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principles of disease > antimicrobial chemotherapy > Flashcards

antimicrobial chemotherapy Flashcards

1
Q

what is MBC

A

mininimal bactericidal concentration

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2
Q

what is MIC

A

minimal inhibitory concentration

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3
Q

what are the 3 broad ways a bacteria can be killed

A

inhibition of
cell wall synthesis
nucleic acid synthesis
protein synthesis

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4
Q

what cause inhibition of cell wall synthesis

A

b lactamases disturpt the binding of peptidoglycans by penicillin binding proteins

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5
Q

what two types of antibiotic do this by beta- lactam

how are they countered

A

penicillin’s
cephalosporins

beta lactamase

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6
Q

what is the other method of cell wall synthesis

what is the class 
where do they work
A

inhibiting assembly of a peptidoglycan precursor

glycopeptides
only on gram positive

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7
Q

what are the 6 examples of protein synthesis inhibition classes

A

aminoglycosides
serious gram negative infections (coliform)

macrolides
stop A.A binding

alternative to penicillin - GRAM POSITIVE

tetracyclines - sterph resistant

oxazolidinones - stops start codon reorganisation
linezolid- treatment of serious infections

cyclic lipopeptide

daptomycin uses against GRAM POSITIVE

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8
Q

What is parental administering

A

administering of drug via IV or IM (intra muscular methods)

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9
Q

penicillin G

A

used in gram positive (gram negative resistant)

inhibition of cell wall synthesis

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10
Q

vancomycin

A

glycopeptide
before beta lactam stage
only given parentally
only GRAM POSITIVE (aerobic and anaerobic)

gram negative is resistant

toxicity is a common problem

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11
Q

teicoplanin

A

glycopeptide
before beta lactam
only given parentally
only GRAM POSITIVE

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12
Q

linezolid

A 
''new'' class 
only one of the oxazolidinones
orally - serious infections MRSA (metacycline resistant)

inhibiton of protein synthesis

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13
Q

daptomycin

A

cyclical lipopeptide
works against GRAM POSITIVE (MRSA) only on specialist advice

imnhibiton of protein synthesis

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14
Q

gentamicin

A

used in serious gram negatives (coliform)

and staphylococci is also affected

toxicity to renal function is common

inhibiton of protein of synthesis

cheapest to use

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15
Q

what’s important about aminoglycosides

A

resistance in GRAM NEGATIVES IS V.UNCOMMON

protein synthesis

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16
Q

erythromycin

A 
macrolides
alternative to penicillin 
GRAM POSITVE
some staph and streph resistant
protein synthesis
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17
Q

clarithromycin

A

macrolides
alternative to penicillin
GRAM POSITVE
protein synthesis

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18
Q

doxycyclines tetracyclines

A

are used as a alternative to penicillin and work against gram positive bacteria

protein synthesis

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19
Q

co-trimoxazole

A

Trimethoprim and sulphamethoxazole

used in the treatment of chest infection instead of cephalosporins

and UTIs

reduce c.diff

inhibition of nucleic acid synthesis

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20
Q

ciprofloxacin

nalidixic acid

A

Fluoroquinolones
nucleic acid inhibition
particularly effective against NEARLY ALL gram negative bacteria

QUINOLONES

DO NOT USE IN CHILDREN – floating children

taken orally

pseudomonas

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21
Q

levofloxacin

A

Fluoroquinolones
nucleic acid synthesis

work well against gram negative
but also increased gram POSITVE sensitivity

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22
Q

what are the 2 types of antibiotic resistance

A

inherent/intrinsic resistance

acquired resistance

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23
Q

what is inherent resistance

A

resistance that is related more often than not to the cell wall and the lack of penetrating

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24
Q

what is acquired resistance

A

resistance that varies between strain of bacteria

  1. either a spontaneous mutation (during bacteria replication)
  2. resistance genes passed from bacteria to bacteria Plasmids or transposons
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25
Q

what are the two forms of beta- lactam resistance

A

beta lactamase - common in GRAM NEGATIVE BACTERIA
activity against penicillin and cephalosporins

mutation of penicillin binding proteins

26
Q

what are the two ways to over come beta- lactamase production

A

introduce a beta-lactamase inhibitor that protrcts the antibiotic drom degredation enzymes

the other is to modify the penicillin side chain (make it bigger to protect the beta lactam ring)

27
Q

what is an example of a beta-lactamase inhibitor

A

co-amoxiclav

amoxicillin plus the b-lactamase inhibitor clavulanic acid

FLUCLOXACILLIN IS ANOTHER EXAMPLE

28
Q

what is an example of a penicillin modify antibiotic

A

the antistaphylococcal drug FLUCLOXACILLIN

29
Q

what are ESBLs

A

extended spectrum beta lactamases

GRAM NEAGITVIVE

organisms with this resistance are resistant to all beta lactam antibiotics

30
Q

what are CPEs

A

Carbapenemase Producing Enterobacteriaceae

Gram negative organisms, resistant to the carbapenems

sometimes leaving NO antimicrobial options

31
Q

what is the best known bacteria that has altered PBPs

A

penicillin binding proteins

MRSA

32
Q

what is the resistance to vancomycin in

A

vancomycin resistant enterococci (VRE)

