Antimicrobial Chemotherapy 2 COPY

Question 1

What are some commonly used B-lactams (penicillins)?

Answer 1

Benzyl penicillin

Amoxicillin, ampicillin

Co-amoxicaly

Flucloxacillin

Piperacillin

Imipenem, meropenum

Question 2

What does benzyl penicillin act against?

Answer 2

Gram positive bacteria

Question 3

What does amoxicillin and ampicillin act against?

Answer 3

Gram negative bacteria

Question 4

What does co-amoxicaly act against?

Answer 4

B-lactamase producing coliforms

Question 5

What is flucloxacillin the best treatment for?

Answer 5

Staphyloccocal infection

Question 6

What does piperacillin treat?

Answer 6

Extended gram negative coverage

Question 7

What does imipenem and meropenem treat?

Answer 7

Most bacteria, including anaerobes

Question 8

What is a class of B-lactams other than penicillin?

Answer 8

Cephalosporins

Question 9

How does the activity of cephalosporins change against gram negative and positve bacteria through the generations?

Answer 9

Activity against gram negative bacteria increases

Activity against gram positive bacteria decreases

Question 10

What are the 3 generations of cephalosporins?

Answer 10

1) Cephradine
2) Cefluoxime
3) Ceftrixone

Question 11

What are some commonly used agents other than B-lactams?

Answer 11

Aminoglycosides

Glycopeptides

Macrolides

Quinolones

Question 12

How are aminoglycosides administered?

Answer 12

Only parenterally

Question 13

What are aminoglycosides useful against?

Answer 13

Gram negative bacteria

Question 14

What gram positive bacteria is sensitive to aminoglycosides?

Answer 14

Only staphylococci

Question 15

What is an example of an aminoglycoside?

Answer 15

Gentamicin

Question 16

How are glycopeptides administered?

Answer 16

Parenteral use only

Question 17

What are glycopeptides active against?

Answer 17

Gram positive bacteria (anaerobic and aerobic)

Question 18

What are examples of glycopeptides?

Answer 18

Vancomycin

Teicoplanin

Question 19

What are macrolides mainly active against?

Answer 19

Gram positive bacteria

Question 20

When are macrolides often used?

Answer 20

As an alternative to penicillin for people who are allergic

Question 21

What are examples of macrolides?

Answer 21

Clarithromycin

Erythromycin

Azithromycin

Question 22

What are quinolones active against?

Answer 22

Nearly all gram negative bacteria

Question 23

What are some miscellaneous commonly used agents?

Answer 23

Metranidazole

Fusidic acid

Co-trimoxazole

Tetracyclines

Clindamycin

Question 24

What is metronidazole used against?

Answer 24

Anaerobes, both gram positive and negative

Question 25

What is fusidic acid used against?

Answer 25

Staphyloccocus

Question 26

What is co-trimoxazole?

Answer 26

A combination of trimethoprim and sulphamethoxazole

Question 27

What kinds of infection are tetracyclines useful for?

Answer 27

Some genetial tract and respiratory tract infections

Question 28

What is clindamycin useful against?

Answer 28

Gram positive and anaerobes

Question 29

What are some commonly used new agents?

Answer 29

Linezolid Daptomycin

Question 30

What is linezolid used against?

Answer 30

MRSA

Question 31

What is daptomycin active against?

Answer 31

Only gram positive bacteria

Question 32

What is daptomycin useful for the treatment of?

Answer 32

Serious MRSA infections

Question 33

What is a positive of linezolid compaired to glycopeptides?

Answer 33

It can be given orally

Question 34

What are some agents that are only used for urinary tract infections?

Answer 34

Nalidixic acid Nitrofurantoin

Question 35

What is nalidixic acid active against?

Answer 35

Only against gram negative aerobes (coliform) bacteria

Question 36

What is nitrofurantoin effective against?

Answer 36

Most gram negative bacteria Some gram positive bacteria

Question 37

What are most antimicrobials associated with?

Answer 37

Adverse reactions

Question 38

What does the incidences of adverse reactions depend on?

Answer 38

Dose of therapy Duration of therapy

Question 39

What are some different kinds of adverse reactions?

