
- Penicillin
- Cephalosporins
- Carbapenems

because they are beta lactam antibiotics

YES
- Vancomycin

because it is a glycopeptide antibiotic

SAME MOA, DIFFERENT ABX

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11
Q

are oral manifestations common in HIV/AIDS?

why are oral assessments so important in HIV patients?

A

yes - Related to falling CD4 T cell count

yes - infection puts them at higher risk of progression to AIDS

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12
Q

different types of resistance

-resistant to _____
-resistant to _____
-resistant to _____

A
  • drug resistant strains like MRSA
  • resistant to an entire antimicrobial class like CRE (carbapenem resistant enterobacteriaceae)
  • resistant to multiple drugs/classes like MDRO
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13
Q

vancomycin

T/F
Works on:
- Gram +
- MRSA
- PCN resistant pneumococcus
- CNS infections
- C. diff (PO)
- Pseudo membranous colitis (PO)

A
  • Gram +
  • MRSA
  • PCN resistant pneumococcus
    X- CNS infections
  • C. diff (PO)
  • Pseudo membranous colitis (PO)

DOES NOT CROSS BBB

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14
Q

T/F
risk factos for HIV

  • Men having sex with men
  • Injection drug use
  • black male
  • Heterosexual sex
  • Mother to baby transmission – perinatal
  • blood transfusion
A

all true

  • Men having sex with men #1
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15
Q

anti_________ Medications:
- slow the growth of bacteria
- Stop the growth of bacteria
- Kill bacteria

they can be
- Naturally occurring in nature
- Synthetic
- Semisynthetic

A

Antimicrobials (interchangeable with antibiotic)

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16
Q

patient with a history of injection drug use reports:
- Fever
- Sore throat
- Swollen lymph nodes
- Rash
- Muscle aches
- Night sweats
- Mouth ulcers
- Chills
- Fatigue
lasting several weeks

what would we consider they get tested for?

A

HIV

Since they are general symptoms, must consider risk factors and life styles, and consider testing for HIV

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17
Q

(CRE)
Carbapenem resistant Enterobacteriaceae

hospital or community acquired infection?

A

hopsital

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18
Q

Peak and trough levels

______ – 30 mins after drug admin
Highest concentration of medication in person

_______ – 30 min prior to med next dose due
Lowest concentration of medication in person

A

Peak and trough levels

Peak – 30 mins after drug admin
Highest concentration of medication in person

Trough – 30 min prior to med next dose due
Lowest concentration of medication in person

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19
Q

When HIV invades __________ and become part of that WBC’s DNA = the individual is infected with HIV for______

A

When HIV invades CD4 T cells and become part of that WBC’s DNA = the individual is infected with HIV for life

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20
Q

If a bacterium produces the enzyme beta lactamase how will we treat it?

A

We must combine 2 drug types to work against bacteria that produces beta lactamase = beta lactamase inhibitor combinations

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21
Q

Resistance -
Ability of an organism to survive against _______ or makes the ___________ ineffective

can be Innate (natural) or acquired (mutated)

A

Resistance
Ability of an organism to survive against an antimicrobial (med that slows/stops/kills bacteria) or makes the antimicrobial ineffective

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22
Q

HIV integrase, HIV protease, reverse transcriptase

HIV uses its enzyme called ___________________ to turn its RNA into DNA

HIV uses its enzyme called _______________ to insert its DNA into the WBC’s genetic material which allows more to be replicated

HIV uses its enzyme called ____________ to attack helper T cells, replicate HIV, and release more HIV

A

HIV uses its enzyme called reverse transcriptase to turn its RNA into DNA

HIV uses its enzyme called HIV integrase to insert its DNA into the WBC’s genetic material which allows more to be replicated

HIV uses its enzyme called HIV protease to attack helper T cells, replicate HIV, and release more HIV

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23
Q

why are there only a few antiviral meds?
- By the time s/s develop and we think were sick, the virus has finished ____________
- Antiviral meds only work during cell ______________
- Viruses live inside the body’s cells so drugs that may kill a virus could also____________

A

why are there only a few antiviral meds?
- By the time s/s develop and we think were sick, the virus has finished replicating
- Antiviral meds only work during cell replication
- Viruses live inside the body’s cells so drugs that may kill a virus could also kill the healthy cells

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24
Q

sputum culture or urine culture?

