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Bloc G - Infection > Apr24 M3,4-Antimicrobial antibiotics > Flashcards

Apr24 M3,4-Antimicrobial antibiotics Flashcards

1
Q

important nose and sinus bacterial pathogens

A
  • Strep pneumoniae
  • group A strep (GAS)
  • Staph aureus
  • Haemophilus influenza
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2
Q

important throat and pharynx bacterial pathogen

A

group A strep

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3
Q

important middle ear bacterial pathogen

A

Strep pneumoniae

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4
Q

important urinary tract bacterial pathogen

A

-enterobacteriaceae
-enterococcus
(would come from gut)

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5
Q

important CNS bacterial pathogens

A
  • Neisseria meningitidis
  • Haemophilus influenzae
  • Strep pneumoniae
  • Listeria
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6
Q

important eye bacterial pathogens

A
  • Haemophilus
  • Moraxella
  • Neisseria gonorrhoeae
  • Strep pneumoniae
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7
Q

important wound infection bacterial pathogens

A
  • Staph aureus

- Group A strep

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8
Q

important bone and joint bacterial pathogens

A
  • Staph aureus
  • GAS
  • Kingella kingae
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9
Q

important blood bacterial pathogens

A

anything can cause that except the non invasive bacteria

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10
Q

Abx that have the same bioavailability if taken po or IV

A
  • clindamycin
  • fluoroquinolones
  • septra
  • tetracyclines
  • metronidazole
  • linezolid
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11
Q

what is the rate limiting step in giving Abx po (for Abx what are equally good po and IV)

A
  • GI tolerance

- GI absorption (if diarrhea or nauseated, colitis, gastritis)

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12
Q

how time-dependent (conc independent) antibodies work

A

activity dependent on the AMOUNT OF TIME spent above the MIC of the organism

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13
Q

classic type of Abx that is time-dependent

A

beta-lactams (penicillins, cephalosporins, carbapenems)

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14
Q

how concentration dependent antibodies work

A

activity is dependent on CONCENTRATION above the MIC

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15
Q

classic type of Abx that is concentration dependent

A

aminoglycosides

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16
Q

beta lactam Abx (penicillin and derivatives) molecular structure

A
  • have a beta-lactam ring in their molecular strcture
  • this ring looks like the peptidoglycan wall (looks like the 2 acids in the wall, N-acetylglucosamine (NAG) and N-acetylmuramic acid (NAM))
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17
Q

mechanism of action of beta lactams

A

picked up by penicillin binding protein and inhibition of cell wall synthesis. wall is weak when enough penicillin in it and it bursts

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18
Q

how resistance to beta lactams develops

A
  • formation of enzymes that inactivate penicillin (penicillinase precisely or beta lactamase in general): destroy the beta lactam ring (happens in MSSA)
  • mutated penicillin binding protein (e.g. in MRSA and strep pneumoniae). don’t recognize beta lactams
  • decrease in Abx penetration in bacteria
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19
Q

how can we fight the resistance of bacteria that make beta-lactamases (like MSSA)

A

add beta lactamase inhibitors to the Abx regimen

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20
Q

what beta lactamase inhibitors do

A

bind beta-lactamases of bacteria and rid them so a beta-lactam Abx can work

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21
Q

penicillin general coverage

A

especially for gram positive anaerobes but gram negative too (including anaerobes, gram+ and -)

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22
Q

problems encountered with penicillin

A
  • MSSA (resistant S aureus that developed a penicillinase)
  • resistant gram negative enterobacteriaceae (developed beta-lactamases)
  • new pathogens that are resistant (pseudomonas spp)
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23
Q

name of specific penicillins designed to target MSSA (penicillinase S aureus) + disadvantage

A
  • methicilin
  • cloxacilin
  • problem = loss of anaerobic activity
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24
Q

penicillins created to extend their coverage ot gram negatives and one bacteria it helps for specifically

A
  • ampicillin IV
  • amoxicilin (Amoxil) po (are both in the aminopenicillins family)
  • good for E.coli
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25
Q

penicillins designed to expanded gram negative coverage including Pseudomonas aeruginosa (and wound infection and sepsis caused by this organism)

A
  • ticarcillin

- piperacillin

26
Q

(EXAM) combination in which penicillins are given + side effect

A
  • penicillin + beta-lactamase inhibitor combination

- diarrhea SE bc of beta-lactamase inhibitors

27
Q

(EXAM) penicillin + bli coverage

A
  • most gram + (including S. aureus, Enterococcus, Listeria)
  • most gram - RESPIRATORY pathogens (haemophilus and moraxella spp) and ENTERIC pathogens
  • most anaerobes (gram+ and gram-)
  • NO PSEUDOMONAS COVERAGE
28
Q

(EXAM) only two penicillin + bli combinations that have the usual penicillin + bli coverage but also pseudomonas spp coverage

A
  • ticarcillin + clavulanic acid (Timentin IV)

- piperacillin + tazobactam

29
Q

(EXAM) perfect situations for using broad spectrum penicillin + bli combinations

A

very sick, immunosuppressed patients in hospital, with sepsis or dying

30
Q

(EXAM) specific advantage that beta lactamase inhibitors add (in the penicillin + bli combination)

