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Pharmacology > Antibiotics podcast done > Flashcards

Antibiotics podcast done Flashcards

1
Q

What are some adverse effects from Gentamicin?

A
  • Nephrotoxicity
  • Ototoxicity (8th cranial nerve - irreversible vestibular and auditory toxicity)
  • neuromuscular paralysis
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2
Q

Inhibitors of bacterial protein synthesis….. (3)

A

tetracyclines

macrolides

aminoglycosides

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3
Q

What are the narrow-spectrum penicillins?

A

Penicillin G

Penicillin V

flucloxacillin

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4
Q

Name the six classes of bacteriostatic antibiotics

A
  • Tetracyclines
  • Sulphonamides
  • Macrolides
  • Chloramphenicol
  • Trimethoprim
  • Spectinomycin
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5
Q

Definition of pharmacodynamics

A

The study of the mechanism of action by which drugs produce their pharmacologic effects.

The effect of the drugs on the body.

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6
Q

For women, what must you always ask?

A

Date of last menstrual bleed

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7
Q

Which penicillin can great Staphylococcus aureus?

A

flucloxacillin has activity against beta-lactamase-producing organisms such as Staphylococcus aureus as it is beta-lactamase stable

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8
Q

IMPORTANT

Which drug groups (according to modus operandi) are bacteriocidal?

A

Those that target :

Cell Wall (van, pen, ceph)

or

Cell membrane (aminoglyc, polymyx)

or

DNA synthesis (metro, f/quin)

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9
Q

What are the four basic stages of pharmacokinetics?

A

Absorption
Distribution
Metabolism
Elimination

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10
Q

What do these drugs have in common?

(CPACMAN)

Grapefruit

Protease inhibitors

Azole antifungles

Cimetidine

Macrolides (Except Azithromycin)

Amiodarone

Non-DHP CCBs (diltiazem and verapamil)

A

Inhibitors of some enzymes of cytochrome P450 pathway.

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11
Q

What does the Volume of Distribution help predict?

A

Whether the drug will be concentrated in the blood plasma (eg. with albumin), or within the tissues.

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12
Q

Why are bactericidal drugs more favourable than bacteriostatic?

A
  • a faster microbiological response
  • less likely to elicit microbial resistance
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13
Q

What three mechanisms do bacteria exert resistance to Beta-lactam antibiotics?

A
  • inactivation of drug by Beta-lactamase enyzmes (main cause)
  • reduced affinty of PBP for the antibiotics
  • decreased entry od drugs into bacteria through outer membrane porins.
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14
Q

What protein in the blood would slow down the distribution process of a drug?

A

albumin

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15
Q

What is pharmacokinetics?

A

the study of drug disposition in the body. It focuses on the changes in drug plasma concentration.

Plasma concentration will change according to absorption, distribution and elimination.

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16
Q

why do bacterial protein synthesis inhibitors work?

A

due to differences in structure and function of ribosomes in prokaryotic and eukaryotic cells.

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17
Q

What kind of drug is gentamicin?

A

aminoglycoside

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18
Q

What is special about haemophilus influenzae and Moraxella catarrhalis?

A

These bacteria produce pencillinase , they need clavulanate combination.

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19
Q

Distribution of drug in the body depends on four main factors.

The first is blood flow, what are the others?

A

Lipophilicity (is the drug lipid soluble?)

Capillary permeability (Liver is more permeable than brain, so drug goes to Liver)

Plasma and Tissue Binding (albumin)

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20
Q

What is vancomycin used for?

+ what happens if >> infusion rate?

A

MRSA (rem. staphlococcus) - given orally.

Adminstered parenterally to treat systemic infections.

>>> infusion rate = hypotension, erythematous rash on face/ upper body “red man syndrome”

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21
Q

How do macrolide antibiotics work?

A

Inhibit bacterial protein synthesis

(affect the 50s ribosomal subunit)

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22
Q

What is special about gram -ve bacteria and penicillins?

A

they are innately resistant to pencillins because if impermeable porins in outer membrane

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23
Q

Folate synthesis inhibitors (2)

A
  • sulfanomides
  • trimethoprim
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24
Q

There are two groups that are bacteriostatic and inhibitor folate synthesis. One group is sulfanomides, what’s the other drug?

A

Trimethoprim

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25
Q

What are the extended-spectrum penicillins?

A

amoxicillin

ampicillin

piperacillin

ticarcillin

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26
Q

what is Ceftazidime?

Kef- ta -zid -i -me

A

cephalosporin antibiotic, used in hospitals.

Cephalosporins

-antibacterials. interrupt cell wall biosynthesis

Used for pseudomonas aeruginosa

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27
Q

both tetracyclines and macrolides affect bacterial protein synthesis. Which is other main group that also affects protein synthesis?

A

Aminoglycoside (eg. streptomycin, gentamicin)

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28
Q

What is efficacy of a drug?

A

The ability of a drug to initiate a cellular effect. Also called instrinsic activity. NOT directly related to receptor affinity.

a full agonist has maximal efficacy, partial agonists will never have the same efficacy as full agonist.

