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Unit 1 ID+LC > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Minimum inhibitory concentration (MIC)

A

stops growth

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2
Q

Minimum bactericidal concentration (MBC)

A

kills 99%

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3
Q

bacteriostatic vs

bacteriocidal

A

stops growth/reproduction of bacteria

Kills bacteria directly

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4
Q

Broad spectrum antimicrobials

A
  1. Chloramphenicol
  2. Tetracycline
  3. Sulfonamides
  4. Trimethoprim

*assume everything else is narrow if it isnt also on extended antimicrobials list

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5
Q

Extended use antimicrobials

A
  1. Aminoglycosides
  2. Macrolides
  3. Streptogramins
  4. Extended spec- PCNs
  5. Cephalosporins
  6. Carbapenems
  7. FQ

*assume everything else is narrow if it isnt also on broad spect. antimicrobials list

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6
Q

Cell wall synthesis inhibitors

A
  1. B lactams
    - PCNs, Cephalo, Carbapen, Monobactams
  2. Glycopeptides
    - Bacitracin
    - Vancomycin
  3. Cycloserine (TB)
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7
Q

Penicillins

  • MOA
  • Pharmacokinetics (excretion)
  • Adverse rxn
A

MOA: Inhibit cell wall synth, bactericidal

Pharmacokinetics:
Renal excretion

Adverse:
Anaphylaxis (Type I)
Rash (Type III)
Convulsions at high dose

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8
Q

Which of the PCNs are good oral and which good IV?

A

All are good oral except:

  1. PCN G (IV/IM)
  2. Anti-pseudomonal (IV)
    - Piperacillin (B lactamase inhib)

All rest are good oral

  1. Pen V
  2. PCNase resistant
    - Methicillin
    - Oxacillin
  3. Extended spectrum
    - Ampicillin
    - Amoxicillin (w/ B lactam inhib)
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9
Q

Which are harder to treat? Gram - or Gram +?

A

Gram - : thin cell wall
- like a thin bullet proof vest - diff to penetrate

(Gram + have thick cw: like thick dry wall which absorbs more)

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10
Q

Spectrum/Uses (targets) of:
Pen G
Pen V

A

Gram +/- cocci,

Gram + bacilli, most anaerobes

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11
Q

Spectrum/Uses (targets) of:

Penicillinase resistant PCNs

A

B-lactamase producing S. aureus

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12
Q

Spectrum/Uses (targets) of:

Extended spectrum PCNs

A

Now PCN can target Gram -

*ie: enterobacteriaceae, H. flu, E. coli

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13
Q

Spectrum/Uses (targets) of:

Antipseudomonal (PCN)

A

Less Gram + (like nl PCN) and more Gram -

  • remember gram - are harder to treat
  • Ie: pseudomonas, bacteroides
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14
Q

List Cephalosporins (182)
1st gen:
2nd gen:
3rd gen:

A

1st gen:
- Cefazolin, Cephalexin

2nd gen:
- Cefoxitin, Cefaclor, Cefuroxime

3rd gen:
- Ceftriaxone, Cefoxatime, ceftazidime

4th:
- Cefipine

5th:
- Ceftaroline

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15
Q

Pharmacokinetics of Cephalosporins

- which one can distribute well to CSF?

A

Most IV, some po

3rd gen distributes well to CSF
- Ceftriaxone, cefoxatime, ceftazidime

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16
Q

Protein synthesis inhibitors

A
  1. Cloramphenicol
  2. Clindamycin
  3. Oxazolidinones*
    - Linezolid
  4. Macrolides
  5. Streptogramins**
  6. AG
  7. TCN
  8. Rhupirocin
17
Q

Which protein synthesis inhibitors target 30s and which at 50s bacterial subunit? (leaving hu 80s unaffected)

A

buy AT 30, CCEL at 50
(184)

30s:
Aminoglycosides (cidal)
Tetracycline (static)

50s:
Chloramphenicol
Clindamycin (cidal)
Erythromycin (static)
Linezolid
18
Q

List aminoglycosides

A

(184) “mean” for ameanoglycoside

mean GNATS

Gentamycin
Neomycin
Amikacin
Tobramycin
Streptomycin
19
Q

Toxicity for aminoglycosides

A

(184) “mean” GNATS caNNOT kill anaerobes

Nephrotoxicity
Neuromuscular block
Ototoxicity (esp with loop diuretic)
Teratogen

