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Small Animal Medicine > Infectious Dz - Antibiotic Review > Flashcards

Infectious Dz - Antibiotic Review Flashcards

1
Q

What do bacteriostatic antibiotics do?

A

They stop bacterial growth by interfering with protein synthesis and metabolism

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2
Q

What do bactericidal antibiotics do?

A

The kill bacteria by interfering with cell wall or nucleic acid synthesis

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3
Q

What antibiotics are bacteriostatic?

A

Chloramphenicol, sulfanomides, trimethoprim, clindamycin, doxycycline, and macrolides

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4
Q

What antibiotics are bactericidal?

A

Beta-lactams, fluoroquinolones, aminoglycosides, Timethoprim sulfas (which is the combo of sulfanomides and trimethoprim), vancomycin, and metronidazole

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5
Q

When will the classification of an antibiotic (static or cidal) influence your choice of antibiotic?

A

If there are life-threatening infections or an immunocompromised individual

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6
Q

What is the minimum inhibitory concentration (MIC)?

A

The lowest concentration of an antimicrobial that will inhibit bacterial growth

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7
Q

What factors does the in vitro value not take into account?

A

In vivo factors - Antibody in the serum, urine, and bile, pH of the infected environment, and presence of biofilms

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8
Q

What is efficacy of an antibiotic related to?

A

the amount of time that the antibiotic concentration is above the MIC

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9
Q

What maximizes efficacy of antibiotics?

A

Multiple daily doses, continuous administration, OR giving a single daily (high) dose

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10
Q

What antibiotics are time-dependent?

A

Penicillins, cephalosporins, carbapenems, macrolides, lincosamides, and tetracyclines

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11
Q

What antibiotics are concentration dependent?

A

Fluoroquinolones, aminoglycosides, and metronidazole

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12
Q

What four antibiotics/groups are part of the beta lactam structural group?

A

Penicillins, cephalosporins, carbapenems, and monobactams

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13
Q

Are the beta lactams cidal or static? Time or concentration dependent?

A

Cidal and time-dependent

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14
Q

How do beta lactams work?

A

They block cell wall synthesis by inhibiting penicillin-binding proteins

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15
Q

How are beta lactams metabolized?

A

They are renally excreted - high concentrations in the urine

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16
Q

What forms of penicillin do we use in small animals?

A

Amoxicillin/ampicillin and Ticarcillin

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17
Q

What is the spectrum of activity of penicillins?

A

Excellent activity against Gram + and anaerobes
Some gram - efficacy
Not effective against Pseudomonas

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18
Q

What enzyme do gram - bacteria produce that inactivates beta-lactam antibiotics?

A

Beta lactamase

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19
Q

What can extend the efficacy of penicillins against beta lactamase inhibitors?

A

Clavulanic acid (Clavamox) and Sulbactam (Unasyn)

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20
Q

What generation of cephalosporins has the most activity against gram negative organisms?

A

4th generation - activity increases with the generation

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21
Q

What is the spectrum of cephalosporins?

A

Effective against Gram positives

Resistant to all Gram + beta-lactamases

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22
Q

What carbapenems are used in small animal medicine?

A

Imipenem and Meropenem

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23
Q

What ‘effect’ do carbapenems have that other beta-lactams don’t have?

A

a post-antibiotic effect

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24
Q

What are Carbapenems effective against?

A

Gram negative and positive bacteria - there is little resistance as of now because these drugs are reserved for serious infections (the big guns)

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25
Q

How are Carbapenems formulated?

A

In IV and SQ routes because there is poor oral absorption

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26
Q

Uses of Carbapenems should be limited to what?

A

Serious multi-drug resistant gram - infections and in immunocompromised individuals

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27
Q

What glycopeptide do we use in small animal medicine?

A

Vancomycin

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28
Q

Is Vancomycin static or cidal? Time or concentration dependent?

A

Cidal and time-dependent

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29
Q

How do glycopeptides work?

A

They inhibit cell wall synthesis by binding amino acids used in its synthesis

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30
Q

How are glycopeptides formulated?

A

IV due to poor oral absorption

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31
Q

When is it recommended to use glycopeptides?

A

Only for multi-drug resistant gram + infections - Clostridium difficile and Methicillin-resistant Staph infections

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32
Q

What are the adverse effects of glycopeptides?

