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pharmacology > Antibiotic > Flashcards

Antibiotic Flashcards

1
Q

What is the drug of choice for meningitis caused by listeria monocytogen?

A

Ampicillin

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2
Q

What is the drug used for severe staphylococcal infection like endocarditis and pneumonia ? What is the administration?

A

Nafcillin and oxacillin ( parenteral )

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3
Q

What is the drug of choice for therapy of meningitis caused by suspectible staphylococcus pneumonia? And what is the administration of the drug?

A

Penicillin G intravenously

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4
Q

What is the category of penicillin?

A

Natural penicillin,
anti-staphylococcal penicillin,
extended spectrum penicillin
and anti pseudomonal penicillin

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5
Q

Mechanism of action for beta lactams?

A

Inhibiting transpeptidase
Activate autolytic enzyme
Unactivate penicillin binding proteins

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6
Q

What is the drug that used for otitis media , bronchitis and sinusitis? What is the administration?

A

Amoxicillin orally

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7
Q

What drug is used for eradication of Helicobacter pylori and duodenal and gastric ulcers?

A

Amoxicillin

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8
Q

What drugs of penicillin are used for serious infection caused by pseudomonas areuginosa

A

Piperacillin, ticarcillin

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9
Q

Examples for natural penicillin

A

Penicillin G ,penicillin V

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10
Q

Examples for anti-staphylococcal penicillin

A

Nafcillin, oxacillin, and dicloxacillin

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11
Q

Examples for extended spectrum penicillin

A

Ampicillin and amoxicillin

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12
Q

Examples for anti pseudomonal penicillin

A

Carbenicillin, ticarcillin and piperacillin

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13
Q

The Oral absorption of penicillin varies according to

A

Particular penicillin used
PH of the patient’s stomach
presence of food and G.I. track

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14
Q

All the penicillin should be given without food, but What are the penicillin that should be taken with food?

A

Penicillin V and amoxicillin

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15
Q

What is the distribution of penicillin?

A

They are widely distributed in the body fluids, and It can across the placenta
The entrance to CSF is minimal except with inflammation of meninges

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16
Q

The metabolism of penicillin

A

Metabolized by hepatic enzymes
Dosage adjust might be needed

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17
Q

The elimination of penicillin

A

Renal through tubular secretion and glomerular filtration

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18
Q

All penicillins require dosage adjustments in renal failure.
What is the penicillin that does NOT need dose adjustment

A

Anti staphylococcal penicillins

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19
Q

The bacterial resistance to penicillin

A

1-Bacterial enzyme (beta lactamase/penicillinase)
2-decrease penetration to the target site
3-Inability to bind to penicillin binding protein
4-Lack for activation of autolytic enzymes

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20
Q

Beta lactamase are most common in what kind of bacteria

A

Gram-negative bacteria

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21
Q

What is the solution for bacterial resistance to penicillin with beta lactamase

A

Combined penicillins with beta lactamase inhibitors

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22
Q

What is the examples of combination of antibiotic with beta lactamase inhibitor?

A

1- agumentin ( amoxicillin + clavulanic acid)
2- unasyn ( ampicillin + sulbactam)
3- zosyn ( piperacillin + tazobactam)

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23
Q

What is the adverse effects of penicillin?

A

1-hypersensitivity
2-diarrhea
3- nephritis
4-neurotoxicity
5-hematologic toxicity

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24
Q

Cephalosporin are from a fungus called

A

Cephalosporium acremonium

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25
Q

What is the second choice for many infections

A

Cephalosporins

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26
Q

Cephalosporins works for what kind of bacteria?

A

Gram-positive and gram-negative

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27
Q

What kind of administration used for urinary infection while taking cephalosporins (cefaclor)

A

Oral

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28
Q

The generation of cephalosporin based primarily on

A

Spectrum of antibacterial activity
The basis of anti-microbial activity (including beta lactamase stability and pharmacological properties)

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29
Q

What is the changes if we go from the first to fourth generation of cephalosporins

A

1-The spectrum of activity against gram negative organisms and the stability against beta lactamase INCREASE
2- same or REDUCED spectrum of activity against gram positive organisms and pharmacokinetics differences

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30
Q

Which generation of cephalosporins has good activity against gram positive and against most gram negative

A

The fifth generation

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31
Q

Which generation of cephalosporins have activities against anaerobic bacteria

A

The second and the fifth

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32
Q

Which cephalosporin drugs have anti pseudomonal activity

A

1- ceftazidine 3rd
2- cefepime 4th
3- ceftolozane 5th

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33
Q

The most potent anti pseudomonal from cephalosporins is

A

Ceftolozane 5th “which derived from ceftazidine 3rd”

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34
Q

The only cephalosporins that is used against MRSA

A

ceftoraline 5th

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35
Q

The absorption of cephalosporins

A

Good on oral administration
Unaffected by food (except: cephradine and cefaclor for which it may be delayed)

