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Lindsey's D&D Unit 3 > Antimicrobial Agents I > Flashcards

Antimicrobial Agents I Flashcards

1
Q

Bactericidal agents can compensate for pts with _____.

A

impaired host defenses

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2
Q

Is it beneficial or toxic for clindamycin to accumulate in bone? Why?

A

beneficial- treat osteomyelitis

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3
Q

What is an important consideration for metronidazole?

A

drug-drug interaction w/ alcohol due to inhibition of aldehyde metabolism

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4
Q

What are extended spectrum Abx?

A

effective against gram + AND -

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4
Q

Name the DQ CRIMES.

A

D- doxycycline Q- quinolones C- clindamycin R- rifampin I- isoniazis M- metronidazole E- erythromycin-like S- sulfonamides

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5
Q

What are the 5 major mechanisms of antibacterial resistance to Abx?

A
  1. altered targets 2. enzymatic destruction 3. alternative resistant metabolic pathway 4. decreased entry 5. increased efflux
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5
Q

Name 4 drugs that readily enter the CNS.

A
  1. chloramphenicol 2. sulfonamides 3. cephalosporin (3/4) 4. rifampin- metronidazole
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5
Q

What is an important consideration for the sulfonamides?

A

renal crystalluria

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6
Q

What is an important consideration for isoniazid?

A

genetic polymorphism of N-acetyl transferase metabolism; potential hepatotoxicity

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7
Q

What is mutational/chromosomal resistance?

A

multiple steps/generations; each succeeding generation becomes slightly more resistant

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7
Q

Name 2 drugs that have selective/toxic accumulations and where.

A
  1. aminoglycosides- inner ear/brush border 2. tetracyclines- bone and teeth
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7
Q

What is an important consideration for doxycycline?

A

not renally eliminated tetracycline

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8
Q

What drugs should not be used in pregnancy, or with caution? (6)

A
  1. aminoglycosides 2. metronidazole 3. chloramphenicol 4. tetracyclines 5. fluoroquinolones 6. voriconazole
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9
Q

Choose: Oral Abx DO/DO NOT cross the placenta.

A

DO

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9
Q

What is the post-antibiotic effect?

A

some Abx, like aminoglycosides and fluoroquinolones, continue to kill or inhibit growth or bacteria for several hours after the conc of drug falls below the MIC

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9
Q

What is direct Abx toxicity?

A

affect host cellular processes

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11
Q

What is transformation?

A

bacteria picks up free DNA from the environment

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11
Q

Superinfections are more common in those aged ____ or ____.

A

under 3yo, over 50yo

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12
Q

Bactericidal agents are req for treatment of infections that are _____.

A

not accessible to host immune system responses

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12
Q

Why are the DQ-CRIMES drugs important?

A

they have possible drug-drug interactions, genetic polymorphisms, or hepatotoxicity considerations

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12
Q

What are the cell wall synthesis inhibitors?

A

Penicillins (-cillin, Clavulanic acid) cephalosporins (Cef-) carbapenems (-penem) vancomycin

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13
Q

Abx’s may alter the activity of ____ drug metabolizing enzymes, causing indirect toxicity.

A

CYP450

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14
Q

Name 4 drugs that have selective/beneficial accumulations and where.

A
  1. clindamycin- bone 2. macrolides- pulmonary cells 3. tetracyclines- gingival crevicular fluid and sebum 4. nitrofurantoin- urine
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15
Q

How can resistance be minimized?

A

only use Abx when need is established; select Abx based on compatibility; use adequate duration and concentration

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15
Q

_____ agent is preferred in severe infections.

A

Bactericidal

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15
Q

Is it beneficial or toxic for tetracyclines to accumulate in gingival crevicular fluid and sebum? Why?

A

beneficial- treatment of periodontitis and acne

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16
Q

What is acquired resistance?

A

selective pressures produce successive generations of organisms with biological traits that minimize drug action

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18
Q

What are the 2 modes of acquired resistance?

A
  1. mutational/chromosomal resistance 2. plasma mediated
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20
Q

____ agents are req for treatment of infections that are not accessible to host immune system responses.

A

Bactericidal

21
Q

What is concentration dependent killing?

A

some abx kill bacteria faster when given in doses that result in higher plasma concentrations

23
Q

____ agents act more quickly and their action is often irreversible.

A

Bactericidal

24
Q

What are the broad classifications of antibiotics?

A

gram + or - cocci; gram + or - rods; gram + or - anaerobes; atypical bacteria

25
Q

Is it beneficial or toxic for aminoglycoside to accumulate in the inner ear and renal brush border? Why?

A

toxic- increased tendency for ototoxicity and nephrotoxicity

27
Q

What determines whether an Abx is bactericidal or bacteriostatic?

