Final Exam Part 3 Flashcards
Most gram positive organisms are ____ and most gram negative organisms are _____.
Gram positive = cocci
Gram negative = rods
It is more difficult to kill a gram ____ organism than a gram ___ one.
More difficult to kill a gram NEGATIVE organism than a gram POSITIVE one
What is a beta lactamase enzyme?
Bacterial enzyme that inactivates drugs
Describe the bacterial cell wall of a gram positive organism. (2)
- Many layers of peptidoglycan strands
2. Within the peptidoglycan strands exist the penicillin binding proteins and beta lactamases
Describe the bacterial cell wall of a gram negative organism. (3)
- Contains 2 membranes separated by a periplasmic space
- Beta lactamases are located in the periplasmic space
- Outer membrane has aqueous channels in the which some drugs may enter
What is the major side effect of antimicrobials?
C Diff
Antimicrobials are ____ and _____, and increase sensitive to ______.
Ototoxic
Nephrotoxic
UV light
What is the MOA of bacterial wall inhibitors (beta lactams).
Inhibits the linking of the peptide and prevents linkage of structural components of the cell wall
Inhibitors of bacterial cell membrane function destroy the ______ allowing escape of ____.
Destroy the cell membrane
Allow for escape of nutrients
List 3 drugs classified as inhibitors of bacterial DNA/RNA synthesis. Describe their MOA.
- Fluoroquinolone: inhibit DNA gyrase enzyme preventing relaxation of supercoiled DNA
- Metronidazole: Activity restrict to anaerobes and certain Protozoa
- Antifolates/Sulfonamides: Interfere with the production of folate which is necessary for the production of purines and DNA
List 4 indications for the use of Vancomycin.
- Resistant streptococci
- Resistant staphylococci
- C. Difficile
- MRSA
Vancomycin is not affected by _______. Why?
Not affected by beta lactamases
Why?: Lack a beta-lactama ring
What is MRSA? How does it spread?
- Methicillin-resistant staphylococcus aureu
2. Spreads through direct contact and can live on surface for 70+ days
List 4 ADRs associated with use of fluroquinolones.
- Cystic lesion in articular cartilage
- Tendon ruptures
- Peripheral neuropathy
- Long QT interval
Describe the lifecycle of the HIV virus. (7)
- Fusion of virus to the host cell surface receptor
- Surface glycoprotein (gp120) on HIV binds to receptors on T cells, macrophages, and dendritic cells
- Penetration and un-coating exposing RNA
- Viral RNA converted to viral DNA by reverse transcriptase enzyme
- Transcription of the host cell’s DNA and the viral DNA occurs and is followed by translation and production of viral proteins
- Protease enzyme hydrolyzes the newly formed proteins into smaller units and assembles them w/ viral RNA to produce new virions
- Budding and release of new HIV particles
List 5 major drug classifications used to control HIV.
- Fusion inhibitors
- Nucleoside reverse transcriptase inhibitors
- Non-nucleoside reverse transcriptase inhibitors
- Protease inhibitors
- Integrase inhibitors
What is the role of beta lactamase inhibitors?
Can be combined with antibiotics to inhibits beta lactamase from breaking down antibiotics, providing additional ammunition to fight the microbe
What is the difference between adjuvant and neoadjuvant therapies?
- Adjuvant therapy: Often used AFTER primary treatments like surgery/radiation
- Neoadjuvant therapy: Often used BEFORE primary treatments are given
Provide 2 examples of adjuvant and neoadjuvant therapies.
- Adjuvant: Surgery is performed after radiation to remove the cancer
- Neoadjuvant: When a cancer mass is too large to eliminate, treatment is given to shrink the tumor prior to radiation/surgery once the mass is smaller (breast/colon cancers)
List 18 main side effects of almost all chemotherapy agents, acute and long term. (Sorry lol)
- Chemo-brain
- Pain
- Fatigue
- Malnourishment
- Nausea
- Diarrhea
- Damage to gastrointestinal epithelium
- Stomatitis
- Myelosuppression
- Depression of growth in children
- Alopecia
- Sterility
- Teratogenicity
- Cardiotoxicity
- Organ toxicity
- Extravasation injury
- Neuropathy
- Secondary cancers
Why might a PT treat someone on a Plant alkaloid (Taxanes)?
