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Practice topics Exam 1 > Antimicrobials I and II - Antibacterial Drugs > Flashcards

Antimicrobials I and II - Antibacterial Drugs Flashcards

1
Q

Structure of bacteria of pharmacological interest - cell wall

A

all bacteria have a cell wall that consists of peptidoglycan

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2
Q

Structure of bacteria of pharmacological interest - peptidoglycan

A

a macromolecule composed of peptides and sugars that provide a rigid support structure that is found only in bacteria
Thick = gram pos
Thin = gram neg

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3
Q

Structure of bacteria of pharmacological interest - Lipopolysaccharide

A

makes up the outer membrane structures of gram neg bacteria cell wall and consists of phospholipid and polysaccharides

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4
Q

Structure of bacteria of pharmacological interest - cytoplasmic membrane

A

similar in structure to the eukaryotic cell membrane

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5
Q

Structure of bacteria of pharmacological interest - cytoplasm

A

contains the ribosome, nutrients, metabolites, plasmids, nucleoid DNA

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6
Q

Size of bacteria

A

Bacteria are small

0.2-5 um

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7
Q

Shape of bacteria - cocci

A

round
diplo = pair
strepto = chain
staphylo = grape like cluster

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8
Q

Shape of bacteria - bacilli

A

rods

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9
Q

Shape of bacteria - spirochetes

A

spiral shaped

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10
Q

Shape of bacteria - pleomorphic

A

many shaped

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11
Q

Nomenclature

A

Named by staining and shape (gram positive cocci)

Named by genus and species (escherichia coli)

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12
Q

Pathogenicity

A

when bacteria have neg impact or harmful effect on human health they are said to be pathogenic

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13
Q

Bacteria have harmful effects because they

A

compete with the host for nutrients
can stimulate an immune response ultimately causing tissue destruction
release toxins

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14
Q

Principles of chemotherapy - chemotherapy =

A

treatment of a disease with the use of chemicals to kill or impair the growth of microorganisms or cancerous cells

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15
Q

Principles of chemotherapy - antibmicrobial chemotherapy

A

grounded in principles of germ theory disease

agents aimed at eradicating microorganisms

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16
Q

Principles of chemotherapy - antibmicrobial chemotherapy - graph

A

as you increase antimicrobial agent/therapy, there is a decrease in the organism burden because you are killing stuff

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17
Q

Principles of chemotherapy - selective toxicity

A

aimed at killing or impairing growth of the specific target organism without harming the host

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18
Q

Principles of chemotherapy - Drug targets

A

aim to achieve selective toxicity by using drugs targeted to structures unique to the microorganism (like cell wall)

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19
Q

Principles of chemotherapy - Drug targets - common strategies for killing or inhibiting microorganism growth will be to target

A

folate synthesis needed to make DNA
disrupting mRNA synthesis
blocking protein synthesis
disrupting cell wall or membrane synthesis

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20
Q

Principles of chemotherapy - Bactericidal

A

agent that will kill the bacteria

once the organism is exposed to the drug, it is no longer viable

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21
Q

Principles of chemotherapy - bacteriostatic

A

an agent that will inhibit growth of the bacteria but will not kill the bacteria

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22
Q

Principles of chemotherapy - narrow spectrum

A

a drug that has an effect on one type or species of organisms

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23
Q

Principles of chemotherapy - If a particular pathogen is known to be the causative agent for a given disease/infection, using ____ is a logical choice

A

narrow spectrum antibiotic

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24
Q

Principles of chemotherapy - broad spectrum

A

a drug that has an effect on a wide variety of organisms

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25
Q

Principles of chemotherapy - If the causative agent is not known, an approach may be to treat with ___

A

broad spectrum antibiotic

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26
Q

Principles of chemotherapy - prophylactic therapy

A

treatment in the absence of infection in order to prevent disease

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27
Q

Principles of chemotherapy - pre emptive therapy

A

treatment of high risk patients that have become infected but are asymptomatic

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28
Q

Principles of chemotherapy - empirical therapy

A

treatment of a symptomatic pt without further testing or confirmation of the organism

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29
Q

Principles of chemotherapy - definitive therapy

A

tx once the pathogenic organism has been identified and appropriate drug identified

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30
Q

Principles of chemotherapy - suppressive therapy

A

generally a low dose therapy used as a secondary prophylaxis

problem that caused initial infection is likely to still be present

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31
Q

Principles of chemotherapy - resistance

A

an organism is said to develop resistance to a chemotherapeutic agent when the agent is no longer or less effective toward an organism
Resistance develops as a result of organismal changes and/or clinical practice