A

Red man syndrome (humans) and nephrotoxicity

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33
Q

Are fluoroquinolones cidal or static? Time or concentration dependent?

A

Cidal and concentration-dependent

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34
Q

How do fluoroquinolones work?

A

They cause disruption of DNA synthesis by inhibition of DNA gyrase and topoisomerase IV

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35
Q

What fluoroquinolones do we use in small animal medicine?

A

Marbofloxacin, enrofloxacin, ciprofloxacin, and pradofloxacin

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36
Q

What is the spectrum for fluoroquinolones?

A

Gram - bacteria, but also effective against + at higher doses
Poor efficacy against anaerobes
Attains high intracellular concentration which is good for Mycoplasma

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37
Q

What infections are fluoroquinolones good for and why?

A

They are highly lipophilic which provides for excellent penetration for prostatic and respiratory infections

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38
Q

What are the adverse effects of enrofloxacin in cats?

A

Acute retinal degeneration

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39
Q

What is a safer fluoroquinolone in cats?

A

pradofloxacin

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40
Q

What adverse effects do fluoroquinolones cause in young animals (4-28 weeks)?

A

Cartilage/joint toxicity

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41
Q

What does pradofloxacin cause when given in high doses in dogs?

A

Myelosuppression

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42
Q

Is metronidazole static or cidal? Time or concentration dependent?

A

Cidal and concentration dependent

43
Q

How does metronidazole work?

A

It is a prodrug that is activated in the bacterial cytoplasm to a free radical that causes DNA damage

44
Q

What is the spectrum of metronidazole?

A

It is especially effective against anaerobes (both gram + and - ) and protozoans (Giardia)

45
Q

What are the adverse effects of metronidazole?

A

Neurotoxicity with higher doses - there are generally vestibular signs

46
Q

True or False: Sulfonamides are always combined with trimethoprim

A

True

47
Q

What is the MOA of trimethoprim-sulfonamide (TMS)?

A

Synergistic inhibition of folate metabolism, resulting in inhibition of purine synthesis

48
Q

What enzyme does trimethoprim produce?

A

dihydrofolate reductase

49
Q

What enzyme does sulfonamide produce?

A

pteridin synthase

50
Q

What are sulfonamides effective against?

A

Gram + and - bacteria - especially Nocardia
Protozoal organisms

Variable efficacy against anaerobes

51
Q

Where do sulfonamides have excellent penetration?

A

in prostatic tissue

52
Q

Where are sulfonamides in high concentration?

A

urine

53
Q

What are the adverse effects of sulfonamides?

A

KCS, immune-mediate thrombocytopenia, hemolytic anemia/aplastic anemia, polyarthritis, hepatotoxicity, and bone marrow suppression

54
Q

How should you monitor for adverse effects of sulfonamides?

A

Shirmer tear test, liver panels, and CBC

55
Q

What aminoglycosides do we use in small animal medicine?

A

Amikacin, gentamicin, tobramycin, and neomycin

56
Q

What is the MOA of aminoglycosides?

A

Interfere with outer membrane LPS structure and inhibit protein synthesis by binding to the 30S ribosomal subunit

57
Q

Are aminoglycosides static or cidal? Time or concentration dependent?

A

cidal and concentration dependent

58
Q

What organs do the aminoglycosides have poor penetration into?

A

The prostate, brain/CSF, and the eye

59
Q

What is the spectrum of aminoglycosides?

A

Excellent gram - activity, good gram + activity

Anaerobes have intrinsic resistence

60
Q

How are aminoglycosides formulated?

A

SC, IM, IV, or topical administration because there is poor oral administration

61
Q

Where are aminoglycosides excreted?

A

in the urine

62
Q

What are the adverse effects of aminoglycosides?

A

Nephrotoxicity and ototoxicity

63
Q

What chloramphenicols are used in small animal medicine?

A

Chloramphenicol, florfenicol and thiamphenicol

64
Q

What is the MOA of chloramphenicols?

A

Inhibits protein synthesis by binding to the 50S ribosomal subunit

65
Q

Are chloramphenicols static or cidal? time or concentration dependent?

A

Static and time dependent

66
Q

What is the spectrum of chloramphenicols?

A

Broad spectrum - gram +/- and anaerobes

67
Q

What organs do chloramphenicols have excellent penetration?

A

Brain, eye, and prostate due to excellent lipid sollubility

68
Q

What are the adverse effects of chloramphenicols?

