Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Week 2&3 FCP > Antibiotics and Antimicrobial Resistance > Flashcards

Antibiotics and Antimicrobial Resistance Flashcards

1
Q

What is antimicrobial stewardship

A

Coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What questions should you ask when deciding to use antimicrobials

A

Is there good evidence of a bacterial infection?
What diagnostics will you employ that help decision-making?
When are cultures (and sensitivity used) used?
If you make the choice to use what drives your final choice of antibiotic?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is critically important antibiotic (CIA)

A

Last line resorts for human medicines - very bad if any resistance builds up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the different ‘lines’ of antibiotics

A

Primary (1st line)
Secondary (2nd line)
Tertiary (3rd line)
Restricted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which line of antibiotics should you reach for first, and how to approach using the other lines

A

Primary
To use secondary - justify why didn’t use primary
To use tertiary - need C&S and justification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why are some antibiotics restricted in animals

A

Critical in human medicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give some examples of primary (1st line) antibiotics (x6)

A

Penicillins
1st generation cephalosporins
Amoxy/clav
Tetracyclines
TMPS (Trimethoprim/sulfonamide)
Lincosamides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give some examples of broad (x1) and narrow (x2) spectrum secondary (2nd line) antibiotics

A

Broad
- Chloramphenicol
Narrow
- Aminoglycosides
- Metronidazole
- Macrolides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name 2 secondary (2nd line) antibiotics which are critically important

A

Fluoroquinolones
Cefovecin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name some tertiary (3rd line) antibiotics

A

3rd and 4th gen cephalosporins
Rifampicin
Fosfomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name the steps in the 7-point plan for the responsible use of antimicrobials

A
  1. Work with clients to avoid the need for antimicrobials
  2. Avoid inappropriate use
  3. Choose the right drug for the right bug
  4. Monitor antimicrobial sensitivity - C&S
  5. Minimise use
  6. Record and justify deviations from protocols
  7. Report suspected treatment failure to the VMD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name 4 ways to work with clients to avoid the need for antimicrobials (step 1 in the 7-point plan)

A

Regular health checks
Use symptomatic relief or topical treatment where appropriate
Isolate infected animals where possible
Keep animals healthy - vaccinations, good diet, good practices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name 4 ways to avoid inappropriate use of antibiotics (step 2 in the 7-point plan)

A

Avoid using them when not needed - viral infections
Restrict use to animals who are unwell or at risk
Advise clients on correct use
Avoid underdosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name 3 ways to choose the right drug for the right bug (step 3 in the 7-point plan)

A

Identify target organisms
Use narrow-spectrum where possible
Understand how antimicrobials work and their pharmacodynamic properties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name 2 ways to monitor antimicrobial sensitivity (step 4 in the 7-point plan)

A

Culture and sensitivity where you can
If C&S is not possible - empirical antibiotic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name 3 ways to minimise use of antimicrobials (step 5 in the 7-point plan)

A

Use only when necessary
Assess use and develop protocols
Use alongside aseptic techniques and guidelines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Name 2 ways to record and justify deviations from protocols (step 6 in the 7-point plan)

A

Justify choice - especially when using secondary or tertiary line antimicrobials
Keep accurate records

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why do we report suspected treatment failure to the VMD (step 7 in the 7-point plan)

A

It may be the first indicator of resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does PROTECT ME stand for

A

Prescribe only when necessary
Reduce prophylaxis
Offer other options
Treat effectively
Employ narrow spectrum
Culture appropriately
Taylor practice policy
Monitor
Educate others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What 6 factors can influence choice of antimicrobials

A

Principals of treatment
Cost/client
Food producing animals
Empirical selection
Pharmacodynamic considerations
Other factors - risk of drug class

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name the 2 spectrums of antibiotics

A

Narrow spectrum - targets a narrow group of bacteria (gram +ve or -ve)
Broad spectrum - targets gram +ve and -ve bacteria, will have more impact on other bacteria in the host so more likely to cause a bad reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the difference between bacteriocidal and bacteriostatic antibiotics and give examples