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36
Q

The distribution of cephalosporins

A

Well distributed into most body tissue like:
Bone, pleural fluid, pericardial fluid and synovial fluid

37
Q

Which cephalosporins does NOT need dose adjustment

A

Ceftriaxone and cefoperazone

38
Q

The adverse effects of cephalosporins

A

Allergic manifestation: to those who had an anaphylaxis response to penicillin
Bleeding : due to anti vit.k effect

39
Q

The reason behind developing carbanpenems and monobactams

A

To deal with beta lactamase producing gram negative resistance penicillin

40
Q

Example for carbapenem

A

Imipenem ( broad spectrum antibiotic)
Ertapenem
Meropenem

41
Q

What is been used with imipenem to block its breakdown by the kidneys

A

Cilastatin

42
Q

What kind of administration that is used with carbapenem

A

IV “ NOT absorbed orally”

43
Q

The adverse effect of carbapenem

A

Seizures

44
Q

Examples for Monobactam

A

Aztreonam which is active against gram-negative aerobic bacteria
Resistant most beta lactamase

45
Q

Aminoglycosides divided into

A

Systematic and topical

46
Q

Systematic aminoglycoside are

A

Streptomycin
Gentamicin
kanamycin
amikacin
tobramycin

47
Q

Topical aminoglycoside are

A

Neomycin
Framycetin

48
Q

Does the aminoglycosides considered to be bactericide or bacteriostatic

A

Bactericides

49
Q

Based on the mechanism of action, in what category does aminoglycosides belong to?

A

Interferes with proteins synthesis, 30 ribosomal subunit

50
Q

Aminoglycosides used to treat what kind of bacteria

A

Aerobic, gram-negative bacteria

51
Q

What is the adverse effect of aminoglycosides?

A

Ototoxicity , nephrotoxicity

52
Q

What is the distribution of aminoglycosides

A

Distribute only extracellularly
Do not penetrate brain or CSF no not absorbed orally

53
Q

What is the mechanism of action of aminoglycosides

A

They are positively charged bind to the negative charge of the bacterial membrane and disturb it + interfere with protein synthesis

54
Q

The antibacterial spectrum of aminoglycosides is / or what kind of bacteria does the aminoglycosides work against

A

Gram-negative aerobic bacilli
Gram-positive cocci
NOT NOT effective against G+ve bacilli, G-ve cocci nor anaerobes

55
Q

What is the pharmacokinetics of aminoglycosides

A

1-Highly polar=poor Oral
2-Administrated parenterally or applied locally
3-Poorly protein bound
4-No significant metabolism
5-Excreted unchanged in urine
6-Dosage adjustments is needed

56
Q

Clinical use for aminoglycosides

A

1-gram-negative bacillary infection
(Septicemia, pelvic and abdominal sepsis)
2-bacterial endocarditis
3-pneumonias, tuberculosis
4-brucellosis
5-topical- neomycin
6-Infection of conjunctiva or external ear

57
Q

Share toxicity of aminoglycosides

A

Ototoxicity, nephrotoxicity, neuromuscular blockage, skin rash

58
Q

Which aminoglycosides are more likely to produce neuromuscular blockade

A

Streptomycin and neomycin

59
Q

Which aminoglycosides are least likely to produce neuromuscular blockade

A

Tobramyosin

60
Q

Which aminoglycosides are more likely to produce nephrotoxicity

A

Gentamicin, amikacin and tobramycin

61
Q

Is the nephrotoxicity caused by aminoglycosides are reversible?

A

Reversible of drug promptly discontinue

62
Q

Precautions and contraindication for aminoglycoside

A

1-pregnancy : fetal ototoxicity
2-with other ototoxic drugs: furosemide, minocycline
3-with nephrotoxic drugs: vancomycin, cisplatin
4- elderly patient
5-those with kidney disease
6-muscle relaxant
7-do not mix with any other truck in the same syringe

63
Q

What is the most commonly used aminoglycosides?

A

Gentamicin

64
Q

Why is the gentamicin or most commonly use?

A

More potent
Broader spectrum
Low-cost, reliability of use, long experience
Acts synergistically with ampicillin, penicillin G, ticarcillin, ceftriaxone and Vancomycin

65
Q

the prototypes of Glycopeptide antibiotics are :

A

Vancomycin, teicoplanin

66
Q

What is the mechanism of action of vancomycin?

A

Inhibits cross-linking of peptidoglycan which cause the destruction of bacterial cell wall

67
Q

Why does Vancomycin considered important?