GRAM POSITIVES

glycopeptide resistance
staph.aureus

33
Q

Benzyl penicilli

A

was the original naturally occurring substance discovered by Fleming and largely acts against gram positive organism

34
Q

Amoxicillin

A

better oral absorption than penicillin G

was good for some gram negative but now 30% resistance

35
Q

Piperacillin

A

good coverage

gram positive and gram negative - (mainly anti-anaerobic)

36
Q

Imipenem, meropene

A

carbapenems - have the widest spectrum of all - active against most bacteria including aerobes

37
Q

ceftriaxone

A

cephalosporins

aren’t really used as often culture c.diff

38
Q

Azithromycin

A

a macrolide that is useful for single dose chlamydia (miscellaneous bacteria)

39
Q

what are allergic reactions related to antibiotics

A

immediate hypersensitivity

  • anaphylactic shock
  • IgE mediated (within mins)

delayed hypersensitivity

  • most common is a rash
  • but fevere, sickness can occur

Gastrointestinal side effects
- commonly encountered with antibiotic use

40
Q

what are the outcomes from Gastrointestinal

A

common diohrea caused by c.dif (side effect)

c.dif over grows normal bacteria in the prescence of antibiotics

41
Q

what are the 4 Cs

why is their use being reduced

A

cephalosporins, ciprofloxacin, clindamycin, co-amoxiclav

reduced use to minimise the killing of all commensal GI flora in

42
Q

how is clostridium difficicile fought

A

oral vancomycin

43
Q

what else can broad spectrum antibiotics cause

A

thrush

candida albicans

44
Q

what are the toxicity’s caused by antibiotics

A

liver (hepatotoxicity) - flucloxacillin, tetracycline

renal - gentamicin (aminoglycoside)

neurological
optic nerve - anti TB drugs
convulsions - high penicillin and cephalosporin

haematology - anti MRSA agent linezolid - bone marrow suppression

plantlets lowered

45
Q

what is the problem with anti-TB drugs

A

very toxic especially to the neurological system

46
Q

how are adverse reactions minimised

A

use the minimum dose to get the highest efficacy

47
Q

what are the 3 possible outcomes of microbial combinations

A

additive/agonist - increase clinical effect
antagonistic- combined effect is less

synergistic - team work (penicillin and gentamicin)

penicillin breaks the cell wall for Gentamicin

48
Q

when are drugs additive/synergistic

A

when both are either cidal or static

49
Q

what are the 4 types of anti-fungal drugs

A

Allylamines
Echinocandins
Azoles
Polyenes

50
Q

what do polyene drugs do

examples

A

bind to ergosterol the fungal cell wall however also cholesTEROL

Amphotericin B - only anti fungal for IV use - extremely toxic to everything but for really serious yeast and fungal infections

Nystatin - topical or oral use for serious fungal infections

51
Q

what are Azoles

examples what do they do

A

Inhibit ergosterol synthesis

Fluconazole - non toxic but has some Candida resistance

not all yeast sensitive to fluconazole

Voriconazole and itraconazole are used to treat aspergillosis

52
Q

what are Echinocandins

examples and what are they used on

A

inhibit the synthesis of glucan polysaccharide

Caspofungin, Mycafungin and Anidulafungin

used for treatment of serious Candida and Aspergillus infections

53
Q

what do Allylamines do
example
what is it used on

A

suppress ergosterol synthesis
terbinafine
fungal infection of skin and nails (athletes foot)

54
Q

how are anti-virals resistance tested

A

Genotypic analysis

55
Q

what is the ONLY type of anti-virals

A

virustatic

NO VIRUCIDAL

56
Q

Aciclovir

A

nucleoside analogue

specific for virus-infected as needs to be coded by virus enzymes

low toxicity

Aciclovir is active against Herpes Simplex virus (cold sores - orally treated) and Varicella zoster virus (IV)

57
Q

what is the ciclovir for

A

Anti-Herpes Virus Drugs

58
Q

why is Foscarnet different

A

different type of drug which can be used for some HSV, VZV and CMV infections resistant to the nucleoside analogue

highly nephrotoxic

only given IV

59
Q

what is special about anti HIV treatment

main drug example

A

Combination therapy- least three drugs

zidovudine
nucleoside analogue - interferes with reverse transcriptase

60
Q

what are two examples of Drugs for Chronic Hepatitis B and C

A

Interferon- alpha
produced by genetic engineering - chronic hep B and C
serious side effects, costly

cant be given orally (subcutaneous injection )

Lamivudine - selected patients - hepatitis B.
given orally.

61
Q

drugs used for viral respiratory infections

A

Zanamavir and Oseltamivir influenza A or B within 48 hours

Ribavarin
nucleoside analogue
inhaled as a fine spray
treats Respiratory Syncytial Virus (RSV)

62
Q

What other drugs are used in anti HIV treatment

A

Squinavir

Drunavir

principles of disease (18 decks)

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