Answer 39

Allergic reaction Immediate hypersensitivity Delayed hypersensitivity Gastrointestinal side effects Thrush Liver toxicity Renal toxicity Neurological toxicity Haematological toxicity

Question 40

What is an example of immediate hypersensitivity?

Answer 40

Anaphylactic shock

Question 41

What are some common gastrointestinal side effects?

Answer 41

Nausea Vomiting Diarrhoea

Question 42

What is thrush?

Answer 42

Surpress normal flora in parts of the body resulting in overgrowth of resistant organisms

Question 43

What are examples of liver toxicity?

Answer 43

Transient elevators of liver enzymes Severe hepatitis

Question 44

What is haematological toxicity?

Answer 44

Toxic effects on the bone marrow resulting in selective depression of one cell line (neutropenia) or unselective depression of all bone marrow elements (pancytopenia)

Question 45

What is neutropenia?

Answer 45

Selective depression of one cell line of bone marrow

Question 46

What is pancytopenia?

Answer 46

Unselective depression of all bone marrow elements

Question 47

How can adverse side reactions be minimised?

Answer 47

Antimicrobials should only be used when indicated and in the minimum dose and duration to achieve efficacy

Question 48

Who should adverse reactions be reported to?

Answer 48

Commitee on safety of medicines

Question 49

What has been set up on each health board to monitor antimicrobial prescribing and develop policy?

Answer 49

Antimicrobial management teams

Question 50

What are factors that should be considered when deciding which antimicrobial agents to use are?

Answer 50

Age Renal function Liver function Pregnancy

Question 51

What is prophylaxis?

Answer 51

Administration of antimicrobials to prevent the future occurence of infection

Question 52

What should happen when the organism causing infection is unknown?

Answer 52

Empirical antimicrobial therapy (broad spectrum) should be commenced if urgent treatment is required

Question 53

What should we consider when deciding which drug to use?

Answer 53

Spectrum of antimicrobial agent Monotherapy v combination Penetration to site of infection Monitoring Dose and duration of therapy

Question 54

What can mixing drugs do?

Answer 54

Cover mixed infections by more than one organism Could have enhanced effect together Minimise the development of resistant strains

Question 55

Why is monitoring done?

Answer 55

Difference between a therapeutic and toxic dose is small in a drug with a low therapeutic index

Question 56

What are the 3 possible outcomes when we use antimicrobials in combination?

Answer 56

Anatagonistic and combined effect is less than the sum of their individual contribution Synergistic and their combined effect is greater than the sum of their individial contribution Their effects are addictive

Question 57

What is a cidal antibiotic (bactericidal)?

Answer 57

One that kills bacteria without reliance on the patient's immune system to help

Question 58

What is a static antibiotic (bacteriostatic)?

Answer 58

One that prevents the organism multiplying but it is the patient's immune system which kills off the bacteria

Question 59

What is the combination of two cidal or two static drugs?

Answer 59

Synergistic or addictive

Question 60

What is the combination of one static and one cidal drug?

Answer 60

Antagonistic

Question 61

What is the role of the laboratory, and of medical microbiologists?

Answer 61

Give advice on the choice of antimicrobial

Question 62

What are the 2 reasons for monitoring the serum levels of an antimicrobial?

Answer 62

Ensure that therapeutic levels have been achieved Ensure that levels are not so high to be toxic

Question 63

What does the serum levels being the same as the tissue depend on?

Answer 63

Antimicrobial's ability to penetrate

Question 64

What is serum levels?

Answer 64

Amount of medication in your blood

Question 65

What is the simplest way to measure the minimum inhibitory concentration (MIC) of an antibiotic agent?

Answer 65

E-test

Question 66

What is an E-test?

Answer 66

Commercially available paper strip which has a gradient of antibiotic concentration from the point where the organism intersects the strip

Question 67

What are methods of measuring the minimum inhibitory concentration (MIC) an an antibiotic agent other than an E-test?

Answer 67

Automated, which labs use, where growth of individual isolates are measured in the presence of different concentrations of each antibiotic and MIC is calculated

Question 68

What does in vitro laboratory test give?

Answer 68

A prediction whether the infection is likely to be cured by the antibiotic in question

Question 69

What are factors that influence the outcome of using antibiotics?

Answer 69

Route of administration Dosing schedule Penetration of antibiotic to target site Interaction with other drugs