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Year 3 > Antimicrobial Chemotherapy > Flashcards

Antimicrobial Chemotherapy Flashcards

1
Q

name 10 classes of antimicrobials

A 
penicillins (b-lactams)
cephalosporins (b-lactams)
aminoglycosides
gylcopeptides
macrolides
quinolines
others
antifungals
antivirals
immunoglobulins
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2
Q

list 6 principles of prescribing for antibiotics

A 
indications
clinical diagnosis and severity
patient characteristics
antimicrobial selection
regimen selection
liaison with lab
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3
Q

name 4 mechanisms of resistance

A

alteration of target site to reduce/eliminate binding of drug
destruction or inactivation of antibiotic
blockage of transport into antibiotic into cell
metabolic bypass

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4
Q

give 6 examples of hospital bugs with increasing resistance

A
  • Methicillin resistant S. aureus (MRSA)
  • Methicillin resistant S. epidermidis (MRSE)
  • Vancomycin resistant Enterococcus (VRE)
  • Vancomycin intermediate S. aureus (VISA / GISA)
  • Extended-spectrum (β-lactamase gram negatives (ESBL)
  • Multiresistant Tuberculosis
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5
Q

give examples of community bugs with increasing resistance

A
  • HIV
  • Food-borne (Salmonella, Shigella, H pylori)
  • Malaria
  • Pneumococcus
  • Hepatitis B& C
  • E coli O157
  • Lyme disease
  • Legionnaire’s
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6
Q

what are the indications for antimicrobials?

A

therapy - empiric/directed
prophylaxis
primary - antimalaria, pre-op, PEP
secondary - to prevent a second episode

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7
Q

what are the patient characteristics when selecting an antimicrobial?

A 
age
renal function
liver function
immunocompromised 
pregnancy
known allergies
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8
Q

what are the factors to consider when selecting an antimicrobial?

A 
guideline or individualised therapy
likely organism
empirical therapy or result based
bactericidal vs bacteriostatic drug
single or combination 
potential adverses effects
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9
Q

what are the likely pathogens in a soft tissue infection?

A 
o Streptococcus pyogenes
o Staphylococcus aureus
o Streptococcus group C or G
o E. Coli
o Pseudomonas aeruginosa
o Clostridium sp.
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10
Q

what are the likely pathogens in pneumonia?

A 
o Streptococcus pneumonia
o Haemophilus influenzae
o Staphylococcus aureus
o Klebsiella pneumonia
o Moraxella catarrhalis
o Mycoplasma pneumonia
o Legionella pneumonia
o Chlamydia pneumonia
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11
Q

what drug class is bactericidal?

A

beta-lactams

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12
Q

how do bactericidal drugs work?

A

act on the cell wall to kill the organism

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13
Q

indications for bactericidal drugs

A

neutropenia
meningitis
endocarditis

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14
Q

what class of drugs are bacteriostatic?

A

macrolides

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15
Q

how to bacteriostatic drugs work?

A

inhibit protein synthesis
prevent colony growth
require host immune system to mop up residual indfection

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16
Q

when are bacteriostatic drugs useful?

A

in toxic mediated illness

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17
Q

what are the advantages of single antimicrobial therapy?

A

simpler
fewer side effects
fewer drug interactions

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18
Q

for what would you use combination antimicrobial therapy?

A

HIV and TB
Severe sepsis
Mixed orgnisms

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19
Q

when selecting a regimen for antimicrobials what do you need to consider?

A 
route of administration
dose
ADR
duration
IV vs oral
inpatient vs outpatient
therapeutic drug monitoring
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20
Q

discuss route of administration in regards to antimicrobials

A

Oral bioavailability is the ratio of drug level when given orally compared with level when given IV. It can vary widely e.g. flucloxacillin 50-70% and linezolid 100%. The oral route can be used if not vomiting, normal GI function, no shock, and no organ dysfunction. Use the IV route if there is severe or deep-seated infection, and when the oral route is not reliable

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21
Q

name the potential adverse effects of antimicrobials

A 
allergy
GI
Candida
liver
renal
neurological
haematological
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22
Q

antimicrobial ADR: allergy

A

immediate hypersensitivity - anaphylaxis

delayed hypersensitivity - rash, drug fever, seurm sickness, erythema nodosum, stevens-johnson syndrome

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23
Q

what type of antibiotics are people most likely to be allergic to?

