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NMT150 - All Therapeutics > Spotlight Lectures Weeks 1-6 (Midterm) > Flashcards

Spotlight Lectures Weeks 1-6 (Midterm) Flashcards

1
Q

What are the 4 mechanisms of antibiotic resistance?

A

1) Modifications of the Antibiotic Molecule
2) Decreased Antibiotic Penetration and Efflux
3) Changes in Target Sites
4) Resistance Due to Global Cell Adaptations

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2
Q

What is the purpose of antibiotic stewardship?

A
  • measure antibiotic prescribing (who has access)
  • improve antibiotic prescribing by clinicals and use by patients (only when needed)
  • minimize misdiagnoses or delayed diagnoses
  • ensure that the right drug, dose, and duration are selected
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3
Q

Define bactericidal

A

kills sensitive organisms so that number of viable organisms fall rapidly after exposure

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4
Q

Define bacteriostatic

A

inhibits growth of bacteria but does not kill them

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5
Q

What are the 3 antimicrobial spectrums?

A

1) Narrow- spectrum: agent is active against a single species or limited group of pathogens
2) Broad-spectrum: agent is active against a wide range of pathogens
3) Extended-spectrum: agent falls in between (intermediate)

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6
Q

What are the components of a gram-positive bacterial cell wall?

A

lipoteichoic acid
peptidoglycan cell wall
plasma membrane

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7
Q

What are the components of a gram-negative bacterial cell wall?

A

outer lipid membrane
peptidoglycan
plasma membrane

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8
Q

All beta-lactam antibiotics interfere with ___

A

bacterial cell wall synthesis

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9
Q

Inhibition of bacterial transpeptidase (penicillin-binding protein) ___

A

inhibits peptidoglycan cross-linking

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10
Q

Penicillin V is a ____ antibiotic

A

narrow-spectrum

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11
Q

Penicillin V is administered in an ___

A

oral suspension

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12
Q

What are the adverse effects of penicillin V?

A

GI upset, nausea, vomiting, diarrhea, rash, hypersensitivity reactions (rare)

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13
Q

What illness is penicillin typically used for?

A

Group A streptococcal pharyngitis

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14
Q

Amoxicillin is an ____ penicillin that results in greater activity against additional ____

A

extended-spectrum
gram-negative bacteria

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15
Q

Cephalosporins are a large group of antibiotics that have greater ___

A

structural diversity

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16
Q

Cephalosporins are more resistant to ___ and increases their range of antimicrobial activity

A

beta-lactamases

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17
Q

Cefadroxil and cephalexin are first-generation ___

A

cephalosporins

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18
Q

Cefadroxil and cephalexin may be used as alternatives to ____

A

penicillin

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19
Q

What are the adverse effects of cefadroxil and cephalexin?

A

GI upset, nausea, vomiting, diarrhea, hypersensitivity (some cross-reactivity with penicillins)

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20
Q

Prokaryotic ribosomes are composed of ___ and ___ subunits

A

30S
50S

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21
Q

Macrolides inhibit ____ which functions to link amino acids together in a growing peptide chain

A

peptidyl transferase

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22
Q

Macrolides interfere with ___ and confer ___ activity

A

translocation
bacteriostatic

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23
Q

Azithromycin, Clarithromycin and Clindamycin are alternatives for those allergic to ___

A

penicillin

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24
Q

Azithromycin is less likely than other macrolide antibiotics to ___

A

interact with other drugs

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25
Q

What are the adverse effects of azithromycin?

A

GI upset, nausea, vomiting, diarrhea, rash, QTc interval prolongation

26
Q

Clarithromycin increases the ___

A

levels of some common drugs (i.e., atorvastatin, lovastatin, simvastatin, prednisone.)

