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Pharmacology > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

What is the goal of antibacterial therapy?

A

Help the body eliminate infectious organisms without toxicity to the host

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2
Q

What are three examples of natural defense mechanisms in animals?

A

Mucociliary escalator in the respiratory tractFlushing effect of urinationGut normal flora

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3
Q

What are of primary importance in preventing and/or controlling infection in patients?

A

Natural defence mechanisms

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4
Q

What are the four quadrants of the antimicrobial spectrum?

A

Gram positive aerobesGram negative aerobesObligate anaerobesPenicillinase producing Staph

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5
Q

What are the six atypical bacterial species that don’t fit into the antimicrobial spectrum quadrants?

A

RickettsiaMycoplasmaChlamydiaBorreliaBartonellaMycobacterium

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6
Q

How does bacterial resistance occur?

A

Antibacterial agents preferentially select for resistant populations of bacteria

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7
Q

When should antibacterial agents be used?

A

Definitively diagnosed bacterial infectionLikely diagnosis when all signs and data are consideredBelieved likely to progress without therapyWould cause critical illness if it occurred and was not treated

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8
Q

What is the main type of antibacterial therapy used?

A

Empirical therapy - don’t know for sure what bacteria is but use the best possible drug with the signs shown

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9
Q

What should you base your prescription of antibacterial drugs on?

A

Clinical problem and the most likely organisms to be pathogens in that site

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10
Q

What is strongly recommended if therapy fails or infection immediately recurs after therapy?

A

Culture and sensitivity

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11
Q

What could be given if you do not want to give antibacterials but owner feels something should be done?

A

Vitamin therapy - no resistance and little to no side effects

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12
Q

What are the clues that a bacterial infection is present?

A

Heat, redness and swellingPyrexiaNeutrophiliaBacterial cause common for signs

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13
Q

Is vomiting without diarrhoea indicative of antibacterial therapy?

A

No - no bacteria that cause this

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14
Q

Should antibacterial therapy be considered for a cat less than 10 with haematuria?

A

No - feline idiopathic cystitis - resolves in 5-7 days with no real treatment

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15
Q

Why is it rare for cats presenting with urine problems for the cause to be bacterial?

A

Have a very concentrated urine that bacteria are unable to survive well in

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16
Q

What seven things should be considered before providing antibacterial therapy?

A

Predict likely bacteria?Predict susceptibility?Is culture needed/feasible?Pharmacokinetic factors?Side effects or increased patient risk?Client compliance issues?Cost considerations?

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17
Q

What are the five factors that affect the success of antibacterial therapy?

A

What bugs live where?Bacterial susceptibilityDistribution to site of infectionLocal conditionsClient compliance

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18
Q

What three main places do infections come from?

A

EnvironmentOther animalsWithin

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19
Q

If a drug is not susceptible in vitrohow will it work in vivo?

A

Generally resistant in vivo

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20
Q

Why might a drug only be possibly effective in vivoif pathogen is sensitive in vitro?

A

Variety of pharmalogical, host and bacterial factors affect effectiveness in vivo

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21
Q

What is MIC?

A

Minimum inhibitory concentratin

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22
Q

Define MIC

A

Lowest concentration of drug that will inhibit bacterial growth

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23
Q

What level of MIC is used to determine therapeutic dose?

A

MIC90 - concentration that will inhibit 90% of isolates of a bacterial species

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24
Q

Which antimicrobials cause inhibition of cell wall synthesis?

A

PenicillinsCephalosporinsBacitracin

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25
Q

Which antimicrobials cause inhibition of cell membrane function?

A

PolymyxinsAmphotericin BImidazolesNystatin

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26
Q

Which antimicrobials cause inhibition of protein synthesis?

A

ChloramphenicolMacrolidesLincosamidesTetracyclinesAminoglycosides

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27
Q

Which antimicrobials cause inhibition of nucleic acid synthesis?

A

SulphonamidesTrimethoprimQuinolonesMetronidazoleRifampin

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28
Q

What do bacteriostatic antimicrobials do?

A

Temporarily inhibit growth of organisms though effect is reversible once drug removedDrug concentration should be maintained above the MIC throughout dosing interval

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29
Q

What are the five bacteriostatic antimicrobials?

A

ChloramphenicolLincosamidesMacrolidesTetracyclinesNon-potentiated sulphonamides

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30
Q

What do bactericidal antimicrobials do?

A

Under ideal conditions kill bacteria and are preferred when concerned about site of infection or host defences

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31
Q

What are the six examples of bactericidal antimicrobials?

