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Principles of disease Jess > Antimicrobial Chemotherapy > Flashcards

Antimicrobial Chemotherapy Flashcards

1
Q

What are antibiotics only active against?

A

Bacteria

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2
Q

What is a bactericidal?

A

Antimicrobial that kills bacteria

E.g penicillin

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3
Q

What does an organism that is sensitive mean?

A

If it is inhibited or killed by the antimicrobial available AT SITE OF INFECTION

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4
Q

What is MBC?

A

Minimal bactericidal concentration - (needed to kill given organism)

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5
Q

What is a bacteriostatic?

A

Antimicrobial that inhibits growth of bacteria

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6
Q

What does it mean if an organism is resistant?

A

If it is not killed or inhibited by antimicrobial available at site of infection

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7
Q

What is MIC?

A

Minimal inhibitory concentration - of antibodies=microbial needed to inhibit growth in given organism.

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8
Q

What are the routes of administration of antibiotics?

A

Topical - cream, applied to skin
Systemic - pills, taken internally, orally or parenterally
Parenteral - needle - IV or IM (intramuscularly)

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9
Q

Antibiotics cause inhibition of:

A

Cell wall synthesis
Protein synthesis
Nucleic acid synthesis

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10
Q

What can we do about side effects and toxicity?

A

Consider dose and duration

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11
Q

Side effects

A

Allergic reactions - commonly associated with penicillin and cephalosporins

Immediate hypersensitivity - anaphylactic shock

Delayed hypersensitivity

Gastrointestinal - nausea, vomiting

Thrush

Renal toxicity

Neurological toxicity - e.g optic neuropathy (losing sight)

haematological toxicity - toxic effect on bone marrow

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12
Q

Minimising adverse reactions

A

Antibiotics/ antimicrobial should be used only when indicated and in minimum dose. With the duration Jesse Cary to just achieve efficacy.

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13
Q

What patient characteristics need to be taken into account when prescribing antibiotics?

A

Age
Renal function
Liver function
Pregnancy

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14
Q

Prophylaxis

A

Administration of antibiotics to prevent future occurrence of infection

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15
Q

Indication for antimicrobial:

A

Prophylaxis

Therapy

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16
Q

Drug related considerations

A

Antibiotic should be effective against known/ likely causative organism

Choice is based on results of sensitivity of tests, if not - educated test.

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17
Q

Mono therapy or combination of antimicrobial?

A

More than one mixed together

Effects: additive - same effect as singular one
Antagonistic - less effect as singular one
Synergistic - more effect than singular one

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18
Q

Most common combination?

A

Penicillin and gentamicin.

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19
Q

Susceptibility testing

A

Simplest way to measure MIC (min inhibitory concentration) is with the
E TEST

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20
Q

What is an E test used for?

A

To determine the Minimum inhibitory concentration of one antibiotic against one organism

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21
Q

Which antibiotics are involved in cell wall synthesis inhibition

A

Penicillin

Cephalosporin

  • both beta-lactams.
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22
Q

What do beta-lactams do?

A

Inhibit cell-wall synthesis

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23
Q

What are vancomycin and teicoplanin?

A

Glycopeptides
Work on inhibiting cell wall synthesis before beta-lactams
Only act on gram-positive organisms

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24
Q

What is dangerous about vancomycin?

