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Pharmacology > Antimicrobial > Flashcards

Antimicrobial Flashcards

1
Q

What are examples of penicillins?

A

penicillin G, ampicillin

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2
Q

What are examples of cephalosporins?

A

ceftriaxone, ceftaroline

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3
Q

What is an example of monoactam?

A

azotreonam

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4
Q

What is an example of carbapenams?

A

imipenam

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5
Q

What is an example of trycylic glycopeptide?

A

vancomycin

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6
Q

What is an example is cyclic lipopeptide?

A

daptomycin

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7
Q

What is an example of tetracyclines?

A

tetracyline

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8
Q

What are examples of macrolides?

A

azithromycin, erythromycin

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9
Q

What is an example of lincosomides?

A

clindamycin

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10
Q

What are examples of streptogramins?

A

quinopristin, dalfopristin

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11
Q

what are examples of aminoglycosides?

A

gentamicin, tobramycin

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12
Q

What is an example of sulfonamides?

A

sulfamethoxazole

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13
Q

What are examples of quinolones?

A

ciprofloxacin, levofloxacin

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14
Q

What drug has its own group?

A

trimethoprim

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15
Q

What is selective toxicity?

A

kill or damage a microbe without damage to the host

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16
Q

What is therapeutic index?

A
  • TI= LD50/ED50
  • ratio of the toxic dose to the effective dose

LD must be large; ED must be low

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17
Q

What does -cidal mean in antibiotics?

A

kill bacteria

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18
Q

What does -static mean in antibiotics?

A

stop abcteria from growing; does NOT kill

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19
Q

What drugs are bacteriostatic?

A
  • tetracyclines
  • erythromycin
  • chloramphenicol
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20
Q

What drugs are bacteriocidal?

A
  • penicillins
  • aminoglyocsides
  • cephalosporins
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21
Q

What is the exception that can be either -cidal or -static?

A

sulfonamides

surf between cidal and static

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22
Q

Where would bacteriostatic and bacteriocidal agents be located on a graph?

A

bacteriostatic agents would be located above bacteriocidal agents

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23
Q

What group of drugs are beta lactams?

A
  • penicillins
  • cephalosporins
  • monobactams
  • carbapenems
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24
Q

What drugs play a role in cell wall synthesis?

A
  • penicillins
  • cephalosporins
  • monobactams
  • carbapenems
  • vancomycin
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25
Q

What drugs play a type of role in DNA to RNA synthesis?

A
  • quinolones: DNA gyrase, replication
  • rifampin: RNA polymerase
  • metronidazole: damage DNA
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26
Q

What drugs play a role in protein synthesis?

A
  • tetracyclines
  • aminoglycosides
  • chloramphenicol
  • macrolides (azithromycin, erythromycin)
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27
Q

What drugs play a role in the cell membrane?

A
  • polymyxins
  • daptomycin
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28
Q

Which drugs play a role in the production of folic acid?

A
  • trimethoprim
  • sulfonamides

PABA -> DHFA -> THFA

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29
Q

What are the reasons why a patient may not respond to therapy?

A
  • misdiagnosis
  • no infection
  • do not complete full length of therapy
  • patient self treatment of infection with antimicrobials that were not prescribed to them
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30
Q

What are some factors to consider when treating an infection?

A
  • sensitivity of organism to drug
  • appropriate dosage
  • route of admin.
  • duration of therapy
  • special patient features
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31
Q

What is meant by “superinfection”?

A

when an antimcirobial migth disturb the ecologically balance leading to overgrowth of pathogenic microbes that are resistant to the antimicrobial agent

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32
Q

What is an example of something that can cause a superinfection?

A

C. Diff Albicans

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33
Q

What are the microorganisms that are most likely to cause a burn and traumatic/surgical wounds?

A
  • staph
  • strep
  • pseudo. aeru
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34
Q

What are the microorganisms that are most likely to cause a skin infection?

A
  • staph
  • strep
  • herpes
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35
Q

What are the microorganisms that are most likely to cause a wound infection?

A
  • staph
  • E. coli
  • bact fragilis
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36
Q

What si the difference between the MIC and MBC?