A

PenicillinsCephalosporinsAminoglycosidesFluoroquinolonesPotentiated sulphonamides (TMPS)Metonidazole

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32
Q

What two things can bactericidal antimicrobials dependent on?

A

Time and concentration

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33
Q

What determines the therapeutic success of time dependent antimicrobials?

A

Time above MIC over 24hr period

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34
Q

What are three examples of time dependent antimicrobials?

A

PenicillinsCephalosporinsTMPS

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35
Q

What do bacteria need to be doing for time dependent antimicrobials to be effective?

A

Multiplying

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36
Q

What determines the therapeutic success of concentration dependent antimicrobials?

A

Peak concentration achieved or area under the concentration curve

37
Q

What are three examples of concentration dependent antimicrobials?

A

AminoglycosidesFluoroquinolonesMetronidazole

38
Q

Do bacteria need to be multiplying with concentration dependent antimicrobials?

A

No - can combine with bacteriostatic drugs

39
Q

What is the optimal ratio for concentration dependent antimicrobials?

A

Maximum concentration divided by MIC is greater than 8

40
Q

Which antimicrobials are not effective against gram positive aerobes?

A

AminoglycosidesMetronidazole

41
Q

Which antimicrobials are not effective against gram negative aerobes?

A

MetronidazolePenicillin GLincosamidesMacrolides

42
Q

Which antimicrobials are not effective against obligate anaerobes?

A

FluoroquinolonesAminoglycosides

43
Q

Which antimicrobials are not effective agains penicillinase producing staph?

A

Penicillin GAminopenicillinsMetronidazole

44
Q

What do aminoglycosides need to work?

A

Oxygen

45
Q

What type of bacteria does Metronidazole not work against?

A

Aerobes

46
Q

What are some examples of antimicrobials that are effective for treating gram positive aerobes?

A

Penicillin GAnimopenicillinsCephalosporinsLincosamidesMacrolidesTetracyclinesRifampin

47
Q

What are some examples of antimicrobials that are effective at treating gram negative aerobes?

A

FluoroquinolonesAminoglycosides2nd and 3rd gen. CephalosporinsTicarcillin-clavulanate

48
Q

What are some antimicrobials that are effective at treating obligate anaerobes?

A

Penicillin GAmoxy-clavClindamycinMetronidazoleChloramphenicolRifampin

49
Q

What are some antimicrobials that are effective at treating penicillinase producing staph?

A

Amoxy-clav1st and 2nd gen. CephalosporinsCloxacillinFluoroquinolonesRifampin

50
Q

What are the three antimicrobials that are effective treatments but some important species are resitant? Which quadrant do they work in?

A

Fluoroquinolones - gram positive aerobesAmoxy-clav - gram negative aerobesClindamycin - penicillinase producing staph

51
Q

What are the four ‘brown’ drugs and which quadrants are they not that effective against?

A

1stgeneration cephalosporins, cefovicin and amoxycillin- against gram negative aerobes and obligate anaerobesLincosamides (not clindamycin)- against anaerobesTMPS- all quadrantsTetracyclines- all quadrants except gram positive aerobes

52
Q

Which antimicrobial drug has excellent activity against atypical bacteria?

A

Tetracyclines

53
Q

What limits distribution of antimicrobials in tissues with adequate blood supply?

A

Perfusion - free drug concentrations in plasma are directly related to or equal to concentration in interstitial space

54
Q

What limits distribution of antimicrobials to tissues without adequate blood supply?

A

Permeability - lipid membrane forms a barrier to drug diffusion

55
Q

Where do most antibacterial drugs reach therapeutically adequate concentrations?

A

In bone and synovial fluid

56
Q

Which areas of the body is it difficult for antimicrobials to access?

A

BrainEyeProstateBronchusMammary glandIntracellularPoorly vascularised tissues

57
Q

What are the six bacteria that are intracellular?

A

BartonellaBrucellaChlamydophilaMycobacteriumRickettsiaStaphylococcus

58
Q

Which antimicrobials poorly penetrate barriers?

A

PenicillinsCephalosporinsBeta-lactamase inhibitorsPolymixinsAminoglycosides

59
Q

Which antimicrobials have good penetration?

A

SulphonamidesTrimethoprimLincosamidesMacrolidesTetracycline

60
Q

What are the antimicrobials with great penetration across barrier?

A

ChloramphenicolFluroquinolonesLipophilic tetracyclinesMetronidazoleRifampin

61
Q

What five environmental conditions affect the success of antimicrobial therapy?

