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Advanced Pharm Fall 24' > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

What does the term ‘antibiotic’ mean?

A

Anti – against, biotic – life

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2
Q

Who was Paul Ehrlich and what did he contribute to antibiotics?

A

Developed ‘Salvarsan’, a chemotherapy for syphilis. “The first chemo drug”

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3
Q

What significant discovery did Alexander Fleming make?

A

First ‘true’ antibiotic – Penicillin

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4
Q

What is the primary purpose of antibiotic sensitivity testing?

A

To determine the effectiveness of antibiotics against specific infections

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5
Q

What does a Gram Positive cell wall contain? Also, does it have a thin or thick peptidoglycan layer?

A

Teichoic acid, Thick Peptidoglycan layer.

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6
Q

What additional feature does a Gram Negative cell wall have? (Causes endotoxin effects when the bacteria is destroyed)

A

An additional outer membrane containing lipopolysaccharide (LPS)

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7
Q

What is selective toxicity in the context of antibiotics?

A

Ability to target bacterial cells without harming human cells

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8
Q

List the modes of action of antibiotics

A
  • Inhibition of cell wall synthesis
  • Disruption of cell membrane
  • Inhibition of protein synthesis
  • Inhibition of nucleic acid synthesis
  • Inhibition of folic acid synthesis
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9
Q

What is the mechanism of action of Penicillin?

A

Inhibits cell wall synthesis by attaching to enzymes that cross-link peptidoglycans

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10
Q

What are common adverse reactions associated with antibiotics?

A
  • Hypersensitivity
  • Anaphylactic shock
  • Skin rash
  • GI upset
  • Nephrotoxicity
  • Ototoxicity
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11
Q

What are carbapenems known for?

A

Use in more beta-lactamase resistant bacteria, wide spectrum of activity (Imipenem, Meropenem)
-Can penetrate CNS
-Very Expensive

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12
Q

What is Vancomycin used for?

A

Alternative to PCN in beta-lactamase resistant bacteria.
-Effective against Gram (+) bacteria and MRSA
-Considered “Drug of Last Resort”

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13
Q

True or False: Vancomycin is considered a ‘drug of last resort’.

A

True

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14
Q

What is the primary action of polymyxin?

A

Disrupts cell membrane, effective against Gram (-)

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15
Q

What type of ribosomes do bacterial cells have? What about humans? Are they different?

A

Bacteria have 70S ribosomes and differ from humans who have 80S ribosomes

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16
Q

What are tetracyclines known for?

A

Bacteriostatic, widest spectrum of activity but can destroy normal intestinal microbiota and cause severe GI disorders
-Increased risk of C. Diff

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17
Q

What is the prototype drug of the macrolide class?

A

Erythromycin

18
Q

Fill in the blank: Fluoroquinolones inhibit _______.

A

DNA gyrase (bacterial)

This feature makes fluoroquinolones very effective against G- activity and still pretty good against G+

Different types include
- Cipro
- Levaquin
- Floxin
Effective especially in UTI and RTI
- Consider possibility of bone and joint infections as well as ADRs

19
Q

What are sulfonamides used for?

A

Inhibition of Folic Acid Synthesis
Without folic acid, bacteria cannot produce DNA or RNA
Helpful in cases of
- Pneumocystis
- Toxoplasmosis
- Often use in conjunction with trimethoprim (Bactrim, Sentra)

20
Q

Name two antifungal agents.

A
  • Imidazoles (creams like ketoconazol inhibit cell membrane formation)
  • Polyenes (Amphotercin and Nystatin can help treat systemic infections)
  • Dermatophytes like Griseofulvin (for oral use) and Lamisil (topically)
21
Q

What are the ideal characteristics of an antimicrobial agent?

A
  • Solubility
  • Selective Toxicity
  • Non-allergenic
  • Stability
  • Resistance not Easily Acquired
  • Reasonable Cost
22
Q

What is the mechanism of resistance acquisition in microorganisms?

A

Natural selection, chromosomal mutation, and Extrachromosomal resistance

23
Q

What are the clinical considerations when prescribing antibiotics?