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32
Q

Principles of chemotherapy - resistance develops due to

A

1 - reduced drug entry into organism
2 - inc drug export from organism
3 - expression of enzymes by organism that destroy the drug
4 - change in expression enzymes that activate the drug
5 - impaired drug binding to original target
6 - development of new or diff pathway that are not inhibited by drug

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33
Q

Principles of chemotherapy - Bacteria will develop resistance through the

A

acquisition of new genetic material or a mutation in the existing genome that is selected under clinical/antibiotic pressure

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34
Q

General tx strategies

A

target cell wall and membrane
target protein synthesis
target DNA/RNA synthesis and function

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35
Q

General tx strategies - target cell wall and membrane synthesis - how

A

1 disrupt cell wall structure and rigidity which alters function of wall, homeostasis, and induces autolysis
2 punches holes in membrane with detergents that alter permeability

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36
Q

General tx strategies - target protein synthesis - how

A

drugs that bind bacterial specific ribosome and inhibit protein synthesis or cause misreading during translation
result is change in bacterial metabolic function, impaired growth, and cell death

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37
Q

General tx strategies - target DNA/RNA synthesis and function - how

A

disrupt the structure, synthesis or function of DNA or RNA leading to impaired growth and reproduction

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38
Q

General tx strategies - target cell wall and membrane synthesis - Cell wall synthesis inhibitors are (1) _____ which includes what

A

Beta lactam compounds!

Includes penicillins, cephalosporins, monobactams, and carbapenems

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39
Q

General tx strategies - target cell wall and membrane synthesis - penicillins

A

Natural - penicillin G and V
Synthetic - Amoxicillin! and methicillin
Natural agents have limited spectrum while synthetic have broader

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40
Q

General tx strategies - target cell wall and membrane synthesis - penicillins - MOA

A

Bind to and inhibit group of enzymes called penicillin binding proteins (PBPs)
The PBPs play a role in cell wall synthesis

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41
Q

General tx strategies - target cell wall and membrane synthesis - penicillins - key adverse effects

A

HYPERSENSITIVITY! (5%) rash, hives, itching, resp diff, anaphylaxis
CNS - confusion, hallucination
Blood - anemia, thrmbocytopenia

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42
Q

General tx strategies - target cell wall and membrane synthesis - cephalosporins

A

Used frequently if penicillin not tolerated (mild rx to pen)
In general, these are more resistant to B lactamase so they are not as susceptible to degredation
They are organized into four groups/generations based on their spectrum of activity

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43
Q

General tx strategies - target cell wall and membrane synthesis - cephalosporins - generation

A 
increase spectrum as you move 1-4
1 - Cephalexin (+)
2 - Cefoxitin (+ and -) 
3 - Ceftriaxone (broad -, limited + use) 
4 - Cefepime (broad + and broad -)
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44
Q

General tx strategies - target cell wall and membrane synthesis - cephalosporins - MOA

A

bind to and inhibit PBPs

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45
Q

General tx strategies - target cell wall and membrane synthesis - cephalosporins - Key adverse effects

A

HYPERSENSITIVITY - rash, hives, itching, resp diff, anaphylaxis
Metabolism - need to avoid alcohol
Blood - bleeding disorder (2-6%)

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46
Q

General tx strategies - target cell wall and membrane synthesis - Monobactams

A

Only one agent - Aztreonam
Spectrum of activity is limited to gram - rods
Important feature includes penetration of CSF
Tx serious infections like pneumonia, meningitis, sepsis

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47
Q

General tx strategies - target cell wall and membrane synthesis - Monobactams - MOA

A

bind and inhibit PBPs

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48
Q

General tx strategies - target cell wall and membrane synthesis - Monobactams - Key adverse effects

A

Hypersensitivity - decreased severity though!