A

penicillin

cephalosporin

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24
Q

antimicrobial ADR: GI

A

nausea, vomiting, diarrhoea

c, diff

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25
Q

antimicrobial ADR: candida

A

broad spectrum penicillins, cephalosporins

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26
Q

antimicrobial ADR: liver

A

all drugs, particularly tetracyclines, TB drugs

more likely if existing liver disease

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27
Q

antimicrobial ADR: renal

A

gentamicin, vancomycin

more likely if pre-existing renal disease or nephrotoxic meds

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28
Q

antimicrobial ADR: neurological

A

ototoxicity - gent, vanc
optic neuropathy - ethambutol
convulsions, encephalopathy - penicillins, cephalosporin
peripheral neuropathy - isoniazid, metronidazole

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29
Q

antimicrobial ADR: haematological

A

marrow toxicity

megaloblastic anaemia - co-triaxazole

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30
Q

how must you liaison with the lab in relation to antimicrobials

A

send appropriate specimens - culture/direct detection/serology
receiving results - preliminary culture results, sensitivity results, final results
monitoring - disease activity, therapeutic drug monitoring

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31
Q

what antibiotics inhibit cell wall synthesis?

A

B-lactams - penicillins and cephalosporins

gylcopeptides - vanc, teicoplanin

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32
Q

what antibiotics inhibit protein synthesis?

A

aminoglycosides - gent
macrolindes - clarithromycin
tetracyclines - doxy
oxazolidinones - linezoid

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33
Q

what antibiotics inhibit nucleic acid synthesis?

A

trimethoprim
sulphonamides - sulfamthoxazole
quinolones - ciprofloxacin

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34
Q

name 5 penicillins

A 
benzylpenicillin V
amoxicillin
flucloxacillin
co-amoxiclav
piperacillin with tazobactam
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35
Q

benzylpenicillin V: acitivity

A

streptococci
neisseria
spirochetes

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36
Q

benzylpenicillin V: main uses

A 
soft tissue
pneumococcal
meningococcal
gonorrhoea
syphilis
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37
Q

amoxicillin: acivity

A

broad spectrum but resistance common

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38
Q

amoxicillin: main uses

A

UTI

RTI

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39
Q

flucloxacillin: acivity

A

staphyloccoi

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40
Q

flucloxacillin: main uses

A

S. aureus

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41
Q

co-amoxiclav: activity

A

broad spectrum inc anaerobes

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42
Q

co-amoxiclav: main uses

A

UTRI
RTI
Soft tissue
SSI

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43
Q

piperacillin/tazobactam: activity

A

brad spectrum incl pseudomonas, anaerobes

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44
Q

piperacillin/tazobactam: main uses

A

neutropenic sepsis

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45
Q

name 4 cephalosporins

A

cefradine
cefuroxime
ceftriaxone
ceftazidime

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46
Q

cefradine: activity

A

broad spectrum, resistance

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47
Q

cefradine: main uses

A

UTI

soft tissue infection

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48
Q

cefuroxime: activity

A

broad spectrum

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49
Q

cefuroxime: main uses

A

UTRI
RTI
surfical prophylaxis

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50
Q

ceftriaxone: activity

A

broad spectrum esp gram -ve bacilli

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51
Q

ceftriaxone: main uses

A

hospital infections e.g. bacteraemia, pneumonia, abdo spesis

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52
Q

ceftriaxone: is a risk factor for?

A

MRSA
C. diff
VRE

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53
Q

ceftazidime: activity

A

broad spectrum esp gram -ve bacilli

pseudomonas

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54
Q

ceftazidime: main uses

A

pseudomonal infections in hospital and cystic fibrosis

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55
Q

ceftazidime: is a risk factor for?

