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Adv Pharm > Chapter 70: Basic Principles in Antimicrobial > Flashcards

Chapter 70: Basic Principles in Antimicrobial Flashcards

1
Q

2017 LRI deaths

A

2.56 million
4th leading cause of death

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2
Q

selective toxicity

A

most important concept underlying antimicrobial therapy

selective inhibition of the growth of the microorganisms without damage to the host. the drug must be more toxic to a pathogen than a pathogens host

this is possible due to difference in structure or metabolism between pathogen and the host

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3
Q

3 main MOA of AB

A

inhibit cell wall synthesis or function
beta lactams: PCN, cephlosporins, carbapenems, monobactams, vancomycin, daptomycin, polypeptides

inhibit nucleic acid synthesis or function
inhibit DNA gyrase: topoisomerase, IV quinolones
inhibits folate synthesis: Bactrim
create free radials: metronidazole, nitrofurantoin

inhibit protein synthesis:
inhibit 50s subunit: macrolides, clindamycin, linezolid, streptogramins, chloramphenicol
inhibit 30s subunit: aminoglycosides, tetracycline, tigercycline

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4
Q

classifications of AB

A

based on MOA: bacteriostatic or bactericidal

based on spectrum: broad spectrum (work on larger group of bacteria) or narrow spectrum (work on limited group of bacteria)

broad can kill more of natural flora. often start patient on broad AB, then get C/S, then switch to NS AB -helps with AB resistance and less SE.

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5
Q

bacteriostatic

A

inhibits bacteria from reproducing, but does not otherwise kill them​

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6
Q

bactericidal

A

actively kills bacteria

fast killing

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7
Q

note on bacteriostatic vs bactericidal

A

In reality there is not a sharp distinction between the two, as categorization depends upon drug concentration and bacterial species​

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8
Q

narrow spectrum AB

A

act on a single, limit group of micro-organisms

ex. isoniazid given for mycobacterium

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9
Q

extended-spectrum AB

A

effective against gram + organisms and a significant number of gram - organism

ex. ampicillin

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10
Q

broad-spectrum AB

A

effective against a wide variety of microbial species

ex. tetracycline and chloramphenicol

can alter the nature of intestinal flora = super infection

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11
Q

microbes

A

Bacteria​

Virus​

Fungus​

Parasites​
Helminth​
Protozoa ​

​

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12
Q

shapes of bacteria

A

cocci -tend to be gram +. staph & strep

bacilli (rods) -tend to be gram -.

vibrios, spirilla, spirochetes

can form spores or have flagella

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13
Q

gram stain

A

Determines gram + or gram -, helps determine what AB needed ​

Gram + has thick peptidoglycan wall –absorbs dye ​

Gram – has thin PG wall –does not absorb dye. Also has outer membrane. Hard to treat bc of outer membrane. ​

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14
Q

gram +

A

Thick peptidoglycan cell wall​

Examples​
Streptococcus​
Staphylococcus​
Enterococcus​
Clostridium​
Listeria​

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15
Q

gram -

A

Outer plasma membrane with very thin peptidoglycan wall.​

Examples​
Neisseria​
Moraxella​
E Coli *​
Klebsiella *​
Enterobacter​
Serratia​
Citrobacter​
Bordetella​
Pseudomonas *​
Proteus​
Helicobacter *​
Campylobacter​
Salmonella​
Shigella​

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16
Q

Anaerobes

A

Anaerobes include all bacteria which grow and reproduce only in the absence of oxygen​

The are predominately found in the GI tract (Including the oral cavity)​*

Play a role in appendicitis, diverticulitis, aspiration pneumonias​

While they are generally stainable via gram stain, they are rarely referred to as gram positive or negative in clinical practice​

Examples​
Clostridium​
Bacteroides​
Peptostreptococcus​
Actinomyces​
Fusobacterium​

17
Q

atypical bacteria

A

An inexact term applied to bacteria which are particularly unusual in cellular structure, morphology, biochemistry, or life cycle.​

