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Lippincotts pharmacology 6th edition > Ch. 37 Principles of Antimicrobial Therapy > Flashcards

Ch. 37 Principles of Antimicrobial Therapy Flashcards

1
Q

prior to initiating treatment

A

obtain a sample culture of the organism

however if patient is critically ill: empiric therapy

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2
Q

may be indicated when the organism is unkown or polymicrobial infections are likely

A

broad-spectrum therapy

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3
Q

gram positive cocci in the spinal fluid of a neworn infant

A 
streptococccus agalactiae (group B streptococcus)
-penicilin G sensitive
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4
Q

gram (+) cocci in the spinal fluid of a 40 yr old pt is most likely to be

A

S. pneumoniae

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5
Q

S. pneumonai is resistent and sensitive to

A

resistant to penicillin G and requires treatment with a high dose 3rd generation cephalosporin (ceftriaxone) or Vancomycin

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6
Q

show unpredictable susceptibility patterns and require susceptibility testing to determine appropriate antimicrobial therapy?

A

gram(-) bacill, enteroccoci, and staphylococcal species

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7
Q

have predictable susceptibility patterns to certain antibiotics

A

streptococcus pyogenes and Neisseria meningitidis

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8
Q

antimicrobial drugs are classified as

A

bacteriostatic

bactericidal

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9
Q

arrest the growth and replication of bacteria at serum (of urine) levels achievable in the patient , thus limiting the spread of infection until the immune system attchs, immobilizes, and eliminates the pathogen

A

bacteriostatic

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10
Q

kill the bacteria at drug serum levels achievable in the patient

A

bactericidal

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11
Q

drug of choice for the seriously ill and immunocompromised patients

A

bactercidal

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12
Q

bacteriostatic agent against staphylococcus aureus and enterococci but is bactercidal against S. Pneumoniae

A

Linezolid

-antibiotic bacteriostatic for one organism and bactercidal for another

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13
Q

the lowest antimicrobial concentration that prevents visible growth of an organism after 24 hours of incubation

A

minimum inhibitory concentration (MIC)

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14
Q

quantitative measure of in vitro susceptibility and is commonly used in practice to streamline therapy

A

MIC

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15
Q

lowest concentration of antimicrobial agent that results in a 99.9% decline in colony count after overnight broth dilution incubations

A

minimum bactercidal concentration (MBC)

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16
Q

elipid solubility of a drug

A

penetrates into the brain

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17
Q

chloramphenicol and metronidazole

A

significant penetration into the CNS

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18
Q

b-lactam such as peniciliin

A

only penetrate the blood-brain barrier when there’s infection:
meningitis

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19
Q

low molecular weight compounds

A

cross blood-brain barrier

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20
Q

vancomycin is low molecular weight or high molecular weight?

A

high molecular weight, penetrates poorly even in the presence of meningial inflammation

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21
Q

protein binding drugs

A

do not enter CSF

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22
Q

patient factors

A 
immune system
renal dysfunction
hepatic dysfunction
poor perfusion
age
pregnancy/lactation
multi-drug resistant organisms
safety of the agent
cost of therapy
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23
Q

immune system requires

A

high doses of bactercidal agents

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24
Q

renal dysfuntion

A

vanncomycn, aminglycosides

modification

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25
Q

hepatic dysfunction

A

antibiotics concentrated or eliminated by liver

erythromycin and doxycycline

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26
Q

poor perfusion

A

lower limbs of a diabetic patient , reduces the amount of antibiotic that reaches that area

27
Q

age

A

newborns -renal and hepatic elimination is poor

same with elderly folk

28
Q

neonates vulnerable to the toxic effects of

A

chloramphenicol and sulfonamides

29
Q

contraindications for tetracyclines or quinolones

A

young children

-affect bone growth

30
Q

has less specificity an are reserved for life-threatening infections because of the potential serious toxicity to the patient

A

chloramphenicol

31
Q

methicillin-resistant Staphylococcus aureus (MRSA) treatment

A

vancomycin, clindamycin, daptomycin (most expensive), linezolid (expensive)