A

Bacteriocidal - Kills the organism e.g. penicillin, cephalosporins
Bacteriostatic - temporarily inhibit the growth of an organism (reversible if removed) e.g. tetracyclines, chloramphenicol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If a patient is immunocompromised, should you use bacteriocidal or bacteriostatic antibiotics

A

Bacteriocidal
Bacteriostatic require the hosts immune system to remove the bacteria, so if immunocompromised this is not ideal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does MIC stand for and what is its definition

A

MIC = minimum inhibitory concentration
The concentration required at the site of infection to achieve bacterial inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What does MBC stand for and what is its definition

A

MBC = minimum bactericidal concentration
The concentration required at the site of infection to kill the bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Name the 7 main targets of action for antibiotics

A

Cell wall targeting
Inhibition of cell wall synthesis
Inhibition of protein synthesis
Inhibition of cell membrane function
Disruption of DNA structure
Inhibition of DNA dependent RNA polymerase
Interfering with other pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why is peptidoglycan a good target for antimicrobials

A

It is unique to bacterial cell walls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Name the 4 groups of antibiotics which target the cell wall

A

Beta lactams
Peptide antibiotics
Bacitracin
Teixobactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do beta lactams target the cell wall and give some examples

A

Inhibit the transpeptidase penicillin-binding protein (PBP) which stops peptide links from forming in the cell wall
Examples:
- Penicillins
- Cephalosporins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How do peptide antibiotics target the cell wall and give some examples

A

Directly interact with the cell wall D-Ala-D-Ala section which prevents the synthesis of the NAG/MAM polymers
Examples:
- Vancomycin - CIA protected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Give some examples of antibiotics which work by inhibiting protein synthesis

A

Aminoglycosides
Tetracyclines
Clindamycin

32
Q

How do antibiotics commonly inhibit protein synthesis

A

Target ribosomes and bind specific proteins meaning proteins cannot be synthesised

33
Q

Give an example of an antibiotic which targets RNA synthesis

A

Rifampicin

34
Q

How do Sulphonamides/Trimethoprim (TMPS) affect the DNA

A

Competitive inhibitors of the enzyme dihydropteroate synthetase
Inhibits the synthesis of dihydrofolate which is required for DNA synthesis

35
Q

How do Quinolones and Novobiocin affect the DNA

A

Bind to and stop DNA gyros
Inhibits supercoiling of the chromosome
Disrupts DNA-associated processes

36
Q

How do nitroimidazoles affect the DNA

A

The reduction products of this group are reactive with DNA which damaged the DNA
Causes DNA strands to break

37
Q

What conditions do aminoglycosides not work well in and why

A

Anaerobic conditions
They require aerobic respiration to enter the cell

38
Q

What conditions do nitroimidazoles require

A

Anaerobic conditions
They need to be reduced by anaerobic bacteria to be metabolised into their active form

39
Q

Give 2 examples of aminoglycosides

A

Streptomycin
Neomycin

40
Q

Give 2 examples of tetracyclines

A

Oxytetracycline
Doxycycline

41
Q

Name 3 reasons you may use a combination of antibiotics

A
  1. Treating mixed bacterial infections
  2. Achieving synergistic antimicrobial activity against resistant strains
  3. To reduce risk or overcome bacterial resistance
42
Q

Why might you use a combination of penicillins and aminoglycosides

A

Penicillins have good anaerobic coverage
Aminoglycosides have a good effect on gram negatives

43
Q

What action do B-lactams have which is useful when using other antibiotics

A

Facilitate movement of other drugs through the damages cell wall => the microbe

44
Q

What action does Clavulanic acid have which aids penicillin

A

Prevents B-lactamase destruction of penicillin

45
Q

Name 5 reasons that antibiotic treatment can fail

A
  1. Unjustified therapy - a viral infection
  2. Poor selection
  3. Wrong dose/ regimen
  4. Suppressed host response
  5. Resistance
46
Q

Name 3 ways resistance to antimicrobials can be assessed

A
  1. Liquid culture MIC minimum inhibitory concentration) determination
  2. Disk diffusion (Kirby-Bauer) - diameter of zone inhibition for a genus os matched to a breakpoint for MIC
  3. Detection of known resistance genes or mutations
47
Q

By which value is resistance defined

A

Clinical breakpoint values

48
Q

How are clinical breakpoints related to MIC

A

If MIC is less than X, then it is scored as sensitive
If MIC is more than X, the scored as resistant

49
Q

Why are you at risk of bacterial resistance if you are below the MIC

A

The susceptible bacteria may survive but grow slower / less well compared to the resistant.
So the resistant bacteria slowly take over.

