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Pharmacology > Exam 4-1 > Flashcards

Exam 4-1 Flashcards

1
Q

Antibiotics

A

Medications used to treat bacterial infections
*Ideally, before beginning antibiotic therapy, the suspected areas of infection should be cultured to identify the causative organism and potential antibiotic susceptibilities

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2
Q

Bacterial Morphology Shapes

A
  • Coccus
  • Bacillus
  • Coccobacillus
  • Fusiform Bacillus
  • Vibrio
  • Spirillum
  • Spirochete
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3
Q

Gram Positive Bacteria

A
  • Actinobacteria

* Firmicutes

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4
Q

Firmicutes

A
  • Bacilli, order Bacillales
  • Bacilli, order Lactobacillales
  • Clostridia
  • Mollicutes
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5
Q

Actinobacteria

A
  • Actinomyces
  • Arthrobacter
  • Corynebacterium
  • Frankia
  • Micrococcus
  • Micromonospora
  • Mycobacterium
  • Nocardia
  • Propionibacterium
  • Streptomyces
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6
Q

Bacilli, order Bacillales

A
  • Bacillus
  • Listeria
  • Staphylococcus
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7
Q

Bacilli, order Lactobacillales

A
  • Enterococcus
  • Lactobacillus
  • Lactococcus
  • Leuconostoc
  • Pediococcus
  • Streptococcus
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8
Q

Clostridia

A
  • Acetobacterium
  • Clostridium
  • Eubacterium
  • Heliobacterium
  • Heliospirillum
  • Megasphaera
  • Pectinatus
  • Selenomonas
  • Zymophilus
  • Sporomusa
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9
Q

Mollicutes

A
  • Mycoplasma
  • Spiroplasma
  • Ureaplasma
  • Erysipelothrix
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10
Q

Gram Negative Bacteria

A
  • Acinetobacter- Acinobacillus
  • Bordetella- Brucella
  • Campylobacter- Cyanobacteria
  • Enterobacter- Erwinia
  • Escherichia coli- Franciscella
  • Helicobacter- Hemophilus
  • Klebsiella- Legionella
  • Moraxella- Neisseria
  • Pateurella- Proteus
  • Pseudomonas- Samonella
  • Serratia- Shigella
  • Treponema- Vibrio
  • Yesinia
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11
Q

Empiric therapy

A

Treatment of an infection before specific culture information has been reported or obtained.

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12
Q

Definitive Therapy

A

Antibiotic therapy tailored to treat organism identified with cultures

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13
Q

Prophylactic Therapy

A

Treatment with antibiotics to prevent an infection, as in intraabdominal surgery or after trauma

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14
Q

Therapeutic Response

A

Decrease in specific signs and symptoms of infection are noted (fever, elevated WBC, redness, inflammation, drainage, pain)

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15
Q

Subtherapeutic Response

A

Signs and symptoms of infection do not improve

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16
Q

Antibiotic Therapy Cont.

A
  • Superinfection
  • Pseudomembranous colitis
  • Host factors
  • Genetic host factors
  • G6PD
  • Slow acetylation
  • Allergic reactions
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17
Q

Antibiotic: Classes

A
  • Sulfonamides
  • penicillins
  • cephalosporins
  • macrolides
  • quinolones
  • aminoglycosides
  • tetracyclines
  • others
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18
Q

Antibiotic Therapy: Mechanism of Action

A
  • Interference with cell wall synthesis
  • Interference with protein synthesis
  • Interference with DNA replication
  • Acting as a metabolite to disrupt critical metabolic reactions inside the bacterial cell
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19
Q

Actions of Antibiotics

A
  • Bacterial: Kill bacteria
  • Bacteriostatic: inhibit growth of susceptible bacteria, rather than killing them immediately; will eventually lead to bacterial death
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20
Q

Antibiotics: Sulfonamides

A

One of the first groups of antibiotics

  • sulfadiazine
  • sulfamethoxazole
  • sulfisoxazole
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21
Q

Sulfonamides are often-

A

combined with another antibiotic
-sulfamethoxazole combined with trimethoprim (a nonsulfonaminde antibiotic), known as Bactrim, Septra, or co-trimoxazole (SMX-TMP)

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22
Q

Sulfonamides: Mechanism of Action

A
  • Bacteriostatic Action
  • Prevent synthesis of folic acid required for synthesis of puriness and nucleic acid
  • Do not affect human cells or certain bacteria- they can use preformed folic acid
  • Only affect organisms that synthesize their own folic acid
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23
Q

Sulfonamides: Indications

A
  • Effective against both gram-positive and gram-negative bacteria
  • Treatment of UTIs caused by susceptible strains of:
  • Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus vulgaris, Staphylococucus aureus
  • Pneumocystis jiroveci pneumonia (PJP)
  • sulfamethoxazole/trimethoprim (co-trimoxazole)
  • Upper respiratory tract infections
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24
Q