32
Q

vancomycin, aminoglycosides, and amphotercin B

A

parental route

-poorly absorbed via GIT

33
Q

show a significant increase in the rate of bacterial killiing as it is concentration dependent killing

A

aminoglycosides and daptomycin

34
Q

b-lactams, macrolides, clindamycin , and linezolid

A

time-dependent killing

35
Q

persistent suppression of microbial growth that occurs after levels of antibiotic have fallen below the MIC

A

PAE

post antibiotic effect

36
Q

antimicrobial drugs exhibiting long PAE

A

aminoglycosides and fluoroquinolones

1 dose per day against gram(-) bacteria

37
Q

chemotherapuetic spectra

A

narrow-spectrum antibiotics
extended-spectrum antibiotic
broad-spectrum antibiotics

38
Q

niazid is considered

A

narrow-spectrum antibiotic

only against Mycobacterium tuberculosis

39
Q

ampicillin is considered

A

extended-spectrum antibiotics

acts against gram(+) and gram (-)

40
Q

tetracycline, fluoroquinolones, and carbapenems are considered

A

broad-spectrum antibiotics

wide variety of microbial species

41
Q

can alter the nature of the normal bacterial flora and precipitate a superinfection due to organisms such as clostridium difficile

A

broad-spectrum antibiotics

42
Q

treatment of tuberculosis benefits from

A

drug combinations

43
Q

this combination shows synergism

-treatment for enterococcal endocardititis

A

b-lactams and aminoglycosides

44
Q

interferes with the bactercidal effects of penicillins and cephalosporins

A

bacteriostatic tetracycline

45
Q

gram(-) organisms are inherently resistant to

A

vancomycin

46
Q

drug resistance

A 
genetic alterations
altered expression of proteins in drug resistant organism
-modification of target sites
-decreased accumulation
-enzymatic inactivation
47
Q

involves alterations in one or more of the major bacterial penicillin-binding proteins, resulting in decreased binding of the antibiotic to its target

A

S. pneumoniae resistant to b-lactam antibiotics

48
Q

gram (-) bacteria can limit the penetration of certain agents , including b-lactam antibiotics as a result

A

alteration in the number and structure of porins (channels) in the outer membrane

-decreased accumulation

49
Q

antibiotic-inactivating enzymes include

A

b-lactamases , acetyltransferases, esterases

50
Q

b-lactamases perform:

A

hydrolytic inactivation of the b-lactam ring of penicilins, cephalosporins

51
Q

acetyltransferases perform:

A

transfer an acetyl group to the antibiotic

-inactivating chloramphenicol or aminoglycosides

52
Q

esterases perform:

A

hydrolyze the lactone rings of macrolides

53
Q

prophylactic use of antibiotics

A

dental procedures and surgeries. for prevention purposes rather than treatment of infections

54
Q

complications of antibiotic therapy

A

hypersensitivity
direct toxicity
superinfections

55
Q

urticaria (hives) to anaphylactic shock, stevens-johnson syndrom (SJS) or toxic epidermal necrolysis

A

examples caused by antibiotic hypersensitivity

56
Q

ototoxicity caused by aminoglycosides is an example of

A

direct toxicity

57
Q

broad-spectrum antibiotics can lead to

A

superinfections

58
Q

inhibitors of cell membrane function

A

isoniazid, amphotericin B, polymyxins

59
Q

inhibitors of bacterial cell metabolism

A

sulfonamides

trimethoprim

60
Q

inhibitors of cell wall synthesis

A

b-lactams

vancomycins, daptomycins, telavancin, fosfomycin

61
Q

inhibitors of protein synthesis in the bacterial cell

A

tetracyclines, aminoglycocides, macrolides, clindamycin, chloramphenicol, linezolid

62
Q

inhibitors of nucleic acid function of synthesis of a bacterial cell

A

fluroquinolones

rifampin

63
Q

factors that influence concentration and penetration of cerebro spinal fluid

A

lipid solubility
molecular weight (small)
protein binding of the drug

64
Q

antibiotic that exhibits a long post antibiotc effect that permits once-daily dosing

A

gentamicin

Lippincotts pharmacology 6th edition (6 decks)

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