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Antibiotics Flashcards

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1
Q

Different targets of antibiotics

A 
Cell wall
DNA/RNA synthesis
Folate synthesis
Cell membrane
Protein synthesis
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2
Q

Categories of cell wall antibiotics

A 
Beta lactams
Glycopeptides
Bacitracin
Fosfomycin
D-cycloserine
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3
Q

Examples of B-lactams

A

Penicillins
Cephalosporins
Carbapenems
Monobactams

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4
Q

Categories of antibiotics that prevent DNA/RNA synthesis

A

Quinolones
Nitromidazoles
Rifamycins

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5
Q

Examples of antibiotics that interfer with folate synthesis

A

Trimethoprim

Sulfonamides

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6
Q

Examples of antibiotics that prevent cell membrane formation

A

Daptomycin

Polymixins

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7
Q

Groups of antibiotics that interfer with protein synthesis

A 
30s: 
Tetracyclines
Aminoglycosides
50s:
Lincosamides
Oxazolidinones
Chloramphenicol
Macrolides
(Ta locum!)
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8
Q

Penicillins

A 
Penicillin G
Penicillin V
Piperacillin
Ampicillin
Amoxicillin
Nafcillin
Dicloxacillin
Ticarcillin
Oxacillin
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9
Q

Cephalosporins (10)

A 
Cefazolin
Cephalexin
Cefuroxime
Ceftriaxone
Cefotaxime
Cefixime
Ceftaxidime
Cefepime
Cefoxitin
Cefotetan
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10
Q

Carbapenems

A 
Meropenem
Ertapenem
Doripenem
Imipenem
Aztreonam
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11
Q

Quinolones/fluoroquinolones

A

Ciprofloxacin
Levofloxacin
Gatifloxacin
Moxifloxacin

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12
Q

Nitromidazoles

A

Tinidazole
Nitrofurantoin
Metronidazole

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13
Q

Rifamycins

A

Rifampin
Rifabutin
Rifapentine

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14
Q

Examples of tetracyclines

A

Tetracycline
Doxycycline
Minocycline
Tigecycline

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15
Q

Examples of macrolides

A

Erythromycin
Clarithromycin
Azithromycin
Telithromycin

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16
Q

Examples of aminoglycosides

A

Streptomycin
Tobramycin
Amikacin
Gentamicin

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17
Q

Examples of lincosamides

A

Clindamycin

lincomycin

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18
Q

Examples of glycopeptides

A 
Vancomycin
Teichoplanin
Telavancin
Ramoplanin
Dalbavancin
Oritavancin
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19
Q

What does MALDI-TOF stand for?

A

Matrix Assisted Laser Desorption Ionisation- Time of Flight

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20
Q

Draw the flow chart for gram negative rod identification

A

Obligate anaerobes (Bacteroides)
Micro-aerophilic (oxidase positive Campylobacter)
Aerobic

MacConkey agar:
no: Parvobacteria (chocolate agar, requires X, V H.influenza)
yes:

Lactose fermentation:
yes: Chrome agar (pink e.coli)
no:

Oxidase
positive: Pseudomonas
No: Enterobacteriaceae (salmonella, shigella)

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21
Q

Draw the flow chart for gram positive cocci identification

A

Catalase test
+ve: Staphylococcus
-ve: Streptococcus

Coagulase
+ve Staph aures

MacConkey agar:
+ve Enterococcus (lancefield group D)
-ve

Blood agar
alpha (optochin s: Strep pneumoniae r: Strep viridans)
beta (bacitracin s: Strep pyogenes/group A r: Strep agalactiae/group B)
gamma: enterococcus

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22
Q

Treatment for community acquired pneumonia

A

Septic?