A

Irreversible aplastic anemia in humans

Reversible bone marrow suppression

69
Q

What species are chloramphenicols poorly tolerated in?

A

cats - they get GI signs and BM suppression

70
Q

What tetracyclines do we use in small animal medicine?

A

tetracycline, doxycycline, and minocycline

71
Q

Are tetracyclines static or cidal? Time or concentration dependent?

A

Static and time dependent

72
Q

What is the MOA of tetracyclines?

A

Inhibits protein synthesis by binding 30S ribosomal subunit

73
Q

What is the spectrum of tetracyclines?

A

Gram + and - intracellular bacteria (rickettsiae) and spirochetes

74
Q

What are the adverse effects of tetracyclines?

A

vomiting, esophagitis and esophageal strictures in cats, hepatopathy, and possible dental discoloration with use of doxy

75
Q

What lincosamides do we use in small animal medicine?

A

Clindamycin and lincomycin

76
Q

Are lincosamides static or cidal? Time or concentration dependent?

A

Static and time dependent

77
Q

What is the MOA of lincosamides?

A

inhibits protein synthesis by binding to 50S ribosomal subunit

78
Q

What is the spectrum of lincosamides?

A

Gram postitives, anaerobes, and protozoans

79
Q

What are the adverse effects of lincosamides?

A

Esophagitis in cats

80
Q

What macrolides do we use in small animal medicine?

A

Erythromycin, tylosin, clarithromycin, and azithromycin

81
Q

Are macrolides static or cidal? Time or concentration dependent?

A

Static and time dependent

82
Q

What is the spectrum of macrolides?

A

Gram +, some gram -, and mycobacterium (clarithromycin)

83
Q

What macrolide is good for antibiotic resistant diarrhea?

A

tylosin

84
Q

Are fungi eukaryotes or prokaryotes?

A

eukaryotes

85
Q

What antifungals do we use?

A

Azoles, amphotericin B, 5-flucytosine, and terbinafine

86
Q

What imidazoles do we use in small animal medicine?

A

Ketoconazole, clotrimazole, and enilconazole

87
Q

What triazoles do we use in small animal medicine?

A

Itraconazole, fluconazole, voriconazole, and posaconazole

88
Q

Do imidazoles or triazoles have more side effects?

A

imidazoles

89
Q

What is the MOA of azoles?

A

They are fungistatic - interfere with ergosterol synthesis through inhibition of 14 alpha-demethylase

90
Q

What are the adverse effects of azoles?

A 
Inhibition of mammalian p450
Suppression of adrenal function (ketoconazole)
Teratogenic
Hepatotoxicity
Ulcerative skin lesions (itraconazole)
91
Q

What is the MOA of Amphotericin B?

A

Causes pores in the cell membrane by binding to sterols

Macrophage activation

92
Q

Is amphotericin B static or cidal?

A

Static but cidal at high doses

93
Q

What are the adverse effects of amphotericin B?

A

nephrotoxicity

94
Q

What is the MOA of 5-Flucytosine?

A

It is a fluorinated pyrimidine that interferes with DNA replication when converted to fluorouracil

95
Q

What is 5-Flucytosine effective against?

A

Only against Cryptococcus and Candida

96
Q

Is 5-Flucytosine static or cidal?

A

static

97
Q

Why is 5-Flucytosine never used alone?

A

Because resistance develops quickly when used as a single agent

98
Q

What are the adverse effects of 5-Flucytosine?

A

Cutaneous drug eruptions (dogs) and myelosuppression

99
Q

How does Terbinafine work?

A

It inhibits squalene epoxidase, causing intracellular accumulation of squalene

100
Q

Is terbinafine static or cidal?

A

cidal

101
Q

What is terbinafine especially effective against?

A

dermatophytes

102
Q

What are the adverse effects of terbinafine?

A

Most are unknown, but it is known to cause facial pruritus in cats

103
Q

You are treating a 15 year old spayed female cat with a suspected UTI. Which antibiotic would be the best choice for treatment?

a. Enrofloxacin
b. Gentamicin
c. Amoxicillin
d. Chloramphenicol

A

c. Amoxicillin

Not enrofloxacin because it causes acute retinal degeneration in cats
Not Gentamicin because…. not entirely sure, but it does cause nephrotoxicity
Not Chloramphenicol because it is poorly tolerated in cats

Small Animal Medicine (100 decks)

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