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Pharmacology > Therapeutic Interventions for Bacterial Infections > Flashcards

Therapeutic Interventions for Bacterial Infections Flashcards

1
Q

Structure of bacterial cell walls

A
  • peptidoglycan molecules in their cell walls that protect them from the environment
  • peptidoglycan molecules form a set of chains called penicillin-binding proteins because penicillins and related antibiotics bind to them
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2
Q

Penicillins

A
  • beta-lactam ring structure of penicillin binds PBPs causing lysis of growing bacteria by damaging cell walls
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3
Q

Resistance to penicillin

A
  • mutate so they lack the PBPs that are the target of penicillins
  • secrete an enzyme (penicillinase or beta-lactamase) that splits penicillin;s beta-lactam ring, often in response to penicillin
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4
Q

Penicillin Generalization

A
  • mainly active against gram-positive bacteria
  • most have narrow spectrum of antimicrobial activity
  • widely distributed to tissues
  • nearly all are rapidly excreted by kidneys
  • short half-lives so it has to be given more often
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5
Q

Prototype Drug: Penicillin G Potassium

  1. therapeutic effects and uses
  2. mechanism of action
  3. Adverse effects
A
  1. mostly gram-positive bacteria/ bacterial endocarditis and prosthetic heart valves, rheumatic fever, congenital heart disease
    2/ inhibits bacteral cell wall synthesis by binding to PBPs
  2. urticaria/allergies/anaphylaxis
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6
Q

Cephalosporins - 20 types in 5 generations

A
  • first - gram positive and some gram negative
  • second - broader spectrum than first
  • third - broader spectrum than second and longer duration of action
  • fourth - effective against bacteria that are resistant to earlier generations
  • fifth - extended gram-positive effectiveness, including MRSA infections
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7
Q

Cephalosporins Generalizations

A
  • generally safe
  • most common side effects (allergy/rash/GI complaints)
  • elimination in kidneys
  • use with caution in nursing mothers and patients with renal impairment
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8
Q

Cephalosporin prototype Drug: Cefotaxime

  1. therapeutic effects and uses
  2. mechanism of action
  3. adverse effects
A

1 . third generation cephalosporin with broad spectrum activity against both gram + and gram - / infections of the respiratory tract, urinary tract, genital infections, septicemia, meningitis, endocarditis, bone and joint infections
/infection prophylaxis in surgical patients
2. inhibits bacterial wall synthesis by binding to specific PBPs
3. rash, diarrhea, allergic response, potential superinfection, pain, phlebitis and IM injection sites, anaphylaxis, seizures

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9
Q

Carbapenems

A

broad-spectrum antibiotics with similar properties to other beta-lactams

  • provide better activity against serious gram - and multidrug resistant infections than most cephalosporins or penicillins
  • low incidence of adverse effects
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10
Q

Tetracyclines

A
  • active against both gram negative and gram positive bacterial.
  • drug of choice for typhus, cholera, rocky mountain spotted fever, lyme disease, H. pylori, ulcers and chlamydia
  • bacteriostatic - prevents formation of proteins from amino acids. prevents making of bacterial cell wall.
  • wide spread resistant to tetracycline has developed.
  • take on empty stomach
  • incompletely absorbed in intestine, thus can alter flora, causes super-infection
  • if given parenterally, can be hepatotoxic and cause photosensitivity
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11
Q

Prototype Drug Tetracycline

  1. therapeutic effects and uses
  2. mechanism of action
  3. Adverse effects
  4. Serious Adverse effects
A
  1. susceptible gram + and gram - bacterial including: chlamydia, rickettsia, mycoplasmas, certain protozoa, H. pylori
  2. inhibits bacterial protein synthesis. Terminates the growing amino acid chain prematurely
  3. super infections/nausea vomiting epigastric burning diarrhea/discoloration of teeth/photosensitivity/
  4. hepatotoxicity/anaphylaxis/exfoliative dermatitis
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12
Q

Macrolides

A
  • most effective against gram-positive
  • alternative drugs for patients allergic to penicillin
  • generally well tolerated and safe
  • decreased hepatic metabolism of other drugs thus drug interactions are possible
  • bacteriostatic in low doses, can be bactericidal in high doses
  • suffix - thromycin
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13
Q

Macrolide prototype drug: Erythromycin

  1. therapeutic effect
  2. mechanism of action
  3. adverse effects
  4. serious adverse effects
A
  1. prophylaxis and treatment of susceptible bacterial infections including legionella, chlamydia, listeria, campylobacter, as well as upper and lower respiratory tract infections and skin infections
  2. inhibits protein synthesis/kills of bacteria/considered bacteriostatic, but may be bactericidal in high doses
  3. N&V/abdominal cramping/phlebitis
  4. Cholestatic hepatitis/ototoxicity (hearing loss, vertigo, dizziness)/cardiotoxicity - palpitations, chest pain, arrhythmias
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14
Q

Aminoglycosides

A
  • effective against aerobic gram-negative bacteria including pseudomonas, enterobacteriaceae family, also used for TB
  • prevention of protein synthesis
  • bacteriostatic
  • reserved for serious systemic infections, must be given parenterally
  • associated with post-anitbiotic effect (activity of drug continues even as serum levels drop)
  • may serious adverse effects including nephrotoxicity, ototoxicity, and neuromuscular blockade, thus these drugs are only used when other drugs are not effective
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15
Q