  • Gram stain
  • Culture and sensitivity
  • Urinalysis
  • Culture and sensitivity
A

Sputum
- Gram stain
- Culture and sensitivity

Urine
- Urinalysis
- Culture and sensitivity

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25
T/F 1. Community and hospital acquired (nosocomial) infections get the same antibiotic? 2. antibiotics/antimicrobials can penetrate certain areas of infection, such as lungs, kidney, urine, etc. differently? 3. some antibiotics only work against certain organisms? 4. Best practice is to get cultures before starting antimicrobials? 5. Cultures might be delayed if pt is critically ill (meningitis, severe sepsis, etc.) and we just need to get antibiotics going before cultures come back? 6. If antimicrobials are given before cultures, this wouldn't effect identification of bacteria?
1. F Community or hospital acquired (nosocomial) - Differences in susceptibility patterns and potential organisms. nosocomial is more virulent! 2. T 3. T 4. T 5. T 6. F - If antimicrobials are given before cultures, this might prevent organisms from growing in culture disrupting identification of bacteria
26
HIV stage 1, 2, or 3? early infection (acute) - Rapid replication - Undetectable by labs - No symptoms - Infectious!!
stage 1
27
are antivirals effective against these viruses? - herpes simplex virus - HSV-1 (cold sores) - HSV-2 (genital herpes) - herpes zoster virus (shingles) - skin infections - influenza A - influenza B - RSV - Hepatitis - HIV - CMV - UTI - MRSA
- herpes simplex virus - HSV-1 (cold sores) - HSV-2 (genital herpes) - herpes zoster virus (shingles) X- skin infections = bacterial - influenza A - influenza B - RSV - Hepatitis - HIV - CMV X- UTI = bacterial X- MRSA = bacterial
28
Can HIV cause cognitive problems? Can HIV cross BBB? what could these s/s indicate in an HIV patient? - Poor concentration - Mental slowness - Memory loss - Changes in behavior - Difficulty finding words - Depression - Motor, speech, balance, vision problems
yes yes HIV associated dementia or AIDS dementia complex (an AIDS-defining condition)
29
1. HIV targets CD4 which is on WBC (3): ______, ______, _____ 2. HIV binds to WBC and _____ 3. HIV uses its enzyme called ________ to turn its RNA into DNA 4. HIV uses its enzyme called HIV_____ to insert its DNA into the WBC’s genetic material 5. This allows more HIV to be _______ 6. HIV uses its enzyme called HIV _______ to attack, replicate, and release more HIV 7. It goes after _______
1. HIV targets CD4 which is on WBC: T lymphocytes (T cells), monocytes, and macrophages 2. HIV binds to WBC and enters WBC 3. HIV uses its enzyme called reverse transcriptase to turn its RNA into DNA 4. HIV uses its enzyme called HIV integrase to insert its DNA into the WBC’s genetic material 5. This allows more HIV to be replicated 6. HIV uses its enzyme called HIV protease to attack, replicate, and release more HIV 7. It goes after helper T cells (lymphocytes)
30
Broad spectrum or narrow spectrum? -Works against numerous organisms (gram + and -) -Good for if we don’t know what the specific organism is -Effective against only a few species of organisms (gram + or -) -Good for if we know what the organism is and what drug is sensitive to it
Broad spectrum - Works against numerous organisms (gram + and -) - Good for is we don’t know what the specific organism is Narrow spectrum - Effective against only a few species of organisms (gram + or -) - Good for if we know what the organism is and what drug is sensitive to it
31
organisms may be/become antimicrobial resistant because of: - innate resistance = _____________ - organisms share genetic material - organisms mutate = This happens when ____________
- innate resistance - natural defenses that an organism possesses to fight off infections. - Organisms share genetic material to survive - Organisms mutate to survive = This happens when organism is exposed to an antimicrobial agent and it is not taken long enough to completely kill all the organisms
32
Antimicrobial MOA 1. 2. Increase cell wall permeability 3. Lethal inhibition of protein synthesis 4. Nonlethal inhibition of protein synthesis 5. 6. Disrupt specific metabolic or biochemical reactions which 2 are missing that we learned about the drugs this week
1. Inhibit cell wall synthesis = fluid leaks in a cells burst 5. Inhibit or alter DNA/RNA synthesis or alter DNA function = mess up DNA/RNA
