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SA Clinical Pharmacology & Therapeutics > S9) Antimicrobial Agents > Flashcards

S9) Antimicrobial Agents Flashcards

1
Q

What is an antibacterial drug?

A

An antibacterial drug is a chemical substance that kills or inhibits the growth of bacteria at a discrete target site

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2
Q

What is an antibiotic?

A

An antibiotic is an antibacterial drug of microbial origin e.g. penicillin from Penicillium mold

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3
Q

What is the unique property of antimicrobials?

A

Antimicrobials target microbial biochemistry

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4
Q

Identify some antibiotics which target DNA synthesis

A
  • Quinolones e.g. ciprofloxacin
  • Folic acid antagonists e.g. trimethoprim sulphonamides
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5
Q

Identify some antibiotics which target protein synthesis

A
  • Aminoglycosides e.g. gentamicin
  • Macrolides e.g. erythromicin
  • Tetracyclines
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6
Q

Identify some antibiotics which target cell wall synthesis

A
  • Beta-lactams e.g. penicillins, cephalosporins, carbapenems
  • Glycopeptides e.g. vancomycin
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7
Q

What are the two reasons for antibiotics?

A
  • Prevention of infections
  • Therapy of significant bacterial infections
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8
Q

Identify some groups of people at increased risk of infection

A
  • Peri-operative – prevention of surgical site infections
  • Short term – meningitis contacts
  • Long term – asplenia, immunodeficiency
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9
Q

What are clinically significant infections?

A

Clinically significant infections are infections that if left untreated will cause death, permanent harm or medium to long term disability

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10
Q

What are the two ways in which one can treat a clinically significant infection?

A
  • Treatment of culture-proven infection
  • Empirical treatment of suspected infection
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11
Q

What are the two different ways that one might use antibiotics empirically?

A
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12
Q

Which factors helps one determine the likely cause of an infection?

A
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13
Q

Which factors helps one determine which antibiotics are likely to be effective?

A
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14
Q

Which factors helps one determine which antibiotic is the best choice?

A
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15
Q

What are the adverse events of antibiotics?

A
  • Toxicities
  • Allergic reactions
  • Idiosyncratic reactions
  • Ecological effects – C.difficile, selection of resistance
  • Drug interactions
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16
Q

What would ideal antibiotic therapy look like?

A
  • Clean kill of infecting bacteria – minimal impact on commensal organisms, no resistance in any surviving pathogens
  • No unwanted effects in patient e.g. drug interactions, toxicities
17
Q

Illustrate how one measures the susceptibility of bacteria to antibacterials

A
18
Q

What is the minimum inhibitory concentration?

A

MIC is the minimum concentration of antibiotic required to inhibit growth of a bacterium in vitro (mg/l)

19
Q

Therapeutic drug monitoring is used to ensure a non-toxic adequate dose for some antibiotics.

Identify these

A
  • Aminoglycosides
  • Glycopeptides
20
Q

Describe the mechanism of antibiotic resistance through the following pathways:

  • Antibiotic inactivation
  • Alteration of target site
  • Alteration of metabolic pathways
  • Reduced intracellular antibiotic accumulation
A
21
Q

What does it mean when a pathogen is multi-drug resistant?

A

Multi-drug resistant – non-susceptibility to at least one agent in three or more antimicrobial categories

22
Q

What does it mean when a pathogen is extensively drug resistant?

A

Extensively drug resistant – on-susceptibility to at least one agent in all but two or fewer antimicrobial categories

23
Q

What does it mean when a pathogen is pan drug resistant?

A

Pan drug resistant – non-susceptibility to all agents in al antimicrobial categories

24
Q

Identify the two ways in which bacteria can become resistant to carbapenem

A
  • Reduced bacterial intracellular concentration
  • Carbapenemase production
25
Q

MOA of amoxicillin

A
  1. binds to transpeptidase active site
  2. blocks transpeptidase activity
  3. interupts bacterial cross linking and cell walls synthesis
26
Q

why is Clauvulanic acid prescribed with amoxicillin (Co-amoxicalv)

A

It is a beta-lactamase inhibitor, amoxicillin is a beta lactam.

Clauvulanic will prevent the break down of the amoxicillin cell wall and help protect it

27
Q

CURB-65 score

A
28
Q

treatment options for CURB score between 1-2 and can take enteral medication

A

amoxicillin 500mg

then 2nd line, doxycycline

the 3rd line, clarithromycin

29
Q

treatment for CURB score 2 but can’t take enteral meds

A

amoxicillin

then clarithromycin

then levofloxacin

30
Q

treatment for CURB 3-5

A

co amoxiclav

then levofloxacin

31
Q

CYP vs statins

A

CYPs are responsible for metabolising statins, some macrolides inhibit CYPs which means the metabolism of statins is reduced

this means there are higher levels of statins in the body

32
Q

why is drug monitoring important

A
  1. therapeutic drug monitoring: measuring the drug levels in a patient’s blood to ensure that the drug is at an effective level
  2. detect drug toxicity; adjust dose
  3. Drug interactions
  4. Non-compliance: patients don’t follow drug routine so ineffective treatment or drug toxicity
33
Q

What is the mechanism of action of aciclovir?

A

→ inhibits DNA synthesis

  1. when it enters the cell it is converted into an active form (acyclovir monophosphate) by thymidine kinase
  2. then it is converted into acyclovir triphosphate, a potent inhibitor of viral DNA polymerase
  3. This results in premature chain termination and the inhibition of further viral DNA synthesis
34
Q

when can the treatment of herpes with acyclovir be used

A

initial infection: first episode of painful blisters

recurrent infection: will see milder symptoms

supression:used to suppress In people with regular outbreaks

herpes labialis: cold sores caused by HSV-1 around lips

35
Q

what are the main interventions for antimicrobial stewardship

A
  1. antibiotic prescribing guidelines
  2. antimicrobial restriction policies
  3. education and training
  4. antimicrobial susceptibility testing: seeing which antibiotic is most appropriate
    5.
36
Q

which antibiotic is strongly associated with causing C.Diff infections

A

clindamycin

37
Q

what are some side effects of docycline

A

can cause photosensitivity and is teretogenic

38
Q

side effects of vancomycin

A

can cause redman syndrome pruritus, an erythematous rash that involves the face, neck, and upper torso

SA Clinical Pharmacology & Therapeutics (36 decks)

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