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Block 5 > Antimicrobials > Flashcards

Antimicrobials Flashcards

1
Q

Bactrim is a combination of what two drugs?

A

Sulfonamides and Trimethoprim

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2
Q

Fluoroquinolones mechanism of action?

A

it inhibits the DNA synthesis, messes with the bacterial DNA

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3
Q

What are the 2 big problems for Macrolides?

A

narrow spectrum, poor GI intolerance

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4
Q

Televancin has the same coverage as what?

A

Vancomycin- it is a copy cat

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5
Q

The amount of time that the area of the curve (AUC) of the antibiotic remains above the MIC. Used in pharmacodynamic models to express if an antimicrobial would be effective against a certain pathogen.

A

AUC/MIC ratio

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6
Q

What type of therapy is designed to be initiated as soon as an infection is presumed, usually upon presentation with symptoms of an infection and physical evidence of an infection?

A

Empiric therapy- this is used the most and you will have to be correct in the beginning otherwise outcome are bad

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7
Q

Inhibitors of folate synthesis are what?

A

metabolic inhibitors

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8
Q

What is the drug of choice for tick infections?

A

Doxycycline

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9
Q

The highest concentration of a drug is the peak, the lowest concentration of a drug is trough. What are these important in?

A

the dosing cycle

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10
Q

What is the drug of choice for Group A Streptococcus?

A

Penicillin

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11
Q

The lowest concentration of agent required to sterilize the medium or to kill 99.9% of the bacterial count after in-vitro placement

A

MBC- minimum bactericidal concentration

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12
Q

The mechanism of action for tetracyclines is to inhibit bacterial _______ by reversibly bind to __________.

A

protein synthesis, reversibly binding to the 30s ribosomal subunit

  • the 30s ribosomal subunit has the mechanism of action for inhibiting protein synthesis
  • bacteriostatic
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13
Q

What should you ask your patient when considering Metronidazole?

A

alcohol use

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14
Q

The inhibition or destruction of the infecting organism without damage to the host cells (kill the bad, save the good)

A

selective toxicity

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15
Q

What is special about ceftazidime?

A

it is the only drug in the 3rd generation cephalosporin that covers pseudomonas

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16
Q

What does Metronidazole cover?

A

anaerobes- bacteroides and C. difficile

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17
Q

What is the only beta-lactamase antibiotic that covers MRSA?

A

Ceftaroline

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18
Q

Adverse drug reaction for aminoglycosides?

A

Nephrotoxicity- acute tubular necrosis

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19
Q

What has an antipseudomonal beta-lactam and a beta-lactamase inhibitor added to it? Only reason to use it?

A

Piperacillin/Tazobactam

the antipseudomonal beta-lactam is in the piperacillin

Use because we suspect pseudomonas

broadest Penicillin

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20
Q

What is important to know about the mechanism of action for Vancomycin?

A

it destroys the cell wall

  • inhibits bacterial cell wall synthesis at a different site than Beta-Lactams
  • inhibits synthesis and assembly of second stage of peptidoglycan polymers
  • binds to D-alanine-D-alanine portion of cell wall precursors
  • bactericidal (except for Enterococcus)
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21
Q

Mechanism of action for Macrolides?

A

inhibits protein synthesis, 50s ribosomal subunit

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22
Q

What is limited to very severe infections and is resistant to a lot of things? The binding to the 30s is 5x higher than in tetracyclines and is therefore more ____.

A

Tigercycline, potent

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23
Q

What is the dosing of Vancomycin based on?

A

primarily renal excretion, must know the patient’s kidney function

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24
Q

The persistent effect of an antimicrobial agent on microbial growth following brief exposure of the microorganisms to the antimicrobial agent

A

PAE- postantibiotic effect

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25
Q

Beta-lactams and glycopeptides are what?

A

cell wall synthesis inhibitors

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26
Q

What increased the spectrum of Penicillin a little bit and added coverage for enterococcus?

A

Aminopenicillins

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27
Q

You can use _____ for MSSA but you must use Vancomycin for _____.