33
Eventually when HIV causes ________ to collapse = _______ infection and ________ can occur
Eventually when HIV causes the immune defense to collapse = opportunistic infection can occur (infections caused by microorganisms that typically do not cause illness in healthy individuals but can become problematic in people with weakened immune systems. These infections often occur when the body's ability to fight off the microorganisms is compromised) and Neoplasms can occur (abnormal growths of tissue. They can be benign-non-cancerous or malignant-cancerous)
34
HIV T/F Can replicate inside and outside of a living host’s cells? Virus contains only RNA (no DNA)? Destroys the body’s ability to fight infections? Primary target of HIV = CD4 T cells (which leads to immune system collapse)?
F - Can only replicate inside of a living host’s cells T - Virus contains only RNA (no DNA) T - Destroys the body’s ability to fight infections T - Primary target of HIV = CD4 T cells (which leads to immune system collapse)
35
When HIV ________ in infected WBC and sheds virus particles = HIV is present in _____ and body fluids
When HIV multiplies in infected WBC and sheds virus particles = HIV is present in blood and body fluids
36
HIV stage 1, 2, or 3? symptomatic HIV infection - AIDS (CD4 T cells below 200) - Without treatment – may live for 3 years
stage 3
37
HIV is a Retrovirus = type of virus that uses ___________ to convert its RNA information into DNA, which is then integrated into the host cell's DNA. This integration allows the virus to replicate using the host cell's machinery HIV Destroys _____ cells
uses reverse transcriptase (an enzyme) CD4 T cells (white blood cell that plays a crucial role in the immune system. help coordinate the immune response to infections and other foreign substances)
38
(Nosocomial infections)
Hospital acquired infections Infections that happen while the patient is in a healthcare facility
39
T/F transmission of AIDS - toilet seats - Sex without a condom - kissing - Mother to baby - bathing - sneezing - Sharing injection equipment - hugging - Blood transfusion - sweat - organ transplant - sharing food - insect bites
X- toilet seats - Sex without a condom X- kissing - Mother to baby X- bathing X- sneezing - Sharing injection equipment X- hugging - Blood transfusion X- sweat - organ transplant X- sharing food X- insect bites
40
HIV Treatment guided by shown effectiveness (CD4 count, viral load) and patient preferences - CD4 count – do we want a high or low CD4 count? - Viral load – do we want a high or low viral load?
- CD4 count – how many CD4 cells are in a drop of blood, the more the better - Viral load – how much HIV there is in a drop of blood, the less the better
41
- HIV related encephalopathy - Pneumocystic jiroveci PNU - TB - Invasive cervical cancer - Kaposi’s sarcoma - Wasting syndrome - AIDS dementia complex - Pervasive candidiasis what is the significance of these conditions?
AIDS-defining conditions (ADCs) - a group of infections and diseases that occur in people with HIV/AIDS when their immune system is severely weakened. These conditions are often caused by opportunistic pathogens, which are organisms that typically don't cause illness in people with healthy immune systems. They are a significant indicator of AIDS test for CD4 T cell count!
42
a measure of the lowest concentration of an antimicrobial agent that prevents the visible growth of a particular microorganism. It's a critical value in determining the appropriate dosage of an antibiotic to treat an infection. We always want to give the lowest amount possible while still being effective.
Minimum inhibitory concentration MIC
43
HIV stage 1, 2, or 3? Seroconversion - Antibodies are now detectable - Flu like symptoms for several weeks - Highly infectious!!
stage 1
44
Why is HIV such a problem? SATA - HIV decreases the number of CD4 T helper cells = these are necessary for immune function - HIV replicates profusely - HIV completely overwhelms the body’s defense system - HIV always causes AIDS
- HIV decreases the number of CD4 T helper cells = these are necessary for immune function - HIV replicates profusely - HIV completely overwhelms the body’s defense system X- only untreated HIV causes AIDS
45