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29
Q

way aren’t tetracyclines very popular?

A
  • because they are bacteriostatic.
  • increased resistance.
  • can cause discolouration of teeth if used by pregnant women or children under eight years old.
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30
Q

Groups of antibiotics that are bacterial cell wall inhibitors (4)

A
  • penicillins
  • Cephalosporins
  • monobactam
  • others; vancomycin, fosfomycin
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31
Q

What is the main use for flucloxacillin?

A

It’s not inactivated by penicillinases, and thus effective in infections caused by penicillin-resistant staphylococci.

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32
Q

Metronidazole

(nitroimidazole compound)

A

active against anerobic protozoa.

Also some anerobic bacteria; H.pylori, C. difficle

Drug of choice for amebiasis, giardiasis, trichomoniasis

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33
Q

Definition of pharmacokinetics

A

How the body affects the drug

34
Q

What is pharmacodynamics?

A

this is the study of the detailed mechanism of action by which drugs produce their pharmacologic effects.

35
Q

Extended-spectrum penicillins are be subdivided into two groups, what are they?

A
  1. aminopenicillins (amoxcillin and ampicillin)
  2. antipseudomonal penicillins (piperacillin, ticarcillin)
36
Q

How do macrolides work?

A

inhibit protein synthesis

37
Q

what is the most serious adverse effect of aminoglycosides? (2)

A

nephrotoxicity

ototoxicity

(most common cause of drug-induced renal failure)

rem. gentamicin, neomycin, stephomycin

38
Q

What do these have in common?

Phenytoin

Carbamazepine

Rifampin

Alcohol (Chronic)

Barbiturates

St. John’s Wort

PCRABS

A

Inducers of some of the main enzymes in Phase I cytochrome P450 reactions.

39
Q

What can amoxicillin treat on its own?

A
  • upper respiratory tract infections
  • community-acquired pneumonia
40
Q

What is potency?

A

a characteristic of drug action useful for comparing different pharmacologic agents.

41
Q

what does MRSA stand for?

A

methicillin resistant Staphylococcus aureus

42
Q

tetraycline cause teeth discolouration. What is another important adverse effect?

A

phototoxicity; need to be careful when sunbathing.

(safe after 18 weeks gestation)

43
Q

What are common side effects of penicillins?

A

nausea, vomiting, diarrhoea

44
Q

what is Gentamicin used for?

A

drug of choice for serious infections, eg. endocarditis, septicaemia, meningitis

45
Q

Why aren’t cephalosporins routinally administered for chest infections?

A

Permit overgrowth of Clostrium difficile, and they alter normal flora in the gut (also the quinolones)

Also… insufficient activity against haemophilus influenzae

46
Q

What is doxycycline example of?

A

Doxycycline is a broad-spectrum antibiotic of the tetracycline class.

47
Q

Which penicillins are anti-pseudomonal?

A

piperacillin/ tazabactum

ticarcillin/ clavulanic acid

48
Q

Vancomycin belongs to which group?

and how do they work?

A

Glycopeptides

Inhibit bacterial cell wall synthesis

49
Q

Which drugs target gram -ve?

A

Aminoglycosides

(eg. gentamicin)

Carbapenems

50
Q

What are the Five Rights?

A

Right Patient

Right Drug

Right Time

Right Dose

Right Route

51
Q

How are penicillins and Cephalosporins eliminated?

A

via the kidneys

52
Q

Piperacillin and Ticarcillin belong to which class of penicillins?

A

antipseudomonal

53
Q

There are THREE narrow spectrum penicillins, what are they?

A

Penicillin G (Benzylpenicillin)

Pen V (Phenoxymethylpenicillin)

Flucloxacillin

Unlike other penicillins, flucloxacillin has activity against beta-lactamase-producing organisms such as Staphylococcus aureus

54
Q

What drug would you use for serious infections? Endocarditis, septicaemia, meningitis?

A

Gentamicin

55
Q

What four subgroup of antibiotics share the Beta-lactam structural ring?

(these antibiotics affect cell wall synthesis)

A

Penicillins

Cephalosporins (described by generations eg. 4th gen Cefepime)

Carbapenems

Monobactams

56
Q

What can be used to treat (some strains of) pseudomonas aeruginosa?

A

antipseudomonal penicillins (eg. piperacillin)

57
Q

Name some macrolides

A

Clarithromycin

Erthromycin

Azithromycin

Telithromycin

58
Q

Quinolones/ floroquinolones. bacteriostatic or cidal?

A

Bacteriocidal… they are inhibitors of DNA gyrase.

59
Q

Gram +ve is the largest group of bacteria, give some examples.

A

Staphylococcus

Stephtococcus

Clostridium

Enterococus

Listeria

60
Q

Both these groups are inhibitors of bacterial protein synthesis, but they are different. WHY?

aminoglycosides

(eg. gentamycin)

tetracyclines

A

tetracyclines are bacteriostatic because reactions with bacteria are reversible.

61
Q

How do tetracycline antibiotics work?

A

Inhibitor of bacterial protein synthesis

(30s Ribosome subunit)

62
Q

What four things can antimicrobial drugs target?