Yes: Co-amoxiclav 1.2g iv tds + clarithromycin 500 mg po/iv bd (if severe add single dose gentamicin 5 mg/kg iv)

No:
CURB65 0-1 amoxicillin 500 mg po tds
CURB65 2-5 amoxicillin 1 g iv tds + clarithromycin 500 mg po bd

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23
Q

CURB65

A 
Confusion (AMT abbreviated mental test <=8)
Urea (>7 mmol/L)
Resp rate (>30 brpm)
BP (<90 systolic, <=60 diastolic)
Age (>=65 years)
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24
Q

First line treatment for Staph aures

A

Flucloxacillin (Vancomycin if resistant)

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25
Q

Tazocin

A

piperacillin + tazobactam

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26
Q

Co-amoxiclav

A

amoxicillin (beta lactam) + clavulanic acid (B-lactamase inhibitor)

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27
Q

Mechanisms for antibiotic resistance

A

Efflux pumps
Alteration in outer membrane permeability (e.g loss of porin channel)
Target modification
Inactivating enzymes
Genetic mutation
Vertical/horizontal gene transfer (pilus)

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28
Q

Incidence

A

Rate of occurance of new cases (useful for short lived conditions)

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29
Q

Prevalence

A

How many people have it.
Frequency of existing cases in a defined population.
Useful for chronic conditions

30
Q

Incubation period

A

Time between exposure to an infection and appearance of first symptoms.

31
Q

A vector

A

An agent that carries/transmits an infectious patogen into another living organism.

32
Q

Treatment for c.tetani

A

ITU
Human tetanus Ig (IM at multiple sites to neutralise toxin)
Metronidazole.
Vaccine available

33
Q

Treatment for haemophilus influenza

A

First choice for life threatening:
3rd generation cephalosporin (ceftriaxone as it penetrates CSF)

Less serious: oral ampicillin

34
Q

Gram negative structure

A

LPS in outer membrane (lipid A, O polysaccharides)
Outermembrane
Peptidoglycan cell wall
Inner membrane

Contains aqueous transmembrane channels (porins) which allows entry of some antibiotics.

35
Q

Symptoms of Neisseria gonorrhoea

A 
Men:
Urethral pus
Tenesmus (wanting to poo)
Proctitis (inflammation of rectum and anus)
Discharge PR (especially if gay)

Women:
Often asymptomatic

Baby:
Blind

36
Q

Latent period

A

Time from exposure to becoming infectious

37
Q

Mycobacterium pathogenesis

A

Mycobacteria ligate TLR2 as they infect macrophages.
Ligation of TLR2 leads to production of NO and secretion of IL12.
Presentation of mycobacteria antigens to T cells with IL12 causes macrophage stimulation and division.
T cells release IFNgamma. More macrophages recruited and granuloma formation.

38
Q

Reactivation of TB

A

10% risk in lifetime.
Risk greatest within first 2 years.
Risk factors include HIV (10%/year).
Immunocompromised (corticosteroids, TNFalpha antagonists).

39
Q

Treatment for N. gonorrhoea

A

Ceftriaxone

40
Q

Mechanism of beta lactam antibiotics

A

Bind penicillin binding proteins (PBPs).
Inhibit peptidoglycan cross-linking.
Bactericidal if cells are actively dividing.

41
Q

What is penicillin G?

A

benzylpenicillin

42
Q

What is penicillin V?

A

Oral version of penicillin G

43
Q

Spectrum of activity for penicillin G/V

A

Used to be wide: syphilis, anaerobes, gram +ves, a few gram -ves.
Now resistance (not that useful against other gram -ves/anaerobes).
Still the best antibiotic for penicillin-sensitive Streptococci, Neisseria, and spirochaetes.

44
Q

Examples of extended spectrum penicillins (ESPs)

A

Ampicillin

Amoxicillin

45
Q

Spectrum of activity of ESPs

A

Improved activity against some gram -ves.
e.g H.influenza and E.coli (useful in RTI/UTIs).
Less activity agains gram +ves than penicillin G but still useful.

46
Q

Which has better oral bioavailability? Amoxicillin or Ampicillin

A

Amoxicillin

47
Q

Examples of antistaphylococcal penicillins

A

Flucloxacillin

Methicillin

48
Q

Spectrum of activity of flucloxacillin

A

Stable to staphylococcal beta-lactamase so active against penicillin resistant S.aures.
Mainstay of treatment for S.aures infections.

Also active against some other gram +ves e.g streptococci so good for skin infections.
NOT useful against gram -ves.

49
Q

How does S.aures develop resistance to methicillin/flucloxacillin?

A

Modification of PBP target.