A
  • Clinical findings
  • Microbiologic diagnosis
  • Narrow vs. Broad spectrum
  • Optimal dose for the patient
  • Response to treatment
  • Adjunctive measure considerations
24
Q

What are the main classes of antibiotics summarized?

A
25
Q

Does gram negative bacteria have a thin or thick peptidoglycan layer?

A

Thin peptidoglycan layer but it has an additional outer membranous layer containing lipopolysaccharides (bacteria destruction releases endotoxins into the bloodstream)

26
Q

What are some common gram-positive bacteria?

A

Staphylococcus and Streptococcus

27
Q

What are common gram-negative bacteria?

A

E. Coli, Proteus, Enterococcus, Klebsiella, and Enterobacter

28
Q

General Spectrum of Antibiotic Activity

A
29
Q

Critical considerations concerning Vancomycin?

A

-10% adverse reactions
-Irritates tissues
-Can cause chills/fever
-Can cause ototoxicity and/or nephrotoxicity
* can cause “Red-Neck” syndrome

30
Q

Why is the disruption of cell membranes best for G- bacteria?

A

NO ENDOTOXIN RELEASE
Antibiotics like polymyxin have a detergent-like effect within the bacterial cell membranes, creating pores in the membrane so it can be washed out and destroyed without causing a true membrane rupture. Doing so will prevent the endotoxin release of the LPS in G- bacteria.

31
Q

True or false: Polymyxins can be given systemically?

A

True but it is a last resort option because they can easily cause neuro- and nephrotoxicity.
-Very effective against more resistant G- strains

-Typically only used topically (Neosporin triple antibiotic containing polymyxin, neomycin, and bacitracin)

32
Q

Aminoglycoside pneumonic lists (TANGS, AAMINO, NANO)

A
33
Q

Why are protein synthesis inhibiting antibiotics like tetracyclines, macrolides, and aminoglycosides considered the most broad-spectrum class?

A

They are highly selective because the inhibition of 70S ribosomes are different than humans who have 80S ribosomes.

This allows them to attack bacterial cells without significantly damaging the cells of animals.

34
Q

Most prominent adverse drug reactions (ADR) of tetracyclines? Why don’t we give tetracyclines to children?

A

ADRs for tetracyclines include:
- GI Upset such as N/V/D
- Bone issues (discoloration of non-erupted adult teeth)
- Neurotoxicity
- Ototoxicity
- Nephrotoxicity
- Allergy

We do not typically administer to children due to the staining mentioned above.

35
Q

Even though it’s less common, what is a possible side affect of macrolides?

A

GI Upset - Usually just flatulence

36
Q

Besides the standard tetracyclines and macrolides, what are some other protein synthesis (70s Ribosomes) inhibitors?

A
  • Neomycin (topical)
  • Clindamycin (For Anaerobes)
  • Chloramphenicol (Consider serious toxicities)
  • Streptogramins
  • Oxazolidinones (Linezolid for MRSA, VRE)
37
Q

What is special about Rifamycin?

A

It binds to bacterial RNA polymerase

38
Q

Toxicities of Sulfonamides?

A
  • Allergenic
  • May precipitate in urine
  • Hematopoetic disturbances
39
Q

What are some antiprotozoan agents?

A

Quinine
* to treat malaria
* Hydroxychloroquine
Metronidazole (Flagyl)
* Treatment for Giardia and Trichomonas
* Consider side effects like birth defects, cancer and weird one Black hairy tongue

40
Q

Name some anti-parasitic drugs.

A
  • Niclosamide – Tapeworms
  • Mebendazole – Roundworms
  • Ivermectin - river blindness roundworm
    Not FDA-Approved but used to treat COVID-19
  • Permethrin – lice
41
Q

What are the common side effects of antimicrobials?

A
  • Toxicity
  • Allergies
  • Disruption of normal microbiota (can lead to C. Diff)
42
Q

More considerations in antibiotic selection

A
  • Concomitant disease states?
  • Prior adverse drug reactions?
  • Impaired elimination or metabolism?
  • Age
  • Pregnancy status
  • Genetics

Advanced Pharm Fall 24' (16 decks)

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