Often produce paresthesias and foot/wrist drop
What is the difference between tyrosine Kinase inhibitors and Mammalian target of rapamycin? What are the indications for each?
Tyrosine kinase inhibitors (TKIS): work INSIDE the cell to inhibit tyrosine kinase receptors (inhibit signaling system that would lead to cell division)
Indication of TKIS: CML, breast, hepatocellular, and renal cancer
Mammalian target of rapamycin (mTOR) inhibitor: Prevent mTOR from activating signaling pathways involved in angiogenesis and cell growth
Indications of mTOR: Kidney, pancreas, breast and brain cancer
What are 2 serious side effects of anthracycline should the PT be aware of?
- Cardiac toxicity (no more than 4 doses given)
2. Myelosuppression
List 3 MOAs of Monoclonal Antibodies.
- Flag cancer cells for destruction
- Block growth signals and receptors
- Deliver other anti cancer agents to the site of the tumors
Cytokines stimulate the growth of _____ and help them to get revved up.
T cells
____ cancer vaccines are comprised of the patient’s own tumor cells.
Autologous
______ cancer vaccines are comprised of many different cancer cells working to induce a response against a tumor associated antigen.
Allogenic
List 4 goals of treatment of cancer vaccines.
- Delay or stop cancer cell growth
- Cause tumor shrinkage
- Prevent cancer from recurring
- Eliminate cancer cells that have not been killed by other treatment methods
What is the MOA of colony stimulating factor?
Helps to regenerate neutrophil recovery following myelosuppressive therapy to minimize the extent of patient’s nadir and reduce infection
______ is the most common dose limiting side effect.
NEUTROPENIA: low WBC count
Chemotherapy will be withheld when _____ count drops below ____ and/or _____ count is below ______.
Neutrophil count below 500/mm3
Platelet count below 100,000/mm3
When should the PT refrain from treating a patient on chemotherapy?
When the PT has an active infection, cough or fever, to protect the patient from illness
List 5 general risk factors for neutropenia.
- Age
- Female
- Malnutrition
- Open wounds
- Comorbidities (hepatic/renal dysfunction)
List 5 treatment related factors that increase risk for neutropenia.
- Previous history of neutropenia
- Extensive previous chemotherapy
- Type of chemotherapy (combined modality)
- Dose intensity
- Radiation
What signs of infection should you be looking for when treating patients on chemotherapy? (GI, respiratory/urinary tracts, indwelling devices, skin/mucous membranes, generalized)
- GI: mucositis and diarrhea
- Respiratory tract: cough, dyspnea (on exertion), abnormal breathing sounds
- Urinary tract: dysuria, frequency, urgency, color/odor changes
- Indwelling devices: site redness, edema, tenderness, warmth
- Skin and mucous membranes: redness, edema, tenderness and warmth
- Generalized: flu-like, FEVER, chills, myalgia, malaise, fatigue
_____ is the most reliable sign of infection in patients with neutropenia.
Fever >38 degrees C
_____ in the setting of neutropenia has a high mortality rate.
Septic shock
List 7 risk factors for thrombocytopenia.
- Myelosuppressive chemotherapy
- Radiation therapy (concurrent)
- Bone marrow involvement
- DIC
- Fever
- Concomitant disease
- Nutrition deficiencies
List 8 clinical signs of thrombocytopenia.
- Petechiae and bruising
- Overt bleeding
- Enlarged liver or spleen
- Occult or overt blood in stool or urine
- Prolonged menstruation
- Headaches
- Hypotension
- Tachycardia
Strong vesicants are a type of _______.
Anti tumor antibiotics
What is a vesicant injury?
Severe muscle and tissue damage that can occur if strong vesicants leakage occurs outside the veins.
