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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
Principles of chemotherapy - If the causative agent is not known, an approach may be to treat with ___
broad spectrum antibiotic
26
Principles of chemotherapy - prophylactic therapy
treatment in the absence of infection in order to prevent disease
27
Principles of chemotherapy - pre emptive therapy
treatment of high risk patients that have become infected but are asymptomatic
28
Principles of chemotherapy - empirical therapy
treatment of a symptomatic pt without further testing or confirmation of the organism
29
Principles of chemotherapy - definitive therapy
tx once the pathogenic organism has been identified and appropriate drug identified
30
Principles of chemotherapy - suppressive therapy
generally a low dose therapy used as a secondary prophylaxis | problem that caused initial infection is likely to still be present
31
Principles of chemotherapy - resistance
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
32
Principles of chemotherapy - resistance develops due to
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
33
Principles of chemotherapy - Bacteria will develop resistance through the
acquisition of new genetic material or a mutation in the existing genome that is selected under clinical/antibiotic pressure
34
General tx strategies
target cell wall and membrane target protein synthesis target DNA/RNA synthesis and function
35
General tx strategies - target cell wall and membrane synthesis - how
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
36
General tx strategies - target protein synthesis - how
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
37
General tx strategies - target DNA/RNA synthesis and function - how
disrupt the structure, synthesis or function of DNA or RNA leading to impaired growth and reproduction
38
General tx strategies - target cell wall and membrane synthesis - Cell wall synthesis inhibitors are (1) _____ which includes what
Beta lactam compounds! | Includes penicillins, cephalosporins, monobactams, and carbapenems
39
General tx strategies - target cell wall and membrane synthesis - penicillins
Natural - penicillin G and V Synthetic - Amoxicillin! and methicillin Natural agents have limited spectrum while synthetic have broader
40
General tx strategies - target cell wall and membrane synthesis - penicillins - MOA
Bind to and inhibit group of enzymes called penicillin binding proteins (PBPs) The PBPs play a role in cell wall synthesis
41
General tx strategies - target cell wall and membrane synthesis - penicillins - key adverse effects
HYPERSENSITIVITY! (5%) rash, hives, itching, resp diff, anaphylaxis CNS - confusion, hallucination Blood - anemia, thrmbocytopenia
42
General tx strategies - target cell wall and membrane synthesis - cephalosporins
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
43
General tx strategies - target cell wall and membrane synthesis - cephalosporins - generation
``` increase spectrum as you move 1-4 1 - Cephalexin (+) 2 - Cefoxitin (+ and -) 3 - Ceftriaxone (broad -, limited + use) 4 - Cefepime (broad + and broad -) ```
44
General tx strategies - target cell wall and membrane synthesis - cephalosporins - MOA
bind to and inhibit PBPs
45
General tx strategies - target cell wall and membrane synthesis - cephalosporins - Key adverse effects
HYPERSENSITIVITY - rash, hives, itching, resp diff, anaphylaxis Metabolism - need to avoid alcohol Blood - bleeding disorder (2-6%)
46
General tx strategies - target cell wall and membrane synthesis - Monobactams
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
47
General tx strategies - target cell wall and membrane synthesis - Monobactams - MOA
bind and inhibit PBPs
48
General tx strategies - target cell wall and membrane synthesis - Monobactams - Key adverse effects
Hypersensitivity - decreased severity though! | Skin rashes, itching
49
General tx strategies - target cell wall and membrane synthesis - Carbapenems
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
General tx strategies - target cell wall and membrane synthesis - Carbapenems - key pharmacological effect
related to ability of these agents to penetrate tissue and fluids very well access to a lot of compartments in the body
51
General tx strategies - target cell wall and membrane synthesis - Carbapenems - MOA
bind to and inhibit PBPs
52
General tx strategies - target cell wall and membrane synthesis - Carbapenems - Adverse effects
Hypersensitivity - less severe! (less than 1%) - skin rash, itching CV - hypotension CNS - confusion, tremor, seizures
53
General tx strategies - target cell wall and membrane synthesis - Others - Glycopeptide antibiotics
Vancomycin! produced by two specific bacteria commonly use in tx of bloodstream infections, endocarditis, and meningits Resistance is developing
54
General tx strategies - target cell wall and membrane synthesis - Others - Glycopeptide antibiotics - MOA
Prevents elongation of the peptidoglycan cell wall structure
55
General tx strategies - target cell wall and membrane synthesis - Others - Glycopeptide antibiotics - adverse effects
Skin irritation at injection site | FLUSHING (red neck syndrome)
56
General tx strategies - target cell wall and membrane synthesis - Others - Polypeptides and detergents
Bacitracin (polypeptide) and polymyxin B (detergent) | often used together topically for skin infections
57
General tx strategies - target cell wall and membrane synthesis - Others - Polypeptides and detergents - Bacitracin
Polypeptide - spectrum of activity is broad and includes gram + and - bacteria
58
General tx strategies - target cell wall and membrane synthesis - Others - Polypeptides and detergents - polymyxin B -
detergent | spectrum of activity is primarily gram -
59
General tx strategies - target cell wall and membrane synthesis - Others - Polypeptides and detergents - MOA
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
General tx strategies - target cell wall and membrane synthesis - Others - Polypeptides and detergents - key adverse effects
Bacitracin - hypersentivity - skin rash, itching, (rare) | Polymyxin B - rare adverse effects when administered topically
61
General tx strategies - target cell wall and membrane synthesis - Beta lactamase inhibitors are what
Clavulanic acid used in combination with amoxicillin (augmentin) for example
62
General tx strategies - target cell wall and membrane synthesis - beta lactamase inhibitors MOA
inhibit beta lactamase
63
General tx strategies - target cell wall and membrane synthesis - beta lactamase inhibitors key adverse effects
similar to the penicillin agent used in combination | so hypersensitivty
64
General tx strategies - protein synthesis inhibitors include what
Aminoglycosides Macrolides Tetracycline Few other specific compounds
65
General tx strategies - protein synthesis inhibitors - in general, their MOA is what
disrupt process of translation by targeting molecular machinery (50S and 30S) that is needed to translate mRNA to protein disrupts the ribosome subunits
66
General tx strategies - protein synthesis inhibitors - Aminoglycoside ex
Streptomycin Gentamicin Neomycin BROAD SPECTRUM
67
General tx strategies - protein synthesis inhibitors - Aminoglycoside - unique features
Used in combination with beta lactam antibiotic to treat serious gram neg infection OFTEN used in combination and not alone
68
General tx strategies - protein synthesis inhibitors - Aminoglycoside - MOA
Binds 30S disrupts initiation of peptide formation
69
General tx strategies - protein synthesis inhibitors - Aminoglycoside - Key adverse effects
kidney - renal tubular necrosis EAR - OTOTOXICITY - dizzy, ringing, fullness Skin - hypersensitivity
70
General tx strategies - protein synthesis inhibitors - Macrolides ex
Erythromycin Clarithromycin Azithromycin Spectrum - mostly gram pos, some neg
71
General tx strategies - protein synthesis inhibitors - Macrolides - MOA
Binds to 50S and prevents elongation of peptide
72
General tx strategies - protein synthesis inhibitors - Macrolides - Key adverse effects
GI (2-18%) Change of GI upset is high on z pack! | skin - hypersensitivity