A

Because of its effectiveness against multiple drug resistant organism
Such as MRSA and enterococci

68
Q

Vancomycin is effective against

A

Gram-positive organism and MRSA

69
Q

Spectrum of activity of vancomycin

A

1- Effective against gram-positive, streptococci, staphylococci and pneumococci
2- effective against Neisseria spp. (only G- can work against)
3- endocarditis caused by MRSA
4- Used for treating enterocolitis associated with clostridium difficle ( since it’s not absorbed from the G.I.)

70
Q

Adverse effects of vancomycin

A

Fever, chills, phlebitis -at the infusion site-
Flashing (red man syndrome) due to histamine release
Ototoxicity , nephrotoxicity

71
Q

What is the administration bacitracin?

A

Locally or IM against resistance staphs
Orally for treating diarrhea especially against clostridium difficle

72
Q

What is the antibiotic that used in disaffecting the gut before an operation?

A

Bacitracin

73
Q

What is the mechanism of action of bacitracin?

A

Inhibits the biosynthesis of peptidoglycan by inhibition of dephosphorylation of phospholipid

74
Q

What is the mechanism of action of polymyxin B?

A
  • Forms of complex with membrane phospholipids and disrupt cell membranes
  • Bactericidal but restricted to gram negative bacteria
  • use locally for local infection of wounds with gram-positive antibacterial, bacitracin
  • used Orally for the treatment of G.I. infection
  • IM or intrathecal injection for systematic infections
75
Q

What is the mechanism of action of the fluoroquinolones?

A

Bacteriocidal agent
They block bacterial DNA synthesis by inhibiting bacterial DNA gyrase and topoisomerase

76
Q

Bacterial resistance against fluoroquinolones

A

Point mutations in the binding site of the target enzyme
Change in the permeability of the organism

Resistance to one fluoroquinolones confers cross resistance to all members of the class

77
Q

Generation of fluoroquinolones

A

1st -> nalidixic acid-> G-ve NOT pseudomonas species

2ed-> norfloxacin, ciprofloxacin, ofloxacin -> G-ve +pseudomonas species + G+ve + some atypicals

3ed -> levofloxacin moxifloxacin -> 2ed+ extended coverage of atypicals + G+ve

4th-> trovafloxacin -> 3ed + anaerobic coverage (withdrawn due to liver toxicity)

78
Q

What is the pharmacokinetics of fluroquinolone?

A
  • Well absorbed orally almost equal to intervenous administration
  • The absorption impaired by divalent cations ( Mg, Ca, AL )
    -Adjustments required in patient with creatinine clearance <50
  • Limited CSF penetration
79
Q

Clinical use for fluoroquinolone

A

1-urinary track infection (G-ve bacteria)
2-travelers’ diarrhea —>ciprofloxacin
3-tuberculosis
4-prostatitis
5-anthrax
6- Respiratory infection caused by pseudomonas aeruginosa (cystic fibrosis ,otitis)

80
Q

Adverse effects of fluoroquinolone

A

1-Generally considered safe
2-GIT —> nausea, vomiting, diarrhea
3-CNS —>confusion, insomnia, dizziness, anxiety, seizures
4-CVS—> arrhythmia
5-Damage growing cartilage and bone
6-Phototoxicity (avoid excessive sun exposure)
7-Hypoglycemia (levofloxacin)

81
Q

Contraindication of fluroqoinolone

A

Children -18
Pregnancy
Lactation
Epilepsy
Arrhythmia
—Drug drug interaction between ciprofloxacin and theophylline (through inhibition of CYP 450 metabolizing enzyme)

82
Q

Classification of macrolides

A

Narrow spectrum
erythromycin
Broad spectrum
Clarithromycin
Roxithromycin
Azithromycin

83
Q

What is the mechanism of action of macrolide?

A

Bacteriostatic agent that inhibits protein synthesis by binding to the 50 S ribosomal subunit

84
Q

Macrolide work against what kind of bacteria?

A

Gram-positive and gram-negative bacteria

85
Q

Therapeutic uses for macrolide

A

Staphylococcal infection
Streptococcal infection
Helicobacter pylori infection
Chlamydial infection
- diphtheria
- Syphilis
- Mycoplasma pneumonia

86
Q

Pharmacokinetics of macrolide

A

—Erythromycin base is destroyed by stomach acid, so it must be administrated with enteric coating —
Food interferes with absorption (the broad-spectrum macrolides are fairly acid resistance)
Distribution : erythromycin are widely distributed in the body

87
Q

Adverse effects of macrolides

A
  • Hypersensitivity ( fever, skin rash)
  • Gastrointestinal effect ( nausea, vomiting, diarrhea )
  • Hepatitis with cholestatic jaundice
88
Q

Macrolides are excreted through

A

Azithromycin and erythromycin are excreted through bile
Clarithromycin through kidney

89
Q

Under what category of pregnancy drug is the macrolides?

A

Erythromycin and Azimyocin are category B
Clarithromycin is category C

pharmacology (5 decks)

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