27
Q

Lincosamides interfere with ___ but do not inhibit ___

A

translocation
peptidyl transferase

28
Q

Lincosamides are 4 times more likely to cause ____ compared to other antibiotics

A

Clostridium difficile infections

29
Q

Clindamycin may be used for treatment in symptomatic patients with multiple recurrent episodes of ___

A

pharyngitis

30
Q

What are the adverse effects of clindamycin?

A

diarrhea and increased risk of C. difficile colitis

31
Q

Antibiotic therapy is most beneficial for people who are at high risk of developing ____ and who have confirmed ____

A

acute rheumatic fever
streptococcal infection

32
Q

Antibiotics reduce the duration of symptoms by approximately ___

A

16 hours

33
Q

Sample Question: Which of the following antibiotic is suitable for use in a patient with an immediate hypersensitivity reaction to penicillin?
A) Amoxicillin
B) Cephalexin
C) Cefadroxil
D) Azithromycin

A

D) Azithromycin

34
Q

Upper respiratory tract infection (URTI) involves an infection of what structures?

A

nose, sinuses, pharynx, larynx and large airways

35
Q

What are the viral causes of URTIs?

A

rhinovirus, adenovirus, parainfluenza virus, enterovirus, respiratory syncytial virus (RSV)

36
Q

True or false: The diagnosis of URTIs is typically a clinical diagnosis, but nasal and nasopharyngeal swabs/aspirates can be used

A

true

37
Q

What are the complications associated with URTIs?

A

pneumonia, sinusitis, otitis media, coinfection with bacterial agents, and exacerbation of preexisting medical conditions (asthma and COPD)

38
Q

What are the characteristics of the common cold?

A
  • mild and self-limited
  • nasal mucosal erythema and edema
  • rhinorrhea and nasal congestion
  • sore throat, cough, sneezing
  • headache and low-grade fever
  • onset of symptoms bein 1-3 days after exposure and can last 7-10 days or persist up to 3 weeks
39
Q

What are the 4 botanical treatment strategies?

A

1) enhance immune system’s first line and second lines of defense
2) choose herbs with tissue and microbial specificity
3) relieve common symptoms (i.e., sore throat, congestion, rhinorrhea)
4) prevent recurrence

40
Q

Review the herbal actions and know their function:

A
  • antivirals/antimicrobials
  • immune stimulants
  • deep immune tonics
  • adaptogens
  • anti-catarrhals/mucolytics
  • expectorants
  • diaphoretics
  • demulcents
  • lymphatics
  • anti-inflammatories
41
Q

Antimicrobials and immune stimulant herbs can have a ___ effect by attacking the microorganism and/or destroying its cell wall, inhibiting replication, or inhibiting enzymes in the pathogenesis of infection OR an ____ action by preventing viral entry into the cell or stimulating phagocytes, lymphocytes or other immune cells to attach the pathogen

A

direct
indirect

42
Q

Many herbal antimicrobials display _____

A

tissue specificity

43
Q

What are the considerations for choosing the right antimicrobial herbs?

A
  1. where is the site of infection - choose herbs with tissue specificity
  2. age of the patient and general health status - choose gentle herbs at lower dosing for children, elderly and those with chronic disease
  3. specific pathogen - use herbs that target the pathogen causing harm
  4. history of antibiotic use - some herbs require a healthy gut flora to activate bioavailable metabolites of herbs
44
Q

Review the material medica for common cold:

A

Achillea millefolium
Allium sativum
Althea officinalis
Andrographis paniculata
Baptisia tinctoria
Echinacea angustifolia /
purpurea
Eleutherococcus senticosus
Eupatorium perfoliatum
Glycyrrhiza glabra
Hydrastis canadensis
Ligusticum porteri
Lomatium dissectum
Mentha piperita
Oleo europaea
Origanum vulgare
Panax ginseng
Phytolacca spp
Sambucus nigra
Salix alba
Thymus vulgaris
Verbascum Thapsus
Zingiber officinalis, etc

45
Q

What are the main actions and constituents of baptisia tinctoria (wild indigo)?