73
General tx strategies - protein synthesis inhibitors - Tetracyclines ex
Tetracycline | Doxycycline
74
General tx strategies - protein synthesis inhibitors - tetracycline MOA
Binds 30S
75
General tx strategies - protein synthesis inhibitors - tetracycline key adverse effects
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
General tx strategies - protein synthesis inhibitors - Others - name and MOA
Chloramphenicol Clindamycin Both bind to 50S
77
General tx strategies - protein synthesis inhibitors - Others - Chloramphenicol - when used
Rare, except for serious infections like typhus and rocky mountain spotted fever can also be used for eye infections
78
General tx strategies - protein synthesis inhibitors - Others - Chloramphenicol - Adverse effects
GI | SUPERINFECTION - oral and vaginal candidiasis (suppresses normal biota and inc risk of yeast infection)
79
General tx strategies - protein synthesis inhibitors - Others - Clindamycin - when used
2nd line agent as alternative to penicillin and erythromycin for tx of local and systemic infection
80
General tx strategies - protein synthesis inhibitors - Others - Clindamycin - key adverse effects
GI | skin - hypersentivity, shock
81
General tx strategies - DNA/RNA synthesis inhibitors - what are 4 ways
Antifolate drugs - inhibit synthesis of DNA Gyrase and Topoisomerase inhibitors - inhibit winding and unwinding DNA damage - damage integrity of DNA Replication inhibitors
82
General tx strategies - DNA/RNA synthesis inhibitors - what are they
``` Rifamycins Sulfonamides Trimethoprim TMP-SMX Fluroquinolones Metronidazole ```
83
General tx strategies - DNA/RNA synthesis inhibitors - Rifamycins are what
Rifamin | Used in tx of disease caused by mycobacterium like TB and leprosy
84
General tx strategies - DNA/RNA synthesis inhibitors - Rifamycins MOA
Replication inhibitor by inhibiting conversion of DNA to RNA and inhibiting RNA synthesis
85
General tx strategies - DNA/RNA synthesis inhibitors - Rifamycins key adverse effects
GI Hypersens (6%) - mild, rash/fever Liver - changes in function
86
General tx strategies - DNA/RNA synthesis inhibitors - Rifamycins - common use
infection of prosthetic devices
87
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - do what and what are ex
inhibit DNA synthesis Sulfonamides Trimethoprim Trimethoprim-sulfamethoxazole (TPM-SMX)
88
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Sulfonamides - ex
Sulfadiazine Sulfamethoxazole Sulfamethizole
89
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Sulfonamides - MOA
Substitutes for precursor and then you get competitive inhibition
90
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Sulfonamides - key adverse effects
GI Skin - hypersens, PHOTO! Urinary - causes cystalluria, hematuria, obstruction
91
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim - ex
Trimethoprim! | Pyrimethamine
92
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim - commonly used to tx what
UTI
93
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim - MOA
inhibitor of bacterial dihydrofolate reductase - leads to impaired DNA synthesis
94
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim - Key adverse effects
GI is the most common! Blood - hyperkalemia (geriatrics), anemia!!! skin - hypersens, itching CNS - HA, dec appetite
95
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim-sulfamethoxazole (TPM-SMX) is used for what
UTI and prostatitis Also, low dose can be used to treat recurrent UTI Combo can also tx pneumonia and salmonella
96
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim-sulfamethoxazole (TPM-SMX) - MOA
Synergistic combination!!! Target diff enzymes in same pathway so work synergistically to get a greater effect
97
General tx strategies - DNA/RNA synthesis inhibitors - Antifolate drugs - Trimethoprim-sulfamethoxazole (TPM-SMX) - key adverse effects
Individual side effects Sulf - GI, skin (photo), UT Trim - GI, Blood (hyperK and anemia), skin, CNS
98
General tx strategies - DNA/RNA synthesis inhibitors - Fluoroquinolones - ex
Ciprofloxacin | Levofloxacin
