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PHPG 2093 > ANTIBACTERIAL DRUGS 2 > Flashcards

ANTIBACTERIAL DRUGS 2 Flashcards

1
Q

Nyatakan 2 jenis antibacterial agents yg merencant sintesis dinding sel

A

(1) Beta lactam antibiotik
- Penicillin,Cephalosporins,Carbapenem,
Monobactam
(2) Miscellaneous antibiotic
- Vancomycin & Bacitracin

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2
Q

Terangkan MOA beta lactam antibiotik

A

Ia akan mengikat pada PBP pada dinding sel bakteria lalu merencat enzim transpeptidase. Tanpa ikatan peptida antara NAM & NAM dalam dinding sel akn mybbkan struktur dinding sel tidak stabil. Maka, ini akan menyebbkan perbezaan tekanan osmotik lalu sel lysis

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3
Q

Nyatakan 5 jenis pengkelasan bagi penicillin

A
  • Penicillin asli
  • Penicillinase/Lactamase resistant penicillins (anti staph penicillin)
  • Extended spectrum penicillin
  • Antipseudomonal penicillins
  • Combination of extended spectrum penicillins / antipseudomonal penicillin with beta lactamase inhibitor
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4
Q

Terangkan spectrum activity bagi (1) Penicillin asli

A
  • active against gram (-) & (+) cocci, gram (+) bacilli & spirochetes
  • sensitive to penicillinase enzymes
Cth : 
- Benzyl penicillin (Penicillin G)
Benzathine Penicillin 
(Benzathine Penicillin G)
Phenoxymethyl Penicillin 
(Penicillin V)
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5
Q

Terangkan spectrum activity bagi (2) Penicillinase / Lactamase resistant penicillin

A
  • effective against beta lactamase producing stapylococci
  • have low/no activity against other gram (+) & (-) organisms
  • resistant to penicillinase enzymes
Cth:
- Cloxacillin
Flucloxacillin
Nafcillin (not in FUKKM)
Methicillin (Not available)
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6
Q

Terangkan spectrum activity bg (3) extended spectrum penicillin

A
  • gram (+) coverage with extended coverage of more gram (-) bacteria
  • Ampicillin more active on shigella & H.influenza
  • Amoxicillin is more active against Salmonella & Streptococcal fecalis
  • Sensitive to penicillinase enzyme
Cth :
Ampicillin
Amoxicillin
Carbenicillin (not in 
FUKKM)
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7
Q

Terangkan spectrum activity (4) antipseudomonal penicillins

A
  • broad spectrum but only used for pseudomonas,infection & ampicillin resistant proteus
  • have activity against anaerobic gram (-) bacteria
  • have synergistic effect when they are used with aminoglycosides
  • sensitive to penicillinase enzymes

Cth :
Ticarcillin (not in
FUKKM)
Piperacillin

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8
Q

Terangkan spectrum activity (5) combination extended spectrum penicillins or antipseudomonal penicillin with beta lactamase inhibitor

A
  • resistant pd penicillinase enzyme
Cth :
Amoxicillin & clavulanic acid
Ampicillin Sodium & Sulbactam 
Sodium
Piperacillin & Tozabactam
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9
Q

Penicillin’s Indication

A
  • Streptococcal infections, e.g. wound sepsis, acute throat infections, subacute bacterial endocarditis,.. etc.
  • Staphylococcal infections of skin, mucous membrane and bone.
  • Pneumococcal infections e.g. pneumonia.
  • Syphilis and gonorrhoea.
  • Meningococcal infections: Penicillin diffuses into the CSF only when the meninges are acutely inflamed.
  • Typhoid and paratyphoid fevers: Ampicillin and Amoxycillin.
  • Pseudomonas infection: Ticarcillin or Piperacillin
  • Diphtheria and tetanus
  • PROPHYLAXIS: prevent recurrent of Rheumatic fever and prevent subacute bacterial endocarditis
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10
Q

Penicillin Drug Interactions

A
  • Bacteriostatic drug
  • Antipseudomonal penicillin
    with aminoglycoside
  • Methotrexate
  • Oral Contraceptive Pills
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11
Q

Penicillin Adverse Effects

A
  • Hypersensitivity
  • Neurotoxicity and seizure in renal failure
    patient
  • Neutropenia dan thrombocytopenia (Nafcillin)
  • Interstitial nephritis (Methicillin)
  • Hepatotoxicity- cholestatic jaundice(Coamoxiclav, Flucloxacillin)
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12
Q

Penicillin’s Warning & Precautionary Label

A

• Serious allergic reaction warning: Symptoms include a skin rash with or without blisters, flu-like symptoms
or swelling of your throat, tongue, or mouth.
• Severe diarrhea warning: This drug may cause diarrhea during and after your treatment with it due to Clostridium difficile.
• Prescription completion warning: If don’t complete
the prescription, this may cause resistance.
• Penicillins should be used with caution in individuals with histories of significant
allergies and/or asthma.
• Care should be taken to avoid intravenous or intra-arterial administration, or injection into or near major peripheral nerves or blood vessels, since such injections may produce neurovascular
damage.

