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Pharmacology > 14-15 Selecting Anti-Microbials > Flashcards

14-15 Selecting Anti-Microbials Flashcards

1
Q

5 Steps to Approach Empiric Therapy

A 
1- Clinical Diagnosis
2- Obtain Specimens
3- Microbiologic Diagnosis
4- Determine necessity for empiric therapy (is the pt at high risk)
5- Institute treatment
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2
Q

5 things to consider in selecting antibiotics

A 
1- ID/sensitivity
2- Site of infection
3- Safety of agent
4- Pt health factors
5- cost of therapy
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3
Q

use of antimicrobial agents before the pathogen for a particular illness is known

A

Empiric Therapy

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4
Q

Combination (Empiric) Therapy Drugs

A

Clindamycin + gentamicin

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5
Q

Single broad spectrum antibiotic

A

Imipenem / cilastatin

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6
Q

3 ways to distinguish target from host

A

1- Cell Wall
2- Ribosomes/Protein Synthesis
3- Enzyme action

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7
Q

family that inhibits the synthesis of the peptidoglycan layer

A

Beta-Lactams

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8
Q

Examples of Beta Lactams

A

Cephalosporin, Penicillin, bacitracin, fosfomycin, vancomycin

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9
Q

Competes with PABA to decrease the action of an enzyme that makes folic acid from PABA (Inhibits PABA–> Dihydrofolic Acid)

A

Sulphonamides

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10
Q

Inhibits dihydrofolate reductase (Dihydrofolic Acid FH4)

A

Trimethoprim

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11
Q

RNA polymerase inhibitor

A

Rifampin

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12
Q

DNA gyrase inhibitor

A

Fluoroquinolones

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13
Q

Aminoglycosides, Chloramphenicol, Clindamycin, Macrolides, Streptogramins, Tetracycline

A

Protein synthesis inhibitors

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14
Q

What bacteria do you use the following on: Penicillin G and V, Penicillinase-resistant penicillins: nafcillin, methicillin, Vancomycin, Erythromycin , Clindamycin

A

Gram-positive cocci and gram-negative bacilli

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15
Q

What bacteria do you use the following on: Aminoglycosides (e.g., gentamicin), Cephalosporins (e.g., 2nd generation)

A

Gram-negative aerobes

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16
Q

What bacteria do you use the following on:Broad-spectrum penicillins such as ampicillin, Extended-spectrum penicillins such as carbenicillin, Cephalosporins (third generation), Tetracyclines, Imipenem, Trimethoprim, Sulfonamides: sulfamethoxazole, Fluoroquinolones: ciprofloxacin, norfloxacin

A

Gram-positive & negative microorganisms

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17
Q

When the drug is > MIC it

A

Inhibits bacterial growth

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18
Q

When the drug is >MBC it

A

kills the organism

19
Q

3 Mechanisms for why a drug would not reach its target

A

1- Gram (-) outer membrane porins
2- Target is intracellular
3- Efflux Pumps

20
Q

2 Examples of Drug Inactivation

A

1- Bacteria producing beta-lactamases

2- Mycobacterium tuberculosis losing the ability to convert isoniazid to its active form

21
Q

What type of antibiotics promote resistance and how?

A

Broad spectrum antibiotics, kills off normal flora which are competing organisms to the infection

22
Q

A drug that targets the ribosome and is actively transported across the cell membrane using the cell’s electrochemical gradient

A

Gentamicin

23
Q

Give 3 Antibiotic Classes Affected by Efflux Pumps

A

Tetracyclines, chloramphenicol, fluoroquinolones, macrolides, beta-lactam antibiotics

24
Q

A new infection that develops because the antibiotics eliminated the inhibitory influence of the normal flora thus allowing for a second infectious agent to flourish

A

Superinfection

25
Q

3 qualities of a drug of choice

A

Increased efficacy, decreased toxicity, and narrow spectrum

26
Q

3 conditions that contraindicate a primary drug

A

1- Allergic
2- Drug is unable to penetrate to the infection
3- Pt has unusual susceptibility to drug, more toxic

27
Q

When should sulphonamides not be used, why?

A

In infants, it would produce kernicterus which causes a severe displacement of bilirubin from plasma proteins, resulting in a severe neurologic disorder

28
Q

binds to developing teeth causing discoloration, targets protein synthesis

A

Tetracycline

29
Q

In what infection does the use of combination antibiotics actually decrease the chance of resistance

A

tuberculosis

30
Q

In fungal meningitis, what can you give the pt along with amphotericin B to prevent the drug from damaging the kidneys

A

flucytosine

31
Q

In treatment of ________ , ______ can be given along with aminoglycosides to increase the drugs uptake

A

Enterococcal endocarditis, penicillin

32
Q

What characteristic implies that two drugs are synergistic

A

a 4 fold increase in the antibacterial activity of one of the drugs, a decrease to 1/4 the MIC for that drug

33
Q

3 Mechanisms for antibiotic synergism and an example for each

A

1- Blockade of steps in metabolism (Trimethoprim-sulfamethoxazole for folic acid production )
2- Inhibition of enzymatic activity (Beta-lactams and beta-lactamase inhibitor like sublactam)
3- Enhancement of Ab uptake (Penicillins increase uptake of aminoglycosides in staphylococci, enterococci)

34
Q

2 Examples of Antibiotic Antagonism

A

1-Chloramphenicol is stopping protein synthesis then penicillin doesn’t work
2- Tetracycline inhibits the growth of the bacteria and thus stops penicillin

35
Q

Ends in cillin

A

Penicillins, bind to PBP

36
Q

Ends in cycline

A

Tetracycline, binds 30s ribosomal subunit

37
Q

Ends in mycin or micin

A

Aminoglycosides, inhibits protein synthesis

38
Q

Ends in oxacin

A

Quinolone, DNA gyrase inhibitor

39
Q

Starts with cef or ceph

A

cephalosporins, inhibits protein sysnthesis

40
Q

ends in micin

A

Macrolides, inhibits protein synthesis (similar to aminoglycosides)

41
Q

What type of agent shows stopped growth over time

A

Bacteriostatic

42
Q

What type of agent shows declining growth over time

A

Bactericidal

43
Q

3 Examples of bactericidal drugs

A

Beta lactams, rifampin, and quinolones

44
Q

3 examples of bacteriostatic drugs

A

Tetracyclines, chloramphenicol, macrolides

Pharmacology (3 decks)

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