Skin rashes, itching

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49
Q

General tx strategies - target cell wall and membrane synthesis - Carbapenems

A

Imipenem, ertapenem, meropenem
Spectrum of activity includes btoh gram + and -
Resistant to B lactamase but susceptible to similar enzyme (carbamenemase)
Imipenem is inactived in kidney so is administered with cilastatin to prevent inactivation

50
Q

General tx strategies - target cell wall and membrane synthesis - Carbapenems - key pharmacological effect

A

related to ability of these agents to penetrate tissue and fluids very well
access to a lot of compartments in the body

51
Q

General tx strategies - target cell wall and membrane synthesis - Carbapenems - MOA

A

bind to and inhibit PBPs

52
Q

General tx strategies - target cell wall and membrane synthesis - Carbapenems - Adverse effects

A

Hypersensitivity - less severe! (less than 1%) - skin rash, itching
CV - hypotension
CNS - confusion, tremor, seizures

53
Q

General tx strategies - target cell wall and membrane synthesis - Others - Glycopeptide antibiotics

A

Vancomycin! produced by two specific bacteria
commonly use in tx of bloodstream infections, endocarditis, and meningits
Resistance is developing

54
Q

General tx strategies - target cell wall and membrane synthesis - Others - Glycopeptide antibiotics - MOA

A

Prevents elongation of the peptidoglycan cell wall structure

55
Q

General tx strategies - target cell wall and membrane synthesis - Others - Glycopeptide antibiotics - adverse effects

A

Skin irritation at injection site

FLUSHING (red neck syndrome)

56
Q

General tx strategies - target cell wall and membrane synthesis - Others - Polypeptides and detergents

A

Bacitracin (polypeptide) and polymyxin B (detergent)

often used together topically for skin infections

57
Q

General tx strategies - target cell wall and membrane synthesis - Others - Polypeptides and detergents - Bacitracin

A

Polypeptide - spectrum of activity is broad and includes gram + and - bacteria

58
Q

General tx strategies - target cell wall and membrane synthesis - Others - Polypeptides and detergents - polymyxin B -

A

detergent

spectrum of activity is primarily gram -

59
Q

General tx strategies - target cell wall and membrane synthesis - Others - Polypeptides and detergents - MOA

A

Bacitracin - inhibits cell wall synthesis by blocking incorporation of amino acids and nucleic acids into cell wall
Polymyxin B - punches hole in membrane by binding to phospholipids in cell membrane

60
Q

General tx strategies - target cell wall and membrane synthesis - Others - Polypeptides and detergents - key adverse effects

A

Bacitracin - hypersentivity - skin rash, itching, (rare)

Polymyxin B - rare adverse effects when administered topically

61
Q

General tx strategies - target cell wall and membrane synthesis - Beta lactamase inhibitors are what

A

Clavulanic acid used in combination with amoxicillin (augmentin) for example

62
Q

General tx strategies - target cell wall and membrane synthesis - beta lactamase inhibitors MOA

A

inhibit beta lactamase

63
Q

General tx strategies - target cell wall and membrane synthesis - beta lactamase inhibitors key adverse effects

A

similar to the penicillin agent used in combination

so hypersensitivty

64
Q

General tx strategies - protein synthesis inhibitors include what

A

Aminoglycosides
Macrolides
Tetracycline
Few other specific compounds

65
Q

General tx strategies - protein synthesis inhibitors - in general, their MOA is what

A

disrupt process of translation by targeting molecular machinery (50S and 30S) that is needed to translate mRNA to protein
disrupts the ribosome subunits

66
Q

General tx strategies - protein synthesis inhibitors - Aminoglycoside ex

A

Streptomycin
Gentamicin
Neomycin
BROAD SPECTRUM

67
Q

General tx strategies - protein synthesis inhibitors - Aminoglycoside - unique features

A

Used in combination with beta lactam antibiotic to treat serious gram neg infection
OFTEN used in combination and not alone

68
Q

General tx strategies - protein synthesis inhibitors - Aminoglycoside - MOA

A

Binds 30S disrupts initiation of peptide formation

69
Q

General tx strategies - protein synthesis inhibitors - Aminoglycoside - Key adverse effects

A

kidney - renal tubular necrosis
EAR - OTOTOXICITY - dizzy, ringing, fullness
Skin - hypersensitivity

70
Q

General tx strategies - protein synthesis inhibitors - Macrolides ex

A

Erythromycin
Clarithromycin
Azithromycin
Spectrum - mostly gram pos, some neg

71
Q

General tx strategies - protein synthesis inhibitors - Macrolides - MOA

A

Binds to 50S and prevents elongation of peptide

72
Q

General tx strategies - protein synthesis inhibitors - Macrolides - Key adverse effects

A

GI (2-18%) Change of GI upset is high on z pack!

skin - hypersensitivity

73
Q

General tx strategies - protein synthesis inhibitors - Tetracyclines ex

A

Tetracycline

Doxycycline

74
Q

General tx strategies - protein synthesis inhibitors - tetracycline MOA

A

Binds 30S

75
Q

General tx strategies - protein synthesis inhibitors - tetracycline key adverse effects

A

GI
SKIN - PHOTOSENS, hypersens
NUTRITION INTERACTION - binds Ca which impairs growth of calcified tissue esp. during growth (bone, teeth) - need to be careful with pregnant pt or child

76
Q

General tx strategies - protein synthesis inhibitors - Others - name and MOA

A

Chloramphenicol
Clindamycin

Both bind to 50S

77
Q

General tx strategies - protein synthesis inhibitors - Others - Chloramphenicol - when used

A

Rare, except for serious infections like typhus and rocky mountain spotted fever
can also be used for eye infections

78
Q

General tx strategies - protein synthesis inhibitors - Others - Chloramphenicol - Adverse effects

A

GI

SUPERINFECTION - oral and vaginal candidiasis (suppresses normal biota and inc risk of yeast infection)

79
Q

General tx strategies - protein synthesis inhibitors - Others - Clindamycin - when used

A

2nd line agent as alternative to penicillin and erythromycin for tx of local and systemic infection

80
Q

General tx strategies - protein synthesis inhibitors - Others - Clindamycin - key adverse effects

A

GI

skin - hypersentivity, shock

81
Q

General tx strategies - DNA/RNA synthesis inhibitors - what are 4 ways

A

Antifolate drugs - inhibit synthesis of DNA
Gyrase and Topoisomerase inhibitors - inhibit winding and unwinding
DNA damage - damage integrity of DNA
Replication inhibitors

82
Q

General tx strategies - DNA/RNA synthesis inhibitors - what are they

A 
Rifamycins
Sulfonamides
Trimethoprim 
TMP-SMX
Fluroquinolones 
Metronidazole
83
Q

General tx strategies - DNA/RNA synthesis inhibitors - Rifamycins are what

A

Rifamin

Used in tx of disease caused by mycobacterium like TB and leprosy

84
Q

General tx strategies - DNA/RNA synthesis inhibitors - Rifamycins MOA

A

Replication inhibitor by inhibiting conversion of DNA to RNA and inhibiting RNA synthesis

85
Q

General tx strategies - DNA/RNA synthesis inhibitors - Rifamycins key adverse effects

A

GI
Hypersens (6%) - mild, rash/fever
Liver - changes in function

86
Q

General tx strategies - DNA/RNA synthesis inhibitors - Rifamycins - common use

A

infection of prosthetic devices

87
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - do what and what are ex

A

inhibit DNA synthesis
Sulfonamides
Trimethoprim
Trimethoprim-sulfamethoxazole (TPM-SMX)

88
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Sulfonamides - ex

A

Sulfadiazine
Sulfamethoxazole
Sulfamethizole

89
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Sulfonamides - MOA

A

Substitutes for precursor and then you get competitive inhibition

90
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Sulfonamides - key adverse effects

A

GI
Skin - hypersens, PHOTO!
Urinary - causes cystalluria, hematuria, obstruction

91
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim - ex

A

Trimethoprim!

Pyrimethamine

92
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim - commonly used to tx what

A

UTI

93
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim - MOA

A

inhibitor of bacterial dihydrofolate reductase - leads to impaired DNA synthesis

94
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim - Key adverse effects

A

GI is the most common!
Blood - hyperkalemia (geriatrics), anemia!!!
skin - hypersens, itching
CNS - HA, dec appetite

95
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim-sulfamethoxazole (TPM-SMX) is used for what

A

UTI and prostatitis
Also, low dose can be used to treat recurrent UTI
Combo can also tx pneumonia and salmonella

96
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim-sulfamethoxazole (TPM-SMX) - MOA

A

Synergistic combination!!! Target diff enzymes in same pathway so work synergistically to get a greater effect

97
Q

General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim-sulfamethoxazole (TPM-SMX) - key adverse effects

A

Individual side effects
Sulf - GI, skin (photo), UT
Trim - GI, Blood (hyperK and anemia), skin, CNS

98
Q

General tx strategies - DNA/RNA synthesis inhibitors - Fluoroquinolones - ex

A

Ciprofloxacin

Levofloxacin

99
Q

General tx strategies - DNA/RNA synthesis inhibitors - Fluoroquinolones - used in tx of

A

urinary, GI, and resp infections as well as some STDs like gonorrhea

100
Q

General tx strategies - DNA/RNA synthesis inhibitors - Fluoroquinolones - MOA

A

Inhibits the winding and unwinding needed for replication

101
Q

General tx strategies - DNA/RNA synthesis inhibitors - Fluoroquinolones - key adverse effects