50
Q

Treatment against pseudomonas

A 
Piperacillin
Tazocin
Ceftazidime
Meropenem
Gentamicin
Ciprofloxacin
51
Q

Cephalosporins specrum of activity

A

Broader spectrum than penicillins.
Most are active agains Staph aures and Strep.

Unlike penicillins, NOT active against enterococci or listeria (add ampicillin if risk of listeria).
Veriable activity against gram -ves.

Inactive against anaerobes (combine with metronidazole if anaerobic cover needed).

52
Q

Group 2 cephalosporins cover

A

Good activity against common gram +ve (S.aures and Strep).
Limited activity against gram -ve (NOT for H.influenza).

Uses: outpatient treatment for upper resp, urinary, soft tissue infections.

53
Q

Group 3 cephalosporins cover

A

Active agains wide range of gram +ve and -ve but NOT pseudomonas.

Uses: severe sepsis (urinary, resp and soft tissue infections).

54
Q

Group 4 cephalosporins cover

A

Active agains wide range of gram +ve and more gram -ve but NOT pseudomonas.
Long half life allows administration once per day.
Can get into CSF.

Uses: severe infections including bacterial meningitis.

55
Q

Group 6 cephalosporins cover

A

Similar to group 4 but also ACTIVE against pseudomonas.

Uses: wide range of severe infections.

56
Q

Carbapenems (cover and usage)

A

Broadest spectrum beta-lactam antibiotics.

Stable to most beta-lactamase and ESBL producing gram negatives.
Active against most (but not all) gram +ve and -ve bacteria.

57
Q

Glycopeptides (examples and cover)

A

e.g vancomycin, teichoplanin

Active against gram +ves including enterococci and MRSA.
NOT active against gram -ves: large molecules cannot penetrate outer membrane.
Poor oral availability. Give IV.

58
Q

Group 2 cephalosporins examples

A

e.g cefalexin, cefradine (first generation oral)

59
Q

Group 6 cephalosporins examples

A

e.g ceftazidime (3rd generation, parenteral)

60
Q

Group 3 cephalosporins example

A

e.g cefuroxime (second gen, parenteral)

61
Q

Group 4 cephalosporins examples

A

e.g ceftriaxone, cefotaxime (3rd generation, parenteral)

62
Q

Spectrum of aminoglycosides

A

Active transport into cell.

Potentially bactericidal against staphylococci and most gram -ves including pseudomonas.

Poor oral availability. Give IV.

Risk of ototoxicity and nephrotoxicity so monitor levels.

63
Q

Tetracyclines (spectrum and uses)

A

Broad spectrum but bacteriostatic.
Good oral availability.

Active against wide range of gram +ve and -ve but increasing resistance.

Uses:
Rickettsia, lyme disease.
Prophylaxis malaria.

Causes discolouration of bones and teeth (avoid in young children).

64
Q

Agent that causes lyme disease

A

Borelia burgdorferi

65
Q

Use of trimethoprim

A

Uncomplicated UTIs.

66
Q

Folate antagonist that you use in combination with other things

A

Sulphonamides

Co-trimoxazole (septrin)= sulfamethoxazole + trimethoprim: synergism.

Used against a range of gram +ve, gram -ve and some protozoa (e.g PCP)

67
Q

What is PCP?

A

Pneumocyctis pneumonia

68
Q

Causative agent of PCP

A

Pneumocystis jirovecii (yeast)

69
Q

Spectrum of activity of nitromidazoles

A

Active against most anaerobes.

Used to treat some protozoa (Entamoeba histolytica, Giardia).

70
Q

Capsulated bacteria

A

Gosh Some Nasty Killers Have Serious Capsule Protection

Group B strep
Strep pneumoniae
Neisseria meningitides
Klebsiella pneumoniae
Haemophilus influenza type B
Salmonella typhi
Cryptococcus neoformans (fungi)
Pseudomonas aeruginosa
71
Q

Catalase Positive Organisms

A

Catalase Positive: Notoriously Bubbling HASSLE

Candida
Pseudomonas
Nocardia
B. cepacia
H. pylori
Aspergillus
Staphylococci
Serratia
Listeria
E.coli

Microbiology (4 decks)

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