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Pharm 2 Part 3: Chemotherapy and Antibiotics and Antifungals > Pharm: L23-24: Chemotherapy > Flashcards

Pharm: L23-24: Chemotherapy Flashcards

1
Q

Therapeutic Agent enters HOST: What happens? (2)

  1. What about a Chemotherapeutic Agent?
A
  1. Has an EFFECT on the HOST and the Host METABOLIZES the agent.
  2. Hits the host: can cause TOXICITY and the Host METABOLIZES it.

It Also has a THERAPEUTIC EFFECT on the PATHOGEN FACTOR, and the Pathogen Factor can have RESISTANCE to a CHEMO Agent.

*Host: Host Defense System tries to destroy the Pathogen Factor, while that Pathogen causes DISEASE in the HOST.

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2
Q

Uniqueness of Chemotherapy

  1. SELECTIVE TOXICITY: What is it?
  2. What does CHEMOTHERAPY SELECT for? (She made a big deal about this in lecture)
  3. What is a potential problem with this class of drugs?
  4. What does Chemotherapy essentially do?
A
  1. Need greater toxicity to Parasite than Host
  2. SELECTS FOR RESISTAN STRAINS
  3. HYPERSENSITIVITY AND ORGAN DIRECTED TOXICITY
  4. LOWERS THE MICROORGANISM LOAD so the HOST DEFENSE SYSTEM can rid the body of foreign organisms
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3
Q

Pharmacokinetics of Chemotherapy Drugs

  1. Why is it important to REACH and MAINTAIN ADEQUATE BLOOD LEVELS?
  2. Maintenance of Constant Blood Levels is MORE IMPORTANT with what Agents?
A
  1. Prevent development of Resistance
  2. with BACTERIOSTATIC (need an immune response to be functional) than bactericidal Agents (used in someone not cell immunocompetent cuz antibiotic can take care of infection on its own)
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4
Q

2 Ways to get a Pathogen: What are they?

A
  1. Natural and Acquired
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5
Q

Mechanisms of getting a pathogen

  1. Pathogen or cell can do 3 things?
  2. What can happen to the Drug Target?
  3. Increased Production of what?
  4. What altered pathway can Bypass the drug target?
  5. MULTIPLE DRUG RESISTANCE: often transmitted by what?
A
  1. Fail to Absorb the Drug; Inactivate the Drug; Pumps the Drug Out (MDR, P-Glycoprotein)
  2. It can be modified, thus you get resistance to the drug
  3. of Target Molecules
  4. Altered METABOLIC PATHWAY
  5. Often transmitted by Plasmids
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6
Q
  1. Antimicrobial Resistance: What 3 things?
A
  1. Antibiotic Degrading Enzyme; Antibiotic Altering Enzyme; and Antibiotic Resistance Genes can create Efflux Pumps
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7
Q

Antimicrobial Resistance

  1. Acquired by:
    a. Mutation and passed how to Daughter cells?

b. HORIZONTAL TRANSFER of resistance determinants from a Donor cell, often of another bacterial species by what 3 things?

A
  1. a. VERTICALLY
    b. Transduction (bacteriophages) (Donor Bacterium: Phage injects DNA into cell, then they create themselves in the bacterium and they just pack as much DNA into the head before lysing the bacterium…this means it can get incorporation of DNA from the donor bacterium)

Transformation (Incorporation of Free DNA) (Bacterial cell lysed and some DNA can be lysed and become free floating DNA that can be picked up and incorporated into another Bacterium’s DNA)

and Conjugation (Transfer of Genes through sex pilus) (basically it’s bacterial sex thru pilli. Mainly G- and MDR)!! **HAS TO HAVE CELL TO CELL CONTACT WITH THIS (not the other 2)

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8
Q

Vertical Transfer

  1. Tends to happen in what?
A
  1. Streptomycin (Ribosomal mutation)
  2. Quinolones (Gyrase Gene Mutation)
  3. Rifampin (RNA Polymerase Gene Mutation)
  4. 2ndary drug resistance to Antituberculous Agents in M. Tuberculosis
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9
Q

