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Unit 2- Pharm > Chemotherapy I/II > Flashcards

Chemotherapy I/II Flashcards

1
Q

Receptor-Effector concept

A

specific bullets to kill bacteria

salvarsan

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2
Q

Selective toxicity of chemotherapy

A

need greater toxicity to parasite than host

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3
Q

What are two potential problems associated with chemotherapy

A

hypersensitivity and organ directed

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4
Q

How does chemotherapy work

A

lowers the microorganism load so that the host defense system can get rid of the foreign organisms from the body

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5
Q

Three adverse effects of antimicrobial therapy

A

overextensions of pharmacologic actions

organ directed toxicity

hypersensitivity reactions

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6
Q

What six drugs lead to hepatotoxicity?

A

tetracyclines

isoniazid

erythromycin estolate

clindamycin

sulfonamides

amphotericin B

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7
Q

Which five drugs lead to renal toxicity?

A

cephalosporins

vancomycin

aminoglycosides

sulfonamides

amphotericin B

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8
Q

Which three drugs are associated with ototoxicity?

A

aminoglycosides

vancomycin

minocycline (vestibular only)

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9
Q

Which two drugs are associated with visual toxicity?

A

ethambutol

isoniazid

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10
Q

Which two drugs (plus one class of drugs) leads to hemopoietic toxicity?

A

many antiviral agents

chloramphenicol

sulfonamides

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11
Q

What are some drug allergy symptoms? (4)

A

anaphylactic shock

skin rashes

immune induced blood dyscrasias

immune hemolytic anemias

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12
Q

Which two drugs are associated with hemolytic anemias?

A

sulfonamides

nitrofurantoin

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13
Q

Which three drugs are associated with photosensitivity?

A

tetracyclines

fluroquinolones

sulfonamides

** high risk for secondary infections

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14
Q

With chemotherapeutic agent which six things need to be considered with host, pathogen factor, and chemotherapeutic agent?

A
  • metabolism of host
  • toxicity of chemotherapeutic agent
  • disease caused by pathogen factor
  • host’s defense system
  • resistance of host
  • therapeutic effect on pathogen factor
  • pathogen’s resistance against chemotherapeutic agent
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15
Q

What are the five general mechanisms of action on microorganisms?

A
  1. inhibit synthesis of cell wall
  2. damage outer membrane
  3. modify nucleic acid or DNA synthesis
  4. modify protein synthesis (at ribosomes)
  5. modify energy metabolism within the cytoplasm (at folate cycle)
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16
Q

Chemotherapy selects for

A

drug resistant stains

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17
Q

What two types of drug resistance are there?

A

natural and acquired

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18
Q

Mechanism for resistance:

pathogen or cell fails to:

A

absorb drug

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19
Q

Mechanism for resistance:

pathogen or cell

A

inactivates drug

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20
Q

Mechanism for resistance:

pathogen or cell

A

pumps drug out (MDR, p-glycoprotein)

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21
Q

Mechanism for resistance:

drug target is ______ thus resistant to drug

A

modified

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22
Q

Mechanism for resistance:

increased production of

A

target molecules

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23
Q

Mechanism for resistance:

altered metabolic pathway

A

bypasses drug target

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24
Q

How does multiple drug resistance occur?

A

transmitted by plasmids

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25
Q

Antimicrobial resistance is acquired by:

a mutation and passed ______ by selection to daughter cells

A

vertically

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26
Q

Antimicrobial resistance is acquired by ______ ____ of resistance determinants from a donor cell, often of another bacterial species.

A

horizontal transfer

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27
Q

Three examples of horizontal transfer

A

transduction (bacteriophages)

transformation (incorporation of free DNA)

conjugation (transfer of genes through sex pilus)

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28
Q

Transduction uses a __________ to incorporate donor DNA into recipient bacterium

A

bacteriophage

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29
Q

In transduction, what type of DNA will receipient bacterium have?

A

bacteriophage DNA and bacteria’s DNA

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30
Q

How does transformation work?

A

Bacterial cell lysed –> new bacteria picks up a bacterial chromosome from lysed cell and that bacterial chromosome gets incorporated into bacterial cell’s DNA

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31
Q

How does conjugation work?

A

Direct cell-to-cell contact.

2 bacterial cells - 1 has a mobile blasma and pilus. Pilus from donor cell attaches to recipient cel
Relaxosome connects donor cell to the transferosome of recipient cell. Now, the recipient cell has been injected with mobile plasmid.

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32
Q

What does horizontal transfer result in?

A

multiple drug resistance

33
Q

What type of bacteria is particularly susceptible to horizontal transfer?

A

gram (-)

34
Q

6 causes of antibiotic resistance?

A

over-prescribing of antibiotics

patients not finishing tx

over-use of antiobiotics in livestock and fish farming

lack of new antibiotics being developed

lack of hygiene and poor sanitation

poor infection control in hospitals and clinics

35
Q

Penicillin-resistant strains of ______ account for 50% or more of isolates in some European countries and the proportion of such strains is rising in US

A

pneumococci

36
Q

Worldwide emergency of _____ and _____ that produce b-actamase is major therapeutic problem

A

Haemophilus and gonococci

37
Q

Methicillin-resistant strains of _________ are widely distributed among hospitals and are increasingly isolated from community-acquired infections.