A

actions: lymphatic, anti-microbial, immune-stimulant, anti-catarrhal
constituents: polysaccharides (arabinogalactans)
& glycoproteins, quinolizidine alkaloids, isoflavones,
flavonoids
- part used: root

46
Q

Glycoproteins and polysaccharides stimulate the immune
system by increasing the number of ___ and improving
endogenous defense mechanisms

A

WBCs

47
Q

Baptisia tinctoria (wild indigo) stimulates lymphocyte DNA synthesis and ____ production

A

antibody

48
Q

When is Baptisia tinctoria (wild indigo) indicated?

A

In acute infection with excessive mucus production
associated with laryngitis, pharyngitis, tonsilitis, rhinitis and
sinusitis

49
Q

What are the main actions and constituents of echinacea angustifolia/purpurea (echinacea/coneflower)?

A

actions: anti-microbial, immunomodulator, immune-stimulant, anti-inflammatory, diaphoretic, lymphatic,
vulnerary, anti-catarrhal
constituents: Caffeic acid esters (echinacosides),
polysaccharides (arabinogalactans), alkylamides, VO, alkaloids

49
Q

How can Baptisia tinctoria (wild indigo) be used, and what are the safety concerns?

A
  • decoction, tincture or dried herb
  • can cause nausea, vomiting, anorexia, hypersalivation, tachypnea, tachycardia, respiratory paralysis with toxic doses internally
  • Contraindicated in long-term use or high doses, and pregnancy/lactation
50
Q

Polysaccharides, alkylamides and caffeic acid derivatives
activate immune response via:

A

enhanced granulocyte
chemotaxis, macrophage phagocytosis, and increased
levels of TNF, IL-1, Ig binding, and neutrophils

51
Q

_____ stabilize mucosal connective tissue
against pathogen invasion and repair tissue damage via
inhibition of hyaluronidase

A

Caffeic acid esters

52
Q

True or false: When used preventatively, echinacea shows a 10-20%
relative risk reduction for common cold and is best used in high doses at early stages of infection

A

True

53
Q

How can echinacea angustifolia/purpurea (echinacea/coneflower) be used, and what are the safety concerns?

A
  • decoction, tincture, powdered extract
  • high doses may cause nausea, throat irritation and skin irritation
  • Caution in Asteraceae allergy
  • Selectively modulates CYP 3A4 substrates - potential for interactions
54
Q

What are the main actions and constituents of zingiber officinale (ginger)?

A

Actions: Anti-oxidant, anti-inflammatory, anti-microbial, diaphoretic, carminative, anti-spasmodic
Main Constituents: VO (zingiberene), sesquiterpenes,
oleoresins (gingerols & shogaols)

55
Q

Fresh ginger may stimulate mucosal cells to secrete
____ to counter viral infection

A

IFN-β

56
Q

True or false: Sesquiterpenes in ginger have specific anti-viral
effects against rhinoviruses and RSV by inhibiting viral
attachment and inoculation

A

True

57
Q

True or false: Oleo-resins (gingerols & shogaols) help reduce pain,
suppress coughing and modulate fever

A

True

58
Q

How can zingiber officinale (ginger) be used, and what are the safety concerns?

A
  • infusion, tincture, dry or fresh herb
  • caution with ulcers, GERD, gallstones, kidney disease, bleeding disorders, and those with sensitive stomachs, additive effect with anticoagulant medication
59
Q

What are some other herbal considerations for treating common cold?

A
  • herbal lozenges or infusions for symptom relief of sore throat using demulcent herbs
  • steam inhalations and/or essential oils to relieve cough and congestion
  • rest, hydration & nutrition
  • food as medicine (adding onion, garlic, thyme, oregano, sage etc. to soups or stews)
60
Q

What are the long-term considerations of adaptogen and deep immune tonics?

A
  • support HPA axis and strengthen immune system to prevent recurrence and recover from convalescence

NMT150 - All Therapeutics (6 decks)

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