No cell wall​

Examples​
Mycoplasma​
Chlamydia​
Rickettsia​
Legionella​

atypical penumonia usually is caused by the influenza virus, mycoplasma, chlamydia, legionella, adenovirus, or other unidentified microorganism

18
Q

typical penumonia

A

typical pneumonia usually is caused by bacteria such as streptococcus penumoniae

19
Q

differentiating factor between typical and atypical

A

pt age
young adults are more prone to atypical causes
very young and older people are more predisposed to typical causes

20
Q

antibiotics resistance

A

Develops with misuse of AB​

Killing off weak bacteria and small % of strong survive. (95%/ 5%). Natural selection. These strong bacteria pass the trait to the offspring = resistant generation. ​
mechanism: both drug resistance and non-resistance bacteria exist in body -> pt takes Ab -> non resistant bacteria die. drug resistant AB take over -> thru replication and gene transfer, drug resistant bacteria can dominant and a new infection can occur

Teach:​
Take AB only for infection. Not viruses. Build resistance.​
Take entire prescription. Even when u feel better.​
Don’t share BC u need the ​
Right AB!!​

21
Q

common SE of AB

A
  1. Hypersensitivity ​
    mild- allergy​ -Benadyrl ​
    anaphylactic shock​ -Epinepherine ​
    Watch first dose!​
  2. GI-N/V D. Abdominal pain/ Liver tox​
  3. CNS- confusion, headache​
    any AB that cross BBB ​
    elderly at risk ​
  4. Nephrotoxicity​
    AB in general ​
    take full glass of water with AB ​
  5. Secondary Infections ( 2 types)​
    C diff, Candidiasis​ “super infection “ opportunistic when normal flora is destroy by AB. Can happen during and after therapy. ​
    Bacterial Infection after a viral infection​

​

​

22
Q

antimicrobial stewardship

A

enhancing infection prevention and control

controlling the source of infection

prescribing AB when they are truly needed

prescribing appropriate AB with adequate dosage

using the shortest duration of AB based on evidence

reassessing tx when culture results are back

supporting surveillance of AMR and HAIs and monitoring Ab consumption

educating staff

supporting an interdisciplinary approach

23
Q

3 principles for the selection of AB

A

Identify the affecting organism​
Match the drug with the Bug​
Gram Stain​
PCR Testing (polymerase chain reaction)​

​

Drug Sensitivity of the infecting organism​
Determine Drug Sensitivity​

Host Factors such as the site of infection and the status of the host defenses​
Host Defenses​
Site of infection​
Allergies​
others

24
Q

General Sites of Infection by Bacteria Type

A

Gram Positive Cocci → Skin, soft tissue, heart, lungs, bone, joint, hardware, indwelling lines​

Gram Negative Rods → Lung (HCAP, HAP, VAP), any ​intraabdominal organ, GU System​

Anaerobes → Lung (abscess), oral cavity, intraabdominal organ​

Atypicals → Lung (CAP)​

25
Q

Most Common Broad Spectrum

A

Gram + AB ​
Vancomycin (bactericidal for severe bacterial infections(sepsis, pneumonia, endocarditis);C diff)​
Tx of choice for HA MRSA ​

Gram – AB ​
Zosyn (piperacillin/tazobactam)​
Bactericidal, piperacillin inhibits cell wall synthesis. Tazobactam added d/t resistance of PCN)​
Including psueodmonas ​

26
Q

Prophylactic Use of Antibiotics

A

Estimates indicate that between 30% and 50% of the antibiotics used in the US are administered for prophylaxis. ​

Surgery​

Bacterial Endocarditis​
Do not do as much as we used to​

Neutropenia​

Recurrent UTI’s

27
Q

misuse of AB

A

Common​
1/3 outpatient AB prescribed are either inappropriate or unnecessary ​

Treatment of Viral Infection​

Treatment of Fever with unknown Origin​

Improper Dosage​

Adv Pharm (76 decks)

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