A

Abcess formationPusNecrotic debrisOedema fluidForeign material

62
Q

How can foreign material affect effectiveness of antimicrobial therapies?

A

Phagocytes degranulate to destroy material depleting intracellular bactericidal substancesCan protect bacteria from antibacterial drugs and phagocytosis

63
Q

How does haemoglobin affect penicillin activity?

A

Reduces activity

64
Q

What is TMPS inactivated by?

A

Pus

65
Q

Which drugs does a low pH cause a marked loss of activity in?

A

ErythromycinClindamycinFluoroquinolones

66
Q

What is surgical prophylaxis?

A

Use of antimicrobials pre and post surgery to prevent infection occuring

67
Q

What four things need to be considered when assessing post operative risk of infection?

A

Degree of contaminationVirulence of organismHealth of patientLocal tissue health

68
Q

What seven things should be used to justify surgical prophylaxis?

A

Timing of surgeryHealth of patientLevel asepsisPresence of implantsSurgical timeSurgical techniqueOrgans involved

69
Q

Which patients have an increased risk of post operative infection with their clinical status?

A

Those who are shocked or emaciated

70
Q

Which procedures have a greater post operative infection risk?

A

Emergency procedures

71
Q

How does the duration of the surgery affect the post operative risk of infection?

A

1.5 hours infection rate of 1.6%>1.5 hours infection rate 8%RIsk double for every 30 minutes over 1 hour procedure

72
Q

What is the increase in post operative infection risk with anaesthesia?

A

0.5% increase in risk for every minute beyond 60 minutes

73
Q

How much more at risk of post operative infection are animals receiving propofol?

A

3.8 times more at risk

74
Q

How does clipping affect the post operative risk of infection?

A

Clipped surgical sites before induction 3 times more likely to develop post op infection

75
Q

What six cases are surgical prophylaxis indicated in?

A

Dental proceduresLeukopenic patientsContaminated surgeryOrthopaedic and major abdominal/thoracic surgerySurgical time greater than 90 minsConsequences of infection would be disastrous

76
Q

Why is aseptic technique so important?

A

Antibiotics not a substitute for aseptic technique - can’t compensate for gross contamination, local tissue trauma or compromised patient health

77
Q

Describe administration of surgical prophylaxis

A

Administer before procedureAchieve maximum effect the drug must be present in wound at time of contaminationAdvantages of therapy minimal if commenced later than 3-5 hours after contamination

78
Q

What are the most useless drugs to use for surgical prophylaxis in most small animal cases?

A

Amoxycillin or long acting drugs

79
Q

What are generally recommended as the best drugs for surgical prophylaxis?

A

2ndgeneration cephalosporinsAmoxycillin-clavulanate1stgeneration cephalosporinIV at time of induction or SC or IM 1-2 hours prior to surgery

80
Q

What key questions are asked to determine whether antimicrobials are indicated?

A

Is infection definite, probable or very possible?Could critical illness occur?Any signs of heat, redness, swelling, pyrexia or known cause for presenting signs?

81
Q

What questions need to be asked if you do need to use an antibacterial?

A

Where is infection?What bacteria would I expect there?Do I need to maximise cure chance?What antibacterials would be effective against these bacteria?Are there any pharmacokinetic issues?Are there any side effect issues?Are there any client compliance issues?

82
Q

What are the general withdrawal perios for milk and meat?

A

7 days for milk28 days for meat

83
Q

What should enrofloxacin (Baytril) not be used in?

A

Birds producing eggs for human consumptionLayer replacement birds within 14 days of coming into lay

84
Q

Which animals should metronidazole/phenylbutazone not be used in?

A

Food producing animals as carcinogenic

85
Q

Whose responsibility is it to ensure residues do not enter the food chain?

A

Farmer/owner

86
Q

What two tests are done on produce to check for residues?

A

Milk - beta-lactam test done at dairyMeat - kidney test done at abattoir in case of suspicion

87
Q

What are the two criterion on the WHO list for the importance of antimicrobials?

A
  1. An agent which is the sole, or one of limited therapy, to treat a serious human disease2. An antimicrobial used to treat disease caused by non-human sourced organisms or organisms that may acquire resistance genes from non-human sources
88
Q

What are the three levels of importance of antimicrobials on the WHO list?

A

Critically important - meet both criteriaHighly important - meet one of the criteriaImportant - meet neither of the criteria

89
Q

Which five antibiotics cannot be given orally rabbits?

A 
Penicillins
Lincosamides
Aminoglycosides
Cephalosporins
Erythromycins

Pharmacology (3 decks)

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