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Cmbm 2 Gopi > Antibiotics > Flashcards

Antibiotics Flashcards

0
Q

resistant worries for Vancomycin

A

resistant gene on plasmid(means very mobile gene) being picked up by MRSA

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1
Q

Vancomycin

A

MRSA
penicilin resistant S. pneumo
susceptible enterococcal infections

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2
Q

Drug for vancomycin resistant Enterococci

A

Dancomycin

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3
Q

Target of beta lactam antibiotics

A

Peptidoglycan synthesis

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4
Q

Aerobic gram +

A

staph
strep
enterococci
listeria

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5
Q

anaerobes

A 
clostridium 
actinomyces 
peptostreptococcus 
propionibacterium 
bacteroides 
fusobacterium 
prevotella
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6
Q

aerobic (facultative) gram negative

A

enterobacteriaceae
neisseria
pseudomonas
haemophilus

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7
Q

Atypical/intracellular bacteria

A 
mycoplasma 
chlamydia 
legionella 
mycobacterium 
rickettsia 
spirochetes
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8
Q

Examples of Aminoglycosides

A

streptomycin
gentamicin
amikacin

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9
Q

toxicities of aminoglycosides

A

nephrotoxicity - see elevated creatinine

ototoxicity

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10
Q

Macrolides and Ketolides

A 
Broad spectrum but not deep 
Erythomycin 
Clarithromycin
Azithromycin (known as z pack) 
Telithromycin - ketolide
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11
Q

mechanism of Macrolides

A

bind 23S rRNA of the 50s ribosome

prevents protein elongation

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12
Q

Telithromycin

A

binds at 2 sites

ketolides

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13
Q

Erythromycin

A

can cause GI upset - makes pt nauseous

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14
Q

Azithromycin

A

longer half life

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15
Q

clinical uses for Macrolides

A

empiric therapy for community aquired pneumonia (CAP)

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16
Q

DOC for legionella, mycoplamsa, and chlamydia

A

Macrolides

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17
Q

Most aerobic gram neg rods are resistant to

A

Macrolides

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18
Q

Resistance to Macrolides

A

Efflux pump

Enzyme mediated methylation of binding site on 23S ribosome

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19
Q

Examples of Lincosamide

A

Clindamycin

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20
Q

Clidamycin active against

A

generally anaerobic drug
aerobic gram + including MRSA and s. pneumo
gram + and - anaerobes
some protozoans

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21
Q

mechanism of Tetracyclines

A

bind reversibly to 30s subunit

blocks binding of tRNA

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22
Q

What is clindamycin not useful for?

A

aerobic gram negatives

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23
Q

Tetracycline

A

broad range many aerobic gram pos and neg
anaerobes
Atypicals - especially useful
some protozoa

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24
Q

Adverse reactions to Tetracyclines

A

Not given to childern under 8
Not used in pregnancy
Cause photosensitization - bad sunburn

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25
Q

Fluoroquniolones

A 
Ciprofloxacin - below the waist 
Gatifloxacin
levofloxacin
oflaxacin
moxifloxacin
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26
Q

DNA gyrase inhibitor

A

Fluoroquinolones

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27
Q

clinical uses of fluoroquinolones

A

broad spectrum
aerobic, gram neg bacteria
active against strains of staph and strept and many atypical

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28
Q

toxicities of Fluoroquinolones

A

may damage growing cartilage - so no childern under 18 or pregnant women
Black box warning of tendon rupture

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29
Q

Anti folate drugs

A

TMP/SMX
sulfonamides
trimethoprim

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30
Q

anerobic drug

A

metronidazole

clindamycin

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31
Q

TMP/SMX mechanism and activity

A 
broad spectrum 
interferes with folate synthesis by bacteria which is needed for nucleic acid synthesis 
aerobic gm pos (CA-MRSA) 
some aerobic gm neg 
non bacterial organisms
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32
Q

