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Antibiotics Flashcards

1
Q

6 general antimicrobial therapy principles

A
  1. Suspected or known organism
  2. Antibiotic spectrum
  3. Bacteria susceptibility to antibiotic
  4. Concentration of antibiotic at site of infection
  5. Activity of immune system
  6. Bacterial resistance mechanisms
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2
Q

Interfere with growth or replication but do not kill the organism

A

Bacteriostatic agents

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3
Q

Kill the organism

A

Bactericidal agents

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4
Q

Lowest concentration of a given antimicrobial at which an organism’s growth is inhibited

A

Minimum inhibitory concentration (MIC)

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5
Q

When does MIC increase?

A

With reduced susceptibility

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6
Q

What is MBC?

A

Minimum bactericidal concentration

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7
Q

What is cell wall acting typically?

A

Bactericidal

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8
Q

What is protein synthesis inhibitors typically?

A

Bacteriostatic

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9
Q

Is bacteriostatic inhibitory antibiotics concentration lower or higher than bactericidal concentrations?

A

Much lower

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10
Q

What do you use for immunosuppressed patients and serious infections?

A

Bactericidal agents

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11
Q

How can bactericidal be further divided?

A

Concentration (dependent killing)

Time (dependent killing)

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12
Q

What do you want for concentration of bactericidal?

A

Certain peak concentration or AUC

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13
Q

When does time of bactericidal continue?

A

Concentration > than MIC (duration of time concentration above MIC)

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14
Q

Which part of bactericidal is more important for surgical site injection prophylaxis?

A

Time of bactericidal

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15
Q

What is persistent suppression of bacterial growth after antibiotic concentration has fallen?

A

Post antibiotic effect (PAE)

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16
Q

What are 3 possible mechanisms for post antibiotic effect?

A
  1. Persistence of drug at binding site
  2. Need to synthesize new enzymes
  3. Slow recovery from damage
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17
Q

What is when the bacteriostatic and bactericidal effects of two antibiotic agents used together is greater than their effects when administered alone?

A

Synergism

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18
Q

Example of synergism

A

Ampicillin + gentamicin for enterococcal endocarditis

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19
Q

5 physical barriers for drug penetration into anatomical compartments

A
  1. Epithelial and endothelial cell layers
  2. Hydrophobic/hydrophilic properties of drug
  3. Molecule charge
  4. Molecule size
  5. Membrane transporters (P glycoprotein)
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20
Q

4 antibiotic compartment penetration

A
  1. CNS (blood-brain barrier)
  2. Eye (from plasma to retina or ocular cavity)
  3. Pneumonia (pathogens in epithelial lining fluid
  4. Placental barrier (fetal harm)
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21
Q

3 unusual compartments for antibiotic

A
  1. Endocardial vegetation (heart valves)

2. Biofilm formed by bacteria or fungi (prosthetic devices)

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22
Q

Colony of slow growing cells enclosed in an exopolymer matrix

A

Biofilm

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23
Q

Is biofilm negative or positive and why?

A

Negatively charged

Restricts antibiotic access

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24
Q

2 things that alter pharmacokinetics for antibiotics?

A

Renal impairment

Hepatic impairment

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25
Q

Conditions or populations that lead to increased dose requirements of antibiotics

A

Cystic fibrosis

Burn patients

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26
Q

Does renal impairment or hepatic impairment have more effect on dosage adjustments with antibiotics?

A

Renal impairment

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27
Q

Which drug concentration monitoring to avoid toxicity is used?

A

Vancomycin

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28
Q

Which drug concentration monitoring is established with efficacy?

A

Aminoglycosides

Vancomycin

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29
Q

What are the 4 different types of selection for antibiotics are there?

A

Empiric therapy
Definitive therapy
Preventive therapy
Prophylaxis

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30
Q

Patient is symptomatic

A

Empirical therapy

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31
Q

Which are the most likely organisms for empirical therapy?

A

UTI
CAP
SSTI-cellulitis

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32
Q

When are situation need immediate treatment with empirical therapy?