Sulfonamides: Adverse Effects-Blood

A

Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia

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25
Q

Sulfonamides: Adverse Effects: Integumentary

A

Photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrlysis

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26
Q

Sulfonamides: Adverse Effects: GI

A

*N/V/D, pancreatitis

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27
Q

Sulfonamides: Adverse Effects: Other

A

*Convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria

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28
Q

B-Lactam Antibiotics

A
  • Penicillins
  • Cephalosporins
  • Carbapenems
  • Monobactams
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29
Q

Penicillins

A
  • Natural penicillins
  • Penicillinase-resistant penicillins
  • Aminopenicillins
  • Extended-spectrum penicillins
30
Q

Natural penicillins

A

-penicllin G, penicillin V

31
Q

Penicillinase-resistant drugs

A

*cloxacillin, dicloxacillin, nafcillin, oxacillin

32
Q

Aminopenicillins

A

-amoxicillin, ampicillin

33
Q

Extended-spectrum penicillins

A

piperacillin, ficarcillin, carbenicillin

34
Q

Penicillins was first introduced in

A

1940’s

35
Q

Bactericidal inhibits

A

cell wall synthesis

36
Q

Penicillins kill a-

A

wide variety of bacteria

37
Q

Bacteria produce enzymes capable of-

A

destroying penicillins

  • these enzymes are known as beta-lactamases
  • As a result, the medication is not effective
38
Q

Chemicals have been developed to-

A

inhibit these enzymes:

  • clavulanic acid
  • tazobactam
  • sulbactam
39
Q

These chemicals bind with-

A

B-lactamase and prevent the enzyme from breaking down the penicillin, thus making the penicillin more effective

40
Q

Penicillin B-lactamase inhibitor combination products

A
  • ampicillin+ sulbactam= Unasyn
  • amoxicillin+clavulanic acid=Augmentin
  • ticarcillin+ clavulanic acid= Timentin
  • piperacillin+tazobactam=Zosyn
41
Q

Penicillins: Mechanism of Action

A
  • Penicillins enter the bacteria via the cell wall
  • Inside the cell they bind to penicillin-binding protein
  • Once bound, normal cell wall synthesis is disrupted
  • Result: bacteria cells die from cell lysis
  • Penicillins do not kill other cells in the body
42
Q

Penicillins: Indications

A
  • Prevention and treatment of infections caused by susceptible bacteria, such as:
  • Gram-positive bacteria
  • Streptococcus spp. Entercoccus spp. Staphylococcus spp.
43
Q

Penicillins: Adverse Effecs

A
  • Allergic reactions occur 0.7% to 4%
  • Urticaria, pruitus, angioedema
  • Those allergic to penicillins have a fourfold to sixfold increased risk of allergy to other B-lactam antibiotics
  • Cross-reactivity between penicillins and cephalosporins is between 1% and 4%
44
Q

Penicillin: Common adverse effects

A

Nausea, vomiting, diarrhea, abdominal pain

45
Q

Penicillins: Interactions

A

Oral contraceptives

46
Q

Cephalosporins

A
  • First generation
  • Second generation
  • Third generation
  • Fourth generation
  • Fifth generation (not yet marketed)
  • Semisynthetic derivatives from a fungus
  • Structurally and pharmacologically related to penicillins
  • Bactericidal action
  • Broad spectrum
  • Divided into groups according to their antimicrobial activity
47
Q

Cephalosporins: First Generation

A

*Good gram-positive coverage
*Poor gram-negative coverage
*Parenteral and PO forms
*Examples:
-cefadroxil
-cephradine
-cefazolin
-cephalexin
Used for surgical prophylaxis, and for susceptible staphylococcal infections
**cefazolin (Ancef and Kefzol): IV or IM
**cephalexin (Kefzol): PO

48
Q

Cephalosporins: Second Generation

A 
Good Gram-positive coverage
Better gram-negative coverage than first generation
Examples:
-cefaclor
-cefprozil
-cefoxitin
-cefuroxime
-loracabef
-cefotetan
49
Q

cefoxitin (Mefoxin): IV and IM

A
  • used prophylactically for abdominal or colorectal surgeries
  • Also kills anaerobes
50
Q

cefuroxime

A
  • surgical prophylaxis

- does not kill anaerobes

51
Q

Cephalosporins: Third Generation

A

*Most potent group against gram-negative bacteria
*Less active against gram-positive bacteria
Examples:
ceftibuten
cefotaxime
ceftazidime
cefdinir
ceftizoxime
ceftriaxone
ceftazidime

52
Q

ceftriaxone (Rocephin)

A
  • IV and IM, long half-life, once a day dosing
  • Elimination is primarily hepatic
  • Easily passes meniges and diffuse into CSF to treat CNS infections
53
Q

ceftazidime (Ceptaz)