A

It is toxic

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25
What do glyopeptides work on?
Gram positive bacteria only
26
What antimicrobials are used in protein synthesis inhibition?
Aminoglycosides - e.g gentamicin Macrolides& tetracyclines Oxazolinones - linezolid Cyclic lipopeptide - daptomycin
27
What is gentamicin?
An aminoglycoside, Used in inhibition of protein synthesis Especially useful in gram negative bacteria Can be dangerous - very toxic
28
What is linezolid?
Eg of oxazolinone - inhibits protein synthesis Works on MRSA
29
What is daptomycin?
A cyclic lipopeptide Works on gram positive, especially MRSA. Inhibition of protein synthesis
30
What antibiotics are used in nuclei acid synthesis inhibition?
Trimethoprim sulphamethoxazole Fluroquniolones - ciprofloxacin
31
What is ciprofloxacin?
A fluroquinolone Effective in gram-negative bacteria Cannot be used in children as it interferes with cartilage growth
32
Why can ciprofloxacin not be used in children?
As it interferes with cartilage growth
33
What types of antibiotic resistance are there?
Intrinsic/ inherent Acquired
34
What are the two types of acquired inhibition?
Spontaneous mutation to bacterial DNA during replication Spread of resistant gene (by plasmids or transposons)
35
What are the main antibiotic resistances?
Beta-lactam resistance Glycopeptide resistance
36
What are the 2 types of beta-lactam resistance?
B lactamase production - bacterial enzymes which cleave ring of antibiotic, making it inactive. Alteration of PBP at target site -
37
What is staph-aureus resistant to ?
Pencillins
38
What is fluclozacillin?
Modified pencillin which is resistant to actions of beta- lactamase
39
What is used to treat staph-aureus and why?
Flucloxacillin, as produces beta-lactamases which prevents usage of pencillin.
40
What are ESBLs and CPES?
Worrying problems for the future. Resistant to everything.
41
What is MRSA?
Methicillin resistant staph aureus
42
What is MRSA resistant to?
All penicillins and cephalosporins
43
Explain alteration of PBPs as a beta-lactam resistant strategy
Alters protein structure so beta-lactam can no longer bind to stop it.
44
What is ESBLs?
Some gram-negative organisms have these (extended spectrum B - lactamases) which are resistant to all b-lactam agents.
45
Glycopeptide resistance
Only resistant to gram-positive bacteria Vancomycin ad teicoplanin
46
Vancomycin resistance
In enterococci (gram-positive) VRE vancomycin resistant enetrococci Have appeared recently, not common.
47
What is VRE?
Vancomycin resistant enterococci Appeared recently Clinically worrying
48
What is Clostridium dificile?
Anaerobic, gram-positive, bacillus Causes gastro-intestinal side-effects. Can lead to pseudomembranous colitis Detected in stool Treatment = oral vancomycin or oral metronidazole
49
What are the differnt types of allergic reactions?
Immediate hypersensitivity - anaphylactic shock Delayed hypersensitivity - Stevens-Johnson syndrome, rashes
50
What is CDI?
Clostridium dificile infection.- important side effect or antibiotic therapy.
51
What can minimise CDI?
Restricted prescribing of broad spectrum antibiotic according to local protocols.
52
What is thrush?
Over-growth of resistant organisms Brought about by broad-spectrum antimicrobials. E.g overgrowth of yeast Candida albicans Oral/ vaginal candidiasis
53
Liver toxicity
Transient elevation of liver enzymes | Severe hepatitis
54
Drugs associated with liver toxicity?
Tetracycline Anti-TB drugs - isoniazid, rifampicin Flucloxacillin
55
Common side effects?
``` Allergic reactions Liver toxicity Renal toxicity Neurological toxicity Haematological toxicity ```
56
Renal?
Kidneys
57
Renal/ nephrotoxicity
Most commonly seen with aminoglycoside group e.g gentamicin Or Vancomycin Usually reversible
58
Neurological toxicity
Ototoxicity Optic neuropathy Peripheral
59
What is ototoxicty?
Ear toxicity
60
what side effect is associated with anti TB drugs
Optic neuropathy - optic nerve damage | Peripheral neuropathy - damage to peripheral nerves
61
Example of haematological toxicity?
New MRSA agent LINEZOLID (bone marrow suppressor) (could lower platelet counts)
62
Prevention of adverse reactions?
Only when necessary and instructed | Minimum dose and duration that achieves efficacy
63
Care for which groups needs to be given?
Extreme ages Pregnant women Those with renal or liver problems
64
What antimicrobials should be monitored to ensure maximum efficacy and minimum toxicity?
Those with a low therapeutic margin (difference between effective and toxic dose is small)
65
What two situations would antimicrobials be necessary?
Prophylaxis or treatment
66
What drug related considerations need to be acknowledged when giving antimicrobials?
Spectrum of antimicrobial agent Mono therapy vs combination therapy
67
What are the possible outcomes of combination therapy?
Additive Antagonistic Synergistic - great effect together
68
What is the most common example of combination therapy that leads to a synergistic effect?
Pencillin and gentamicin against streptococcal infective endocarditis Penicillin breaks down wall Gentamicin can now reaches ribosomes
69
Combination of a cidal and static drug will most-likely result in
Antagonistic effects
70
Examples of commonly used bacteriostatic drugs
Macrolides Tetracyclines Trimethoprim
71
Examples of bactericidal drugs
B-lactams Aminoglycosides Glycopeptides Quinolones
72
Are anti-virals static or cidal?
Virustatic
73
Which two commonly used antimicrobials have a low therapeutic index and can be toxic?
VANCOMYCIN AND GENTAMYCIN
74
What is the standard duration of therapy and what are the exceptions?
7 days Longer for osteomyelitis or endocarditis Staph aureus - 14 days Urinary tract infection cystitis - 3 days of trimethoprim
75
What are the two main reasons for monitoring serum levels of an antimicrobial ?
Ensure therapeutic levels have been achieved. Ensure levels have not risen to toxicity.
76
Sensitivity/ susceptibility testing
Automated - gives an indication of MIC E test- strip of gradient to compare against
77
What are the classes of anti-fungal drugs?
Polyenes Azoles Allylamines Echinocandins
78
What is amophotericin B?
Used intro-venously for serious yeast infections. It is TOXIC (Anti-fungal drug)
79
What is nystatin?
An anti-fungal drug Used to treat serious fungal infections Topically/ orally routed
80
What treats a yeast infection?
Fluconazole | Type of anti-fungal drug - azole
81
What drug is used to fight fungal infection of skin and nails?
Terbinafine Type of allylamine
82
What are echinocandins used for?
Serious Candida and aspergillus infections (anti-fungal drug)
83
What are the different classes of anti-viral drugs?
Anti herpes drugs Anti HIV drugs Drugs for chronic Hep B and C Drugs for viral respiratory infections
84
Anti-viral resistance
At its very early stages Genotypes analysis - sequencing of part of genome
85
What anti-viral drug is used to treat herpes simplex and varicella zoster?
Aciclovir
86
What does ZIDOVUDINE treat?
HIV

Principles of disease Jess (36 decks)

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