A

anaerobic coverage

31
Q

cephalosporins: something they have that penicillins don’t have

A

resistance to beta-lactamases

32
Q

main gram + organism that is covered with cephalosporins

A

MSSA (staph aureus)

33
Q

cephalosporins how gram+ and gram- coverages vary with generation

A

gram+ : decreasing until 3rd. then increases again until 5th. 5th covers MRSA
gram- : coverage increases until 4th generation. 5th gen loses pseudomonas activity (only 3rd and 4th gen had pseudomonas activity)

34
Q

gram positive organisms that cephalosporins can treat

A
  • MSSA
  • strep pneumoniae
  • group A strep
35
Q

one gram negative that cephalosporins can’t treat

A

campylobacter

36
Q

cephalosporins (are beta lactams) that have pseudomonas (gram-) activity

A

ceftazidime (3rd gen) and the 4th generation cephalosporins

37
Q

two gram+ organisms that cephalosporins don’t cover

A
  • enterococcus spp

- listeria spp

38
Q

carbapenems (are beta lactams) coverage and advantage they have that cephalosporins also have

A
  • broad spectrum (like beta-lactam + bli combination): gram+ (with MSSA), gram-, anaerobes.
  • resistant to beta-lactamases, like cephalosporins
39
Q

carbapenems good situation to use

A

multiple resistant organisms, very sick patients, sepsis

40
Q

carbapenems emerging resistance situation

A

gram negative rods in our gut are developing carbapenemases (resistance)

41
Q

mild side effects of all beta lactams

A
  • GI upset
  • diarrhea (bc of beta-lactamase inhibitors and also in cefixime (Suprax), a 3rd gen cephalosporin))
  • neutropenia
42
Q

serious side effects of beta lactams

A
  • seizures (lower threshold with all beta lactams and some lower the threshold more, but need many grams to have seizure)
  • anaphylaxis (also, if already had anaphylaxis with one penicillin, higher risk of reacting with another penicillin. less risk with cephalosporins and <5% cross-reactivity with carbapenems)
43
Q

Abx used when someone is allergic to penicillin

A

high generation cephalosporin (as move up the classes, R chains are complicated and cover the beta lactam ring from the immune system)

44
Q

(important) which beta-lactams cross the BBB and can be used to tx meningitis

A
  • Penicillin IV high dose
  • Ampicillin IV high dose
  • 3rd gen cephalosporins IV (high dose) (including cefepime)
  • carbapenems
45
Q

(important) which beta lactams have activity against MSSA (staph aureus)

A
  • cloxacillin po/IV and methicillin
  • beta-lactam + bli combinations (po/IV)
  • 1st and 2nd gen cephalosporins (po/IV) (3rd gen IV also works but less)
  • cefepime (a 3rd gen cephalosporin)
  • carbapenems
46
Q

(important) which beta-lactams have activity against pseudomonas

A
  • Ticarcillin and Piperacillin (IV)
  • Timentin (Ticarcillin + clavulanic acid) and Piperacillin+Tazobactam (IV)
  • Ceftazidime (3rd gen cephalosporin) (IV)
  • cefepime (3rd gen cephalosporin) (IV)
  • carbapenems (IV)
47
Q

(important) route of administation of beta-lactams for them to act on pseudomonas

A

IV

48
Q

(important) beta-lactams with anaerobes activity

A

all

49
Q

vancomycin (a glycopeptide Abx) mechanism of action

A

acts on the cell wall and inhibits cross-linking and chain formation

50
Q

vancomycin coverage

A

ONLY gram + (anaerobes included)

51
Q

vancomycin: organism that it covers very well and important thing about route of administration

A
  • clostridium difficile (vanco po)

- doesn’t matter if po bc want effect in gut anyways)

52
Q

vancomycin: special regions that it can reach

A

with higher doses

  • crosses BBB, mainly with inflammation**
  • reaches bone cartilage
  • reaches heart tissue
53
Q

evolution of vancomycin resistance

A
  • MIC of vanco is going up

- will eventually deal with VISA (vanco works) and VRSA (are two kinds of vanco resistant S. aureus)

54
Q

specific S. aureus for which you may use vancomycin

A

MRSA (but will need higher levels of vancomycin)

55
Q

how to make sure vancomycin reaches the needed levels (to get MRSA coverage, BBB and bone cartilage penetration)

A

peak levels of the drug are measured

56
Q

adverse reactions with vancomycin

A
  • nephrotoxicity when given with other drugs (with accumulation, IV*** vanco has a high trough level. meaning a high residual concentration)
  • if given in <1hr, get histamine release (Red-man syndrome), but is not anaphylaxis or allergy. get flushing, hives, hypotn
57
Q

tx of histamine release (flusing, hives, hypotn) caused by vancomycin

A

Benadryl + give vancomycin over a longer course

58
Q

macrolides and ketolides coverage

A
  • gram+ (S pneumoniae, GAS)
  • gram- (campylobacter, bordetella pertussis)
  • atypical (mycoplasma spp, chlamydia spp, clamydophila spp)
  • non-TB mycobacteria
59
Q

main use of macrolides and ketolides

A

treat atypical infections and non-TB mycobacteria infections

60
Q

macrolides used to treat non-TB mycobacteria infections

A
  • calrithromycin

- azythromycin

61
Q

do macrolides cross the BBB, can you use them to treat meningitis

A

no

Bloc G - Infection (39 decks)

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