1. What is the therapeutic goal of antimicrobials?
    Clear tissue of infecting organism
  2. What are the 6 actions that are used to classify antibiotics?
    • 1. inhibits bacterial cell wall synthesis
    • 2. inhibits protein synthesis
    • 3. inhibits nucleic acid synthesis
    • 4. interrupts metabolic pathways
    • 5. disrupts cell membrane permeability
    • 6. inhibits enzyme important in microbe’s function
  3. What is the difference b/w bacteriocidal and bacteriostatic?
    • Bacteriocidal kills bacteria
    • Bacteriostatic inhibits reproduction so host can kill
  4. What is antimicrobial resistance?
    Microorganism no longer affected by a particular antimicrobial that was once effective
  5. What mechanisms cause antimicrobial resistance?
    • Production of drug-inactivating enzyme
    • Change in receptor structure
    • Change in structural features of microbe that affects permeability
    • Development of alternate metabolic pathways
  6. What 2 ways can antimicrobial resistance be conferred on a particular bacterium?
    • Spontaneous mutation
    • Conjugation
  7. What are 3 factors that promote antimicrobial resistance?
    • Administration of antimicrobial when not needed
    • Lack of/improper adherence to regiment
    • Dosing that does not maintain adequate drug levels
  8. What are 5 common resistant microbes?
    • MRSA
    • Penicillin-resistant S. pneumoniae
    • VRE
    • Multi-drug resistant TB
    • HIB
  9. What are 6 principles of antimicrobial selection and administration?
    • 1. Match drug with bug
    • 2. Consider Drug Spectrum
    • 3. Consider combo therapy
    • 4. Consider site of infection
    • 5. Maintain adequate blood levels
    • 6. Antibiotic combination when needed
  10. What is suprainfection?
    Infection with a second organism that occurs while on antibiotic therapy
  11. Which organisms have additional component on their cell wall that most beta-lactam antibiotics cannot penetrate?
    Gram negative bacteria
  12. What are 4 beta-lactam antibiotics?
    • Penicillins
    • Cephalosporins
    • Carbapenems
    • Azetronam
  13. What kind of bacteria are penicillins used to treat?
    Gram positive and some gram negative, some anaerobes
  14. Why don’t penicillins pass blood brain barrier?
    Because they are bound to plasma proteins
  15. How are penicillins eliminated?
    Excreted by kidneys
  16. What can overdose of penicillins cause?
    Neurologic problems (seizures)
  17. What are Beta-Lactamases?
    Enzymes that cut the beta-lactam ring, inactivating beta-lactam antibiotics
  18. What are beta-lactamase inhibitors?
    Drugs that bind to beta-lactamases and keep them from cutting the beta-lactam ring.
  19. What are four penicillin-beta-lactamase inhibitors?
    • Augmentin
    • Unasyn
    • Timentin
    • Zosyn
  20. What two drugs make up Augmentin?
    Amoxicillin and clavulanic acid
  21. What two drugs make up Timentin?
    Ticarcillin and clavulanic acid
  22. What two drugs make up Unasyn?
    Ampicillin and sulbactam
  23. What two drugs make up Zosyn?
    Piperacillin and tazobactam
  24. How are cephalosporins similar to penicillins?
    Structure and activity
  25. What are possible problems with cephalosporins?
    • Chance of increased bleeding with warfarin
    • Disulfram-like reaction if used with alcohol
    • Resistant bacteria, use 3rd or 4th generation with serious infection
  26. What beta-lactam antibiotics have an extremely broad spectrum?
  27. What kind of antibiotic is vancomycin?
    Non-Beta-Lactam antibiotic affecting bacterial cell wall
  28. What are adverse effects of vancomycin?
    • Ototoxicity and nephrotoxicity
    • Drug interactions
    • Rapid infusion causes severe reaction
    • Irritating to veins
  29. What kind of drug is tetracycline?
    Bacteriostatic inhibitors of protein synthesis
  30. What kind of drug are macrolides?
    Bacteriostatic inhibitors of protein synthesis
  31. What kind of drug is clindamycin?
    Bacteriostatic inhibitors of protein synthesis
  32. What kind of drug is chloramphenicol?
    Bacteriostatic inhibitors of protein synthesis
  33. What are three main problems with tetracycline?
    • Poor absorption of some
    • Bind to calcium in developing teeth
    • Suprainfection
  34. What are 3 common macrolides?
    • Erythromycin
    • