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Antimicrobials Flashcards

1
Q

What are the ideal features of antimicrobial agents

A
  • selective toxicity
  • few adverse effects
  • reach site of infection
  • can be given orally or through IV
  • long half life
  • doesn’t interfere with other drugs
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2
Q

What are the 4 mechanisms of action of antimicrobials

A
  • inhibiting cell wall synthesis
  • inhibiting protein synthesis
  • inhibiting cell membrane function
  • nucleic acid synthesis
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3
Q

What 2 classes of antimicrobials inhibit cell wall synthesis

A

Beta-lactams

Glycopeptides

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4
Q

What class of antimicrobials inhibit cell membrane function

A

Polymixins

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5
Q

What class of antibacterials prevent protein synthesis

A
  • tetracyclines
  • aminoglycosides
  • macrolides
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6
Q

What class of antibacterials prevent nucleic acid synthesis

A

Quinolones

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7
Q

How does penicillin prevent cell wall synthesis

A

Binds to the penicillin binding proteins which forms the cross in bridges between the side groups of the peptidoglycan preventing the cross bridges forming

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8
Q

How does vancomycin prevent the synthesis of bacteria cell wall

A

Prevents cross linkages but binding to the cell wall preventing the penicillin binding protein from binding

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9
Q

Under which antibacterial class is vancomycin in

A

Glycopeptides

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10
Q

Under which antibacterial class does penicillin fall under

A

Beta-lactams

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11
Q

What are bacteria cell walls made up of

A

Peptidoglycan (chains of amino acids and peptides)

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12
Q

What are the 3 types of resistance

A
  • intrinsic
  • acquired
  • adaptive
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13
Q

What is intrinsic resistance

A

Where there is target for the drug so it cant enter the bacteria
This is usually permanent

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14
Q

What is acquired resistance

A

Where the organism acquires new genetic material or mutates

Usually permanent

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15
Q

What is adaptive resistance

A

Where the organism responds to the stress of antimicrobials and so high levels of antimicrobials allow the microbe to become resistant
This is reversible as you can take away the stress

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16
Q

What are the 3 mechanisms of resistance

A
  • drug inactivating enzymes
  • altered target
  • altered uptake
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17
Q

What are the 2 genetic mechanisms for antibiotic resistance

A
  • gene mutation

- gene transfer

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18
Q

What is transduction gene transfer

A

Where bacteriophage viruses insert the gene into the bacteria

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19
Q

What is transformation gene transfer

A

Where free DNA can enter at porins in the bacteria cell wall

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20
Q

How can you measure antibiotic activity

A

By disc testing to see what much the organism grows

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21
Q

what are the 4 classifications of antimicrobial agents

A
  • chemical structure
  • target site
  • spectrum
  • bactericidal or bacteriostatic
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22
Q

what are bactericidal agents

A

antimicrobials that kill bacteria

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23
Q

what are bacteriostatic agents

A

antimicrobials which inhibit bacteria growth

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24
Q

how do antimicrobials prevent nucleic acid synthesis

A

by inhibiting the actions of 2 nuclear enzymes inhibiting DNA replication

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25
how does altering the target for antimicrobials cause resistance
it means the target enzyme for the antimicrobial has a lower affinity for it
26
give 2 examples of drug inactivating enzymes which cause antimicrobial resistance
B-lactamases | aminoglycoside enzymes
27
what uptake can be altered to cause antimicrobial resistance
- a decreased permeability | - increased efflux
28
how do antimicrobials usually enter through the cell wall
through holes called porins
29
what is conjugation gene transfer
when genetic information from one bacteria is directly passed to another
30
what is the empiric choice of antibiotics
where an antibiotic is given despite the causative bacteria being unknown
31
outline disc testing
where antibiotics are placed on bacteria growing on agar jelly. the larger the circle becomes around the antibiotic, the more bacteria have been killed and so the more effective it is
32
what is a quantitative way of assessing antibiotics
minimum inhibitory concentration test
33
outline the minimum inhibitory concentration test
you put a concentration of bacteria into each test tube, but the concentration is double diluted by each tube. you then compare which concentrations allow the growth of bacteria
34
give an example of a drug with is an antibacterial and antiprotozoal agent
metronidazole
35
give 2 examples of antiviral agents
- aciclovir | - oseltamivir (tamiful)
36
what is azole
an antifungal agent which inhibits cell membrane synthesis
37
what is polyene
an antifungal which inhibits cell membrane function
38
what is trimethoprim used to treat
UTIs
39
what is trimethoprim sometimes combined with
sulphamethoxazole
40
how does trimethoprim work
inhibits folic acid synthesis preventing DNA replication
41
what is the most common type of quinolone
ciprofloxacin
42
what type of bacteria are quinolones very active against
gram negative | atypical pathogens
43
give 4 examples of penicillin antimicrobials
- penicillin - amoxicillin - flucloxacillin - b-lactamase inhibitors
44
what is flucloxacillin especially active against
staphylococci and streptococci
45
what is amoxicillin active against
gram negatives
46
what is penicillin active against
streptococci
47
what antimicrobial is used in meningitis
ceftriaxone as it can enter the CSF
48
give an example of a glycopeptide antimicrobial
vancomycin
49
what is vancomycin used for
gram positive bacteria
50
why must you be careful when taking vancomycin
it has some toxic affects so there must be therapeutic drug monitoring to compare concentration of antimicrobial in the blood to known levels
51
give an example of a tetracycline
- tetracycline | - doxycycline
52
why shouldn't tetracyclines be given to children under 12
it stains bones and teeth yellow
53
what is antimicrobial stewardship
making sure that there is the appropriate use of antimicrobials for optimal clinical outcomes, reduced toxicity, side effects, costs of health care and limiting selection for resistance
54
true or false - antimicrobial resistance increases with use
true.
55
give 3 consequences of antimicrobial resistance
- treatment failure - prophylaxis failure - economic costs
56
what is antimicrobial prophylaxis
prevention of infection by the use of antimicrobials
57
what is multi-drug resistance
where the bacteria are not susceptible to 3 or more categories of antimicrobials
58
what is extensive drug resistance
where the bacteria are not susceptible to at least one drug in all but 2 antimicrobial categories
59
what is pan drug resistance
where bacteria are not susceptible to any agents in all the antimicrobial categories
60
what 3 types of evidence is there to show that antibacterials cause resistance
- laboratory evidence - ecological studies - individual level data
61
what are ecological studies
studies relating the levels of antibacterial use in a population with levels of resistance
62
what is individual level data
relating prior antibacterial use in an individual with subsequent presence of bacterial resistance
63
what is involved in an antimicrobial stewardship programme
- multidisciplinary team - surveillance using process and outcome measures - interventions
64
who is involved in the stewardship multidisciplinary team
- microbiologist - infection control nurse - hospital epidemiologist - antimicrobial pharmacist
65
what are the 3 intervention types of stewardship programmes
- persuasive - restrictive - structural
66
what is persuasive intervention
giving physicians advise on prescribing antimicrobials and feedback on how they were prescribed
67
what is restrictive intervention
putting a limit on how antimicrobials can be prescribed e.g. having approval by an infection specialist to be able to prescribe an antimicrobial
68
what are process measures
surveillance of antimicrobial use (doses, appropriateness and classes) overtime in the same institution
69
what are outcome measures
surveillance of patient outcomes, the emergence of resistance and c.Diff infection rate
70
which intervention is most effective
initially restrictive but over time there is no significant difference
71
what are the unintended consequences of interventions
- risk of mortality | - risk of readmission

Infection (16 decks)

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