99
General tx strategies - DNA/RNA synthesis inhibitors - Fluoroquinolones - used in tx of
urinary, GI, and resp infections as well as some STDs like gonorrhea
100
General tx strategies - DNA/RNA synthesis inhibitors - Fluoroquinolones - MOA
Inhibits the winding and unwinding needed for replication
101
General tx strategies - DNA/RNA synthesis inhibitors - Fluoroquinolones - key adverse effects
``` A LOT GI - 15% - n/v, diarrhea! Skin - rash, itch, PHOTO Kidney - toxicity Bone/Joints - tendinopathy! ```
102
General tx strategies - DNA/RNA synthesis inhibitors - Metronidazole used why
in treatment of abdominal infections, vaginitis, clostridium difficile colitis, brain abscess
103
General tx strategies - DNA/RNA synthesis inhibitors - Metronidazole - MOA
Prodrug - inactive until taken up by organism - binds to DNA and disrupts function and causes damage
104
General tx strategies - DNA/RNA synthesis inhibitors - Metronidazole - key adverse effects
GI HIGH! (10-12%) PNS - neuropathy!!! Metabolism - need to avoid alcohol
105
Considerations for PT - Skin and soft tissue - Uncomplicated infections often caused by ____, Tx _____
Often caused by staph aureus and Strep pyogens (gram pos) | Tx = penicillins, 1st gen cephalosporins
106
Considerations for PT - Skin and soft tissue - Complicated infections often caused by ____, Tx _____
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
Considerations for PT - Skin and soft tissue - Key issues for PT
Precaution with MRSA - glove and handwash! Adverse effects - hypersensitivity, penecillins can cause anaphylaxis, also might see some CNS effects like confusion, hallucinations
108
Considerations for PT - Bone and joint - most common causative organism of acute osteomyelitis and tx
S aureus and staphylococci | tx - vancomycin, cephalosporins
109
Considerations for PT - Bone and joint - Infectiosn following ortho surgery or vertebral infections are often caused by and tx
E coli and P aeruginosa | Tx = debridement, penicillin, lactamase inhibitor, carbapenem, vancomycin
110
Considerations for PT - Bone and joint - septic arthritis can be caused by what? Tx?
S aureus, S pyogens, strep pneumoniae, neisseria gonorrhoeae Tx = ceftriaxone, vancomycin
111
Considerations for PT - Bone and joint - prosthetic joint infection are commonly caused by what and what is tx
S aureus and staphylococci | tx = rifampin
112
Considerations for PT - Bone and joint - key issues for PT
Adverse effects - hypersensitivity | Penicillin can cause anaphylaxis
113
Considerations for PT - Hospital acquired/healthcare associated pneumonia - caused by what? what is tx?
Gram neg bacilli (E coli, MRSA) Multi drug resistance can be common! Tx = cephalospoing, fluoroquinolone, penicillins, vancomycin for MRSA
114
Considerations for PT - Hospital acquired/healthcare associated pneumonia - Key issues for the therapist
Precaution with MRSA - gloves and handwashing Cephalosporins, penicillins, and vanc - hypersens Pen - anaphylaxis Fluoro - photosensitivity and tendinopathy
115
Considerations for PT - UTI - uncomplicated - cause and tx
cause = e coli tx - bladder, lower UTI = TMP-SMX tx - kidney = TMP-SMX, fluoroquinolone
116
Considerations for PT - UTI - complicated - cause and tx
S aureus or enterococci | tx - TMP-SMX, fluoroquinolone
117
Considerations for PT - UTI - Key issue for therapist
TMP-SMX causes GI issues, hypersens, photosens! Sulfa drugs can cause obstruction and/or hematuria Elderly may have hyperkalemia Fluroro - photosens and tendinopathy
118
Considerations for PT - Antibiotic associated diarrhea - cause
clostrdium difficile
119
Considerations for PT - Antibiotic associated diarrhea - which antibiotics are associated with causing it
fluroro, clindamycin, broad spectru penicillins, broad spectrum cephalosporins
120
Considerations for PT - Antibiotic associated diarrhea - tx
metronidazole | vancomycin if severe
121
Considerations for PT - Antibiotic associated diarrhea key issues for the therapist
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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