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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
What are the extended-spectrum penicillins?
**amoxicillin** ampicillin piperacillin ticarcillin
26
what is Ceftazidime? Kef- ta -zid -i -me
cephalosporin antibiotic, used in hospitals. Cephalosporins -antibacterials. interrupt cell wall biosynthesis Used for pseudomonas aeruginosa
27
both **tetracyclines** and **macrolides** affect bacterial protein synthesis. Which is other main group that also affects **protein synthesis**?
**Aminoglycoside** (eg. streptomycin, gentamicin)
28
What is **efficacy of** a drug?
**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.
29
way aren't **tetracyclines** very popular?
* because they are bacteriostatic. * increased resistance. * can cause **discolouration** of teeth if used by **pregnant women or children under eight years old.**
30
Groups of antibiotics that are bacterial cell wall inhibitors (4)
* penicillins * Cephalosporins * monobactam * others; **vancomycin**, fosfomycin
31
What is the main use for **flucloxacillin**?
It's not inactivated by penicillinases, and thus effective in infections caused by **penicillin-resistant staphylococci.**
32
Metronidazole (nitroimidazole compound)
active against **anerobic protozoa.** Also some anerobic bacteria; H.pylori, **C. difficle** Drug of choice for amebiasis, giardiasis, trichomoniasis
33
Definition of pharmacokinetics
How the body affects the drug
34
What is **pharmacodynamics**?
this is the study of the detailed **_mechanism of action_** by which drugs produce their pharmacologic effects.
35
Extended-spectrum penicillins are be subdivided into two groups, what are they?
1. **aminopenicillins** (amoxcillin and ampicillin) 2. **antipseudomonal** penicillins (piperacillin, ticarcillin)
36
How do macrolides work?
inhibit protein synthesis
37
what is the most serious adverse effect of **aminoglycosides**? (2)
nephrotoxicity ototoxicity (most common cause of drug-induced renal failure) rem. gentamicin, neomycin, stephomycin
38
What do these have in common? **P**henytoin **C**arbamazepine **R**ifampin **A**lcohol (Chronic) **B**arbiturates **S**t. John's Wort **PCRABS**
Inducers of some of the main enzymes in Phase I cytochrome P450 reactions.
39
What can amoxicillin treat **on its own?**
* upper respiratory tract infections * community-acquired pneumonia
40
What is potency?
a characteristic of drug action useful for **comparing different pharmacologic agents**.
41
what does MRSA stand for?
methicillin resistant **Staphylococcus aureus**
42
tetraycline cause teeth discolouration. What is another important adverse effect?
phototoxicity; need to be careful when sunbathing. (safe after 18 weeks gestation)
43
What are common side effects of penicillins?
nausea, vomiting, diarrhoea
44
what is Gentamicin used for?
drug of choice for serious infections, eg. endocarditis, septicaemia, meningitis
45
Why aren't cephalosporins routinally administered for chest infections?
Permit overgrowth of Clostrium difficile, and they alter normal flora in the gut (also the quinolones) Also... insufficient activity against **haemophilus influenzae**
46
What is doxycycline example of?
Doxycycline is a **broad-spectrum** antibiotic of the **tetracycline** class.
47
Which **penicillins** are **anti**-**pseudomonal**?
piperacillin/ tazabactum ticarcillin/ clavulanic acid
48
Vancomycin belongs to which group? and how do they work?
Glycopeptides Inhibit bacterial cell wall synthesis
49
Which drugs target gram -ve?
Aminoglycosides (eg. gentamicin) Carbapenems
50
What are the Five Rights?
Right **Patient** Right **Drug** Right **Time** Right **Dose** Right **Route**
51
How are penicillins and Cephalosporins eliminated?
via the kidneys
52
Piperacillin and Ticarcillin belong to which class of penicillins?
antipseudomonal
53
There are THREE narrow spectrum penicillins, what are they?
