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Antibiotics Flashcards

1
Q

Concentration dependent

A

do not underdose

Aminoglycosides eg. gentamicin
Quinolones eg. moxifloxacin

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2
Q

Time dependent

A

do not skip doses

Beta lactams

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3
Q

BETA LACTAMS-where do they act?

A

Cell wall

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4
Q

are beta lactams time dependent or concentration dependent?

Bacteriocidal or bacteriostatic

A

time dependent

bacteriocidal

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5
Q

adverse side effect beta lactams

A

hypersensitivity

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6
Q

beta-lactams resistance

A 
Cannot be overcome by using higher doses
– In community most 
aerobic Gram negatives,
 anaerobes & 
staphylococci
produce β-lactamases

– Extended spectrum β-lactamases in aerobic Gram negatives in hospitals,
which results in high level resistance to all penicillins & cephalosporins

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7
Q

beta-lactams second resistance

A

mutations in penicillin binding proteins
(e.g. S. pneumoniae) – usually low level resistance, which can be
overcome by using higher doses

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8
Q

Macrolide chief example

A

Azithromycin

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9
Q

macrolide mechanism of killing

A

no protein synthesis 50s ribosome

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10
Q

what do macrolides treat

A

Gram pos
Strep/staph infections that can’t be treated by penicillin

Atypical pneumonia causes: legionella, mycoplasma, chlamydophila

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11
Q

Macrolide toxicity

A

GIT symptoms

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12
Q

H pylori DOC

A

azithromycin

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13
Q

M avium complex in AIDS DOC

A

azithromycin

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14
Q

– Chlamydia urethritis/cervicitis DOC

A

azithromycin single

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15
Q

Tetracycline main drug

A

doxycycline-absorption varies, penetrates cells easily

Limited use for resp infections as strep pneu is often resistant

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16
Q

Tetracycline MOA

A

inhibits 30 S ribosome synthesis

bacteriostatic

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17
Q

resistance tetracycline

A

enzymatic breakdown

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18
Q

toxicity tetracycline

A 
nausea/vomiting, photosensitivity,
teeth discolouration (avoid <8 years/pregnancy)
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19
Q

DOC
Rickettsia
– Brucellosis
– Acne (low dose)

A

TETRACYCLINES

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20
Q

PROPHYLAXIS FALCIPARUM MALARIA

A

tetracyclines

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21
Q

Chlamydia STI (urethritis, PID)
2 antibiotics to treat

A

tetracyclines (superseded by azithromycin)

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22
Q

Sulphonamide plus trimethoprim

A

cotrimoxazole

23
Q

Cotrimoxazole MOA

A

– Block successive steps in bacterial folate pathway

– Prevents nucleic acid synthesis

24
Q

cotrimoxazole side effects

A

Main side effect is sulphonamide hypersensitivity
– Skin rashes – may be severe (Stevens-Johnson
Syndrome/Toxic Epidermal Necrolysis) or +/- systemic

25
cotrimoxazole resistance
mainly used in HIV otherwise toxicity & high prevalence of resistance in community-acquired Gram negatives and S. pneumoniae
26
HIV Pneumocystis jirovecii pneumonia – Toxoplasmosis – Cystoisospora belli diarrhoea treatment
Cotrimoxazole
27
HIV primary prophylaxis
cotrimoxazole | Prevents above & reduces bacterial infections
28
Toxic to DNA (forms highly reactive nitro | radical with anaerobic metabolism Fe:S proteins)
Metronidazole
29
short course metronidazole
metallic taste | Disulfiram-like effect (avoid alcohol)
30
long course metronidazole side effects
neutropaenia | neurotoxic
31
what does metronidazole treat
a lot! It is a broad-spectrum anaerobe agent: Cocci, Gram- bacilli, Gram+ spore-forming bacilli Also effective protozoans lacking mitochondria: – Entamoeba histolytica – Trichomonas vaginalis – Giardia lamblia (ETG)
32
What does penicillin 1 act against
``` Gram + and spiros DOC: Streptococci (few S. pneumoniae highly resistant) – Syphilis & other spirochaetes – Enterococci – Listeria (gram positive bacillus) – Actinomyces ```
33
Aminopenicillins: and how they are different from regular penicillin?
Amoxicillin Treats: gram +, spiros and haemophilus GOOD FOR RESP TRACT INFECS-STREP PNEU diff. from reg. penicillin because cover h. influ (gram neg)
34
Which penicillin resists Beta-lactamase from Staphylococci?
Cloxacillin
35
which penicillin is better absorbed orally
flucloxacillin
36
cloxacillin and flucloxacillin
Both only for Gram positive bacteria | Widely used for skin and soft tissue infections
37
Amoxicillin-clavulanate
broad spectrum community-acquired Gram positive, Gram negative & anaerobe infections
38
1st gen cephalosporin and what does it treat
Cefazolin IV | Streptococci and staphylococci
39
3rd gen cephalosporin and what does it treat
ceftriaxone ``` streptococci staphylococci Gram - (CA) Haemophilus Typhoid Spirochaetes CNS good pene ```
40
ceftriaxone what does it treat?
Good CSF penetration & empiric drug of choice for bacterial meningitis – Drug of choice for typhoid – Drug of choice for gonorrhea (IMI) – Useful broad spectrum agent for serious community infections Excreted mainly bile – Spectrum community-acquired Gram+ (including most S. pneumoniae, not ideal for S. aureus) & Gram-
41
Glycopeptide antibiotic
Vancomycin time dependent not oral
42
what does vancomycin treat
ONLY GRAM POS-Especially cloxacillin-resistant Staphylococci
43
Vancomycin toxicity
IV Slow IV infusion essential (red man syndrome) – Mildly nephro- /oto-toxic – Measure concentration in renal failure & selected organisms
44
Aminoglycosides don't like
AEROBIC GNB
45
aminoglycoside MOA
inhibit protein synthesis | polar-poor tissue penetration
46
aminoglycosides
parenteral | conc dependent killing
47
aminoglycoside example
gentamicin
48
gentamicin
Pyelonephritis – Combined with β-lactams for polymicrobial infections or synergy (enterococci, streptococcal endocarditis)
49
aminoglycoside toxicity
prolonged elevated trough conc ototoxicity nephrotoxicity
50
quinolones MOA
Targets DNA enzymes (gyrase & topoisomerase IV) | CONC DEPENDENT
51
2nd gen quinolone
``` ciprofloxacin doc: Drug of choice – Bacterial dysentery – Pyelonephritis & prostatitis • Alternative to aminoglycosides • Typhoid (resistance is increasing) ``` Gram- aerobes (including Pseudomonas) – poor for Gram+
52
3rd gen quinolone
Moxifloxacin Gram+ (esp Streptococci) and Gram- (except Pseudomonas) MDR TB • Alternative for respiratory tract infections (only if severe beta lactam allergy), cover atypical pneumonia agents as well as conventional bacterial causes of community-acquired pneumonia
53
toxicity quinolones
rashes CNS tendonitis

Therapeutics (6 decks)

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