Horizontal Transfer

  1. Transduction: What bacteria?
  2. Transformation: What bacteria?
  3. Conjugation: What bacteria?
A
  1. Some Strains of Staph. Aureus (Penicillinase) (erythromycin, tetracycline and Chloramphenicol resistance)
  2. Pneumococci and Neisseria (PBPs: Penicilling-Binding-Proteins)
  3. Shigella and Enterobacteriaceae
    a. R-Determinan Plasmi: codes for resistance
    b. RTF: genes needed for bacterial Conjugation

c. R-determinant Plasmid + RTF = Complete R Factor

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10
Q

Resistance:

  1. % of Penicillin-Resistant Strains of Pneumococci?
  2. What is a Major Therapeutic Problem? (Emergence of what)
  3. MRSA: problem with it?
  4. What 3 bacteria now have strains resistant to all known drugs?
  5. Epidemics of multiple drug resistant strains of what have been reported in the US?
A
  1. 50% or more of isolates in some European countries, and the proportion of these strains is rising in the US
  2. Haemophilus and Gonococci that produce B-Lactamase
  3. Seen in hospitals and isolated from Community-acquired infections
  4. Enterococci, Enterobacters, and Pseudomonas
  5. M. Tuberculosis
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11
Q

Antimicrobial Therapy: Adverse Effects

  1. What are three causes?
A
  1. Overextension of Pharmacologic Actions
  2. Organ Directed Toxicity
  3. Hypersensitivity Reactions
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12
Q

Adverse Effects: Toxicity to the Host

  1. Hepatotoxicity: 6 of them (SAT ICE)
A
  1. Sulfonamide; Amphotericin B; Tetracyclines

Isoniazid; Clindamycin; Erythromycin Estolate

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13
Q

Adverse Effects: Toxicity to the Host

  1. Renal Toxicity (5): CAVAS
A
  1. Cephalosporins; Amphotericin B; Vancomycin; Aminoglycosides; Sulfonamides
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14
Q

Adverse Effects: Toxicity to Host

  1. Ototoxicity: (3): MAV
  2. Visual Toxicity (2): IE
  3. Hemopoietic Toxicity (3): MCS
A
  1. Minocycline (Vestibular Only); Aminoglycosides; Vancomycin
  2. Isoniazid; Ethambutol
  3. Many Antiviral Agents; Chloramphenicol; and Sulfonamides
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15
Q

Adverse Effects: Toxicity to Host

  1. Allergies (4) ASII
A
  1. Anaphylactic Shock; Skin Rashes; Immune Hymolytic Anemia; Immune Induced Blood Dyscrasias
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16
Q

Adverse Effects: Toxicity to Host

  1. Idiosyncrasies
    a. Hemolytic Anemias (2)

b. Photosensitivity (3)

A
  1. a. Sulfonamides; Nitrofurantoin

b. Tetracyclines; Fluoroquinolones; and Sulfonamides

17
Q

Empirical Antimicrobial Therapy

  1. When are they frequently used?
    a. What is this based on?
    b. CHOICE of Antimicrobial Agent depends on what?
A
  1. BEFORE PATHOGEN responsible for the illness or the susceptibility to an antimicrobial agent is known
    a. EXPERIENCE
    b. Host factors (immunocompromised, liver/kidney damage, age, dosing requirements, costs, etc)
18
Q

Antibiotics: Different Activity Spectrums

  1. Isoniazid: Type of drug?
  2. Ampicillin?
  3. Tetracycline?
A
  1. Narrow-spectrum antimicrobial drug
  2. Extended-Spectrum Antimicrobial drug
  3. Broad-Spectrum antimicrobial drug
19
Q

After taking culture from infected patient, how do we tell what it is? (Empiric Therapy)

A
  1. coverage by Antibiotics effective against G+, G-, and Anaerobes.
20
Q

Antibiotic Susceptibility

  1. Bacteriocidal = ?
  2. Bacteriostatic = ?
A
  1. Cell Death

2. Growth Inhibition

21
Q

Bacteriocidal vs. Bacteriostatic

  1. Bactericidal: what is it?
  2. Bacteriostatic: What is it?
  3. Organism Dependent: ?
A
  1. No real difference b/w static and cidal concentrations
  2. inhibitory concentrations are much lower than bactericidal
  3. Chloramphenicol is bactericidal against Pneumococci, meningococci and Haemophilus Influenzae
22
Q

MIC vs. MBC

  1. MIC = ?
  2. MBC = ?
A
  1. Minimum Inhibitory Concentration

2. Minimum Bactericidal Concentration

23
Q

Bactericidal Agents

  1. Concentration Dependent Killing
  2. Time Dependent Killing
A
  1. depends on concentration! (Aminoglycosides, Quinolones)
  2. Killing doesn’t increase w/increasing concentrations above MBC (beta-lactams, Vancomycin) but it’s dependent on the TIME OF EXPOSURE to the antibiotic
24
Q