A

Neutropenia

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33
Q

Examination of infected secretion or body fluid to determine pathogen

A

Definitive therapy

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34
Q

What is most likely used to narrow antibiotic to target organism with definitive therapy?

A

Monotherapy

Combo therapy indicated for certain infections (TB, HIV, hepatitis)

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35
Q

What are the 3 types of infections?

A

Acquired
Normal flora
Deactivation or activation

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36
Q

How can you get acquired type of injection?

A

By the community or health care

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37
Q

How can you get normal flora type of injection?

A

Changes in population or normal body organisms, overgrowth of one becomes a pathogen

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38
Q

How can you get reactivating or activation type of infection?

A

Usually immunocompromised host
Fungal infections
TB
viral, CMV, HSV

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39
Q

4 different target microorganism

A

Bacteria - antibacterial
Viruses - antiviral
Fungi - antifungal
Parasites - antiparasitic

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40
Q

3 different classification of antibiotic

A

Class and spectrum of microorganisms it kills
Biochemical pathway it interferes with
Chemical structure of its pharmacophore

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41
Q

4 different classification of antibiotic mechanism of action:

A
  1. Cell wall (or cell membrane) acting
  2. Protein synthesis inhibitors
  3. Inhibit DNA synthesis
  4. Antimetabolites
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42
Q

Antibiotic mechanism of action for cell wall acting

A

Inhibitors of peptidoglycan

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43
Q

Antibiotic mechanism of action for protein synthesis inhibitors

A

Acts on 50S ribosomal unit

Acts on 30S ribosomal unit

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44
Q

What are beta lab tam antibiotics named for?

A

4 member lactam ring

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45
Q

Beta lactam antibiotic

A

Penicillins

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46
Q

Is beta lactam bactericidal or bacteriostatic?

A

Bactericidal

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47
Q

MOA of beta lactams?

A

Inhibit bacteria growth by interfering with cell wall synthesis
-peptidoglycan (cell wall component)

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48
Q

5 different resistance to penicillins

A 
Changes in PBPs 
Cell entry (size of drug vs porins)
Beta lactamase enzymes 
Efflux pumps on gram negative 
Biofilms (adhere to devices, valves)
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49
Q

Anti-staph penicillin

A

Nafcillin

Beta lactamase producing staphylococci (streptococci)

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50
Q

4 adverse effects of penicillins

A

Hypersensitivity rxns .4%-7%
Rash, fever, anaphylaxis, vasculitis, SJS
Act as haptens
Seizure (rare with renal insufficiency)

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51
Q

MOA of cephalosporins

A

Similar to PCNs

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52
Q

How does cephalosporins spectrum compare?

A

Broader

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53
Q

1st generation of cephalosporins

A

Cefazolin

Gram positive, some negative

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54
Q

2nd generation of cephalosporins

A

Increasing gram negative

Cefotetan

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55
Q

3rd generation of cephalosporins

A

Decreasing gram positive, increasing gram negative

Ceftriaxone

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56
Q

Resistance of cephalosporins

A

Gram negative enters bacteria ear - produce beta lactamase (inactivate 1st and 2nd generation agents)

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57
Q

4 adverse effects of cephalosporins

A

Hypersensitivity < PCNs
Cross reactivity with penicillin allergy < 10%
Bleeding risk with cefotetan
Disulfiram rxn

58
Q

2 beta lactamase inhibitors

A

Sulbactam

Tazobactam

59
Q

Inactivate the beta lactamase to make antibiotic active

A

Suicide inhibitors

60
Q

Is beta lactamase inhibitors:
Gram positive or negative
Aerobic or anaerobic

A

Gram negative

Anaerobic

61
Q

What is vancomycin?

A

Glycopeptide

  • inhibits synthesis of cell wall precursors
  • high affinity for D-alanyl D-alanine terminus of cell wall precursor that attaches to the peptidoglycan
  • inhibits transpeptidation
62
Q

Is vancomycin gram positive or negative?