A
  • MIC: used more
  • MBC: can be toxic
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37
Q

What si the goal of MIC to get rid of infection?

A

3-5 times more

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38
Q

What is the first choice of treatment for syphilis?

A

benzathine + penicillin G

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39
Q

What is the first choice of treatment for tuberculosis?

A

rifampin + isoniazid + pyrazinamide + ethambutol

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40
Q

What is the first choice of treatment for pneumonia?

A

piperacillin/tazabactam + tobramycin

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41
Q

Most antimicrobia drugs are excreted by what organ?

A

kidneys

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42
Q

What is creatinine clearance rate?

A
  • measure renal function
  • serve as guide to adjust dose

dose based on patients renal function

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43
Q

For hepatic function, which drug do you need to reduce the dosage for?

A

chloramphenicol

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44
Q

For hepatic function, which drug do you need to use with caution and have NO dosage adjustment?

A

clindamycin

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45
Q

How does the change in dose affect neonates (chloramphenicol)?

A
  • low conc. of UGT which conjugates chloramphenicol; cleared by kidneys
  • infants died from cardiovascular collapse, Gray Baby syndrome
  • give lower dose
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46
Q

How does the change in dose affect neonates (sulfonamides)?

A
  • displace bilirubin from albumin in the blood which can deposit in the brain
  • contraindicated in neonates
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47
Q

How does the change in dose affect children?

A
  • permanent dsicoloration of growing teeth of children
  • can cause intracranial hypertension in infants and children
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48
Q

How does the change in dose affect CHF patients?

A

ticarcillin disodium/calvulanate potassium can cause edema and arrythmia

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49
Q

What dosage needs to be increased for infants/young children?

A

gentamicin

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50
Q

What drug causes the risk of hepatitis to increase with age?

A

isoniazid

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51
Q

What are the contradicted drugs for pregnancy and nursing?

A
  • metronidazole
  • sulfonamides
  • antifolate drugs
  • fluoroquinolones
  • tetracyclines
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52
Q

What is the best combination for synergy?

A

2 drugs from different classes or have different mechanism of action

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53
Q

What are the mechanisms of antimicrobial resistance in pathogenic microbes?

A
  • decrease drug uptake
  • increase durg increase
  • decrease affinity for site of action
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54
Q

What are the gram positive microorganisms?

A
  • staph
  • strep
  • E. faecalis
  • mono
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55
Q

What are the gram negative microorganisms?

A
  • E. coli
  • kleb
  • pseudo
  • H. influenzae
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56
Q

Which microorganisms are anaerobes?

A

C. diff and bacterio fraglis

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57
Q

What are the gram positive characteristics in regards to a membrane?

A
  • lactamase outside
  • thicker peptidoglycan wall
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58
Q

What are the gram negative characteristics in regards to a membrane?

A
  • outer membrane with porin channel
  • thin peptidoglycan layer
  • lactamase inside
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59
Q

Penicillin targets what?

A

transpeptidase

important for cross linking

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60
Q

Fosphomycin inhibits what enzyme?

A

pyruvyl transferase

used in formation of NAM

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61
Q

Peptidoglycan is a target for what enzymes?

A

vancomycin and pentapeptide

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62
Q

What is the mechanism of action for penicillins and cephalosporins?

A
  • inhibit peptidoglycan transpeptidase
  • penicillin binding proteins (PBP)
  • trigger autolysins
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63
Q

What are the chararcteristics of penicillin G?

A
  • narrow spectrum
  • penicillinase-sensitive
  • used to treat trep and necrotize
64
Q

What are the chararcteristics of dicloxacilin?

A
  • narrow spectrum
  • penicillinase-resistant
  • used ot treat staph, skin infection and run of the mill
65
Q

What are the chararcteristics of amooxicillin?

A
  • broad spectrum
  • penicillinase sensitive
  • used ot treat H. influ, E. coli, mono, ear/URTI
66
Q

What are the chararcteristics of ticarcillin?

A
  • broad spectrum
  • penicillin sensitive
  • used to treat pseudo aeru and nocosomial
67
Q

What are the chararcteristics of piperacillin?