Postantibiotic Effect (PAE)

  1. What happens after limited exposure to an Antimicrobial Agent
  2. Mechanism?
  3. in vivo PAE-s are longer than in vitro PAE-s due to what
A
  1. PERSISTENT SUPPRESSION of BACTERIAL GROWTH
  2. unknown
  3. due to POSTANTIBIOTIC LEUKOCYTE ENHANCEMENT!
25
Q

Synergism: When inhibitory or killing effects of 2 or more antimicrobials are used together, what happens?

A
  1. they’re SIGNIFICANTLY GREATER than expected from their effects when used individually
26
Q

Synergism Mechanisms

  1. Blockade of what?
  2. Inhibition of what?
  3. Enhancement of what?
A
  1. steps in metabolic sequence (TMP-SMX)
  2. of Enzymatic Inactivation (Beta-lactamase inhibitors)
  3. of ANTIMICROBIAL AGENT UPTAKE (penicillins increase uptake of aminoglycosides, amphotericin B increases uptake of Flucytosine by fungi)
27
Q

Examples for improved Therapeutic Effects

  1. Penicillin + Aminoglycoside
  2. Doxycycline + Rifampin or Aminoglycoside
  3. Bismuth + Metronidazole + Tetracycline
  4. Ampicillin + Aminoglycoside
A
  1. Enterococcal Endocarditis and Pseudomonas Infections
  2. Brucellosis
  3. H. Pylori
  4. Listeria
28
Q

Examples for Preventing Emergence of Resistant Microorganism

  1. INH + Rifampin
  2. Gentamicin + Carbenicillin
  3. Other considerations?
A
  1. M. Tuberculosis
  2. P. Aeruginosa
  3. Decreasing toxicity, broad spectrum coverage
29
Q

Antagonism: 2 Major Mechanisms

  1. Inhibition of Bactericidal Activity by what?
  2. Induction of Enzymatic Inactivation?
A
  1. by Bacteriostatic Agents

2. Some G- Bacilli contain INDUCIBLE BETA LACTAMASES (Enterobacter, Pseudomonas, Serratia, Citrobacter)

30
Q

Misuses

  1. Trying to treat what kind of infections?
  2. Therapy of what?
  3. Improper Dosage?
  4. Improper duration
A
  1. UNTREATABLE INFECTIONS (like viral infections)
  2. Fever of UNDETERMINED ORIGIN (FUO): find underlying cause
  3. Suboptimal dose is ineffective and promotes development of resistant strains
  4. Strep infection….
31
Q

Development of Superinfections

  1. What is it?
  2. Most often seen with what Tx?
A
  1. Evidence of a NEW INFECTION during the CHEMOTHERAPY of a PRIMARY ONE
  2. Superinfections are most frequently observed w/BROAD SPECTRUM ANTIBIOTICS
32
Q

Intestinal Candidiasis

  1. Most common what?
  2. What is it?
  3. Main cause?
A
  1. superinfection
  2. Fungal Superinfection
  3. Antibiotic therapy is continued and the Fungal Superinfection is treated w/Oral Nystatin or Amphotericin B
33
Q

Staphylococcal Enterocolitis

  1. Problem with it?
  2. What do you do?
A
  1. Life-threatening

2. stop antibiotic therapy and treat Staphyloccous w/Oral VANCOMYCIN

34
Q

Pseudomembranous Colitis

  1. Problem?
  2. Caused by what?
  3. What do you do?
  4. Severe Cases: Treat Symptomatically with what?
A
  1. Life threatening (first seen after Clindamycin)
  2. Clostridium Difficile
  3. stop therapy. Treat w/oral Metronidazole or Vancomycin
  4. fluids, electrolytes and Corticosteroids
35
Q

Antibacterial Prophylaxis

  1. Used in circumstances in which efficacy has been demonstrated and …?
A
  1. Benefits outweigh the risk of prophylaxis
36
Q

Antibacterial Prophylaxis

  1. Surgical procedures: DOC?
A
  1. CEFAZOLIN

Pharm 2 Part 3: Chemotherapy and Antibiotics and Antifungals (7 decks)

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