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semester 1 > Antimicrobial chemotherapy (better cue cards > Flashcards

Antimicrobial chemotherapy (better cue cards Flashcards

1
Q

Define ‘bactericidal’

A

Antimicrobial that kills bacteria

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2
Q

Define bacteriostatic

A

Antimicrobial that inhibits growth of bacteria

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3
Q

Define ‘sensitive’

A

Level of anti-microbial required to inhibit/kill organism at infection site

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4
Q

Define ‘resistant’

A

Organism not killed/inhibited by levels of antimicrobial available at site of infection

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5
Q

Define ‘MIC’

A

Minimal inhibitory concentration - minimum conc. of antimicrobial needed to inhibit visible growth of given organism

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6
Q

Define ‘MBC’

A

Minimal bactericidal conc. - Minimum conc. of antimicrobial needed to kill organism

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7
Q

What are the 3 routes of administration

A

Systemic - taken internally
Topical - Applied to surface, eg skin
Parenteral - Administered intra-venously (iv) / intra-muscularly (im)

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8
Q

What are the 3 mechanisms of action of antimicrobial agents

A

Inhibition of cell wall synthesis (humans don’t have cell walls)
Inhibition of protein synthesis
Inhibition of nucleic acid synthesis

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9
Q

What do Beta lactams Do

A

Disrupt peptidoglycan synthesis
Inhibiting Penicillin-binding proteins

Peptidoglycan Important structure of bacteria cell wall

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10
Q

what two types of drugs are β-lactams

A

Penicillin
Cephalosporins

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11
Q

What are the two types of antimicrobials which inhibit cell wall synthesis

A

Glycopeptides and β-lactams

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12
Q

What are two common glycopeptides

A

Vancomycin
Teicoplanin

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13
Q

Describe the mechanism and range of action of glycopeptides

A

inhibit cell wall synthesis - but at a prior stage than B-lactams
Act only on gram positive organisms

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14
Q

What route of administration must glycopeptides take (unless special circumstances)

A

Parenterally (iv/im)

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15
Q

What is one side effect of vancomycin

A

It is toxic

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16
Q

What are the 4 types of antimicrobials which inhibit protein synthesis

A
  • Aminoglycosides - gram -ve
  • Macrolides and tetracyclines - gram +ve
  • Oxazolidinones - gram +ve
  • Cyclic lipopeptides - gram +ve
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17
Q

What type of bacteria are aminoglycosides useful for?

A

Treating serious gram negative Infection

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18
Q

What type of drug is gentamicin and what is a common side effect of adminsitration

A

Aminoglycoside and is toxic -
Requires careful dosing regime & monitoring of levels

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19
Q

What are the uses of macrolides and tetracyclines

A

Treatment of gram positive infections in patients who are penicillin allergic CANNOT BE USED WITHOUT LABORATORY TESTING

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20
Q

What class of drug is linezolid and what is it commonly used for?

A

oxazolidonones (protein synthesis inhibitor).
good activity against MRSA
Can be given orally

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21
Q

What class of drug is daptomycin and what it is commonly used for?

A

Cyclic lipopeptide (protein synthesis inhibitor).
Activity against gram positives in general and MRSA

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22
Q

What are the 2 classes of drug which inhibit nucleic acid synthesis

A

Trimethoprim
Sulphamethoxazole
Used in combination to form a drug
- Co-trimoxazole

- Fluoroquinolone’s

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23
Q

What type of drug is ciprofloxacin? What it is commonly used for? What are some of the drawbacks of the drug

A

Fluoroquinolone (nucleic acid inhibitor).
used against gram negative organisms.
Taken orally
Not to be used in children

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24
Q

Describe inherent or intrinsic resistance

A

All strains of a given species naturally resistant to antibiotic
Due to inability of drug to penetrate bacterial cell wall

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25
Q

What are the 2 ways in which acquired resistance may be acquired?

A
  1. A spontaneous mutation
  2. Genes that code for resistance spread from organism to organism through plasmids
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26
Q

What are the 2 mechanisms of resistance to β–lactam antibiotics?

A
  1. β-lactamase production - enzymes which cleave β–lactam ring of antibiotic & render it inactive
  2. Alteration of penicillin binding protein (PBP) target site - Mutations in PBP genes result in a modified target site
    B-lactams no longer bind
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27
Q

2 ways to combat B-lactamase?

A
  1. Co-amoxiclav plus the B lactamase inhibitor clauvanic acid
  2. Flucloxacillin - modified form of penicillin
28
Q

What are ESBL’s and what are the implications of their existence

A

Extended spectrum β–lactamases (ESBLs)
Produced by Gram negative organisms.
Break down third generation cephalosporins & penicillins
Render organism resistant to all β–lactam antibiotics

29
Q

What glycopeptide resistant bacteria has appeared recently and what are the implications of this mutation?