50
Q

What is the MSC and what does it mean

A

MSC= minimum selective concentration
It is the concentration at which there is no therapeutic effect but there is still a selective advantage to being resistant or susceptible.

51
Q

Why is a long MSC window bad

A

Can lead to increased resistance

52
Q

Define intrinsic resistance

A

An innate ability to resist the activity of a particular antimicrobial agent through inherent structural or functional characteristics which allow a tolerance of the drug

53
Q

Define acquired resistance

A

When a microorganism obtains the ability to resist the activity of a drug.
Can be a mutation or new gene acquisition.

54
Q

Give 3 examples of intrinsic resistance

A
  1. Poor permeability due to the outer membrane
  2. Target different to the other genera
  3. Lack the target e.g. mycoplasma have no cell wall so any drugs targeting cell wall will not affect them
55
Q

Give 3 ways in which a bacteria can have acquired resistance

A
  1. Gene mutation
  2. Gene acquisition
  3. Co-resistance
56
Q

Give an example of a compound which leads to “degradation” of an antibiotic

A

B-lactamases

57
Q

Which bacteria type are B-lactamases found commonly in

A

Staphylococci

58
Q

Name an antibiotic which is resistance to B-lactamase

A

Methicillin

59
Q

How does “efflux” work as an acquired mechanism

A

Efflux systems pump solutes out of a cell
Allow bacteria to regulate their internal environment by removing toxic substances (including antibiotics)

60
Q

Which group of bacteria have the drug efflux mechanism

A

Gram negative

61
Q

Name the 3 major mechanisms of resistance that work against B-lactams

A

Cleavage of B-lactams by B-lactamases
Extended Spectrum Beta-Lactamase (ESBL’s)
Altered penicillin-binding proteins (PBP)

62
Q

Name the 3 major mechanisms of resistance that work against aminoglycosides

A

Efflux
Enzymatic modification
Ribosomal mutations

63
Q

Name the 3 major mechanisms of resistance that work against quinolones

A

Target mutations
Efflux
Modification

64
Q

Name the 2 major mechanisms of resistance that work against glycopeptides

A

Altered cell wall peptides
Efflux

65
Q

Name the major mechanism of resistance that work against tetracyclines

A

Efflux

66
Q

Name the major mechanism of resistance that work against rifamycins

A

Altered mutated RNA polymerase

67
Q

Name the major mechanism of resistance that work against pleuromutilins

A

Mutations in the 23S rRNA genes
ribosomal proteins preventing binding to target

68
Q

Name 3 factors which increase the risk of resistance selection

A

Underdosing
Length of selective level
Presence of resistant bacteria to select

69
Q

What does MDR, XDR and PDR stand for

A

MDR = multiple drug resistance
XDR = extensive drug resistance
PDR = Pan drug resistance (no usable options)

70
Q

What is the mode of action of B-lactam antibiotics

A

Inhibition of cell-wall synthesis

71
Q

What is the mode of action of Aminoglycoside antibiotics

A

Inhibition of protein synthesis

72
Q

What is the mode of action of quinolones antibiotics

A

Inhibition of DNA gyros and supercoiling

73
Q

What is the mode of action of glycopeptide antibiotics

A

Inhibition of cell wall synthesis

74
Q

What is the mode of action of tetracycline antibiotics

A

Inhibition of translation

75
Q

What is the mode of action of rifamycin antibiotics

A

inhibition of transcription

76
Q

What is the mode of action of oxazolidinone antibiotics

A

Inhibition of formation of 70S ribosomal complex

77
Q

What is the mode of action of pleuromutilin antibiotics

A

Inhibition of the of formation of 50S ribosomal complex

Week 2&3 FCP (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions