Spotlight Lectures Weeks 1-6 (Midterm) Flashcards
What are the 4 mechanisms of antibiotic resistance?
1) Modifications of the Antibiotic Molecule
2) Decreased Antibiotic Penetration and Efflux
3) Changes in Target Sites
4) Resistance Due to Global Cell Adaptations
What is the purpose of antibiotic stewardship?
- 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
Define bactericidal
kills sensitive organisms so that number of viable organisms fall rapidly after exposure
Define bacteriostatic
inhibits growth of bacteria but does not kill them
What are the 3 antimicrobial spectrums?
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)
What are the components of a gram-positive bacterial cell wall?
lipoteichoic acid
peptidoglycan cell wall
plasma membrane
What are the components of a gram-negative bacterial cell wall?
outer lipid membrane
peptidoglycan
plasma membrane
All beta-lactam antibiotics interfere with ___
bacterial cell wall synthesis
Inhibition of bacterial transpeptidase (penicillin-binding protein) ___
inhibits peptidoglycan cross-linking
Penicillin V is a ____ antibiotic
narrow-spectrum
Penicillin V is administered in an ___
oral suspension
What are the adverse effects of penicillin V?
GI upset, nausea, vomiting, diarrhea, rash, hypersensitivity reactions (rare)
What illness is penicillin typically used for?
Group A streptococcal pharyngitis
Amoxicillin is an ____ penicillin that results in greater activity against additional ____
extended-spectrum
gram-negative bacteria
Cephalosporins are a large group of antibiotics that have greater ___
structural diversity
Cephalosporins are more resistant to ___ and increases their range of antimicrobial activity
beta-lactamases
Cefadroxil and cephalexin are first-generation ___
cephalosporins
Cefadroxil and cephalexin may be used as alternatives to ____
penicillin
What are the adverse effects of cefadroxil and cephalexin?
GI upset, nausea, vomiting, diarrhea, hypersensitivity (some cross-reactivity with penicillins)
Prokaryotic ribosomes are composed of ___ and ___ subunits
30S
50S
Macrolides inhibit ____ which functions to link amino acids together in a growing peptide chain
peptidyl transferase
Macrolides interfere with ___ and confer ___ activity
translocation
bacteriostatic
Azithromycin, Clarithromycin and Clindamycin are alternatives for those allergic to ___
penicillin
Azithromycin is less likely than other macrolide antibiotics to ___
interact with other drugs
What are the adverse effects of azithromycin?
GI upset, nausea, vomiting, diarrhea, rash, QTc interval prolongation
Clarithromycin increases the ___
levels of some common drugs (i.e., atorvastatin, lovastatin, simvastatin, prednisone.)
Lincosamides interfere with ___ but do not inhibit ___
translocation
peptidyl transferase
Lincosamides are 4 times more likely to cause ____ compared to other antibiotics
Clostridium difficile infections
Clindamycin may be used for treatment in symptomatic patients with multiple recurrent episodes of ___
pharyngitis
What are the adverse effects of clindamycin?
diarrhea and increased risk of C. difficile colitis
Antibiotic therapy is most beneficial for people who are at high risk of developing ____ and who have confirmed ____
acute rheumatic fever
streptococcal infection
Antibiotics reduce the duration of symptoms by approximately ___
16 hours
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
D) Azithromycin
Upper respiratory tract infection (URTI) involves an infection of what structures?
nose, sinuses, pharynx, larynx and large airways
What are the viral causes of URTIs?
rhinovirus, adenovirus, parainfluenza virus, enterovirus, respiratory syncytial virus (RSV)
True or false: The diagnosis of URTIs is typically a clinical diagnosis, but nasal and nasopharyngeal swabs/aspirates can be used
true
What are the complications associated with URTIs?
pneumonia, sinusitis, otitis media, coinfection with bacterial agents, and exacerbation of preexisting medical conditions (asthma and COPD)
What are the characteristics of the common cold?
- 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
What are the 4 botanical treatment strategies?
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
Review the herbal actions and know their function:
- antivirals/antimicrobials
- immune stimulants
- deep immune tonics
- adaptogens
- anti-catarrhals/mucolytics
- expectorants
- diaphoretics
- demulcents
- lymphatics
- anti-inflammatories
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
direct
indirect
Many herbal antimicrobials display _____
tissue specificity
What are the considerations for choosing the right antimicrobial herbs?
- where is the site of infection - choose herbs with tissue specificity
- age of the patient and general health status - choose gentle herbs at lower dosing for children, elderly and those with chronic disease
- specific pathogen - use herbs that target the pathogen causing harm
- history of antibiotic use - some herbs require a healthy gut flora to activate bioavailable metabolites of herbs
Review the material medica for common cold:
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
What are the main actions and constituents of baptisia tinctoria (wild indigo)?
actions: lymphatic, anti-microbial, immune-stimulant, anti-catarrhal
constituents: polysaccharides (arabinogalactans)
& glycoproteins, quinolizidine alkaloids, isoflavones,
flavonoids
- part used: root
Glycoproteins and polysaccharides stimulate the immune
system by increasing the number of ___ and improving
endogenous defense mechanisms
WBCs
Baptisia tinctoria (wild indigo) stimulates lymphocyte DNA synthesis and ____ production
antibody
When is Baptisia tinctoria (wild indigo) indicated?
In acute infection with excessive mucus production
associated with laryngitis, pharyngitis, tonsilitis, rhinitis and
sinusitis
What are the main actions and constituents of echinacea angustifolia/purpurea (echinacea/coneflower)?
actions: anti-microbial, immunomodulator, immune-stimulant, anti-inflammatory, diaphoretic, lymphatic,
vulnerary, anti-catarrhal
constituents: Caffeic acid esters (echinacosides),
polysaccharides (arabinogalactans), alkylamides, VO, alkaloids
How can Baptisia tinctoria (wild indigo) be used, and what are the safety concerns?
- 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
Polysaccharides, alkylamides and caffeic acid derivatives
activate immune response via:
enhanced granulocyte
chemotaxis, macrophage phagocytosis, and increased
levels of TNF, IL-1, Ig binding, and neutrophils
_____ stabilize mucosal connective tissue
against pathogen invasion and repair tissue damage via
inhibition of hyaluronidase
Caffeic acid esters
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
True
How can echinacea angustifolia/purpurea (echinacea/coneflower) be used, and what are the safety concerns?
- 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
What are the main actions and constituents of zingiber officinale (ginger)?
Actions: Anti-oxidant, anti-inflammatory, anti-microbial, diaphoretic, carminative, anti-spasmodic
Main Constituents: VO (zingiberene), sesquiterpenes,
oleoresins (gingerols & shogaols)
Fresh ginger may stimulate mucosal cells to secrete
____ to counter viral infection
IFN-β
True or false: Sesquiterpenes in ginger have specific anti-viral
effects against rhinoviruses and RSV by inhibiting viral
attachment and inoculation
True
True or false: Oleo-resins (gingerols & shogaols) help reduce pain,
suppress coughing and modulate fever
True
How can zingiber officinale (ginger) be used, and what are the safety concerns?
- 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
What are some other herbal considerations for treating common cold?
- 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)
What are the long-term considerations of adaptogen and deep immune tonics?
- support HPA axis and strengthen immune system to prevent recurrence and recover from convalescence
