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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
what are the two forms of beta- lactam resistance
beta lactamase - common in GRAM NEGATIVE BACTERIA activity against penicillin and cephalosporins mutation of penicillin binding proteins
26
what are the two ways to over come beta- lactamase production
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
what is an example of a beta-lactamase inhibitor
co-amoxiclav amoxicillin plus the b-lactamase inhibitor clavulanic acid FLUCLOXACILLIN IS ANOTHER EXAMPLE
28
what is an example of a penicillin modify antibiotic
the antistaphylococcal drug FLUCLOXACILLIN
29
what are ESBLs
extended spectrum beta lactamases GRAM NEAGITVIVE organisms with this resistance are resistant to all beta lactam antibiotics
30
what are CPEs
Carbapenemase Producing Enterobacteriaceae Gram negative organisms, resistant to the carbapenems sometimes leaving NO antimicrobial options
31
what is the best known bacteria that has altered PBPs
penicillin binding proteins | MRSA
32
what is the resistance to vancomycin in
vancomycin resistant enterococci (VRE) GRAM POSITIVES glycopeptide resistance staph.aureus
33
Benzyl penicilli
was the original naturally occurring substance discovered by Fleming and largely acts against gram positive organism
34
Amoxicillin
better oral absorption than penicillin G was good for some gram negative but now 30% resistance
35
Piperacillin
good coverage | gram positive and gram negative - (mainly anti-anaerobic)
36
Imipenem, meropene
carbapenems - have the widest spectrum of all - active against most bacteria including aerobes
37
ceftriaxone
cephalosporins | aren't really used as often culture c.diff
38
Azithromycin
a macrolide that is useful for single dose chlamydia (miscellaneous bacteria)
39
what are allergic reactions related to antibiotics
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
what are the outcomes from Gastrointestinal
common diohrea caused by c.dif (side effect) c.dif over grows normal bacteria in the prescence of antibiotics
41
what are the 4 Cs | why is their use being reduced
cephalosporins, ciprofloxacin, clindamycin, co-amoxiclav reduced use to minimise the killing of all commensal GI flora in
42
how is clostridium difficicile fought
oral vancomycin
43
what else can broad spectrum antibiotics cause
thrush | candida albicans
44
what are the toxicity's caused by antibiotics
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
what is the problem with anti-TB drugs
very toxic especially to the neurological system
46
how are adverse reactions minimised
use the minimum dose to get the highest efficacy
47
what are the 3 possible outcomes of microbial combinations
additive/agonist - increase clinical effect antagonistic- combined effect is less synergistic - team work (penicillin and gentamicin) penicillin breaks the cell wall for Gentamicin
48
when are drugs additive/synergistic
when both are either cidal or static
49
what are the 4 types of anti-fungal drugs
Allylamines Echinocandins Azoles Polyenes
50
what do polyene drugs do examples
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
what are Azoles examples what do they do
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
what are Echinocandins | examples and what are they used on
inhibit the synthesis of glucan polysaccharide Caspofungin, Mycafungin and Anidulafungin used for treatment of serious Candida and Aspergillus infections
53
what do Allylamines do example what is it used on
suppress ergosterol synthesis terbinafine fungal infection of skin and nails (athletes foot)
54
how are anti-virals resistance tested
Genotypic analysis
55
what is the ONLY type of anti-virals
virustatic NO VIRUCIDAL
56
Aciclovir
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
what is the ciclovir for
Anti-Herpes Virus Drugs
58
why is Foscarnet different
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
what is special about anti HIV treatment main drug example
Combination therapy- least three drugs zidovudine nucleoside analogue - interferes with reverse transcriptase
60
what are two examples of Drugs for Chronic Hepatitis B and C
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
drugs used for viral respiratory infections
Zanamavir and Oseltamivir influenza A or B within 48 hours Ribavarin nucleoside analogue inhaled as a fine spray treats Respiratory Syncytial Virus (RSV)
62
What other drugs are used in anti HIV treatment
Squinavir | Drunavir

principles of disease (18 decks)

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