A

MRSA
c. diff
VRE

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56
Q

name an aminoglycoside

A

gentamicin

57
Q

gentamicin: activity

A

gram -ve bacilli

58
Q

gentamicin: main uses

A

serious gram -ve infections e.g. bacteraemia, endocarditis, neutropenic sepsis

59
Q

gentamicin: ADR

A

renal toxicity

ototoxicity

60
Q

name 3 macrolides

A

clarithromycin
erythromycin
azithromycin

61
Q

clarithromycin: activity

A 
streptococci
staphylococci
mycoplasma
chlamydia
legionella
62
Q

clarithromycin: main uses

A

RTI
soft tissue infection if penicillin allergic
STD

63
Q

erythromycin: activity

A 
streptococci
staphylococci
mycoplasma
chlamydia
legionella
64
Q

erythromycin: main uses

A

RTI
soft tissue infection if penicillin allergic
STD

65
Q

erythromycin: SE

A

Gi intolerance

66
Q

azithromycin: activity

A

better for gram -ve e.g. haemophilus, chlamydia

67
Q

azithromycin: main uses

A

chlamydia

68
Q

name 3 quinolones

A

ciprofloxacin
levofloxacin
moxifloxacin

69
Q

ciprofloxacin: activity

A

gram -ve bacilli inc pseudomonas

some activity against staph and strep

70
Q

ciprofloxacin: main uses

A

complicated UTI
complicated hospital acquired pneumonia
some GI infections

71
Q

ciprofloxacin: ADR

A

c. diff

may affect growing cartilage

72
Q

levofloxacin/moxifloxacin: activity

A 
enhanced activity against staph and strep, less against pseudomonas
pneumococcus
mycoplasma
chlamydia
legionella
73
Q

levofloxacin/moxifloxacin: main uses

A

2nd/3rd line for pneumonia

74
Q

name 2 glycopeptires

A

vancomycin

teicoplanin

75
Q

vancomycin/teicoplanin: activity

A

gram +ve bacteria only (strep/staph)

76
Q

vancomycin/teicoplanin: main uses

A

MRSA
penicillin allergy
oral - c.diff

77
Q

vancomycin/teicoplanin: SE

A

nephrotoxicity

78
Q

trimethoprim: activity

A

gram -ve bacilli

some activity against strep and staph

79
Q

trimethoprim: main uses

A

UTI
RTI
MRSA

80
Q

co-trimoxazole (trimethoprim-sulphamethoxazole): activity

A

broad spectrum
pneumocystis
jiroveci

81
Q

co-trimoxazole (trimethoprim-sulphamethoxazole): main uses

A

RTI

PCP

82
Q

co-trimoxazole (trimethoprim-sulphamethoxazole): SE

A

rash

83
Q

clindamycin: activity

A

strep
staph
anaerobes

84
Q

clindamycin: main uses

A

soft tissue infection

gangrene

85
Q

tetracycline/doxycycline: activity

A 
strep
staph
chlamydia
rickettsiae
brucella
86
Q

tetracycline/doxycycline: main uses

A 
Q fever
brucellosis
chlamydia
atypical pneumonia
MRSA
87
Q

when is tetracycline/doxycycline contraindicated?

A

pregnancy and childhood

88
Q

rifampicin: activity

A

mycobacteria
meningococcus
stapg

89
Q

rifampicin: main uses

A

TB
MRSA
meningococcal prophylaxis
stap

90
Q

meropenem: activity

A

broad spectrum incl anaerobes, pseudomonas

91
Q

meropenem: main uses

A

2nd/3rd line for hospital infections

92
Q

metronidazole: activity

A

anaerobes

protozoa e.g. giardia

93
Q

metronidazole: main uses

A

SSR
giardiasis
amoebiasis
trichomonal infections

94
Q

metronidazole: reacts with what?

A

alcohol

95
Q

linezolid: activity

A

gram +ve bacteria only

strep, staph, enterococci

96
Q

linezolid: main uses

A

2nd line for MSSA, MRSA, VRE

97
Q

linezolid: SE

A

blood and optic neuropathy

98
Q

daptomycin: activity

A

gram +Ve bacteria only

99
Q

daptomycin: main uses

A

2nd line for MSSA, MRSA< VRE

100
Q

when is daptomycin inactive?

A

lung myositis

101
Q

tigecycline: activity

A

very broad spectrum, inc MRSA, ESBL, anaerobes

102
Q

tigecycline: main uses

A

3rd line in intraabdo sepsis, soft tissue infection

103
Q

IV tigecycline is ineffective against?

A

Pseudomonas

104
Q

give 3 examples of azole antifungals

A

fluconazole
itraconazole
voriconazole

105
Q

what is fluconazole active against?

A

candida

106
Q

what is itraconazole active against?

A

candida + aspergillus

107
Q

what is voriconazole active against?

A

candida + aspergillus

108
Q

name 2 polyene antifungals

A

amphotericin

nystatin

109
Q

what is amphotericin active against?

A

candida + aspergillus

110
Q

what is nystatin active against?

A

candida

111
Q

name 3 echinocandin antifungal

A

caspofungin
anidulafungin
micafungin

112
Q

what are the echinocandin antifungals active against?

A

candida + aspergillus

113
Q

what is terbinafine active against?

A

tinea

114
Q

all antiviral drugs are? (virustatic or virucidal)

A

virustatic

115
Q

how do viruses replicate?

A

obligate intracellular parasites

utilise host cell enzymes in order to replicate

116
Q

what makes it hard to develop antivirals?