Penicillin G (Benzylpenicillin) Pen V (Phenoxymethylpenicillin) **Flucloxacillin** **Unlike other penicillins,** flucloxacillin has activity against beta-lactamase-producing organisms such as Staphylococcus aureus
54
What drug would you use for serious infections? Endocarditis, septicaemia, meningitis?
Gentamicin
55
What four subgroup of antibiotics share the Beta-lactam structural ring? (these antibiotics affect cell wall synthesis)
Penicillins Cephalosporins (described by generations eg. 4th gen Cefepime) Carbapenems Monobactams
56
What can be used to treat (some strains of) **pseudomonas** **aeruginosa**?
antipseudomonal penicillins (eg. **piperacillin**)
57
Name some macrolides
**Clarithromycin** **Erthromycin** **Azithromycin** Telithromycin
58
Quinolones/ floroquinolones. bacteriostatic or cidal?
Bacteriocidal... they are inhibitors of DNA gyrase.
59
Gram +ve is the largest group of bacteria, give some examples.
Staphylococcus Stephtococcus Clostridium Enterococus Listeria
60
Both these groups are inhibitors of bacterial protein synthesis, but they are different. **WHY**? **aminoglycosides** (eg. gentamycin) **tetracyclines**
tetracyclines are bacteriostatic because reactions with bacteria are **reversible**.
61
How do **tetracycline** antibiotics work?
**Inhibitor of bacterial protein synthesis** (30s Ribosome subunit)
62
What four things can antimicrobial drugs target?
* inhibiton of cell wall synthesis * disruption of cell membrane function * inhibition of nucleic acid synthesis * inhibition of protein synthesis * RNA synthesis
63
name some groups of drugs that are bacteriostatic
**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
What is flucloxacillin? And what makes it special?
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
Name the six classes that are bacteriocidal
**All the b-lactam group** (penicilliins, cephalosporins, monobactams, carbapenems) **glycopeptides** (vancomycin) **fluoroqinolones** (ciprofloxacin)
66
Give some examples of **gram -ve bacteria**
E. Coli **Pseudomonas aeruginosa** N. gonorrhoea **chlamydia**
67
What drug would treat chlamydia?
tetracycline
68
Name THREE broad spectrum penicillins
Amoxicillin/ co-amoxiclav **ampicillin** piperacillin with Tazobactam (Tazocin)
69
What are the mechanisms of antibiotics? (6)
* inhibit cell wall synthesis * inhibit cell membrane synthesis * inhibit protein synthesis * inhibit folate synthesis * inhibit RNA polymerase * inhibit DNA gyrase
70
**Trimethoprim** moa, indications, side effects
**Antifolate** drug. Weak base that concentrates in **acidic prostate tissues** and **vaginal fluid**s via **ion trapping**. Often used for UTI. SD: nausa, vomiting, epigastric distress, rashes, hepatitis, thrombocytopenia, leukopenia.
71
Ciprofloxacin
**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
What is fluconazole?
Anti-fungal. Azole derivative **excreted in the urine**, therefore can treat **vaginal candidiasis**
73
What is **metronidazole** used for?
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 H**elicobacter pylori**. Metronidazole is available as a **skin preparation** also. First episode of **C. diff**
74
clarithromycin
macrolide alternative to penicillin indicated for chest infections, cellulitis, ear infections, H. pylori
75
what macrolide is indicated for acne?
erthromycin (if tetracyclines not effective - doxycycline)
76
What are the characteristics of aminoglycosides, and give some examples.
**Gentamicin, Tobramycin** (very good for pseudomonas aeruginosa), s**treptomycin, 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
What are the symptoms of vestibular toxicity that maybe associated with aminoglycosides?
dizziness, impaired vision, nystagmus, vertigo, nausea, vomiting, problems with postural balance and walking.
78
What are the symptoms of cochlear toxicity that maybe associated with aminoglycosides?
tinnitus, hearing impairment, irreversible deafness.
79
Some facts about cephalosporins
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
Which antiobiotics are good for C. difficile?
**metronizaole** and **vancomycin** (could put in NG tube if px very unwell)

Pharmacology (13 decks)

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