A

Vancomycin resistant enterococci (VREs)
Major problem: Resistance might spread from enterococci to Staph aureus producing vancomycin resistant staph aureus

30
Q

Describe the spectrum of Benzyl penicillin (penicillin G)

A

Gram +ve organisms
intra-venous treatment of serious pneumococcal, meningococcal and strep pyogens

31
Q

Describe the spectrum of amoxicillin/ampicillin

A

Gram -ve activity
Oral absorption
Effective against streptococci and coliforms

32
Q

Describe the spectrum of co-amoxiclov

A

Effective against B-lactamase producing coliforms

33
Q

Describe the spectrum of flucloxacillin

A

Effective against staph infections

34
Q

Describe the spectrum of piperacillin

A

Gram -ve cover
Effective against Enterococcus faecalis and pseudomonas species

35
Q

Describe the spectrum of cephalosporins

A

Activity against Gram -‘ve organisms increases from 1st through 3rd generation
Activity against Gram +’ve organisms decreases from 1st through 3rd generation
Generally not used as encourage C Diff infections

36
Q

How must cephalosporins be taken?

A

Parenteral use only

37
Q

Describe the spectrum of aminoglycocides

A

Noted for action against Gram -ve organisms
Effective against staphlococci but not streptococci
Gentamicin cheapest and most common aminoglycocide

38
Q

Describe the spectrum of glycopeptides

A

Only gram +’ve organisms are affected (anaerobic +aerobic)

Vancomycin most common example

39
Q

Describe the spectrum of action of macrolides

A

Mainly used against gram +’ve organisms -
Alternative to penicillin for patients with a penicillin allergy

40
Q

Describe the spectrum of action of Quinolones

A

Nearly all gram -‘ve organisms are sensitive

Mainly used in treatment of community acquired pneumonia

41
Q

Describe the spectrum of action of metronidazole

A

Effective against Gram +’ve and -‘ve anaerobes

42
Q

Describe the spectrum of action of fusidic acid

A

staphylococcal drug

43
Q

Describe the spectrum of action of trimethoprim

A

Used in urinary infections

44
Q

Describe the spectrum of action of tetracyclines

A

Used in genital tract and respiratory tract infections

45
Q

Describe the spectrum of action of clindamycin

A

Effective against Gram +’ve organisms

46
Q

What infection is linezolid used against

A

MRSA

47
Q

What infection is fidaxomicin used against

A

C. diff

48
Q

What infection is daptomycin used against?

A

MRSA

49
Q

What are the 4 classes of anti-fungal drugs?

A

Polyenes
Azoles
Allylamines
Echinocandins

50
Q

Describe the mechanism of polyenes

A

Bind to the ergosterol- present in fungal wall
Also binds to mammalian sterols making polyenes TOXIC

51
Q

Describe the use of amphotericin B and Nystatin (Hint: they are Polyenes)

A

Amphotericin B is used intra-venously for serious yeast infections and other fungal infections. Very toxic.

Nystatin is used topically or in oral suspension and is not an intra-venous agent for serious fungal infection

52
Q

Describe the mechanism of Azoles

A

Inhibit ergosterol synthesis

53
Q

What is fluconazole used to treat?

A

Yeast infections

54
Q

What are voriconazole and intraconazole used to treat?

A

Yeast and filamentous fungi including: Aspergillosis

55
Q

Describe the mechanism of allylamines

A

They suppress the ergosterol synthesis but act at a different stage of the synthetic pathway from azoles

56
Q

Describe the use of Terbinafine

A

Used for fungal infections of the skin and nails

57
Q

Describe the mechanism of echinocandinds

A

They inhibit the synthesis of glucan polysaccharide in several types of fungi

58
Q

What are echinocandins used for?

A

Serious candida and aspergillus infections

59
Q

Describe anti-herpes virus drugs

A

All become latent and include: Herpes simplex virus (HSV), eptein-barr virus (HBV), cytomegalovirus (CMV) and Varicella-Zoster Virus (VZV).

60
Q

Describe the mechanism and function of Aciclovir

A

not very toxic
Extremely active against HSV and active against VZV
Intravenously used for serious,
Oral for less serious

61
Q

Describe the use of valaciclovir and famciclovir

A

Related to aviclovir - Used in oral treatment of HSV and shingles

62
Q

Describe the use of valganciclovir

A

Pro drug of ganciclovir -> alternative treatment for CMV.

High levels of bone marrow toxicity

63
Q

Describe the use of foscarnet

A

Used for HSV, VZV and CMV

Highly nephrotoxic

64
Q

Describe the use of Cidofovir

A

Used for CMV retinitis

65
Q

What anti-viral agent is used to treat infections with HIV?

A

Saquinavir

semester 1 (65 decks)

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