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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
Q

What do glyopeptides work on?

A

Gram positive bacteria only

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26
Q

What antimicrobials are used in protein synthesis inhibition?

A

Aminoglycosides - e.g gentamicin

Macrolides& tetracyclines

Oxazolinones - linezolid

Cyclic lipopeptide - daptomycin

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27
Q

What is gentamicin?

A

An aminoglycoside,

Used in inhibition of protein synthesis

Especially useful in gram negative bacteria

Can be dangerous - very toxic

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28
Q

What is linezolid?

A

Eg of oxazolinone - inhibits protein synthesis

Works on MRSA

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29
Q

What is daptomycin?

A

A cyclic lipopeptide

Works on gram positive, especially MRSA.

Inhibition of protein synthesis

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30
Q

What antibiotics are used in nuclei acid synthesis inhibition?

A

Trimethoprim

sulphamethoxazole

Fluroquniolones - ciprofloxacin

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31
Q

What is ciprofloxacin?

A

A fluroquinolone

Effective in gram-negative bacteria

Cannot be used in children as it interferes with cartilage growth

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32
Q

Why can ciprofloxacin not be used in children?

A

As it interferes with cartilage growth

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33
Q

What types of antibiotic resistance are there?

A

Intrinsic/ inherent

Acquired

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34
Q

What are the two types of acquired inhibition?

A

Spontaneous mutation to bacterial DNA during replication

Spread of resistant gene (by plasmids or transposons)

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35
Q

What are the main antibiotic resistances?

A

Beta-lactam resistance

Glycopeptide resistance

36
Q

What are the 2 types of beta-lactam resistance?

A

B lactamase production - bacterial enzymes which cleave ring of antibiotic, making it inactive.

Alteration of PBP at target site -

37
Q

What is staph-aureus resistant to ?

A

Pencillins

38
Q

What is fluclozacillin?

A

Modified pencillin which is resistant to actions of beta- lactamase

39
Q

What is used to treat staph-aureus and why?

A

Flucloxacillin, as produces beta-lactamases which prevents usage of pencillin.

40
Q

What are ESBLs and CPES?

A

Worrying problems for the future.

Resistant to everything.

41
Q

What is MRSA?

A

Methicillin resistant staph aureus

42
Q

What is MRSA resistant to?

A

All penicillins and cephalosporins

43
Q

Explain alteration of PBPs as a beta-lactam resistant strategy

A

Alters protein structure so beta-lactam can no longer bind to stop it.

44
Q

What is ESBLs?

A

Some gram-negative organisms have these (extended spectrum B - lactamases) which are resistant to all b-lactam agents.

45
Q

Glycopeptide resistance

A

Only resistant to gram-positive bacteria

Vancomycin ad teicoplanin

46
Q

Vancomycin resistance

A

In enterococci (gram-positive)

VRE vancomycin resistant enetrococci
Have appeared recently, not common.

47
Q

What is VRE?

A

Vancomycin resistant enterococci

Appeared recently

Clinically worrying

48
Q

What is Clostridium dificile?

A

Anaerobic, gram-positive, bacillus

Causes gastro-intestinal side-effects.

Can lead to pseudomembranous colitis

Detected in stool

Treatment = oral vancomycin or oral metronidazole

49
Q

What are the differnt types of allergic reactions?

A

Immediate hypersensitivity - anaphylactic shock

Delayed hypersensitivity - Stevens-Johnson syndrome, rashes

50
Q

What is CDI?

A

Clostridium dificile infection.- important side effect or antibiotic therapy.

51
Q

What can minimise CDI?

A

Restricted prescribing of broad spectrum antibiotic according to local protocols.

52
Q

What is thrush?

A

Over-growth of resistant organisms
Brought about by broad-spectrum antimicrobials.
E.g overgrowth of yeast Candida albicans
Oral/ vaginal candidiasis

53
Q

Liver toxicity

A

Transient elevation of liver enzymes

Severe hepatitis

54
Q

Drugs associated with liver toxicity?