A
  • undergo renal clearance
  • poor in absense of inflammation
68
Q

What is the pharmacokinetics of penicillins?

A

conc. of drug acheived to treat meningitis, arthritis, endophthalmitis

69
Q

What are the side effects of penicillins?

A
  • NVD
  • superinfection of GI tract: C. diff
  • neurotoxicity: seizures, penicillin G inhibit GABA
  • penicillin allergy
70
Q

What are the mechanisms of resistance of penicillins, carbapenems, monobactam, and cephalosporins?

A
  • changes in PBP
  • tolerance: deficiency in autolytic enzymes
  • changes in the porins (gram -)
  • beta-lactamase
71
Q

What are the drugs in cephalosporins?

A
  1. cefazolin: 1st gen
  2. cefoxitin: 2nd gen
  3. ceftriaxone: 3rd gen
  4. cefepime: 4th gen
  5. ceftaroline: 5th gen
72
Q

What is cefazolin used to treat?

A

used to treat pro mira, E. coli, kleb pneu, staph/strep (PEKS)

73
Q

What is cefoxitin used to treat?

A

used to treat haem influ, enter aero, neiss hono, PEK (HEN PEK)

74
Q

What is ceftriaxone used to treat?

A

used to treat 2nd gen and acine calco, citro dive, entero cloa, serra marce, and GRAM -, meningitis

75
Q

What is cefepine used to treat?

A

used to treat 3rd gen, strep, pseudo aeru, citro freu, seriosu G- nonsocomial infec.

76
Q

What are the chararcteristics of ceftaroline?

A

used to treat 4th gen (besides pseudo aeru), acute bacterial infec., pneum

77
Q

What are the side effects of cephalosporins?

A

DO NOT give to patients with history of severe penicillin reaction

78
Q

What are carbapenems used to treat?

A

used ot treat G-, pseudo aeru, mono, serious nosocomial infections

79
Q

What are the pharmacokinetics of carbapenems?

A
  • primarily renally cleared
  • imipenem hydrolyzed by dipeptidases
80
Q

What are the side effects of carbapenems?

A

seizures, hypersensitivity reactions

81
Q

What is the drug to give someone if they are allergic to penicillin?

A

aztreonam

82
Q

What is monobactam used to treat?

A

used to treat G- (E. coli, kleb pneu, haemo influ, prot vulga, pseudo aeru)

83
Q

What is the pharmacokinetic of monobactam?

A

renally cleared

84
Q

What are he side effects of monobactam?

A
  • GI upset
  • phlebitis, pain at injection
  • cross reactivity
  • hypersensitivity reactions; , 15 of beta lactam allergic patients
85
Q

What is the main drug for tricyclic glycopeptide?

A

vancomycin

86
Q

What is the main drug for monobactam?

A

aztreonam

87
Q

What is the mechanism of action for trycyclic glycopeptide?

A
  • inhibitor of peptidoglycan synthase
  • attaches to NAG and NAM; binds to D-ala-D-ala
  • inhibitor of pentapeptide precursor and membrane carrier
88
Q

What is trycyclic glycopeptide used to treat?

A

G+, MRSA, MRSE, both streps, coryne dipth, both entero faec, serious multi-drug resistant infections, C. diff

89
Q

What are the pharmacokinetics of trycyclic glycopeptides?

A
  • renally cleared
  • can enter CSF with inflamed meninges
90
Q

What are the side effects of trycyclic glycopeptides?

A
  • ototoxicity: rare
  • nephrotoxicity: uncommon
91
Q

What are the mechanisms of tricyclic glycopeptide?

A
  • changes alanine to lactate
  • vancomytcine resistant enterococci
92
Q

What is the drug for cyclic lipopeptide?

A

daptomycin

93
Q

What is th mechanism of action for cyclic lipopeptides?

A

binds to cell membrane, forms pores

94
Q

What is cyclic lipopeptide used to treat?

A

G+, MRSA, VRE

95
Q

What are the pharmacokinetics of cyclic lipopeptides?

A
  • renally cleared
  • pulmonary surfactant inactivates it
  • CANNOT be used for lung infections (ex: pneumonia)
96
Q

What are the side effects of cyclic lipopeptide?

