Antibiotics Flashcards
Definition of antibiotic
substance or compound that kills or inhibits growth of bacteria
Endogenous antibiotic
lysozyme from mucus and tears
selective toxicity
ability of antibiotic to cause harm to bacteria without causing damage to the host
Antibiotic potential targets
cell wall synthesis, membrane integrity, folate synthesis, DNA/RNA synthesis, protein synthesis
Bactericidal
kills bacteria, does not rely on immune system for clearance
Bacteriostatic
bacteria “lassoed,” not propagating or proliferating, immune system able to overwhelm bacteria
Spectrum
broad: targets a variety of species
Narrow: targets a very specific species
Antibiotic resistance
bacteria resist actions of frequently used drugs, can mutate
Major cause of abx resistance
over prescription and misuse
Prevention of abx resistance
appropriate abx, use as indicated(!)
Synergy
inhibitory or killing effects of two or more abx in combination are greater than their effects individually
Antagonism
inhibitory or killing effects of two or more abx in combo are less than their effects individually
Cell wall synthesis inhibitors
Beta lactams (penicillins, cephalosporins, carbapenems), monobactams, glycopeptides and lipoglycopeptides
How do glycopeptides and lipogylcopeptides differ from beta lactams?
glyco/lipoglyco peptodes: inhibit cell wall synthesis by binding to D-alanyl-Dalanine terminus
Beta lactams: interact with transpeptidase
Which antibiotic relies on renal dipeptidase inhibitor celastatin?
carbapenems, imipenem
What differentiates second gen cephalosporins from cephamycins?
cover both G+ and G- while cephamycins are active against B. fragilus and some Serratius spp.
What is the general sprectrum of coverage for monobactam aztreonam?
mostly G-, aerobic bacteria
How does resistance to methicillin happen in MRSA?
transpeptidase (penicillin binding protein) mutation prevents methicillin binding
Protein Synthesis Inhibitors
50s: oxazolidinones, macrolides, ketolides, streptogramins
30s: tetracyclines, aminoglycosides, glycylcyclines
What is the difference in MOA between oxazolidinones and streptogramins?
streptogramins: prevent translation by binding to 50s
oxazolidinones: prevent initiation
DNA/RNA synthesis inhibitors
Fluoroquinolones
What proteins do fluoroquinolones inhibit?
Topoisomerase II in G+ bacteria, Topoisomerase IV in G- bacteria
Membrane integrity and folate synthesis inhibitors
membrane integrity: polymyxins
Folate synthesis: sulfonamides and benzylbiyrimidines
Why are sulfonamide and benzylpyrimidines synergistic?
both inhibit folate, sulfonamide inhibits PABA, benzylpyrimidines inhibit dihydrofolate reductase
Are polymyxins active against G+ bacteria?
no, target LPS on G- bacteria
Penicillin MOA
interfere with transpeptidation reaction, inhibiting cell wall synthesis by preventing cross linking of components
Method of penicillin resistance
Beta lactamases break down beta lactam ring; porin and PBP structure alteration; increased efflux
Method of Penicillin G resistance
beta lactamases
Spectrum of Penicillin G activity
G+ coccii (strep spp.), G- coccii (N. meningitidis), T. pallidum, non-B-lactamase anaerobes (C. perfringens)
Penicillin G AE
hypersensitivity reactions (anaphylaxis), N/V/D
Aminopenicillins MOA
cell wall synthesis inhibitors
Aminopenicillins mechanism of resistance
Beta-lactamases
Spectrum of aminopenicillins
G-, G+; E. coli and other enterics; H. influenzae, Klebsiella spp., Proteus spp., B. fragilis
Penicillinase resistant penicillins drugs
methicillin, nafcillin, oxacillin,dicloxacillin
Resistance to penicillinase resistant penicillins
reduced affinity for med in binding pocket of transpeptidase
Spectrum of penicillinase resistant penicillins
staphylococcal spp.
Antipseudomonal penicillins drugs
carboxypenicillins, ureidopenicillins
Mechanism of resistance for antipseudomonal penicillins
beta-lactamase (although should be co-formulated with tazobactam to inhibit beta-lactamase)
Spectrum of antipseudomonal penicillins
P. aeruginosa, G- bacilli, E. coli, H. influenzae, and B fragilis
Cephalosporin MOA
inhibits transpeptidation reaction by binding and inhibiting transpeptidase
Cephalosporin mechanism of resistance
beta-lactamases, altering porins and molecular structure of transpeptidase, efflux pumps
Cephalosporin AE
maculopapular rash, eosionophilia, fever
First generation cephalosporin drugs
cefadroxin, cephalothin, cephradine, cefazolin, cephalexin
Spectrum of first gen cephalosporins
G+ cocci (S. aureus); NOT MRSA, B. fragilis, enterococci, or S. epidermidis; G- bacteria such as M. catarrhalis, K. pneumonie, E. coli, Proteus mirabilis
Second generation cephalosporin drugs
cefuroxime, loracarbef, cefonicid, cefamanadole, cefalcor, cefoxitin
Spectrum of second gen cephalosporins
H. influenzae, N. meningitidis, S. pneumonia, cefoxitin and cefotetan are active against B. fragilis and some Serratia spp.; NO enterobacter spp.
Third generation cephalosporin drugs
cefotaxime, cefixime, cefdinir, ceftibuten, ceftazimide, ceftriaxone
Spectrum of third gen cephalosporins
expansion of G- coverage, slightly less active against G+ like Strep and Staph spp.; work well against Neisseria and Haemophilus spp. (Not Acinetobacter, Serratia, Enterobacter spp.)
Only third gen cephalosporin active against P. aeruginosa
ceftazidime
Cefdinir is active against….
E. coli, S. pyogenes, H. influenzae, P. mirabilis
Ceftriaxone AE
biliary pseudolithiasis, jaundice
Fourth gen cephalosporin drugs
cefepime