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Joshua's Path > Antibiotics, Antivirals & Antifungals > Flashcards

Antibiotics, Antivirals & Antifungals Flashcards

1
Q

Amoxicillin active against

A

gram positive

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2
Q

macrolides active against

A

gram positive - e.g erythromycin

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3
Q

cell wall inhibitors

A

FAPP CCTV

Flucloxacillin
amoxacillin
penicillin
piperacillin
cephalosprins
carbapenams
teicoplanin (glycopeptide)
vancomycin (glycopeptide)
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4
Q

Protein synthesis inhibitors

A

COMAT

chloramphenicol
oxazolidinones - linezolid
Macrolides - erythromycin
Aminoglycosides - gent
Tetracyclines (cant use in kids)
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5
Q

Inhibitors of DNA synthesis

A

F -aNaerobes
Fluoroquinolones (gram neg)
Nitroamidazoles - anaerobes

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6
Q

Inhibitors of RNA synthesis

A

Rifamycins

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7
Q

cell membrane toxins

A

polymixins - colistin

cyclic lipopeptides - daptomycin

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8
Q

inhibit folate metabolism

A

sulphonamides
diaminopyrimidines

cant use in first trimester due to fears of neural tube defects

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9
Q

do all

A

nitrofurans

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10
Q

an antiviral which can be used in aerosol form to prevent respiratory syncytial virus in children with heart and lung disease

A

ribavirin

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11
Q

What drug is used to prevent verticle transmission of HIV during pregnancy

A

Normal ART for the pregnant woman whether she was on treatment beforehand or not.

Viral load should be tested at 36 weeks.

If viral load is below 50 vaginal birth may continue and the baby should be given zidovudine for 4-6 weeks.

if viral load is above 50, c section with 4 hour previous zidovudine infusion, and baby recieves triple therapy for 4-6 weeks

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12
Q

Tretment for influenza

A

oseltamivir

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13
Q

describe the metabolism of acyclovir

A

uses viral thymidine kinase to make monophosphate, then cells enzymes to di and tri phosphate which is the active compnent and inhibits viral DNA polymerase

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14
Q

CMV treatment

A

ganciclovir

PERCH - owls eyes inclusions

Pneumonitis
Encephalitis
Retinitis
Colitis
Hepatitis
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15
Q

CMV symptoms and treatment

A

ganciclovir

PERCH - owls eyes inclusions

Pneumonitis
Encephalitis
Retinitis
Colitis
Hepatitis
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16
Q

valacyclovir uses

A

HSV VZV

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17
Q

A drug that is effective against influenza A but not influenza B

A

amantadine

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18
Q

Treatment for resistant or sever HSV

A

foscarnet or cidofovir

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19
Q

The drug which can be delivered by inhalation to treat both influenza A and B.

A

Zanamivir - neuraminidase inhibitor

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20
Q

Treatment of an 18 year old with Meningitis.

A

ceftriaxone

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21
Q

A 12 yr old boy requests treatment for widespread impetigo. He developed an urticarial rash 3 yrs ago when he was given penicillin V

A

erythromycin

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22
Q

Patient with an abdominal collection that contains gram –ve anaerobes.

A

metronidazole

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23
Q

56 year old male with endocarditis caused by VRE.

A

linezolid - is an oxazolidinone and is used in Vancomysin resistant enterococcus and MRSA positive. s primarily active against gram +ve

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24
Q

Severe systemic infection before cause has been identified

A

cefuroxime

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25
Q

legionella treatment

A

erythromycin - although macrolides typically have a gram positive action, they are first line in treating legionaires. fluoroquinolones are also useful.

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26
Q

treatment for sepsis, sever CAP, or HAP

A

cefuroxime -
may add clarythromycin to sever CAP
may add met and gent to severe sepsis

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27
Q

optochin sensitive and alpha haemolytic

A

strep pneumon. (viridans is also alpha haemolytic but optochin resistant)

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28
Q

what are tetracyclines good for?

A

intracellular pathogens

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29
Q

Name 5 classes of antifungal

A 
PATFE
Polyenes
Azoles
Turbinofene
Flucytosine
Echinocandin
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30
Q

Name a polyene and their mechanism of action

A

Amphoteracin targets cell membrane integrity

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31
Q

Name yeast targetting antifungals

A

amphoteracin
fluconazole
caspofungin

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32
Q

name an echinocandin

A

caspofungin

33
Q

name an azole

A

fluconazole or ketoconazole

34
Q

name mould targetting antifungals

A

terbinafine - dermatophyte infections

35
Q

what does flucytosine target

A

DNA synthesis

36
Q

which antifungal do you use to treat cryptococcal meningitis

A

amphotericin

37
Q

What colour is gram negative

A

pink

38
Q

what colour is gramm positive

A

purple - staining of the thick peptidoglycan layer

39
Q

what bacteria does not show up on gramm stain

A

mycoplasma

40
Q

Antibiotics which are concentration dependent

A

Aminoglycosides - dependant on the height of the peak to kill. often given once per day and then trough level measured. dose delayed if trough is too high. if peak is not high enough change the dose.

41
Q

describe the action of the cephalosporins

A

Cell wall inhibitors with an increasing action on gram negatives as the generations progress. Designed to be stable against beta lactamases. however now there are extended spectrum beta lactamases to break this down. (enzymatic inactivation)

1st GEn Cephalexin
2nd gen Cefuroxime
3rd gen Cefotaxime, Ceftriaxone. Ceftazidine
Ceftazidime - has antipseudomonal activity but no gram positive

42
Q

What are the beta lactams and what do they do

A

include penicillins, cephalosporins and carbapenams and monobactams. inhibit transpeptidase actions and only act on dividing bacteria(eagle effect) . This makes them inactive in scenarios like sequestred osteomyelitis. grandaughter cells are what break.

