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Semester 3 - Infection > Session 10 - Antimicrobials > Flashcards

Session 10 - Antimicrobials Flashcards

1
Q

Give four types of antimicrobial

A
  • Antibacterial
    • Antifungal
    • Antiviral
    • Anti protozoal
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2
Q

Give three ways in which antibacterial agents can be classified

A
  • Bacteriacidal or bacteriostatic
    • Target site (mechanism of action)
    • Chemical structure (antibacterial class)
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3
Q

Give four targets of antibacterials and their mechanism of action

A
  • Cell wall synthesis
    • Cell membrane function
    • Protein synthesis
    • Nucleic acid synthesis
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4
Q

Give two antibacterial which effects cell wall synthesis

A
  • Beta-lactams (penicillin derivatives)

* Glycopeptides

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5
Q

Give an antibacterial which effects cell membrane function

A

• Polymixins

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6
Q

Give an antibacterial (three) which effect protein synthesis

A
  • Tetracycline - 30s Ribosomes
    • Aminoglycosides (gentomycine) - 30s ribosome
    • Macrolides - 50s ribosome
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7
Q

Give an antibacterial which effects nucleic acid synthesis

A

• Quinolones
○ Trimethoprim

Rifampicin

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8
Q

What is the aim of antibiotics?

A

• Effective prevention and treatment of infections whilst minimising
○ Resistance
○ Unwanted effects

Avoidable costs

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9
Q

Give fiveunwanted side effects of antibiotic use

A
  • GI upsets (nausea, vomiting, diarrhoea)
    • Allergies (skin rashes)
    • Haematological disturbances
    • Organ toxicity (liver, ear, kidney)
    • Super infections (C. Difficile, MRSA, fungal)
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10
Q

What are three areas of antimicrobial usage?

A 
• Intrinsic empiric therapy (best guess)
	• Specific or definitive treatment
		○ Wherever possible narrow spectrum
	• Prophylaxis
		○ Surgical and medical examples
		○ "Dirty" GI surgery
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11
Q

What three factors must be taken into account when selecting antibiotics when you don’t have a lab?

A
  • Clinical diagnosis
    • Probable pathogens
    • Predicted sensitivities (best guess)
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12
Q

What three factors can be used to help decide antibiotic treatment when lab available?

A
  • Specimens
    • Pathogens

Sensitivity testing

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13
Q

Give 5 factors which you need to take into account when choosing antibiotics

A
  • Spectrum of activity
    • Site of infection
    • Patient factors
    • Guidance
    • Hospital/primary care guidance
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14
Q

What is spectrum of activity?

A

• Whether antibiotic works on gram pos/neg bacilli, anaerobes

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15
Q

Give four patient factors which determine choice of antibiotic

A
  • Age, organ function, pregnancy, allergies
    • Severity of infection
    • Route of administration oral/IV (rectal, topical)
    • Interactions with other drugs
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16
Q

What guidance is given to aid choice of antibiotic in a PCT?

A
  • National/local
    • Based on epidemiology and resistance patterns
    • Epidemiology of healthcare-associated pathogens

Costs

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17
Q

What written guidance is available to guide antibiotic choice?

A
  • UHL antimicrobial website

* BNF

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18
Q

Give two indications for combined therapy antibiotics

A
  • Pathogen unknown

* Multiple pathogens possible

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19
Q

What are the two positives of using combined therapy?

A

• Prevent emergence of resistance
• Enhanced activity - addition or synergy
○ Infective endocarditis (tricky to treat due to poor blood supply to heart valve)

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20
Q

Give four types of beta-lactams

A
  • Penicillins
    • Cephalosporins
    • Carbapenems
    • Monobactams
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21
Q

Give three types of penicillins

A
  • Penicillin
    • Amoxicillin
    • Flucloxacillin
    • B lactamase inhibitor combinations
22
Q

What is penicillin active against?

A

• Mainly active against streptococci

23
Q

What is amoxicillin mainly active against?

A

• Active against gram -‘ves and streptococci

24
Q

What is fulcloxacillin active against?

A

• Staphylococci and streptococci

25
Give two b lactamase inhibitor combinations
* Co-amoxiclave | * Piperacillin/tazobactam
26
What does amoxiclav do?
* Active against streptococci * Lots of Gram -'ve * Staphylococci * Anaerobes
27
What is piperacillin used for?
* Active against streptococci * Lots of Gram -'ve * Staphylococci * Pseudomonas
28
Give a good cephalosporin
Cetriaxone
29
What is a cephalosporin used for?
* Gram -'ve * Broad spectrum * NO anaerobic activity
30
Why is cetriaxone (a cephalosporin) used for meningitis?
• Good activity in the CSF
31
Give a type of carbapenem
Meropenem
32
What is meropenem used for?
* Very broad spectrum * Active against most gram negs * Generally safe in penicillin allergy
33
Name a glycopeptide antibiotic
* Vancomycin | * Teicoplanin
34
What is vancomycin?
* Active against most gram pos * Some enterococci resistance * Resistance in staphs rare * Not absorbed (oral for c fii only * Therapeutic monitoring
35
Give two types of tetracycline
• Tetralcycline and doxycycline
36
What do tetracylcine and doxycylcine do?
* Similar spectrum * Broad spectrum, but specific use in penicillin aleergy useually for gram pos * Active in atypical pathogens in pneumonia * Used for Chlamydia * Must not be used for children
37
Give a type of aminoglycosides
Gentamicin
38
What can gentamicin (an aminoglycoside) be used for?
* Profound activity against Gram negs * Good activity in the blood/urine * Potentially nephrotoxic/ototoxic * Therapeutic drug monitoring (TDM) * required * Generally reserved for severe Gram neg * sepsis
39
Name a macrolide
Erythromycin
40
What does erythromycin (a macrolide) do?
* Well distributed including intracellular penetration * Alternative to penicillin for mild gram positive infections * Also active against atypical respiratory pathogens
41
Give an example of a quinolone
Ciprofloxacin
42
What does ciprofloxacin do? (quinolone)
* Inhibit DNA gyrase * Very active against gram negs * Also active against atypical pathogens * Increasing resistance and risk of CDI
43
What does trimethoprim and suphonamides do?
* Inhibitors of folic acid synthesis | * Trimethoprim used for UTI
44
What is co-trimoxazole?
* Combination of trimethoprim and sulphamethoxazole * Used to treat PCP * Has activity against MRSA
45
Name two types of antifungals
• Azoles • Polyenes ○ Nystatin and amphotericin
46
What do azoles do?
* Active against yeasts and molds | * Inhibit cell-membrane synthesis
47
Name two polyenes (antifungals)
* Nystatins | * Amphotericin
48
What do polyenes do?
• Inhibit cell membrane functiom
49
Name two antivirals
* Aciclovir | * Tamiflu
50
What does aciclover do?
* When phosphorylated inhibits viral DNA polymerase * Herpes simplex - Genital herpes, encephalitis * Varicella zost - Chicken pox & Shingles
51
What does tamiflu do?
* Inhibits viral neuraminidase | * Influenza A & B
52
Name an antibiotic effective against anaerobic bacteria and protozoa
Metronidazole

Semester 3 - Infection (14 decks)

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