A
  • IV and IM forms
  • Excellent gram-negative coverage
  • Used for difficult to treat organisms such as Pseudomonas spp.
  • Eliminate renally instead of biliary route
54
Q

Cephalosporins: Fourth Generations

A
  • Broader spectrum of antibacterial activity than third generation, especially against gram-positive bacteria
  • Uncomplicated and complicated UTI
  • cefepime (Maxipime)
55
Q

Cephalosporins: Fifth Generation

A
  • Ceftobipriole (not available)
  • Broader spectrum of antibacterial activity
  • Effective against a wide variety of organisms
  • MRSA
  • Pseudomonas spp.
56
Q

Cephalosporins: Adverse Effects

A
  • Similiar to penicillins
  • Mild diarrhea, abdominal cramps, rash, pruritis, redness, edema
  • Potential cross-sensitivity with penicillins if allergies exist
57
Q

Carbapenems

A
  • Very broad-spectrum antibacterial action
  • Reserved for complicated body cavity and connective tissue infections
  • May cause drug-induced seizure activity
  • this risk can be reduced with proper dosage
  • All given parenterally
58
Q

Carbapenems: imipenem/cilastatin (Primaxin)

A
  • used for treatment of bone, joint, skin and soft-tissue infections
  • Cilastatin inhibits an enzyme that breaks down imipenem
  • meropenem (Merrem)
  • ertapenem (Invanz)
  • doripenem (Doribax)
59
Q

Monobactams

A
  • aztreonam (Azactam)
  • Synthetic beta-lactam antibiotic
  • Primarily active against aerobic gram-negative bacteria (E. Coli, Klebsiella spp., Pseudomonas spp.)
  • Used for moderately severe systemic infections and UTI’s
60
Q

Macrolides

A
  • erythromycin (E-mycin, E.E.S)
  • azithromycin (Zithromax)
  • clarithromycin (Biaxin)
  • dirithromycin
61
Q

Macrolides: Mechanism of Action

A
  • Prevent protein sythesis within bacterial cells
  • Consider bacteriostatic
  • Bacteria will eventually die
  • In high enough concentrations, may also be bactericidal
62
Q

Macrolides: Indications

A

*Strep infections
-Streptococcus pyogenes
(group A B-hemolytic streptococci)
*Mild to moderate URI and LRI
-Haemophilus influenzae
*Spirochetal infections
-Syphilis and Lyme disease
*gonorrhea, Chlamydia, Mycoplasma

63
Q

Macrolides: Indications cont’d

A

azithromycin and clarithromycin

  • recently approved for mycobacterium avium-intracellular complex infection (opportunistic infection associated with HIV/AIDS)
  • clarithromycin
  • recently approved for use in combination with omeprazole for treatment of active ulcer disease associated with Helicobacter pylori infection
64
Q

Macrolides: Adverse Effects

A
  • GI effects, primarily with erythromycin
  • nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia
  • Newer drugs, azithromycin and clarithromycin: fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration
65
Q

Ketolide

A
  • telithromycin (Ketek)
  • Only drug in this class
  • Better antibacterial coverage than mactolides
  • Active against gram-positive bacteria, including multi-drug resistant strains of S. pneumoniae
  • Associated with severe liver disease
  • Use is limited
66
Q

Tetracyclines

A
  • demeclocycline (Declomycin)
  • oxytetracycline
  • tetracycline
  • doxycycline (Doryx, Vibramycin)
  • minocycline
  • tigecycline (Tygacil)
67
Q

Tetracycline: Characteristics

A
  • Natural and semisynthetic
  • Obtained from cultures of Streptomyces
  • Bacteriostatic-inhibit bacterial growth
  • Inhibit protein synthesis
68
Q

Tetracyclines: Info

A
  • Bind (chelate) Ca2+, Mg2+, and Al3+ ions to form insoluble complexes
  • Dairy products, antacids and iron salts reduce oral absorption of tetracyclines
  • Should not be used in children under age 8 or in pregnant/lactating women because tooth discoloration can occur if the drug binds to the calcium in the teeth
69
Q

Tetracyclines: Indications

A
  • Broad spectrum

- Gram negative and gram positive organisms, protozoa, Mycoplasma, Rickettsia, Chlamydia, syphilis, Lyme disease, acne

70
Q

Tetracyclines: Adverse Effects

A
  • Strong affinity for calcium
  • Discoloration of permanent teeth and tooth enamel in fetuses and children, or nursing infants if taken by the mother
  • May retard fetal skeletal development if taken during pregnancy
71
Q

Tetracycllines: Adverse Effects/Alteration in intestinal flora may result in:

A
  • Superinfection (overgrowth of nonsusceptible organisms such as Candida)
  • Diarrhea
  • Pseudomembranous colitis
72
Q

Tetracylines: Adverse Effects/May also cause:

A
  • Vaginal candidiasis
  • Gastric upset
  • Enterocolitis
  • Maculopapular rash

Pharmacology (14 decks)

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