A

limited viral proteins that are potential targets

117
Q

most drugs target what stages in virus replication?

A

intracellular

118
Q

most antivirals are have what mechanism of action?

A

nucleoside analogues - inhibit nucleic acid synthesis

119
Q

antivirals may be used for:

A

prophylaxis
pre-emptive therapy
overt disease
suppressive therapy

120
Q

antivirals in prophylaxis

A

to prevent infection

acyclovir - herpes

121
Q

antivirals in pre-emptive therapy

A

when evidence of infection detected but before symptoms

interferon/ribavirin - HCV

122
Q

antivirals in overt disease

A

aciclovir

oseltamivir

123
Q

antivirals in suppressive therapy

A

to keep viral replication below the rate that causes tissue damage in asymptomatic infected patient
antiretrovirals

124
Q

why may suppressive antiviral treatment be needed after successful treatment?

A

do not eradicate virus from latently infected cells

125
Q

when may you use antivirals for HSV?

A

mucocutaneous - oral ,genital, eye, skin
encephalitis
immunocompromised

126
Q

when may you use antivirals for chicken pox?

A

neonate
immunocompromised
pregnant

127
Q

when may you use antivirals for shingles?

A

only in first 72 hours of onset of symptoms to decrease post-herpetic neuralgia

128
Q

what antivirals and route may you use for HSV and VSV?

A

o Acyclovir – oral, IV, eye ointment, cream
o Valaciclovir – oral
o Famciclovir – oral
o Foscarnet – IV
o Aciclovir like drugs are only active in herpes infected cells

129
Q

describe the mechanism of action of aciclovir

A

Aciclovir is converted by viral thymidine kinase to ACVMP. ACVMP then converted by host cell kinases to ACV-TP. ACV-TP, in turn, competitively inhibits and inactivates HSV-specific DNA polymerase preventing further viral DNA synthesis without affecting the normal cellular processes

130
Q

why is there a lack of cellular toxicity with aciclovir?

A
  1. Initial phosphorylation takes place only in virus-infected cells.
  2. Aciclovir triphosphate inhibits viral (not cellular) DNA polymerase.
131
Q

discuss antivirals and CMV

A 
All available drugs have significant toxicity. Only treat life or sight threatening CMV infections e.g. HIV patients: CMV retinitis, colitis, transplant recipients: pneumonitis. They may also be used to treat neonates with symptomatic congenital CMV infection.
• Ganciclovir – IV, ocular implant
• Valganciclovir – oral
• Cidofovir – IV
• Foscarnet – IV
132
Q

discuss antivirals and HIV

A

This is a fast-changing specialist area for which UK treatment guidelines exist. Combination antiretroviral
therapy (cART), also called highly active antiretroviral therapy (HARRT), uses combinations of antiretrovirals to effectively reduce viral load. This has transformed HIV care with:
1. Restoration of immune function in AIDS
2. Decrease in opportunistic infections

133
Q

discuss antivirals and chronic hep B

A 
• Pegylated interferon alpha (SC)
• Nucleoside/tide analogues
o Tenofovir
o Adefovir
o Entecavir
o Lamivudine
o Emtricitabine
o Telbivudine
134
Q

discuss antivirals and chronic hep C

A

• Often 12-48weeks
• Current therapies
o Pegylated interferon alpha and ribavirin
o As above plus protease inhibitor – telaprevir or boceprevir
• New directly acting antivirals in combination
o Daclatasvir
o Sofosbuvir
o Simeprevir

135
Q

discuss antivirals and respiratory infections

A 
• Influenza A or B
o Oseltamivir, zanamivir
o Role in both treatment and prophylaxis
o Not always indicated, but if used, start within 48 hrs of onset/contact
• RSV
o Ribavirin
o Rarely indicated
136
Q

when should you suspect resistance to herpes virus in immunocompromised patients?

A

no response to appropriate doses within 7 daus

137
Q

if HSV and CMV are resistant to acyclovir, what is usually effective?

A

foscarnet

138
Q

name the 9 components of the antibiotic paradox

A
  1. Antibiotics initially led to poorer hygiene
  2. Antibiotics increase infections
  3. Antibiotics can increase severity of infection
  4. Antibiotics increase infections and mortality in uninfected patients
  5. Are new antibiotics really the answer?
  6. Antibiotics are too cheap – even when new and branded – this encourages inappropriate use
  7. There are many similarities to global warming
  8. Non-human use is greatest
  9. The global village

Year 3 (164 decks)

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