Post-exposure prophylaxis or Pre-exposure prophylaxis? - Use of antiretroviral meds - Detailed sex and drug use hx to determine risk - Determine barriers - Condom use is required - Treatment can reduce risk of HIV transmission by greater than 90%
Pre-exposure prophylaxis PrEP
46
T/F antivirals kill viruses by stopping their ability to replicate, then the body’s immune system can destroy the virus
T
47
Antiretroviral therapy (ART) combination drug nucleoside # med from other class
- (2) nucleoside - (1) med from other class
48
ART class: nucleoside reverse transcriptase inhibitors (NRTI) Given in _____ with other NRTI MOA s/e black box warning
Given in pairs with other NRTI MOA - Enzyme inhibitors: Target enzymes essential for HIV replication. - Stops/blocks reverse transcriptase (enzyme) = blocks HIV retrovirus ability to put its RNA into host WBC DNA s/e - Peripheral neuropathy - Pancreatitis - Lipoatriphy - Hepatic steatosis BLACK BOX WARNING - Lactic acid syndrome
49
infections that could develop post op include (3)
respiratory infections - atelectasis - increased risk of pneumonia surgical wound infections - wound dehiscence - wound reopens or separates, portal for bacterial contamination urinary tract infections
50
Toxic s/e - Ototoxicity – hearing (reversible) - Thrombocytopenia - Nephrotoxic – watch use with other kidney affecting drugs - Watch with neuromuscular blockades (paralyzers) associated with which penicillin or vancomycin?
vancomycin
51
- Fusion inhibitors: Block the fusion of HIV with the host cell membrane. - CCR5 antagonists: Block the CCR5 receptor on the host cell, which HIV uses to enter. Entry blockers: Prevent HIV from entering host cells or Enzyme inhibitors: Target enzymes essential for HIV replication.
Entry blockers: Prevent HIV from entering host cells
52
Post-exposure prophylaxis or Pre-exposure prophylaxis? - Recommendations based on exposure and barriers - ART for 28 days - HIV testing initially and at 6 and 12 weeks after exposure
Post-exposure prophylaxis PEP
53
HIV stage 1, 2, or 3? clinical latency (chronic) - Virus levels have stabilized - Body is fighting infections - Without treatment – 3-12 years in this stage, with potential for progression through this stage faster - With treatment – can live for decades in this stage - May be asymptomatic or mild symptoms
stage 2
54
is a patient with an AIDS defining condition diagnosed with AIDS? Is a patient with a CD4 T cell count less than 200 diagnosed with AIDS? Is a patient with AIDS defining condition and a CD4 T cell count less than 200 diagnosed with AIDS
NO AIDS defining condition - significant indicator of AIDS YES AIDS - CD4 T cell count less than 200 YES AIDS - CD4 T cell count less than 200 (Whether AIDS defining condition is present or not)
55
Super infection - ___________ occurs because of or during treatment for ________________
Super infection Secondary Infection occurs because of or during treatment for primary infection
56
Parenteral transmission of HIV includes - Needle/syringe sharing between injection drug users - Blood or blood products - HC exposure to blood, body fluids, or sharps - sexual encounters
- Needle/syringe sharing between injection drug users - Blood or blood products - HC exposure to blood, body fluids, or sharps X- sexual encounters
57
T/F (Nosocomial infections) Hospital acquired infections have increased virulence (high ability of a pathogen to cause disease) compared to community acquired infections?
true
58
what are beta lactam antibiotics? What do they treat? what is their MOA? which of these are beta lactam antibiotics? - Penicillin - Cephalosporins - Carbapenems - Vancomycin
a class of antibiotics that are widely used to treat bacterial infections They stop the synthesis of the bacterial cell wall. ALL except vancomycin = A glycopeptide antibiotic that inhibits bacterial cell wall synthesis by a different mechanism than beta-lactams
59
antimicrobial resistance organisms are able to thrive in an environment where _________________
antimicrobial resistance organisms are able to thrive in an environment where antimicrobials are present
60
Types of penicillin Natural – PCN G PCN V Penicillinase resistant – nafcillin Aminopenicillin – amoxicillin ampicillin Extended spectrum- piperacillin if you're allergic to one type are you allergic to all types?
yes
61
Bactericidal or Bacteriostatic Medications: -Slow bacterial growth -Stop bacterial growth Bactericidal or Bacteriostatic Medications: -Kill bacteria