A

ONLY gram positive

63
Q

Example of vancomycin that focuses on gram positive organism

A

Staph aureus (MRSA)

64
Q

When will vancomycin resistance becomes a problem?

A

Enterobacter and staph aureus

65
Q

Is vancomycin a beta lactam?

66
Q

Can you use vancomycin if have a penicillin allergy?

A

Yes because it may be an alternative

67
Q

How is therapeutic drug monitoring done with vancomycin?

A

Peak and through concentrations

68
Q

Adverse effects of vancomycin

A
  1. Ototoxicity
  2. Nephrotoxicity
  3. Red-man syndrome
69
Q

What is red-man syndrome?

A

When you infuse vancomycin too quickly

70
Q

What is aminoglycosides and name the 2 drugs

A

Protein synthesis inhibitors
Gentamicin
Tobramycin

71
Q

Is aminoglycosides bactericidal or bacteriostatic?

A

Bactericidal

72
Q

Is aminoglycosides anaerobic or aerobic?

73
Q

Is aminoglycosides reversible?

74
Q

Which ribosomal unit does aminoglycosides act on?

A

30S ribosomal subunit

75
Q

3 possible mechanisms for aminoglycosides:

A
  1. Block of formation
  2. Miscoding of AA
  3. Block of translocation on mRNA
76
Q

Aminoglycosides PK target peak concentrations

A
  • post antibiotic effect

- once daily dose

77
Q

What does macrolides do?

A

Inhibit protein synthesis at 50S

78
Q

If allergic to macrolides, what other antibiotic can you give?

A

Penicillin

79
Q

Is tetracyclines bacteriostatic or bactericidal

A

Bacteriostatic

80
Q

What does tetracyclines inhibit with protein synthesis?

A

30S ribosome subunit

81
Q

Clindamycin MOA

A

Inhibit protein synthesis like macrolides at 50S

82
Q

Is clindamycin anaerobic or aerobic?

83
Q

Oxazolidinones (linezolid) MOA

A

Prevents formation of ribosome complex that initiates protein synthesis at 50S subunit (23S ribosomal RNA)

84
Q

Is oxazolidinones anaerobic or aerobic

85
Q

How does quinolones block bacterial DNA synthesis?

A

Inhibit bacterial topoisomerase II (DNA gyrase) and IV

86
Q

What do quinolone drugs end in?

A

“Floxacin”

87
Q

Which antibiotics inhibit DNA synthesis?

A

Quinolones

88
Q

Who should you avoid giving quinolone to?

A

Pregnancy and pediatrics

89
Q

What are 2 antimetabolites?

A

Trimethoprim (inhibit dihydrofolic acid reductase)

Sulfamethoxazole (inhibit folate synthesis)

90
Q

What is surgical prophylaxis?

A

Decrease risk for surgical site infection (SSI)

91
Q

Surgical classification of clean

92
Q

Surgical classification of clean contaminated

93
Q

Surgical classification of contaminated

94
Q

Surgical classification of dirty

95
Q

no entry into respiratory, GI, GU tracts or oropharyngeal cavity. Generally elective with no break in technique and no inflammation encountered

96
Q

entry into the respiratory, GI, GU, biliary, oropharyngeal cavity without unusual contamination. Also includes clean procedures with minor break in technique

A

Clean contaminated

97
Q

fresh traumatic wounds, gross spillage from GI (no mechanical bowel prep), major break in technique, incisions encountering acute, nonpurulent inflammation

A

Contaminated

98
Q

procedures involving old traumatic wounds, perforated viscera, clinically evident infection

99
Q

When do you want to being first does for surgical prophylaxis?

A

Infusion 60min prior to incision

100
Q

When do you want to start quinolone or vancomycin for surgical prophylaxis

A

120min prior to incision

101
Q

When do you redose throughout operative period?

A

Longer than 4hrs or >2 half lives of antibiotic or major blood loss

102
Q

Duration of prophylaxis

A

Unnecessary beyond surgery

Not greater than 24 (48) hrs

103
Q

What does prolong duration of prophylaxis do?