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13
Q

Terangkan First Generation Cephalosporin

A
  • do not penetrate to CSF
  • senstive to beta lactamase enzyme
  • active against (+) & with some (-)
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14
Q

Terangkan Second Generation Cephalosporin

A
  • do not penetrate CSF
  • used primarily in the management of urinary and respiratory tract,bone & soft tissue infections & prophylactically
  • relatively resistant to beta lactamase
  • gram (+) coverage with enhanced coverage of gram (-) bacteria
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15
Q

Terangkan Third Generation Cephalosporin

A
  • can penetrate to CSF in the presence of meningitis
  • excreted by kidney
  • highly resistant to lactamase
  • have long duration (12hrs) & ceftriaxone has longer duration (24hrs)
  • effective against beta lactamase producing gram (+) coverage with excellent coverage of gram (-) bact & active against anaerobes
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16
Q

Terangkan Fourth Generation Cephalosporin

A
  • can penetrate to CSF in presence of meningitis
  • used primarily in the management of nosomial infections
  • resistant to lactamase
  • Cefepime has a powerful coverage against most gram (+) & gram (-) bact & anaerobes
17
Q

Terangkan Fifth Generation Cephalosporin

A
  • do not penetrate CSF
  • used in management of complicated skin & soft tissue infections in adult resistant to vancomycin
  • resistant to lactamase
  • effective against MRSA less active against gram (-)
  • no activity against pseudomonas
  • less activity against SPACE organism
18
Q

Cephalosporin Indication

A

• Severe undiagnosed sepsis especially in immunosuppressed patient.
• Treatment of infection of respiratory tract, urinary tract, skin, soft tissue,
bones and joints due to susceptible organisms.
• Gram-negative bacterial meningitis may be treated by cefotaxime (third
generation) and ceftriaxone that reach the C.N.S.
• Biliary infection: 3rd generation (cefoperazone or ceftriaxone).
• Gonorrhoea due to penicillin-resistant Gonococci. It is treated by single IM
injection of ceftriaxone.
• Pseudomonal infection when aminoglycosides are not desirable.

19
Q

Cephalosporin Drug Interactions

A

IV ceftriaxone is added to any IV calcium-containing solution
(e.g. Ringer’s or parenteral nutrition) dangerous particulates of
ceftriaxone-calcium can result and precipitate in the lungs and
kidney. Separate between IV ceftriaxone and any IV calciumcontaining solution by at least 48 hours.
• Some third generation cephalosporins inhibit the enzyme aldehyde
dehydrogenase. If they are co-administered with alcohol,
acetaldehyde accumulates in blood leading to nausea and vomiting
(disulfiram-like reaction)

20
Q

Cephalosporin Adverse Effects

A
  • Hypersensitivity
  • Nephrotoxic (1st gen with aminoglycoside and loop diuretic)
  • Hypoprothrombinemia(3rd gen inhibit vit K epoxide reductase )
  • Superinfection with C.difficile
21
Q

Cephalosporin Warning & Precaution

A 
• CONTRAINDICATION: Do not give 
cephalosporin to a person who allergy to 
beta lactam antibiotic/penicillin.
• Prescription completion warning: If 
don’t complete the prescription, this 
may cause resistance.
22
Q

Nyatakan 2 jenis & moa bg Miscellaneous Antibiotic

A

(1) Vancomycin - inhibits cell wall synthesis by binding to the D-Ala D-Ala terminal of the growing peptide chain during cell wall synthesis, resulting in inhibition of the transpeptidase which prevents further elongation & cross linking of the peptidoglycan matrix
- active againts gram (+) organism
(2) Bacitracin - inhibits the building of peptidoglycan unit (cell wall units)
- gram (+) bacteria

23
Q

Terangkan Carbepenem

A
  • cth ubat :
    (i) imipenem+cilastatin - must combine to inhibit renal dihydropeptidase enzyme. If not, can lead to low urinary excretion & significant renal toxicity
    (ii) meropenem, does not undergo metabolism by renal dihydropeptidase enzyme
  • last resort of many bacterial infections
  • broad spectrum antibiotic that share similarity in structure & mechanism with penicillin
  • highly resistant to beta lactamase
24
Q

Terangkan Monobactam

A
  • cth ubat : Aztreonam (Azactam)
  • shared similarity in structure & mechanism with penicillin
  • highly resistant to beta lactamase
  • used as alternative to aminoglycosides in severe respiratory,urinary,biliary,GIT & female genital tracts infections
  • has no cross sensitivity with penicllins or cephalosporins
  • can be given to patients who allergic to penicillin
25
Q

Vancomycin & Bacitracin Indication

A 
Vancomycin :
Indication: 
• treat serious MRSA infection in patient allergy to penicillin or cephalosporin.
• Treat antibiotic associated enterocolitis
• Adverse effect:
• Red man syndrome
• Ototoxicity
• Nephrotoxicity

Bacitracin :
Indication: Only topically in combination with neomycin and polymyxin for minor skin infections due to serious
nephrotoxicity.

26
Q

Carbapenem & Monobactam Adverse Effects

A 
Carbapenem :
- Blood disorders.
• Seizures in high doses. Meropenem is 
less likely to provoke seizures.
• G.I.T: nausea, vomiting.

Monobactam :
• Hematological effects
• Nephrotoxicity
• Pseudomembranous colitis

PHPG 2093 (14 decks)

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