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MFMII > Antimicrobial Chemotherapy > Flashcards

Antimicrobial Chemotherapy Flashcards

1
Q

what is therapeutic index

A

difference between effective dose and toxic dose

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2
Q

what is a bacteriostatic drug

A

inhibit bacterial growth, but pt defense must still eliminate the microbes

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3
Q

what is a bactericidal drug

A

kill bacteria

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4
Q

which are bacteriostatic drugs

A
  1. Tetracyclines
  2. Trimethoprim
  3. Aminoglycosides
  4. macrolide
  5. sulfonamides
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5
Q

which are bactericidal drugs? (cell wall inhibitors)

A
  1. Beta lactams
  2. vancomycin
  3. fluoroquinolones
  4. metronidazole
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6
Q

which drugs are synergistic

A

penicillins and aminoglycosides

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7
Q

which drugs are antagonistic

A

chloramphenicol and aminoglycosides

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8
Q

what are 3 requirements for antimicrobials

A
  1. favorable pharmacokinetics
  2. minimal adverse effects (including minimal suppression of normal microbiota)
  3. overcome resistance
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9
Q

what is MIC

A

minimal inhibitory concentration: lowest concentration a drug prevents growth in vitro

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10
Q

what is MBC

A

minimal bactericidal concentration: lowest concentration that kills 99.9% of in assay

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11
Q

what are MIC and MBC measurements?

A

quantitative measurements

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12
Q

what is antimicrobial serumcidal concentration?

A

minimum concentration required to kill a patient’s bacterial isolate in the presence of their own serum

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13
Q

what is a good qualitative assay?

A

kirby bauer (disk diffusion) is fast

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14
Q

what is a good quantitative assay?

A

broth macro/microdilution or Etest (slowe)

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15
Q

what does Kirby Bauer test for

A

sensitivity to drugs (qualitative assay)

  1. sensitivity to drug
  2. intermediate sensitivity to drug
  3. resistant to drug
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16
Q

what does the quantitative E test

A

read zone of occlusion after incubation period that is microgram/m:

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17
Q

what do AST do

A

measure how sensitive bacteria are to Abx

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18
Q

what factors need to be considered before giving chemoprophylactics to patient?

A
  1. characteristics of patient (age, immune status, gender, pregnancy)
  2. risk vs benefit
  3. will it be short term?
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19
Q

is treatment of baby with erythromycin a justified chemoprophylactic?

A

yes

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20
Q

is prophylaxis against malaria justified?

A

yes

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21
Q

prophylaxis against animal or human bites justified?

A

yes

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22
Q

prophylaxis after surgeries that cross mucosal barrier justified?

A

yes

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23
Q

is giving prophylactic to patient that demands if justified?

A

no, unjustified

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24
Q

what if surgery does not cross mucosal barrier?

A

no prophylactic, unjustified

25
Q

what factors dictate Abx efficacy?

A
  1. infection site
  2. pathogen and minimal inhibitory concentration
  3. patient’s pathophysiology (age, diseases)
26
Q

which sites of infection are difficult to treat due to barriers, location, or blood flow?

A 
CSF - csf blood barrier
brain BBB
prostate difficult to penetrate
dead bone no blood flow 
kidneys does not penetrate well
27
Q

what host physiological factors need to be considered before Abx?

A
  1. liver and kidney function
  2. weight (BMI, age, volume of distribution)
  3. critical illnesses
  4. pregnancy (because cross the placenta)
28
Q

which drugs are safe in pregnancy?

A
  1. penicillins
  2. azithromycin
  3. metronidazole
  4. cephalosporins
  5. clindamycin
29
Q

what circumstances limit effectiveness of antimicrobial agents?

A
  1. abscess formation
  2. immunosuppression
  3. superinfections
  4. drug antagonism
  5. foreign bodies or biofilms
30
Q

mechanism of action of beta lactam drugs

A

binds to transpeptidase competitively inhibits (catalyze the formation of peptide bridges between NAG and NAM - crosslinkages) to disrupt cell wall synthesis

31
Q

what cells are beta lactams effective against

A

gram + mostly, only against actively growing cells

32
Q

which medication classes are cell wall synthesis inhibitors?

A
  1. penicillins
  2. cephalosporins
  3. carbapenems
  4. monobactums
33
Q

which medication classes are protein synthesis inhibitors?

A
  1. macrolide and lincosamide
  2. aminoglycosides
  3. tetracyclines
  4. chloramphenicol
  5. oxazolidinones
34
Q

which drug classes are folate synthesis inhibitors?

A
  1. sulfamethoxyzole

2. trimethoprim

35
Q

which drug classes are DNA synthesis inhibitors

A
  1. quinolones

2. fluoroquinolones

36
Q

which drug class if RNA synthesis inhibitor?

A

rifamycins

37
Q

which drug class is mycolic acid synthesis inhibitor (mycobacteria)

A
  1. isoniazid

2. ethambutol

38
Q

4 groups of penicillins

A
  1. natural penicillins
  2. anti-staphylococcal penicillins
  3. aminopenicillins
  4. extended spectrum penicillins
39
Q

which is the most potent penicillin

A

Penicillin G

40
Q

which are natural penicillins?

A

penicillin V and G

41
Q

how is penicillin G given and why

A

sensitive to stomach acids so IV or IM, short acting

42
Q

how is penicillin V given and wy

A

acid resistant, given orally

43
Q

what range are natural penicillins?

A

narrow spectrum against gram + and few -

44
Q

what bacteria do cephalosporins act against

A

mostly gram negative

45
Q

moa of vancomycin

A

blocks peptidoglycan synthesis by binding to peptide side chain of NAM (blocks tetrapeptide bridge formation)

46
Q

what is vancomycin effective against?

A

ONLY GRAM POSITIVE

47
Q

general MOA of protein synthesis inhibitors

A

selectively bind to ribosomal subunits (30S or 50S)

48
Q

MOA of cephalosporin

A

resistant to beta lactamases

49
Q

how does bacitracin work

A

inhibits cell membrane, affects permeability that leads to leakage of intracellular compounds

50
Q

MOA aminoglycoside

A

binds to 30S ribosomal protein irreversibly, blocks elongation of polypeptide chains

51
Q

MOA tetracyclines

A

inhibit protein synthesis by blocking amino acyl transfer of tRNA to mRNA ribosome complex

52
Q

MOA chloramphenicol

A

blocks protein synthesis by binding to 50S ribosomal subunit and prevents peptidyl transferase function

53
Q

MOA of macrolides and lincosamide

A

binds to 50S ribosomal subunit

54
Q

MOA of oxazolidinones

A

block formation of tRNA:mRNA:50S complex

55
Q

MOA of trimethoprim and sulfamethoxyzole

A

inhibit different steps in synthesis of folic acid in bacteria (metabolic pathway inhibitors)

56
Q

MOA fluoroquinolone and quinolones

A

target DNA gyrase so inhibits nucleic acid synthesis

57
Q

moa rifamycins

A

inhibition of bacterial DNA-dependent RNA synthesis, high affinity for prokaryotic RNA polymerase

58
Q

moa isoniazid

A

inhibits mycolic acid synthesis (targets cell wall of mycobacteria)

59
Q

moa ethambutol

A

inhibits enzymes required for synthesis of other cell wall components of mycobacteria

MFMII (29 decks)

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