A

Lead to resistance

104
Q

If have beta lactam allergy, what is an alternative for surgical prophylaxis

A

Vancomycin

Clindamycin

105
Q

What is surgical care improvement project (SCIP)

A

Quality measure to Medicare for public display

106
Q

4 key concepts for SSI prophylaxis

A
  1. Antibiotic choice
  2. Dose and therapeutic coverage
  3. Timing of pre-op dose
  4. Duration of post-op antibiotics
107
Q

What should be used when need 30min prior of pre-op dose

108
Q

What should be used when need longer infusion time for pre-op dose?

A

Vancomycin or quinolone

109
Q

5 antibiotics that may affect NMJ

A 
Aminoglycosides 
Quinolones 
Polymyxins 
Tetracyclines 
Clindamycin
110
Q

What are antibiotics additive with

A

Non depolarizing NM blocker
Volatile anesthetics
Local anesthetics

111
Q

Underlying disease that should be used in caution with antibiotics

A

Myasthenia gravis

112
Q

3 different varying mechanisms with antibiotics and NM blockers

A
  1. Inhibit pre synaptic ACh release
  2. Post-synaptic receptor block
  3. Local anesthetic like (inhibit axon AP propagation)
113
Q

How can antibiotics and NM blockade be reversed?

A

Calcium

Neostigmine

114
Q

Which drug does not reverse NM blockade with antibiotics

115
Q

Some general adverse effects of antibiotics?

A

Reasons to be conservative with antibiotic use
Allergic and allergic-like rxns
Effect on normal flora
Resistance

116
Q

What if pt has penicillin allergy?

A

Avoid agents with similar side chain

-penicillins, cefaclor, cefadroxil, cefatrizine, cefprozil, cephalexin, cephradine

117
Q

Which drug does impact oral contraceptive

A

Rifampin does induce estrogen metabolism that leads to increase clearance

118
Q

What to avoid if patient is pregnant?

A
  • TMP/SMX in 3rd trimester
  • doxycycline during all trimester
  • quinolones during all trimester
119
Q

Is metronidazole anaerobic or aerobic?

120
Q

What does mupirocin do?

A

Inhibits tRNA synthetase

121
Q

3 concerns with ALL antibiotics

A
  1. Hypersensitivity rxn
  2. Effect on normal flora
  3. Resistance
122
Q

Penicillin:
- or +
Anaerobic or aerobic

A

-/+

Anaerobic

122
Q

Piperacillin/tazobactam/sulbactam:
- or +
Anaerobic or aerobic

A

-

Anaerobic

122
Q

What is piperacillin?

A

Antipseudomonal penicillin

122
Q

What is the combo of tazobactam?

A

Piperacillin and tazobactam

122
Q

What is the combo of sulbactam?

A

Ampicillin and sulbactam

122
Q

What is Doripenem?

A

Resistant to beta lactamase

123
Q

Doripenem:
- or +
Anaerobic or aerobic

A

-/+

Anaerobic

124
Q

Cefazolin:
- or +
Anaerobic or aerobic

A

-/+

Anaerobic

125
Q

Cefotetan:
- or +
Anaerobic or aerobic

A

Increasing -

Anaerobic

126
Q

Ceftiaxone:
- or +
Anaerobic or aerobic

A

Decreasing + and increasing -

Anaerobic

127
Q

Gentamicin:
- or +
Anaerobic or aerobic

128
Q

Tobramycin:
- or +
Anaerobic or aerobic

129
Q

Erythromycin:

- or +

130
Q

Tetracycline and Doxycline:

- or +

131
Q

Clindamycin:

Anaerobic or aerobic

132
Q

Linezolid:
- or +
Anaerobic or aerobic

A

+

Anaerobic

133
Q

MOA of metronidazole?

A

Nitro radical anion targets DNA

134
Q

Metronidazole:

Anaerobic or aerobic

135
Q

Mupirocin:

- or +

Pharmacology (14 decks)

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