Clinical uses of TMP/SMX

A

UTI
RTI
prostate and vaginal infections

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33
Q

Toxicities of TMP/SMX

A

skin rash

GI upset

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34
Q

bacteriocidal antibiotics

A

antibiotics that target cell wall causing lysis of bacteria
beta lactams
vancomycin
daptomycin - cell membrane

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35
Q

Antibiotics that block protein synthesis

A 
aminoglycosides 30s
macrolides 50s
tetracyclines 30s
clindamycin 50s
chloramphenical 50s 
linezolid 50s
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36
Q

Bacterostatic

A

antibiotics that inhibit growth and/or replication

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37
Q

Antibiotics that inhibit RNA synthesis

A

Rifamycin

Rifabutin

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38
Q

Antibiotics that target DNA or DNA synthesis

A

Quniolones
metronidazole
clofazimine

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39
Q

Antimetabolite antibiotics

A

Trimethoprimsuflamethoxazole (TMP/SMX)
dapsone
para-aminosalicylic acid

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40
Q

Empirical

A

treatment before receiving the test/cultures back

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41
Q

Beta lactams

A 
Effective for certain Gr+ or Gr- 
Penicillins 
cephalosporins 
carbapenems 
monobactams
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42
Q

Antibiotics for Gram + cocci

A

Vancomycin

Daptomycin

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43
Q

TB drugs

A

Isonizad
Ethambutol
Pyrazinamide

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44
Q

Peptidoglycan synthesis and structure

A

Composed of alternating NAG and NAM units linked by transpeptidases (PBP) via D-Ala D-Ala units

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45
Q

Cyloserine

A

inhibits reactions involved in incorporation of alanine into cell wall percusor

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46
Q

Glycopeptides

A

bind to terminal D-ala-D-ala residues prevents incorporation of subunit into growing peptidoglycan

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47
Q

Bacitracin

A

prevents dephosphorylation of phospholipid carrier which prevents regeneration of carrier necessary for synthesis to continue in building peptidoglycan walls

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48
Q

Beta lactams

A

bind to end inhibit enzymes which catalyze this link

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49
Q

Mechanism of action of beta lactam antibiotics

A

transpeptidases catalyse crosslinking of peptidoglycan residues
beta lactam antibiotics bind transpep. and block this reaction resulting in weak cell walls and bacterial lysis if bacteria are actively growing
Bacteriocidal

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50
Q

Types of Penicillins

A

natural
anti-staph penicillins
aminopenicillins
extended spectrum

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51
Q

what is unique about the structure of Penicillin

A

B lactam ring

Thiazolidine ring - essential for activity

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52
Q

Natural penicillins

A 
5 is oral
G is IV or IM 
limited spectrum 
Most strept - GAS, GBS, viridians group NOT s. pneum
Most gram + anaerobes 
N. meningitidis 
Treponema pallidum
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53
Q

Poor activity against aerobic and anaerobic gram neg rods and not active for intracellular bacteria

A

natural penicillin

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54
Q

Anti Staph Penicillin

A

Many staph make beta lactamases
this antibiotic have large side groups making resistant to lactamases
Naficillin and Oxacillin (IV)
Dicloxacillin (oral)

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55
Q

Anti Staph penicillin activity

A

MSSA
MSSE - methicillin resistant staph epidermidis

Not active against
MRSA
MRSE

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56
Q

How is methicillin resistance confered?

A

due to altered PBP

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57
Q

Aminopenicillin

A

Ampicillin
Amoxicillin
amino group is R group - allows penetration through porins of some gram neg (esp. enteric rods)
better absorption through GI than natural penicillins

58
Q

Aminopenicillins activity against

A 
limited spectrum similiar to natural PLUS 
E.coli 
Shigella 
Salmonella enterica 
AND borrelia burgdorferi
59
Q

Extended spectrum penicillins

A

Piperacillin
Ticarcillin
Carbenicillin
better able to penetrate gram neg porins than aminopencillins

60
Q

spectrum of extended spectrum penicillins

A

same as natural PLUS
more enterobacteriaceae
some strains of pneumonia aeruginosa

AKA anti pseudomonal penicillins

61
Q

What is used in combination with aminopenicillins and extended spectrum penicillins?