20
Q

Spectrum of Aminoglycosides

A

Med spectrum Gram - aerobes

TB

21
Q

All protein synthesis inhibitors have GOOD po and IV pharmacokinetics, except ____ which is only good po, and _____ which is only good IV

A

Tetracycline: good po
- renal/biliary excret

Streptogramins: IV only
- hepatic elim

22
Q

Tetracycline (TCN, doxycycline, minocycline) toxicity

A
  1. GI distress (interacts with metal ions in antacids/milk)
  2. Discoloration of teeth and inhibit bone growth in children (bone distribution)
  3. Photosensitivity
  4. Fungal Superinfections
23
Q

Spectrum/use of tetracyclines

A

drugs ability to accumulate intracellularly makes them very effective against Rikettsia and Chalmydia

  1. Rikettsia
  2. Chlamydia
  3. Borrelia (spirochete)
  4. M. pneumonia
24
Q

Pharmacokinetic of macrolides

A

Good PO + IV

  • Concetrates in lungs
  • Hepatic metabolism to active metabolite
  • Biliary elim
25
Q

MOA of macrolides

A

Macrolides block macroSLIDES

- bind to 23S rRNA of the 50s subunit and inhibit protein synthesis

26
Q

Toxicity of macrolides

A

MACRO toxicity for macrolides

Motility issues (GI)
Arrythmia
Cholestatic hepatitis
Rash
eOsiniphilia

Drug interactions due to inhibition of P450

27
Q

CLinical use of macrolides

A

atypical pneumonias

  • Mycoplasma
  • Chlamydia
  • Legionella

STIs
- chlamydia

GPC
- streptococcal infxn in pts allergic to PCN

B. pertussis

28
Q

Chloramphenicol clinical use

A

Broad spectrum

  1. Meningitis
    - H. flu
    - N. meningitidis
    - S. pneumoniae
  2. Rocky Mt spotted fever
    - Rikettsia rikettsii
29
Q

Chloramphenicol toxicity

A
  1. Anemia (dose dep)
  2. aplastic anemia
  3. gray baby syndrome
    - in premature infants bc they lack liver UDP glucuronyl transferase
30
Q

Chloramphenicol pharmacokin

A

Good PO, IV, distrib (CNS/CSF)

Metabolized via glucuronidation
*gray baby syndrome can result in premature infants

31
Q

Clindamycin (185)

Pharmacokinetics

A

Good PO and IV
(Like most protein synthesis inhibitors)

Penetrates into bone

Hepatic metabolism

(treats anaerobic infxns above the diaphragm vs metronidazole which tx below)

32
Q

Clindamycin (185) adverse rxns

A

Pseudomembranous colitis (c. diff overgrowth)

Fever, severe diarrhea

33
Q

Clinical use of Clindamycin

A

Narrow spectrum

  1. Oral infxn
  2. Anaerobic infections in aspiration pneumonia
    - Bacteroides, C. perfringens
  3. Lung abscesses
  4. invasive GAS (gram +) **
34
Q

Which two groups of Protein synth inhibitors can cover Vanco resistant Enterococcus faecium (VREF)?

A

Streptogramins
- Synercid

Oxazolidinones
- Linezolid

*both inhibit at 50s subunit

35
Q

MOA and Pharmacokinetic of Streptogramins (pristins) and Oxazolidinones (linezolid)

A

protein synth at 50s subunit

IV

*linezolid can give good PO too

36
Q

Adverse rxns of streptogramins

A

Inhibits CytP450

- increase plasma lvl of drugs

37
Q

Adverse rxns of oxazolidinones

A 
Serotonin Syndrome:
- HA
- D/N (gastro)
Inhibits MAO
- muscle rigidity
- seizure

Peripheral neuropathy

Bone marrow suppression

38
Q

Which antimicrobial agent to use against G+ species INCLUDING MRSA and VRE

A

Oxazolidinones

- Linezolid

Unit 1 ID+LC (32 decks)

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