A

S. aureus (MRSA)

38
Q

There are now strains of ______, _____, and _____ that are resistant to all known drugs.

A

enterococci, pseudomonas, enterbacters

39
Q

Epidemics of multiple drug-resistant strains of ________ have been reported in US.

A

M. tuberculosis

40
Q

Antimicrobial agents are frequently used ____ the _____ responsible for the illness or susceptibility to a particular antimicrobial agent is known. This is called empirical antimicrobial therapy.

A

before the pathogen

41
Q

Empirical antimicrobial therapy is based on

A

experience

42
Q

Choice of antimicrobial agents depends on

A

host factors - immunocompromised, liver damage, kidney damage, age, dosing requirements, costs, etc.

43
Q

In empirical antimicrobial therapy, you must obtain a culture before/after prescribing antibiotic.

A

BEFORE

then formulate dx.

change therapy if needed.

44
Q

Example of narrow spectrum antimicrobial drug

A

isoniazid

45
Q

Example of extended-spectrum antimicrobial drug

A

ampicillin

46
Q

Example of broad-spectrum antimicrobial drug

A

tetracycline

47
Q

What kind of spectrum is going to have the most adverse side effects?

A

broad spectrum

48
Q

What kind of spectrum will treat the most infections

A

broad-spectrum

49
Q

Broad spectrum antibiotics disrupt

A

natural flora everywhere

50
Q

Empirical therapy timeline: mixed infection suspected

A

infected pt –> take specimens for identification and sensitivity testing –> empirical therapy - coverage by antibiotics effective against Gram-positive, gram-negative, and anaerobes –> receive culture report with sensitivities

IF only a gram negative infection, patient’s tx needs to be adjusted to only tx gram-negative infections.

Same with gram positive.

If mixed - continue therapy as initiated

51
Q

bacteriocidal

A

cell death

52
Q

bacteriostatis

A

growth inhibition

stops growth which allows immune system to take care of infection

53
Q

Zone of clearance is the zone where

A

bacteria cannot grow.

54
Q

Can you tell if antibiotic is cidal or static using agar?

A

No. Clearing just tells you if organism is sensitive to antibiotic

55
Q

increased zone of clearance means

A

increased sensitivity

56
Q

when to use bacteriocidal?

A

bactericidal - no remarkable difference between bacteriostatic and bactericidal concentrations

57
Q

when to use bacteriostatic?

A

inhibitory concentrations are much lower than bactericidal

58
Q

When you remove a bacteriostatis agents, what happens if you do not have a robust immune system?

A

starts growing again. while bacteriostatic agent is present, growth is halted but never dies off, therefore when agent is removed and immune system has not cleared the bacteria, it will begin growing again

59
Q

What happens with bacteriocidal agent is removed?

A

No regrowth.

60
Q

If immunocompromised, what type of agent should we use?

A

bacteriocidal agent

61
Q

It is important to reach and maintain ____ ____ ___ in order to prevent the development of resistance. Maintenance of constant blood levels is more important in what kind of agent?

A

adequate blood levels

bacteriostatic than bactericidal agent

62
Q

Concentration dependent killing

A

rate and extent of killing dependent upon drug concentration (aminoglucosides and quinolones)

63
Q

Time dependent killing

A

killing is not increased with increasing concentrations above MBC (beta-lactams, vancomycin) but is dependent on time of exposure to antibiotic

64
Q

What dictates how long to use an antibiotic?

A

time dependent killing

65
Q

Concentration dependent killing must reach

A

certain concentration of drug to be bactericidal

66
Q

What type of agents inhibit synthesis?

A

bactericidal - cell wall and DNA

67
Q

What type of agents inhibit protein and metabolism

A

bacteriostatis

68
Q

MIC

A

minimum inhibitor concentration - smallest concentration to keep cells from growing

69
Q

MBC

A

minimum bactericidal concentration - smallest concentration to kil cells

70
Q

PAE

A

postantibiotic effect

71
Q

What is PAE?

A

persistent suppression of bacterial growth after limited exposure to an antimicrobial agent

exact mechanism i unknown

72
Q

Clinical importance of PAE

A

don’t have to have dose given as often if PAE exists

73
Q

Synergism

A

when inhibitory or killing effects of two or more antimicrobials used together are significantly greater than expected from their effects when used individually

2 + 2 = 7

74
Q

Synergism mechanism

Blockade of sequential steps in metabolic sequence

A

TMP - SMX

75
Q

Synergism mechanism

Inhibition of enzymatic inactivation

A

beta-lactamase inhibitors

76
Q

Synergism mechanism

Enhancement of

A

antimicrobial agent uptake

77
Q

Synergism: penicillin and aminoglycans together

Independently the cells are inhibited only (static)

A

Penicillin destroys cell walls so aminoglycans can gain entry – cell death occurs (cidal)

78
Q

Antagonism

A

inhibition of bactericidal activity by bacteriostatis agents

2 antibiotics don’t work well together

79
Q

Antagonism: induction of enzymatic inactivation: some gram-negative bacilli contain

A

inducible beta lactamases

drug-drug interactions that nullify effects

Unit 2- Pharm (9 decks)

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