43
Q

what is penicillin active against

A

typically streptococci and clostridia, but broken down by the beta lactamases in staph. - use fluclox.

44
Q

what is amoxicillin active against

A

broad spectrum extending to enterococcus and other negatives. Many are resistant and so adding clavulanic acid makes it stable to these.

45
Q

what is the profile of flucloxacillin.

A

gram positive similar to penicillin except is stable to beta lactamase produced by staph aureus.

Staph aureus is now showing resistance to this (MRSA) by altering the binding site

46
Q

What is the profile of pipericillin.

A

Similar to amoxillin but with additional pseudomonal coverage. broken down by beta lactamases so is added to tazobactam

47
Q

What is the main difference between the efficacy of amoxicillin and cephalosporins?

A

ceph has less activity against anaerobes and so is often added to a nitroamidazole.

48
Q

C dif is associated with which drugs in particular?

A

ceftriaxone

co-amoxyclav

49
Q

What is the action of carbapenams? Name 3.

A

designed to treat ESBLs.
meropenam
imipenam
ertapenem

50
Q

name 2 common carbapenamases

A

Klebsiella and acinetobacter

51
Q

why are glycopeptides useless against gram negatives?

A

Very large molecule that cant penetrate the outer membrane of gram negatives.

52
Q

What unit do aminoglycosides work at?

A

30s ribosomal subunit

53
Q

What is the activity of aminoglycosides? Name 3.

A

Are broad spectrum, but they have no activity against anaerobes. They do have good anti pseudomonal properties though.

Gentamicin
Amikacin
Tobramycin

54
Q

why dont antibiotics work in abcesses

A

dont work very well at a low PH. aminoglycosides particularly

55
Q

What is the profile of tetracyclines? what is their down side?

A

Have broad spectrum activity but particularly effective against intracellular pathogens.

There is wide resistance and its action is only bacteriostatic.
they often cuase a light sentive rash and cannot be used in children due to bone staining.

56
Q

Protein synthesis inhibitors: macrolides, tetracyclines, and chloramphenicol are what?

A

bacteriostatic

57
Q

What is the profile of macrolides?

A

act on the 50s subunit

Their action is against gram positives, however clarythromycin and azithromycin have some negative action.
Ertyhromycin is only positive

They are good at treating intracellular pathogens such as campylobacter and legionella.

58
Q

What are the main uses of chloramphenicol?

A

Eye drops and Meningitis in cephalosporin anaphylactics.

Binds to the 50s subunit also.

59
Q

What are the side effects of chloramphenicol?

A

Can cause aplastic anaemia and grey baby syndrome.

60
Q

What is the use of oxazalidenones?

A

Linezolid - used for Vancomycin resistant enterococcus and MRSA. they have good action against gram positives.

They can cause optic neuritis and thrombocytopenia.

61
Q

What is the action of fluoroquinolones? Name 3.

A 
Ciprofloxacin (broad)
         ^
Levofloxacin (minimal -ve activity)
         ^
Moxifloxacin (positive only)

They inhibit DNA gyrase. They have some use in UTI and now pneumonias to to increased grmm positive activity.

They have no effect against anaerobes.

62
Q

What are nitroamidzoles active aginst?

A

strict anaerobes only by breaking down bacteria DNA.

63
Q

What are the rifamycins used for?

A

Mycobacteria and chlamydiae.

Dna dependant RNA polymerase - inhibiting initiation of protein synthesis.

Side effects include interfering with INR, and turns secretions orange.

64
Q

What is daptomycin used for? what is its pitfall?

A

treating MRSA and VRE with few other treatment options.

It is broken down by surfactant so cannot be used in respiratory disease.

65
Q

What is collistin used for?

A

Active against gram negatives. is nephrotoxic and used fro drug resitant negatives such as pseudomonas, acinetobacter, klebsiella.

66
Q

co-trimoxzalole use?

A

PCP pneumonia.

trimethoprim - UTI against staph and e.coli.

Has haem side effects

67
Q

What are the 4 mechanisms of resistance to antibiotics?

A

BEAT

Bypass step
Enzymatic deactivation
Accumulation of antibiotic reduced
Target site alteration

68
Q

Exapmle of enzymeatic inactivation

A

beta lactamases - beta lactams

69
Q

Example of target site alteration

A

mecA gene involves a change in the PBP recepter (2a)

requires lethal concentrations of beta lactam

shown in strep pneumoniae

70
Q

Where do beta lactams not penetrate?

A

csf

71
Q

By what mechanism are ESBL’s resistant to cephalosporins?

A

Enzymatic inactivation.

72
Q

What drugs have concentration dependant action?

A

aminoglycosides - gent, amikacin, tobramycin

Measure trough level to ensure being removed, and not giving too frequently.

Measure the peak to ensure high enough to kill. can adjust dose

73
Q

What drugs are dependant on their time spent above the minimum inhibitory concentration.

A

penicillins. erythromycin

74
Q

What drugs require an area under the curve? time AND concentration effects?

A

Vancomycin, azithromycin

75
Q

How long should treatment last in endocarditis

A

4-6 weeks

76
Q

how long should the treatment last in osteomyelitis

A

6 weeks

77
Q

group A strep pharyngitis treatment length

A

10 days - ben pen - rheumatic fever and glomerulonephritis

78
Q

When is IVig used?

A

big severe infection where debridement is necessary

79
Q

What antibiotic should be added if listeria is suspected, and in what demographics i this used?

A

amoxicillin

very young under 3 months, or old over 65 or pregnant.

Joshua's Path (9 decks)

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