A

beta-lactam for MSSA, must use Vancomycin for MRSA

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28
Q

Dalbavancin is similar to Oritavancin (copy cats of Vancomycin). What is different about Dalbavancin?

A

1500mg one time or 1000mg dose followed by 500mg dose 1 week later

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29
Q

Certain bacteria make and secrete Beta-lactamases, what are they?

A

gram negatives and staphlococci

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30
Q

Main use for 4th generation cephalosporin?

A

gram-negatives, especially pseudomonas

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31
Q

What generation has the best activity against gram-positive aerobes?

A

first generation cephalosporins

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32
Q

If a pt comes in for surgery without an active infection and you want to prevent an infection by giving Abx, what type of therapy is it?

A

prophylactic

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33
Q

Drugs which irreversibly destroy the ability of a microorganism to replicate, these drugs kill the bacteria without outside assistance from immune system

A

Bactericidal

34
Q

Linezolid is a weak ________ oxidase inhibitor. You can’t give this with _________.

A

monoamine

antidepressants- because it can increase the risk of serotonin syndrome

35
Q

If a patient has a fever, serious painful abdominal cramping, very nasty smelling diarrhea, especially after taking Clindamycin, consider what disease?

A

C. difficile

36
Q

What is not covered by Carbapenems?

A

MRSA

Ertapenem (one of the Carbapenems) does not cover Pseudomonas

37
Q

Vancomycin only covers _____ and the main reason to use this drug is _____.

A

gram-positives, main reason to use this drug is S. aureus

38
Q

While Vancomycin is given BID or TID, this drug is only given QD. This is what separates this drug from Vancomycin and perhaps the reason for being created.

A

Televancin

39
Q

What is the go-to drug for gram-negative aerobes and is definitely used for Enterococcus for synergy?

A

Aminoglycosides

40
Q

Extent of bacterial killing depends on the time the active drug concentration remains above the MIC.

A

concentration-independent (time-dependent) killing

41
Q

The rate and extent of bactericidal action increase with increasing drug concentration. Better killing as the concentration increases.

A

concentration-dependent killing

42
Q

What is special about Oritavancin? (a copy cat of Vancomycin)

A

a one time 1200mg dose that has an elimination 1/2 life of 245 hours

43
Q

Drugs which reversibly impair replicating ability of microorganisms, need the innate immune system to eradicate microorganisms

A

Bacteriostatic

44
Q

Beta-lactams bind to the _______ which is responsible for the assembly, maintenance and regulation of peptidoglycan metabolism. This leads to _____ of cell due to osmotic instability or autolysis.

A

PBP, death

45
Q

What works on the cell wall, is really old, and isn’t used much?

A

Colistin

46
Q

You can’t use Daptomycin for what disease?

A

PNA- this drug is inactivated by the surfactant in the lungs (exam question)

47
Q

What should you avoid in children because it will cause discoloration of teeth? Unless of course it is a life threatening situation.

A

Tetracycline

-kid has tick bite and they might die if you don’t give them this drug, give it to them

48
Q

What do folate synthesis inhibitors do?

A

inhibit folate synthesis, mess with folic acid

49
Q

There are five general mechanisms which antimicrobials exhibit to exert their action on bacteria. What are they?

A
  • inhibition of cell wall synthesis
  • direct damage to the outer membrane of the bacteria
  • modification of nucleic acid/DNA synthesis
  • modify protein synthesis (at the ribosome)
  • modification of the energy metabolism within the cytoplasm (at the folate cycle)
50
Q

What is the oral option for MRSA?

A

Sulfamethoxazole/Trimethoprim

51
Q

What are the most broad spectrum antibiotics that we have right now?

A

Carbapenems- only IV form

52
Q

Penicillins, Cephalosporins, Carbapenems, and Monobactams are all _______ which are _________ that all have the same _________.

A

Beta-lactams, cell wall synthesis inhibitors, mechanism of action

53
Q

What are enzymes released by the bacteria that go out and inactivate the beta-lactam Abx?

A

beta-lactamases

54
Q

What is Red-Man Syndrome?