A

Tetracycline
Anti-TB drugs - isoniazid, rifampicin
Flucloxacillin

55
Q

Common side effects?

A 
Allergic reactions
Liver toxicity
Renal toxicity
Neurological toxicity 
Haematological toxicity
56
Q

Renal?

A

Kidneys

57
Q

Renal/ nephrotoxicity

A

Most commonly seen with aminoglycoside group e.g gentamicin
Or Vancomycin

Usually reversible

58
Q

Neurological toxicity

A

Ototoxicity

Optic neuropathy

Peripheral

59
Q

What is ototoxicty?

A

Ear toxicity

60
Q

what side effect is associated with anti TB drugs

A

Optic neuropathy - optic nerve damage

Peripheral neuropathy - damage to peripheral nerves

61
Q

Example of haematological toxicity?

A

New MRSA agent LINEZOLID (bone marrow suppressor) (could lower platelet counts)

62
Q

Prevention of adverse reactions?

A

Only when necessary and instructed

Minimum dose and duration that achieves efficacy

63
Q

Care for which groups needs to be given?

A

Extreme ages
Pregnant women
Those with renal or liver problems

64
Q

What antimicrobials should be monitored to ensure maximum efficacy and minimum toxicity?

A

Those with a low therapeutic margin (difference between effective and toxic dose is small)

65
Q

What two situations would antimicrobials be necessary?

A

Prophylaxis or treatment

66
Q

What drug related considerations need to be acknowledged when giving antimicrobials?

A

Spectrum of antimicrobial agent

Mono therapy vs combination therapy

67
Q

What are the possible outcomes of combination therapy?

A

Additive
Antagonistic
Synergistic - great effect together

68
Q

What is the most common example of combination therapy that leads to a synergistic effect?

A

Pencillin and gentamicin against streptococcal infective endocarditis

Penicillin breaks down wall

Gentamicin can now reaches ribosomes

69
Q

Combination of a cidal and static drug will most-likely result in

A

Antagonistic effects

70
Q

Examples of commonly used bacteriostatic drugs

A

Macrolides
Tetracyclines
Trimethoprim

71
Q

Examples of bactericidal drugs

A

B-lactams
Aminoglycosides
Glycopeptides
Quinolones

72
Q

Are anti-virals static or cidal?

A

Virustatic

73
Q

Which two commonly used antimicrobials have a low therapeutic index and can be toxic?

A

VANCOMYCIN AND GENTAMYCIN

74
Q

What is the standard duration of therapy and what are the exceptions?

A

7 days

Longer for osteomyelitis or endocarditis

Staph aureus - 14 days

Urinary tract infection cystitis - 3 days of trimethoprim

75
Q

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

A

Ensure therapeutic levels have been achieved.

Ensure levels have not risen to toxicity.

76
Q

Sensitivity/ susceptibility testing

A

Automated - gives an indication of MIC

E test- strip of gradient to compare against

77
Q

What are the classes of anti-fungal drugs?

A

Polyenes
Azoles
Allylamines
Echinocandins

78
Q

What is amophotericin B?

A

Used intro-venously for serious yeast infections.
It is TOXIC

(Anti-fungal drug)

79
Q

What is nystatin?

A

An anti-fungal drug

Used to treat serious fungal infections

Topically/ orally routed

80
Q

What treats a yeast infection?

A

Fluconazole

Type of anti-fungal drug - azole

81
Q

What drug is used to fight fungal infection of skin and nails?

A

Terbinafine

Type of allylamine

82
Q

What are echinocandins used for?

A

Serious Candida and aspergillus infections (anti-fungal drug)

83
Q

What are the different classes of anti-viral drugs?

A

Anti herpes drugs

Anti HIV drugs

Drugs for chronic Hep B and C

Drugs for viral respiratory infections

84
Q

Anti-viral resistance

A

At its very early stages

Genotypes analysis - sequencing of part of genome

85
Q

What anti-viral drug is used to treat herpes simplex and varicella zoster?

A

Aciclovir

86
Q

What does ZIDOVUDINE treat?

A

HIV

Principles of disease Jess (36 decks)

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