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Block 2 > antibiotics and pneumonia > Flashcards

antibiotics and pneumonia Flashcards

1
Q

Penicillin types

A

natural penicillin
aminopenicillin
antistaphylococcal penicillin
extended spectrum/ antipseudomonal penicillin

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2
Q

Natural penicillin

A
  • gram pos, susceptible to beta lactamase

- penicillin V used for oral due to resistant to acid hydrolysis

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3
Q

Aminopenicillin

A
  • gram pos and neg, due to more hydrophilic, enter via porins, but not the pseudomonas
  • susceptible to beta lactamase
  • acid stable: amoxicillin, ampicillin
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4
Q

Antistaphylococcal penicillin

A

methicillin, oxacillin, cloxacillin, flucloxacillin
acid stable: oral
bulky side chain make them resistant to staphylococcal beta lactamase
difficult to diffuse across cell membrane, may be less effective

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5
Q

antipseudomonal penicillin

A
  • effective against gram neg and pseudomonas
    acid labile (except carbenicillin)
    carboxypenicillin: ticarcillin and carbenicillin
    ureidopenicillin: piperacillin
    beta lactamase susceptible
    UTI, bacteremia, skin infections
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6
Q

cephalosporin

A

resistant to beta-lactamase

interstitial nephritis, hypersensitivity, neurotoxicity, coagulopathy

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7
Q

1st gen cephalosporin

A

Gram pos, community acquired enterobacter

cefadroxil

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8
Q

2nd gen cephalosporin

A

gram pos, some gram neg

cefuroxime

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9
Q

3rd gen cephalosporin

A

mainly gram neg, less effective against gram pos

ceftriaxone, cefotaxime

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10
Q

4th gen cephalosporin

A

broad spectrum and increase beta lactamase resistance

cefepime

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11
Q

5th gen cephalosporin

A

borad spectrum

ceftaroline

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12
Q

Macrolide- MOA

A
  • bacteriostatic, prototype: erythromycin
  • inhibit the peptidyl tRNA to transfer from acceptor site to donor site (P site) catalysed by peptidyl transferase, by binding to 50s subunit of ribosome
  • next amino-acyl tRNA cannot bind to the A site
  • inhibit protein synthesis
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13
Q

Macrolide- side effects

A
  • GI disturbances due to motilin receptor stimulation
  • high dose erythromycin causes deafness
  • liver toxicity: estolate salt causes cholestatic hepatitis
  • CYP3A4 interaction except azithromycin
  • prolonged QT interval (arrthymia)
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14
Q

erythromycin

A

same as penicillin G, use for allergic patient

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15
Q

clarithromycin

A

similar to erythromycinn
intracellular bacteria: legionella and chlamydia
M. leprae, H. pylori, T. gondii

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16
Q

azithromycin

A

less effective against gram, pos, more against gram neg

17
Q

telithromycin (ketolide)

A

same as azithromycin, but can be against macrolide resistant strains

18
Q

Tetracycline- MOA

A
  • broad spectrum antibiotics
  • bacteriostatic
  • binds to 30s subunit, block the binding of amino acyl tRNA to the A site, no amino acid added to the peptide chain and no transfer of peptide chain to A site, protein synthesis inhibited
19
Q

Doxycycline

A
  • semisynthetic
  • biliary excretion, therefore suitable for renal impaired patients
  • oral, absorption decreases when taken with food or milk
20
Q

Glycylcycline

A
  • derived from tigecycline, IV infusion
  • biliary excretion again
  • multiresistant gram pos, gram neg and anaerobes
  • not against proteus and pseudomonas
  • complicated skin and soft tissue infection and complicated intra-abdominal infections
21
Q

Eravacycline

A
  • fully synthetic, similar to tigecycline (IV)
  • gram pos cocci, gram neg bacilli, anaerobes
  • high extravascular distribution, especially in the lungs
  • low durg-drug interactions
  • complicated intra-abdominal infections, UTI
22
Q

Tetracycline- side effects

A
  • teeth discolouration (preganant, <8)
  • hepatotoxicity (pregnant)
  • photosensitivity
  • local irritation (avoid IM)
23
Q

fluoroquinolones- MOA

A
  • bactericidal, inhibit DNA replication
    DUAL action
  • topoisomerase II/ DNA gyrase: DNA transcription and replications
  • topoisomerase IV: separation of interlocked and replicated DNA
  • oral and parenteral both ok
24
Q

fluoroquinolone- side effect

A
  • peripheral neuropathy
  • tenndon rupture
  • hypersensitivity
25
Q

fluoroquinolone- excretion

A
  • mostly via urine, moxifloxacin via biliary excretio
26
Q

fluoroquiolone- use

A
  • reserve for resistant respiratory tract infections and UTI

- high tissue penetration including the CNS

27
Q

1st gen- nalidixic acid

A
  • UTI, urinary antiseptics, gram neg
28
Q

2nd gen- ciprofloxacin and ofloxacin

A
  • some gram pos and atypical organism

- broad spectrum gram neg

29
Q

3rd gen- levofloxacin

A
  • gram neg, some (expanded) gram pos and atypical organism
30
Q

4th gen- moxifloxacin

A
  • gram neg, gram pos, anaerobe
31
Q

recommended treatment for CAP

A

beta lactam with or without macrolide

Block 2 (25 decks)

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