A

B lactamase inhibitors

62
Q

Some bacteria that contain beta lactamases

A 
Staph. Aureus 
H. Inf 
N. gonorrhoeae 
Many enterobacteriaceae 
certain anaerobes
63
Q

B lactamase inhibitors

A

can contain b lactam ring to act as decoy or inhibit lactamases following binding

Clavulanic acid
sulbactam
tazobactam

64
Q

Extended spectrum penicillin (ESP) and b lactamase inhibitors

A

Big guns
some of most potent available
Piperacillin/Tazobactam (Zosyn)
Ticarcillin/clavulanate (Timentin)

gives ESP spectrum PLUS 
S. Aureus 
S. pneumo
Most enterobacteriacae
Most pseudomonas
65
Q

Major toxicity of penicillins

A

Hypersensitivity rxns
acts as hapten but immunogenic when binds RBC
Type 1 response - skin rash, Anaphylaxis
Type 2 response - Drug induced hemolytic anemia

66
Q

What is more resistant to Beta lactamases than natural penicillins?

A

Cephalosporins and cephamycins

67
Q

On cephalosporins R1 and R2 side chains affect

A

R1 - antibiotic activity

R2 - affect change in PK properties

68
Q

First generation cephalosporins

A

cefazolin

cephalexin

69
Q

Second generation

A

Cefotetan
cefoxitin
cefuroxime

70
Q

Third generation cephalosporin

A

ceftriaxone

71
Q

fourth generation cephalosporin

A

cefepime

72
Q

Cephalosporins and cephamycins

A

beta lactam antiobiotics
more active against gram neg than natural penicillins
More stable too against many beta lactamases
in general:
increasing generation - aerobic gm + decreases and aerobic gm - increase
generally not useful against anaerobes or intracellular organisms

73
Q

Clinical First generation cephalsporin

A

spect: GAS, viridians, s. pneumo, PLUS some E. coli, klebsiella, proteus

Minor skin and soft tissue infections (alt to anti staph pen)
UTIs (E.coli)

74
Q

Second generation cephalosporins

A

same spect as first generation PLUS
H. Inf
Neisseria species

75
Q

Third generation cephalosporins

A

moderate against aerobic gram + bacteria - MSSA PLUS
increased activity against aerobic gram -
b/c modification of R side chains allow increased penetration through porins
some can cross the BBB - cefotaxime and ceftriaxone
activity against anaerobes - ceftizoxime
activity against pseudomonas - ceftazidime

76
Q

aerobic gram positive think ….

A

Staph

strept

77
Q

N. gonorrhae

A

resistant to a lot of antibiotics

becoming more and more of a problem

78
Q

N. meningitidis

A

not usually problem

can treat with penicillin

79
Q

Fourth generation

A

cefepime
Spectrum 3rd gen PLUS
MSSA
activity against pseudomonas - increased penetration thru porins and affinity to PBP
increased against Enterobacteriaceae - increased resistance to beta lactamases

80
Q

Fourth generation poor against

A

anaerobes

81
Q

Carbapemems

A 
Use for very serious infections - Big guns 
Imipenem, meropenem, ertapenem 
Among MOST broad spectrum 
among LAST LINE of defense against resistant bacteria 
improved penetration of porins 
enhanced binding to PBP 
increased resistance to beta lactamases 
USEFUL for pseudomonas
82
Q

LAST LINE antibiotic

A

carbapemems

some Ecoli and klebsiella developed resistance

83
Q

Carbapenems NOT active against

A

enterococcus
MRSA
C. Diff
Burkholdreia cepacia

84
Q

Hail Mary - last resort antibiotic

A

Imipenem
used with cilastatin (combo called Primaxin)
to inhibit renal dihydropeptidase

85
Q

Monobactams

A

Aztreonam
side groups give ability to penetrate porins and bind to gram neg PBP

CANNOT bind gram + PBP

86
Q

Excellent safety profile

A

Monobactams
safe for pts with penicillin allergies and renal disease
Useful for pseudomonas

87
Q

Spectrum of Monobactams

A

Narrow spectrum
Aerobic gram neg
Moraxella, neisseria, enterobacteriaceae, pseudomonas, haemophilus, burkholderia
* some strains developed resistance

88
Q

Bacterial Mechanisms of resistance to Beta lactams

A

penetration - poor thus intracellular bacteria not affected
Porins - beta lactams must be able to pass through pores - mutations of porins can alter acessibility
Pumps - efflux pumps
Penicillinases - beta lactamases
Penicillin binding proteins - mutation prevents binding
Peptidoglycan - lacking cell wall intrinsically gives resistance

89
Q

Intrinsic resistance to beta lactams

A

intracellular growth
lack of cell wall
porin that excludes antibiotics

90
Q

Acquired resistance to beta lactams

A

mutation
genes from phage - transduction
genes from another bacteria - transformation and conjugation
altered penicillin binding proteins - methicillin resistant
efflux pumps (pseudmonas have mutli drug resist pumps)
decreased permeability of gram neg porins

91
Q

Mechanism of resistance to Cephalosporins

A

production of beta lactamases

92
Q

Vancomycin

A

Laser guided missile
Huge, wont fit through porin
spectrum very narrow
Gram positive only

93
Q

Mechanism of Vancomycin

A

cell wall inhibitor - binds to D-Ala-D-Ala

94
Q

Resistance to Vancomycin

A

Enterococci change to D-Ala-D-lac

resistance gene on plasmid thus concern could transfer to MRSA

95
Q

Clinical app of Vancomycin

A

reserve use for MRSA
penicillin resistant S. pneumo
susceptible enterococcal infection

96
Q

Daptomycin

A 
Laser guided missile - narrow spectrum 
cyclic lipopeptide antibiotic 
lipid portion inserts forming channel in membrane 
induces bacterial lysis 
active against aerobic gram + 
not useful for gram neg bacteria
97
Q

for Vancomycin resistant enterococci

A

Daptomycin

98
Q

Reserve for MRSA, penicillin resistant S. pneumonae, vancomycin resistant enterococci

A

Daptomycin

99
Q

No Alcohol with this drug

A

Metronidazole

100
Q

Metronidazole

A

acts as free radical causing strain breaks bacterial DNA

Active against gram neg anaerobes and most gram pos anaerobes including C. Diff

101
Q

Latent TB treated with

A

Isoniazid

102
Q

Penicillin sensitive S. Pneum

A

Penicillin G

Ampicillin

103
Q

Penicillian resistant S. Pneumo

A 
can overcome intermediate resistance by increasing dosage 
otherwise 
cefuroxime 
ceftriaxone 
vancomycin 
macolides or telithromycin
104
Q

Staph. Aureus
aerobic and gram + cocci
causes what illnesses

A 
skin and wound infections 
septicemia 
Endocarditis 
Pneumonia 
septic arthritis and osteomyelitis
105
Q

All MSSA strains have what mechanism

A

Beta lactamase production

106
Q

MRSA resistance confers resistance from

A

altered PBP

107
Q

Antibiotics for MSSA

A

Anti staph penicillins - Nafcillin, oxacillin

Cephalosporins - 1-3rd generation - cefazolin, cefuroxime, ceftriaxone

108
Q

Antibiotic for Staph Aureus (not MSSA or MRSA)

A

beta lactam plus beta lactamase inhibitor
Ampicillin-sulbactam
Piperacillin-tazobactam
Ticarcillin-clavulanate

109
Q

Antibiotics for MRSA (hospital acquired)

A

Vancomycin

110
Q

Antibiotics MRSA (community acquired)

A

clindamycin

111
Q

Antibiotics for MRSA

A

Linezolid
Quinupristin-dalfopristin
Daptomycin
Tigecycline (like tetracycline)

culture and sensitivity tests should guide therapy

112
Q

MRSA isolates may be susceptible to other non beta lactam antibiotics including

A

clindamycin
doxycycline
minocycline

113
Q

Pseudomonas Aeruginosa

A

causes serious infections in compromised hosts
bacteremia
pneumonia
UTIs
wound infection
lungs of CF patients chronically infected

114
Q

Always base therapy on culture and sensitivity results for this organism

A

P. Aeruginosa

115
Q

Resistance mechanisms of P. Aeruginosa

A

multidrug efflux pump
beta lactamase production
altered porin proteins
aminoglycoside-modifying enzymes

116
Q

Combination therapy for Pseudomonas

A

ceftazidime and tobroamycin (beta lactam and aminoglycan)

Piperacillin and ciprofloxacin (extend spectrum and Fluoro)

117
Q

Treatment for pseudomonas

A

Extended spectrum penicillins (piperacilin and ticarcilin)
Cephalosporins (ceftazidime 3rd and cefepime 4th)
Carbapenems
Aztreonam
Quinolones - some strains
Aminoglycosides

118
Q

enterobacteriaceae

A

aerobic (facultative) gram neg rods

many produce bet lactamases some with broad activity - extended spectrum beta lactamases

119
Q

E coli can cause

A 
diarrhea
intrabdominal infections 
sepsis
UTIs 
meningitis in infants
120
Q

shigella

A

diarrhea

person to person transmission

121
Q

salmonella

A

diarrhea

animal to person

122
Q

klebsiella

A

pneumonia

123
Q

Proteus

A

UTIs

124
Q

Yersinia

A

diarrhea

plague

125
Q

E coli, klebsiella and Proteus

A

ampicillin
cefazolin
TMP/SMX
fluroquinolones

126
Q

If enterobacteriaceae is resistant, use bigger guns

A

3rd gen - cephalosporins, aztreonam, piperacillin-tazobactam, ticarcillin-clavulanate, carbapenems

can add aminoglycans for synergy

127
Q

N. Gonorrhoeae DOC

A

problem organisms, lots of resistance

Ceftriaxone (3rd gen)
cefixime

many resistance mechanisms -efflux pumps, beta lactamases, altered PBP, altered porins

128
Q

N. meningitidis. Treat with?

A

penicillin

if resistant,
use ceftriaxone or cefotaxime (3rd)

129
Q

Gram positive anerobes

A

clostridium
actinomyces
peptostreptococcus
propionibacterium

130
Q

Gram negative anerobes

A

bacteriodes
fusobacterium
prevotella

131
Q

Antibiotics active against at least some Anaerobes

A

penicillin
clindamycin
metronidazole
some second and third generation cephalosporins
beta lactam/beta lactamase inhibitor combinations

132
Q

C. Diff causes

A

antibiotic resistant associated colitis

causes diarrhea and pseudomembranous

133
Q

C Diff treatment

A

metronidazole - given first

Vancomycin

134
Q

Tetracyclines, Macrolides and quinolones are effective for

A

mycoplasma (intracellular)
chlamydia (intracellular)
Legionella (intracellular)
Rickettsia (intracellular) - no macrolide

135
Q

B. burgdorferi - treat with?

A

doxycycline

BUT if kid under 18 use aminopenicillin

136
Q

T pallidum treat with?

A

penicillin

137
Q

what is the second line of drugs for M.tb

A 
streptomycin 
para-aminosalicylic acid 
cycloserine
ethionamide 
amikacin 
levofloxacin 
capreomycin
138
Q

MDR-TB is resistant to ?

A

Isoniazid

Rifampcin

139
Q

XDR-TB is resistant to?

A

Isoniazid
Rif
fluoroquinolone
and one of three injectable second line drugs (capre, kana, amik)

140
Q

What anti Tb drugs acts through inhibiting cell wall synthesis?

A

Isoniazid

Ethambutol

141
Q

What Tb drug acts through disrupting the membrane?

A

Pyrazinamide

142
Q

What drug for TB inhibits RNA synthesis?

A

Rifampin

Cmbm 2 Gopi (16 decks)

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