A

mechanism of action/target; conc achieved in vivo; specific microorganism

29
Q

What are the bacteriostatic mechanisms?

A

inhibition of protein synthesis (except aminoglycosides); inhibition of intermediary metabolic pathways

30
Q

Pseudomembranous colitis due to ____ overgrowth can be life-threatening.

A

Clostridium difficile

31
Q

What are the inhibitors of DNA function?

A

fluoroquinolones (-floxacin) nitrofurantoin metronidazole

33
Q

Bactericidal agent is preferred in ______ infections.

A

severe

34
Q

Is it beneficial or toxic for macrolides to accumulate in pulmonary cells? Why?

A

beneficial- URI treatment

35
Q

What is an important consideration for clindamycin?

A

not renally eliminated

36
Q

_____ means the organisms are killed; ____ means organisms are prevented from growing.

A

Bactericidal; bacteriostatic

37
Q

What is an important consideration for the quinolones?

A

ciprofloxacin is renally cleared but is a non-substrate inhibitor of P450

39
Q

What kind of bacteria has a large reservoir for plasma-mediated transfer?

A

gram-negative coliform bacteria

40
Q

What is an important consideration for rifampin?

A

induces P450, potential hepatotoxicity

41
Q

What is transduction?

A

virus injects resistance to bacteria

42
Q

What kinds of Abx are most likely to cause superinfections?

A

broad spectrum

43
Q

Why are disturbances of host microflora/superinfections?

A

overgrowth of normally suppressed pathogens b/c of broad spectrum Abx

44
Q

What is natural resistance?

A

microbes lack a susceptible target for drug action

45
Q

Name the 6 narrow spectrum Abx.

A
  1. aminoglycosides 2. penicillinase-resistant penicillins 3. clindamycin 4. vancomycin 5. metronidazole 6. penicillin G, V
45
Q

What are the 3 categories of Abx toxicity?

A
  1. direct 2. indirect 3. disturbances of host microflora/superinfections
46
Q

What is plasma mediated resistance?

A

extrachromosomal DNA that can confer immediate resistance

47
Q

What is conjugation?

A

plasmid transfer between 2 physically attached bacteria

49
Q

What are broad spectrum Abx?

A

effective against gram +, gram -, AND atypical organisms

50
Q

What are the protein synthesis inhibitors?

A

macrolides (-mycin) tetracyclines clindamycin chloramphenicol aminoglycosides

52
Q

Which Abx’s are less likely to disturb the host flora?

A

narrow spectrum

53
Q

____ agents can compensate for pts with impaired host defenses.

A

Bactericidal

54
Q

Name 4 drugs that enter the CNS with inflammation.

A
  1. penicillin 2. vancomycin 3. ciprofloxacin 4. tetracycline
56
Q

Bactericidal means_____; bacteriostatic means _____.

A

the organisms are killed; organisms are prevented from growing

57
Q

What is escape?

A

purines, thymidine, serine, methionine released from purulent infections allows sulfonamide resistance; failure to lyse due to lack of osmotic pressure differences in penicillin resistance

58
Q

_____ due to Clostridium difficile overgrowth can be life-threatening.

A

Pseudomembranous colitis

59
Q

Most antibiotics distribute well into tissues outside the CNS, but vary in their ability to cross the ____.

A

BBB

61
Q

Name the 6 broad spectrum Abx.

A
  1. macrolides 2. chloramphenicol 3. fluoroquinolones (moxi, gemi) 4. sulfonamides 5. tetracyclines 6. trimethoprim
62
Q

Name the 4 extended spectrum Abx.

A
  1. aminopenicillins (amox, amp) 2. cephalosporins 3. fluoroquinolones 4. carbapenems
64
Q

Is it beneficial or toxic for nitrofurantoin to accumulate in urine? Why?

A

beneficial- treatment of UTIs

65
Q

What is an important consideration for the erythromycin-like drugs?

A

drug-drug interactions due to inhibition of P450

66
Q

What are the bactericidal mechanisms?

A

inhibition of cell wall synthesis; disruption of cell membrane function; interference with DNA function of synthesis

67
Q

Is it beneficial or toxic for tetracycline to accumulate in bone and teeth? Why?

A

toxic- causes abnormal bone growth and brownish tooth discoloration in fetuses and young children

68
Q

What is indirect Abx toxicity?

A

allergic rxns and hypersensitivities

69
Q

Where does direct toxicity typically manifest?

A

GI tract, liver, kidney, nervous system, blood and blood forming system

70
Q

Which Abx’s require dosage adjustments if renally impaired?

A
  1. penicillin 2. cephalosporins 3. vancomycins 4. aminoglycosides 5 fluoroquinolones
71
Q

What are narrow spectrum Abx?

A

effective against EITHER gram + or -

Lindsey's D&D Unit 3 (12 decks)

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