A 
A LOT
GI - 15% - n/v, diarrhea!
Skin - rash, itch, PHOTO
Kidney - toxicity
Bone/Joints - tendinopathy!
102
Q

General tx strategies - DNA/RNA synthesis inhibitors - Metronidazole used why

A

in treatment of abdominal infections, vaginitis, clostridium difficile colitis, brain abscess

103
Q

General tx strategies - DNA/RNA synthesis inhibitors - Metronidazole - MOA

A

Prodrug - inactive until taken up by organism - binds to DNA and disrupts function and causes damage

104
Q

General tx strategies - DNA/RNA synthesis inhibitors - Metronidazole - key adverse effects

A

GI HIGH! (10-12%)
PNS - neuropathy!!!
Metabolism - need to avoid alcohol

105
Q

Considerations for PT - Skin and soft tissue - Uncomplicated infections often caused by ____, Tx _____

A

Often caused by staph aureus and Strep pyogens (gram pos)

Tx = penicillins, 1st gen cephalosporins

106
Q

Considerations for PT - Skin and soft tissue - Complicated infections often caused by ____, Tx _____

A

often caused by E coli and pseudomonas aeruginosa (include burns, DM, pressure ulcer, surgical infection)
Can also include MRSA
Tx = penicillin plus lactamase inhibitor, carbapenem
Tx if severe = debridement, add vancomycin
MRSA = vancomycin

107
Q

Considerations for PT - Skin and soft tissue - Key issues for PT

A

Precaution with MRSA - glove and handwash!
Adverse effects - hypersensitivity, penecillins can cause anaphylaxis, also might see some CNS effects like confusion, hallucinations

108
Q

Considerations for PT - Bone and joint - most common causative organism of acute osteomyelitis and tx

A

S aureus and staphylococci

tx - vancomycin, cephalosporins

109
Q

Considerations for PT - Bone and joint - Infectiosn following ortho surgery or vertebral infections are often caused by and tx

A

E coli and P aeruginosa

Tx = debridement, penicillin, lactamase inhibitor, carbapenem, vancomycin

110
Q

Considerations for PT - Bone and joint - septic arthritis can be caused by what? Tx?

A

S aureus, S pyogens, strep pneumoniae, neisseria gonorrhoeae
Tx = ceftriaxone, vancomycin

111
Q

Considerations for PT - Bone and joint - prosthetic joint infection are commonly caused by what and what is tx

A

S aureus and staphylococci

tx = rifampin

112
Q

Considerations for PT - Bone and joint - key issues for PT

A

Adverse effects - hypersensitivity

Penicillin can cause anaphylaxis

113
Q

Considerations for PT - Hospital acquired/healthcare associated pneumonia - caused by what? what is tx?

A

Gram neg bacilli (E coli, MRSA)
Multi drug resistance can be common!
Tx = cephalospoing, fluoroquinolone, penicillins, vancomycin for MRSA

114
Q

Considerations for PT - Hospital acquired/healthcare associated pneumonia - Key issues for the therapist

A

Precaution with MRSA - gloves and handwashing
Cephalosporins, penicillins, and vanc - hypersens
Pen - anaphylaxis
Fluoro - photosensitivity and tendinopathy

115
Q

Considerations for PT - UTI - uncomplicated - cause and tx

A

cause = e coli
tx - bladder, lower UTI = TMP-SMX
tx - kidney = TMP-SMX, fluoroquinolone

116
Q

Considerations for PT - UTI - complicated - cause and tx

A

S aureus or enterococci

tx - TMP-SMX, fluoroquinolone

117
Q

Considerations for PT - UTI - Key issue for therapist

A

TMP-SMX causes GI issues, hypersens, photosens!
Sulfa drugs can cause obstruction and/or hematuria
Elderly may have hyperkalemia
Fluroro - photosens and tendinopathy

118
Q

Considerations for PT - Antibiotic associated diarrhea - cause

A

clostrdium difficile

119
Q

Considerations for PT - Antibiotic associated diarrhea - which antibiotics are associated with causing it

A

fluroro, clindamycin, broad spectru penicillins, broad spectrum cephalosporins

120
Q

Considerations for PT - Antibiotic associated diarrhea - tx

A

metronidazole

vancomycin if severe

121
Q

Considerations for PT - Antibiotic associated diarrhea key issues for the therapist

A

diligence in preventing C diff - hand wash
Precautions - glove and gown
Vanco - can cause irritation to skin and flushing
Metronidazole can cause peripheral neuropathy, GI, and interacts with alcohol

Practice topics Exam 1 (15 decks)

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