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Nurs 5229 Clinical Pharmacotherapeutics > Antimicrobial > Flashcards

Antimicrobial Flashcards

1
Q

First question should always be

A

Should I be using an antibiotic (and..what am i treating)

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2
Q

Three classification of antibiotics

A

Classification by susceptible organisms
Classification by MOA
Classification by Type

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3
Q

Identify the likely pathogen

A

stains
serologies
culture and sensitivity
site

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4
Q

4 basic principles of therapy

A 
know the drug
confirm the presence of infection
identify the likely pathogen
select presumptive therapy
monitor therapeutic response
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5
Q

You should see improvement in a patient within

A

24 to 48 hours

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6
Q

phamacokinetics

A

What the body does to the drug

– Concerned with the time course of antimicrobial
concentrations in the body
– Commonly used to determine dosing regimens

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7
Q

Pharmacodynamics

A

What the drug does to the body.

– Concerned with the relationship between those
concentrations and the antimicrobial effect.
– Increasingly important to design dosing regimens which
counteract or prevent resistance

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8
Q

is PK or PD determine dosing

A

PK

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9
Q

MIC

A

MIC: Minimum Inhibitory Concentration

the LEAST amount of drug that is required to kill or slow the organism

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10
Q

MBC

A

MBC: Minimum Bactericidal Concentration

Minimum that will kill the pathogen

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11
Q

Cmax

A

peak serum level after pt takes the drug

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12
Q

Cmin

A

least amount of drug you will see in the body

trough level

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13
Q

AUC

A

Area under the curve

puts all parameters together

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14
Q

Susceptibility testing

A

MIC

• Primary measure of antibiotic activity

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15
Q

– MIC is the lowest antimicrobial

A

concentration that
prevented prevented visible visible growth of an organism organism after 24 hours
of incubation

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16
Q

MIC is a good indicator

A

of the potency of an antibiotic
– It does not tell us about the time course of
antimicrobial activity

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17
Q

Breakpoints

A

Tells us the MIC/Zone values. Lets us know what which pathogens are susceptible, resistant or somewhat resistant

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18
Q

MIC90

A

tells you that 90% of strains of a particular pathogen are inhibited by this drug

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19
Q

PK Parameters help to do what

A
  • Help to quantify the serum level time course of an antibiotic
  • Evaluate antibiotic efficacy
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20
Q

Three most important PK parameters:

A

AUC, Cmax, Cmin

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21
Q

• Area under the curve is a

A

plot of concentration concentration of drug

in plasma against time

22
Q

AUC represents

A

the total amount of drug absorbed by the

body regardless of rate of absorption

23
Q

AUC is usefull in knowing the

A

g the average concentration over a

time interval

24
Q

How high

A

peak level vs MIC

25
Q

how long

A

time above MIC

26
Q

how high for how long

A

ACU vs MIC

27
Q

Peak/MIC

A

Cmax divided by MIC - will give you the formula for concentration antibiotic. How high does it need to be to irradicate the pathogen

28
Q

Time>MIC

A

percentage of dosing interval in which the sum level exceeds the MIC

have to have the drug above a certain concerntraion for 40 to 50 % of dosing inverval in order to be effective

29
Q

24 hr-AUC/MIC

A

24 hour AUC divided by the MIC

These drugs have a percisitant antbiotic effect

30
Q

For a concentration (MAX) antibiotic we want to see that

A

the peak is 10x the MIC

31
Q

for time dosing if you had a drug that was given 10 hours a part how long should the drug be over the MIC

A

40 to 50% or in this case 4 to 5 hours

32
Q

The new science PK and PD

A

Is there an antibiotic level in blood that predicts bacterial
eradication and clinical success?
• If so, what is the optimal profile to maximize bacterial kill?

33
Q

Once PK/PD requirements are known, one can: (3 things)

A

√ Calculate appropriate doses of new or existing agents
– √ Compare antimicrobial activity of existing agents and utilize
data in the development of guidelines
– √ Determine susceptibility of isolated pathogens

34
Q

AUC/MIC ratioa at least what for gram pos an gram neg

A

25-30 pos

125 neg

35
Q

Examples of Peak MIC drugs

A

aminoglycosides

36
Q

examples of time dependent drugs

A

beta-lactums
clindamycin
erythromycin
linezolid

37
Q

24-AUC/MIC drug examples (persistant)

A

azithromycin
quinolones
vancomycin

38
Q

Examples of Multi-Drug Resistant Organisims

A

Strep pneumonaie
M hi illi Methicillin R i es stance S h tap aureus (MRSA CA (MRSA,CA‐MRSA)
– Vancomycin resistant enterococci (VRE)
– Some Gram negative organisms (MDR‐GNB)

39
Q

Factors that Increase Antibiotic

Resistance

A 
• Overuse of Antibiotics
• Inappropriate antibiotics
• Low dose… inadequate levels… subinhibitory
exposure
• Day Care and crowded living
40
Q

Mechanisms of Resistance:

4 main types

A
    1. Decreased Permeability
    1. Antibiotic Efflux Pump
    1. Drug Inactivation
    1. Altered Target Site
41
Q

Decreased permaiblity

A

lack of purions to get into the cell

42
Q

Drug Efflux

A

eflux pumps, pump antibiotic out of the cell after they enter it

43
Q

Drug inactivation

A

Enzymes inactivate the antibiotic

44
Q

Altered Target

A

Changes that occur in the ribosomes

45
Q

Beta‐lactamase

A

– Enzymes which destroy Penicillins and their

relatives

46
Q

Beta‐Lactamase Inhibiting Compounds

A

Beta‐lactam antibiotics to which another
component (e.g. clavulanic acid added to
Amoxicillin) has been added to counteract the
beta‐lactamase

47
Q

Cross-resistance

A

Genetic information may be passed from one

bacteria to another

48
Q

Four types of cross resistance

A

– Mutation
– Conjugation
– Transduction
– Transformation

49
Q

Conjugation

A

one bacteria shares dna with another bacteria

50
Q

transduction

A

viral bacterial eats bacteria and shares DNA with it

51
Q

Transformation

A

bacterial can incorporate dna from another organisim that is in the same enviornment. Bridge is not needed in this type

Nurs 5229 Clinical Pharmacotherapeutics (78 decks)

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