A
  • inhibiton of cell wall synthesis
  • disruption of cell membrane function
  • inhibition of nucleic acid synthesis
  • inhibition of protein synthesis
  • RNA synthesis
63
Q

name some groups of drugs that are bacteriostatic

A

Sulfonamides (block the synthesis of folic acid which is a cofactor for enzymes that synthesize DNA components and amino acids)

tetracyclines (because they reversibly inhibit bacterial protein synthesis)

64
Q

What is flucloxacillin? And what makes it special?

A

Flucloxacillin is a narrow-spectrum beta-lactam antibiotic of the penicillin class.

It is used to treat infections caused by susceptible Gram-positive bacteria.

Unlike other penicillins, flucloxacillin has activity against beta-lactamase-producing organisms such as Staphylococcus aureus (not MRSA though)

65
Q

Name the six classes that are bacteriocidal

A

All the b-lactam group

(penicilliins, cephalosporins, monobactams, carbapenems)

glycopeptides (vancomycin)

fluoroqinolones (ciprofloxacin)

66
Q

Give some examples of gram -ve bacteria

A

E. Coli

Pseudomonas aeruginosa

N. gonorrhoea

chlamydia

67
Q

What drug would treat chlamydia?

A

tetracycline

68
Q

Name THREE broad spectrum penicillins

A

Amoxicillin/ co-amoxiclav

ampicillin

piperacillin with Tazobactam (Tazocin)

69
Q

What are the mechanisms of antibiotics? (6)

A
  • inhibit cell wall synthesis
  • inhibit cell membrane synthesis
  • inhibit protein synthesis
  • inhibit folate synthesis
  • inhibit RNA polymerase
  • inhibit DNA gyrase
70
Q

Trimethoprim

moa, indications, side effects

A

Antifolate drug.

Weak base that concentrates in acidic prostate tissues and vaginal fluids via ion trapping.

Often used for UTI.

SD: nausa, vomiting, epigastric distress, rashes, hepatitis, thrombocytopenia, leukopenia.

71
Q

Ciprofloxacin

A

Fluoroquinolone group

Effective for many gram -ve bacteria.

Used to treat anthrax - postexposure prophylaxis of inhalational anthrax.

serious adverse effects; tendonitis and tendon rupture.

alters blood glucose, phototoxicity, prolongation of QT interval

Contraindicated; children, adolescents, pregnant and lactating women.

72
Q

What is fluconazole?

A

Anti-fungal. Azole derivative

excreted in the urine, therefore can treat vaginal candidiasis

73
Q

What is metronidazole used for?

A

Metronidazole is used to treat a wide variety of infections caused by anaerobic bacteria and protozoa.

Metronidazole is commonly prescribed to treat an infection called bacterial vaginosis. It is also prescribed before gynaecological surgery and surgery on the intestines to prevent infection from developing. It can safely be taken by people who are allergic to penicillin.

Metronidazole is also used to get rid of Helicobacter pylori.

Metronidazole is available as a skin preparation also.

First episode of C. diff

74
Q

clarithromycin

A

macrolide

alternative to penicillin

indicated for chest infections, cellulitis, ear infections, H. pylori

75
Q

what macrolide is indicated for acne?

A

erthromycin

(if tetracyclines not effective - doxycycline)

76
Q

What are the characteristics of aminoglycosides, and give some examples.

A

Gentamicin, Tobramycin (very good for pseudomonas aeruginosa), streptomycin, neomycin (very nephrotoxic).

Bactericidal - interfer with protein synthesis.

Generally poorly absorbed from the gut, and thus adminstered parenterally.

They are not metabolised, they are excreted primarily by the renal glomerular filtration.

Dosage must be reduced in patients with renal impairment because clearance is proportional to GFR (and creatinine excretion)

Active against wide range of aerobic gram-negative bacilli.

Most important side effects; nephrotoxicity and ototoxicity. Aminoglycosides are one of the most common causes of drug-induced renal failure. They can cause acute tubular necrosis.

Ototoxicity; can be both vesicular and cochlear toxicity. Often there is a delay between drug adminstration and onset of symptoms, px may have left the hospital.

77
Q

What are the symptoms of vestibular toxicity that maybe associated with aminoglycosides?

A

dizziness, impaired vision, nystagmus, vertigo, nausea, vomiting, problems with postural balance and walking.

78
Q

What are the symptoms of cochlear toxicity that maybe associated with aminoglycosides?

A

tinnitus, hearing impairment, irreversible deafness.

79
Q

Some facts about cephalosporins

A

Third gen Ceftazidime (IV) is good for pseudomonas (HAP), 2nd gen cefuroxime can be used for CAP.

B-lactam group. 10% of px allergic to pencillin will be hypersenitive.

Renally excreted; dose reduction with renal impairment.

Can cause pseudomembranous colitis (swelling or inflammation of the large intestine) due to an overgrowth of Clostridium difficile.

80
Q

Which antiobiotics are good for C. difficile?

A

metronizaole

and

vancomycin (could put in NG tube if px very unwell)

Pharmacology (13 decks)

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