A
  • myopathy
  • rhabdomyolysis
97
Q

What is the mechanism of resistance of cyclic lipopeptides?

A

treatment failure -> increase in MIC

98
Q

What are the drugs for tetracyclines?

A

tetracycline, minocycline, doxycycline

99
Q

What is the mechanism of action for tetracyclines?

A
  • inhibit protein synthesis
  • bind to 30S subunit
  • prevent attachment of bacteriostatic (TEC)
100
Q

What are tetracyclines used to treat?

A

mycoplasma pneu, cutibact acnes, chlamydia, strep

101
Q

What are the pharmacokinetics of tetracyclines?

A
  • limited CNS penetration
  • doxycycline primarily fecally eliminated -> with renal failure
102
Q

What are the side effcts tetracyclines?

A
  • contraindicated during pregnancy
  • discoloration of teeth and inhibit bone
  • photosensitivity
  • superinfection -> C. diff, C. albicans
103
Q

What is the mechanism of resistance for tetracyclines?

A
  • plasmid-determined resistance: decrease influc and increase efflux
  • ribosomal change
104
Q

What is the drug for glycylcyclines?

A

tigercycline

105
Q

What is the mechanism of action for glycylcyclines?

A
  • bind to bacterial 30S ribosomal subunit
  • bacteriostatic
106
Q

What are the characteristics of glycylcyclines?

A
  • broad spectrum
  • used to treat: G+, G-, MRSA, VRE, PRSP, skin infections
107
Q

What are the side effects of glycylcyclines??

A
  • increase mortality risk, limit use for multi-resistance
  • contraindicated in pregnancy, superinfection
108
Q

What are the drugs for macrolides?

A
  • erythromycin
  • azithromycin
  • clarithromycin
109
Q

What is the mechanism of action for macrolides?

A
  • inhibit protein synthesis
  • binds ot peptidyl-tRNA region on 50S subunit
  • bacteriostatic
110
Q

What are the characteristics of macrolides?

A
  • used to treat chlamydia, H. influenzae, M. catarrhalis, URTI, pneumonia, otis media
  • broad spectrum
111
Q

What are the side effects of macrolides?

A
  • prolong the QTc interval
  • rash
  • hepatits
  • embryotoxic
112
Q

What is the mechanism of resistance of macrolides?

A

methylation of the 23 rRNA binding site, prevents binding

113
Q

What is the drug interaction of macrolides?

A

erythtromycin> clarithromycin, inhibit CYP3A4

114
Q

What are the characteristics of chloramphenicol?

A
  • binds to 50S subunit
  • bacteriostatic
  • bactericidal for meningitis
115
Q

What is chloramphenicol used to treat?

A

haemo influen, neiss meningi, strep, rickett rickett

116
Q

What are the side effects of chloramphenicol?

A
  • anemia
  • gray baby syndrome
117
Q

What are the drugs for lincosamides?

A
  • clindamycin
  • Ca-mrsa
  • CDAD
118
Q

What is the mechanism of action of lincosamides?

A

binds to 50S ribosome subunit, bacteriostatic

119
Q

What are lincosamides used to treat?

A

Ca-mrsa, B lactam allergy, strep, clostri perfri, lung abscess

120
Q

What are the side effects of lincosamides?

A

CDAD, diarrhea, rash, fever, neutropenia

121
Q

What is the mechanism of resistance for linosamides?

A

methylation of the 23rRNA binding site, prevents binding

122
Q

What are the drugs for streptogramins?

A

quinopristin, dalfopristin

123
Q

What is the mechanism of action for streptogramins?

A

binds to 50S subunit, bactericidal

124
Q

What are streptogramins used to treat?

A

primary G+, entero faec (VRE), MRSA, strep, PRSP, osteo, endo

125
Q

What are the side effects of streptogramins?

A

arthralgias, myaglias, pain, phlebitis at infusion site

126
Q

What is the mechanism of resistance for streptogramins?

A

ribosomal methylase, acetyltransferase

127
Q

What are the drugs for aminoglycosides?

A

gentamicin, amikacin, tobramycin

128
Q

What is the mechanism of action for aminoglycosides?

