Antimicrobial - Chemo Principles

Question 1

Prototype of antibiotics is from this source

Answer 1

Biological source

Question 2

Prototype of antimicrobials is from this source

Answer 2

Synthetic source

Question 3

5 factors that affect patient-drug-pathogen interactions

Answer 3

Pharmacokinetics
Pharmacodynamics (ideal is no response)
Immunity
Sepsis
Resistance

Question 4

Factor that affects patient-drug-pathogen interactions:
Drug must be delivered to pathogen at clinically meaningful concentrations and durations with acceptable toxicity

Answer 4

Pharmacokinetics

Question 5

Factor that affects patient-drug-pathogen interactions:
Ideal is no response
Selective toxicity
Toxic reactions from high doses, drug interactions, undesired effects, idiosyncratic reactions, allergic reactions

Answer 5

Pharmacodynamics

Question 6

Ability of the antimicrobial agent to exploit some different between the bacteria and human cells to provide effective antibacterial action with minimal or tolerable toxicity

Answer 6

Selective toxicity

Question 7

A systemic inflammatory response to microbial infection
Complex signaling leads to release of inflammatory mediators

Answer 7

Sepsis

Question 8

Define sepsis

Answer 8

A systemic inflammatory response to microbial infection

Question 9

3 Sepsis-associated pathologies can impact antibiotic pharmacokinetics

Answer 9

Hypotension
Edema endothelial injury
Organ damage

Question 10

The ability of bacteria or other microbes to resist the effects of an antibiotic
Occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections
The microorganisms survive and continue to multiply causing more harm

Answer 10

Resistance

Question 11

2 primary forms of resistance

Answer 11

Natural and acquired resistance

Question 12

Form of resistance:
Inherent property of the microorganism to be unaffected by agent
For example, a microorganism with no cell wall would not be affected to by agent that interferes with cell wall synthesis

Answer 12

Natural resistance

Question 13

Form of resistance:
Has 3 mechanisms: mutation, adaptation, and gene transfer

Answer 13

Acquired resistance

Question 14

3 mechanisms of acquired resistance

Answer 14

Mutation
Adaptation
Gene transfer

Question 15

Gene transfer (involved in acquired resistance) occurs via these extra chromosomal genetic elements

Answer 15

R(esistance) Plasmids

Question 16

Two factors that affect resistance emergence

Answer 16

Evolution
Clinical/environmental practices

Question 17

To acquire resistance, bacteria can develop fewer, none, or mutated _______, reducing drug entry into pathogen

Answer 17

Porins

Question 18

5 major efflux systems

Answer 18

Multidrug and toxic compound extruder (MATE)
Major facilitator superfamily (MFS) transporters
Small multidrug resistance (SMR) systems
Resistance nodulation division (RND) exporters
ATP binding cassette (ABC) transporter

Question 19

Refers to a subset of microbial population that is resistant when the majority is susceptible
Frequently associated with baseline chromosomal mutation rates
Essentially there is always a resistant microorganism

Answer 19

Hetero-resistance

Question 20

Expected profile of activity against infectious organism
Imprecise reference

Answer 20

Spectrum of action

Question 21

Spectrum of action that is therapeutically useful against one of the major groups of infectious agents easily characterized

Answer 21

Narrow spectrum of action

Question 22

Spectrum of action that is more extensive compared to prototype of class

Answer 22

Extended spectrum of action

Question 23

Agent that kills sensitive organisms

Answer 23

Cidal agents

Question 24

2 typical cidal mechanisms of action

Answer 24

Disruption of cell wall or membrane activity
Inhibition of DNA or RNA structure or function

Question 25

Agents that stop organism growth but may not kill sensitive organism Typical action is reversible

Answer 25

Static agents

Question 26

Disruption of cell wall or membrane activity and inhibition of DNA or RNA structure or function are examples of mechanisms of action of this type of agent

Answer 26

Cidal

Question 27

Reversible inhibition of enzymatic processes or protein synthesis/function are examples of mechanisms of action of this type of agent

Answer 27

Static

Question 28

2 static mechanisms of action

Answer 28

Inhibition of enzymatic processes Inhibition of protein synthesis or function

Question 29

Laboratory test for antimicrobial sensitivity used to identify which drugs inhibit bacterial growth and the drug concentrations required for that inhibition

Answer 29

Antimicrobial sensitivity test (AST)

Question 30

What does MIC stand for in the context of antimicrobial sensitivity tests?

Answer 30

Minimal inhibitor concentration

Question 31

3 reasons why earlier treatment is better

Answer 31

Rapidly dividing bacteria are more sensitive Number of resistant organisms is low Usually a single infectious agent

Question 32

3 requirements for choosing a drug

Answer 32

Must be active against the microorganism Must be able to reach effective levels Must be safe

Question 33

4 scenarios when to use combination therapy

Answer 33

Mixed bacterial infections requiring multiple drugs Additional therapeutic benefits provided Will result in enhanced antibacterial activity Prevention of resistance

Question 34

These two drugs are used in combination therapy because they have a synergistic effect against enterococci

Answer 34

Ampicillin and gentamycin

Question 35

Predetermined change in empiric therapy (changing to a different drug) Typically directed at preventing or reducing resistance Proactive by design, reactive by need

Answer 35

Antimicrobial switching

Question 36

A change in route of administration of the same agent

Answer 36

Antimicrobial switch therapy

Question 37

Is short or long term fever usually viral?

Answer 37

Short term

Question 38

Is short or long term fever usually bacterial?

Answer 38

Long term

Question 39

Describes how during illness when host resistance is reduced, organisms of normally low virulence can become highly pathogenic Increasingly common with some treatment regimens (cancer, inflammatory conditions, transplant rejection)

Answer 39

Opportunistic pathogens

Question 40

During pregnancy, there is enhanced _______ and ______ clearance

Answer 40

Renal and hepatic clearance

Question 41

Meds that have cardiac risk in geriatrics Age must be considered when selecting a treatment

Answer 41

Quinolones

Question 42

Quinolone, tetracycline, trimethoprim, and sulfonamides are avoided during pregnancy due to their _________ risk

Answer 42

Teratogenic