Bacteriostatic -Slow bacterial growth -Stop bacterial growth Bactericidal -Kill bacteria
62
When the body forms _______ antibodies = these antibodies are a marker of ________, not protective
When the body forms anti-HIV antibodies = these antibodies are a marker of infection, not protective
63
Types of oral manifestations common in HIV/AIDS - Fungal -_______ = Oral hairy leukoplakia -________= Periodontal disease - Cancerous
Types - Fungal - Viral = Oral hairy leukoplakia - Bacterial = Periodontal disease - Cancerous
64
are there more antimicrobials/antibiotics or antiviral meds?
antimicrobials/antibiotics
65
Why would we give a beta lactam antibiotics? Why would we give a beta lactamase inhibitor combinations?
to treat bacterial infections for bacterium that does not produce the enzyme beta lactamase If a bacterium produces beta lactamase (enzyme), these beta lactam abx (Penicillin, Cephalosporins, Carbapenems) will not work against them! We must combine 2 drug types (beta lactamase inhibitor combinations) to work against this bacteria that produces beta lactamase
66
which antimicrobial MOA is this? - Weaken the cell wall - Allow fluid to get into the cell - Cell swells and bursts - Cell death which drugs/classes have this MOA (4)
Inhibit cell wall synthesis - Penicillin - Cephalosporins - Carbapenems - Vancomycin
67
6 major classes of ART (2 classes of) Entry blockers: Prevent HIV from ____________ (4 classes of ) Enzyme inhibitors: Target enzymes essential for ______
- Entry blockers: Prevent HIV from entering host cells. - Enzyme inhibitors: Target enzymes essential for HIV replication.
68
- nucleoside reverse transcriptase inhibitors (NRTIs): Block the reverse transcriptase enzyme. - NonNRTIs: Block the reverse transcriptase enzyme in a different way. - Protease inhibitors: Block the protease enzyme, which is necessary for HIV to mature and become infectious. - Integrase inhibitors: Block the integrase enzyme, which is necessary for HIV to insert its genetic material into the host cell's DNA. Entry blockers: Prevent HIV from entering host cells or Enzyme inhibitors: Target enzymes essential for HIV replication.
Enzyme inhibitors: Target enzymes essential for HIV replication.
69
Antimicrobial MOA: DNA/RNA disruption Drug class: -Aminoglycosides (3)
Gentamycin Amikacin Tobramycin
70
(Nosocomial infections) Hospital acquired infections have increased virulence (high ability of a pathogen to cause disease) compared to community acquired infections because: 1. 2.
infections could be drug resistant Patients often have increased susceptibility to infection bc they could have - low immune system - post surgery - exposed to invasive procedures like IV, foley cath, and NG tube
71
Antimicrobial MOA: __________ Drug classes: -Aminoglycosides (3) -Lincosamides (1) -Macrolides (2) -Tetracyclines (3) -Fluroquinolones (2) -Sulfonamides (1) -nitroimidazoles (1)
DNA/RNA disruption
72
blood culture - Aerobic = - Anaerobic = - how many sets? - One should always be __________ - can Skin organisms contaminate sample?
Blood - Aerobic – requires oxygen - Anaerobic – doesn’t require oxygen - 2 sets - One should always be peripheral - Skin organisms can contaminate sample
73
CLABSI – CAUTI –
CLABSI – central line-associated bloodstream infection CAUTI – catheter associated urinary tract infection
74
antimicrobial MOA Cell wall disruption -Target: Penicillin (and other beta lactam abx) targets enzymes called _________which are essential for bacterial cell wall. -Binding: Penicillin binds to these enzymes preventing them from________ -Weakening: the bacterial _______ becomes weak and unstable. -Lysis: the bacterial cell eventually _________
- Target: Penicillin targets enzymes called transpeptidases, which are essential for bacterial cell wall. - Binding: Penicillin binds to these transpeptidases, preventing them from functioning properly. - Cell Wall Weakening: the bacterial cell wall becomes weak and unstable. - Lysis: As the cell wall weakens, the bacterial cell eventually bursts and dies.
75
Bacteria or Virus? - parasitic microbe - no cell wall of their own - it survives by putting a piece of its own DNA/RNA into a healthy cell
virus
76
penicillin (in general) broad or narrow spectrum? low or high toxicity?
- Works against many different organisms (broad spectrum) - Low toxicity

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