A

if you run the infusion of Vancomycin too fast the pt and suddenly turn red, this is resolved when the infusion is stopped

55
Q

You must use IV form of Vancomycin for _______ and the capsule form for _____.

A
  • IV form- systemic infections
  • Capsule- C. difficile
  • this drug is so large it cannot cross the GI tract
56
Q

If a pt comes into the ER with PNA and you start them on 2 ABx for community acquired PNA, but you don’t know what bacteria is causing it, what type of therapy is it?

A

empiric (EXAM)

57
Q

Spectrum for Macrolides

A

good for atypical bacteria, does not cover viruses

58
Q

Tetracyclines, macrolides/ketolides, aminoglycosides, chloramphenicol, quinupristin/dalfopristin, clindamycin, linezolid, and glycylcycline are what?

A

protein synthesis inhibitors

59
Q

What are 3 things to know about Aztreonam?

A

only covers gram-negative, it covers Pseudomonas, you can safely use this in patients that have an allergy to penicillin

60
Q

You can’t use this in patients who have poor renal function.

A

SMX/TMP

61
Q

What is it called when you go from a broad spectrum Abx to a narrow spectrum Abx once you know what is causing the infection?

A

deescalation

62
Q

When you know what bacteria is causing a disease and you treat accordingly, what type of therapy is it?

A

definitive/targeted antimicrobial therapy

63
Q

What is the main use for Penicillin?

A

Streptococcus, most other things are resistant

Penicillin is considered narrow even though it is braod

64
Q

What generation has good anaerobic coverage with Cefoxitin (the only one below the diaphragm)?

A

second generation cephalosporins

-others are above the diaphragm and have good aerobe coverage (mainly respiratory)

65
Q

What kills the bacteria outright?

a. Bactericidal
b. Bacteriostatic

A

a. bactericidal

Bacteriostatic prevents the replication of the bacteria, once the bacteria lives out it cycle, it will die

66
Q

What is FQ good for?

A

gram positive, great for community acquired PNA (S. pneumoniae)

67
Q

What are the Tetracyclines?

A

doxycycline, minocycline (used for acne treatment), and tetracycline

68
Q

Any antibiotic can cause diarrhea, but Clindamycin is one of the main things you worry about for what disease?

A

C. difficile

69
Q

Skin disorders caused by SMX/TMP

A

rash, urticaria, epidermal necrolysis, Steven’s-Johnson

70
Q

What does Levofloxacin?

A

pseudomonas and strep pneumo

71
Q

Don’t drink milk or take tums with this medication because it won’t get absorbed.

A

Tetracycline

72
Q

What are we going to use Linezolid for?

A

we suspect MRSA

73
Q

Mechanism of action for aminoglycosides.

A

bactericidal and concentration dependent- once daily, big dose which decreases the nephrotoxicity

74
Q

The lowest concentration of an antimicrobial agent required to prevent visible growth of a microorganism after incubation in artifical liquid media

A

MIC- minimum inhibitory concentration

75
Q

What is very good for gram-positives, can be used for MRSA, covers S. aureus, and covers anaerobes? (very important to know this)

A

Clindamycin

76
Q

What is the adverse drug reaction of Macrolides that is important to know?

A

QTc prolongation
-for azithromycin it increases the risk for sudden cardiac death (black box warning)

seems very important to know

77
Q

What are the protein synthesis inhibitors?

A

tetracyclines, glycylcycline, macrolides/ketolides, aminoglycosides, chloramhenicol, quinupristin/dalfopristin, clindamycin, linezolid

78
Q

This class of drugs is only used for gram-negatives, only IV form, only in the hospital and is used for severe infections.

A

Aminoglycosides

79
Q

Tetracyclines cover what type of aerobes? Especially _______. And it covers _______ bacteria because it does not work on the cell wall.

A

gram-positives are covered, especially S. aureus (MSSA, MRSA), covers atypical bacteria

80
Q

Fluoroquinolones are what?

A

nucleic acid synthesis inhibitors

81
Q

What is rare with monotherapy and more common when administered with other nephrotoxic agents?

A

nephrotoxicity/ototoxicity for Vancomycin

Block 5 (12 decks)

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