Aminoglycosides: Prototype Drug - Gentamicin

  1. therapeutic effects and uses
  2. Mechanism of action
  3. adverse effects
  4. serious adverse effects
A
  1. serious infections caused by aerobic, gram-negative bacilli/a few gram-positive bacteria, including some strains of MRSA
  2. inhibits protein synthesis
  3. N&V/rash and fatigue
  4. ototoxicity/nephrotoxicity/neurmuscular blockage/neurotoxicity
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16
Q

Fluoroquinolones

A
  • prevent DNA replication
  • four generations with activity on all gram-negative bacteria, with some activity on gram-positive bacteria
  • commonly used for urinary tract infections, GI, respiratory and skin infections
  • common suffix - floxacin
17
Q

Fluoroquinolones prototype drug: Ciprofloxacin

  1. therapeutic effects and uses
  2. mechanism of action
  3. Adverse effects
  4. serious adverse effects
A
  1. UTI/sinusitis/pneumonia/infectious diarrhea/certain eye infections/skin, bone and join infections
  2. prevents DNA replication
  3. N&V/diarrhea/phototoxicity/headache/tendonitis/dizziness
  4. pseudomembranous colitis/seizures/toxic psychosis
18
Q

sulfonamides

A
  • active against broad spectrum of microorganisms, classified based on absorption and excretion qualities
  • suppress DNA replication by inhibiting synthesis of folic acid is necessary for thymine metabolism
  • adverse effects include hypersensitivity reactions, blood abnormalities, nausea, vomiting, anorexia
  • some strains are resistant to sulfonamides
19
Q

Sulfonamides prototype drug - Trimethoprim-Sulfamethoxazole

  1. therapeutic effects and uses
  2. mechanism of action
  3. adverse effects
  4. serious adverse effects
A
  1. UTI prophylaxis and UTI/prophylaxis and treatment of p. carinii and shigella/acute episodes during chronic bronchitis
  2. inhibits DNA replication
  3. N&V/skin rash/pruritis/fever/photosensitivity
  4. anaphylaxis, allergic myocarditis, stevens-johnson syndrom epidermal necrolysis, agranulocytosis, aplastic anemia
20
Q

Vancomycin

  1. therapeutic effects and uses
  2. mechanism of action
  3. Adverse effects
  4. serious adverse effects
A
  1. severe gram-positive infections resistant to safer antibiotics/off-label uses for meningitis and antibiotic-induced pseudomembranous colitits
  2. inhibits synthesis of bacterial cell wall/increases permeability of bacterial cell membrane/alters RNA synthesis
  3. red man syndrom - red rash/ nausea, rash, fever, chills
  4. confusion/seizures/hallucinations/extravasation leading to tissue necrosis/ototoxicity/nephrotoxicity/anaphylaxis
21
Q

Common UTIs

A
  • urethritis, cystitis, prostatitis in males, pyelonephritis
22
Q

Common therapies for UTI

A

Sulfonamides
Fluroroquinolones
(drugs specific for UTIs are given b oral route and only reach effective concentrations in the kidneys)

23
Q

Prototype drug for UTI; Nitrofurantion

  1. therapeutic effects and uses
  2. mechanism of action
  3. side effects
  4. serious side effects
A
  1. Macrobid/macrodantin. uncomplicated acute cystitis, usually for prophylaxis of recurrent UTI.
  2. prevents protein synthesis, also inhibits cell wall synthesis
  3. hypersensitivity responses, nausea and vomiting, anorexia, headache, rash
  4. hepatotoxicity/acute and chronic pulmonary toxicity
24
Q

Tuberculosis

A

caused by mycobacterium tuberculosis, spread via airborne droplets, immune system response leads to formation of tubercles in lungs that surround mycobacteria

  • in healthy person - remain dormant and asymptomatic
  • if immunocompromised, infection becomes active
25
Q

Two major goals of pharmacological therapy of TB

A
  • eliminate all tubercle mycobacteria

- avoid emergence of resistant strains

26
Q

three differences of TB drug therapy compared to most bacterial infections

A
  1. therapy my last 6 to 12 months to allow agent to penetrate tubercles.
  2. multiple antibiotics are used to avoid resistance
  3. development of chemoprophylaxis is used to protect those at risk of infection
27
Q

Two phases of pharmacotherapy for Tb

A

initial phase - active cells are killed

continual phase - dormant mycobacteria are killed

28
Q

DOT

A

directly observed therapy

  • nurse must see patient swallow pill
  • necessary for high-risk patients that are non-compliant
29
Q

Prototype Drug for TB: Isoniazid

  1. therapeutic effects
  2. mechanism of action
  3. adverse effects
  4. serious adverse effects
A
  1. M. tuberculosis prophylaxis and treatment
  2. inhibits the synthesis of mycolic acid, a critical component of mycobacterial cell wall/bacteriocidal for rapidly dividing organisms/bacteriostatic for dormant mycobacteria
  3. rash/fever/numbness of hands and feet
  4. neurotoxicity(r/t decrease in vit B) /hepatotoxicity/blood dyscrasias

Pharmacology (14 decks)

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