A
  • inhibit protein synthesis, bind to 30s subunit
  • bactericidal
  • conc. depend. killing
  • synergistic with beta-lactams
129
Q

What are aminoglycosides used to treat?

A
  • primary for aerobic G-, pseudo aeru, both entero, serra marce, prot vulga, kleb pneu, listeria mono, serious G- nosocomial infections
  • combined with beta lactam
130
Q

What is the pharmacokinetics of aminoglycosides?

A
  • primarily renally cleared
  • polar -> decrease distribution
131
Q

What are the side effects of aminoglycosides?

A

nephrotoxicity, ototoxicity, neuromuscular blackade, teratogen, myelosuppression

132
Q

What is the mechanism of resistance of aminoglycosides?

A
  • decrease in porin permeation and ribosomal binding
  • enzymatic inactivation: acetyltransferase and phosphotransferase
133
Q

What is the drug for macrocylic antibiotic?

A

fidaxomicin

134
Q

What is the mechanism of action for macrocylic antibiotic?

A

binds to sigma unit of RNA polymerase, inhibits protein synthesis

135
Q

What is macrocylic antibiotics used for?

A

C. diff, CDAD

136
Q

What are the side effectsof macrocylic antibiotic?

A

abdominal pain, GI hemorrhage, BMS

137
Q

What is pharmacokinetic of macrocylic antibiotic?

A

very little systemic absorption, high fecal conc.

138
Q

What is the drug for sulfonamides?

A

sulfamethoxazole

139
Q

What is the mechanism of action for sulfonamides?

A
  • inhibition of dihydropteroate synthase
  • decrease biosynthesis of DNA, RNA, AA, bacteriostatic
140
Q

What are sulfonamides used to treat?

A
  • broad spectrum
  • strep, both haem, nocard astero, E. coli, kleb granu, chlamydia, UTI
141
Q

Dihydropteroate synthase is inhibited by?

A

sulfonamides

142
Q

Dihydrofolate reductase is inhibited by?

A

trimethoprim

143
Q

What are the side effects of sulfonamides?

A

rash, sulfa allergy, SJS, TEN, kernicterus (newborn encephalopathy)

144
Q

What are sulfonamides used to treat?

A

conjunctivitis, burns, Ag sulfadiazine

145
Q

What are the pharmacokinetics of sulfonamides?

A
  • renally cleared
  • NAT and UGT substrate
  • inhibit CYP2C9 -> increase warfarin AUC
146
Q

What are the mechanism of resistance for sulfonamides?

A
  • DO NOT biosynthesize folic acid
  • increase PABA production
  • dihydropteroate synthase, low affinity for sulfa
  • decrease sulfa permeability
147
Q

What are the mechanisms of action for trimethoprim/sulfamethoxazole?

A
  • DHFRI, DHPSI, synergism
  • bacteriostatic, can be bactericial in blood; can be both in urine
148
Q

What is trimethoprim/sulfamethoxazole used to treat?

A

MRSA, E. coli, UTI, prostatitis

149
Q

What are the side effects of trimethoprim/sulfamethoxazole?

A

BMS, rash, hemolytic anemia

150
Q

What is the mechanism of resistance of trimethoprim/sulfamethoxazole??

A

decrease DHFR afiinity, decrease cell permeation, DHFR overproduction

151
Q

What are the drugs for quinolones (floxacin)?

A

ciprofloxacin, levofloxacin, moxifloxacin

152
Q

What are the mechanisms of action for quinolones (floxacin)??

A

inhibit topoisomerase 2, inhibit DNA replication

153
Q

What are the mechanisms of action for quinolones (floxacin)??

A

inhibit topoisomerase 2, inhibit DNA replication

154
Q

What are the side effects of quinolones?

A

tendonitis, myasthenia gravis

155
Q

What are the drug interactions of quinolones?

A
  • celation, Al, Mg, Fe, Ca
  • inhibit CYP1A2, increase caffeine
156
Q

What is the mechanism of resistance of quinolones?

A
  • increase efflux
  • decrease influx
  • mutation in topoisomerase 2 or 3, decrease binding

Pharmacology (5 decks)

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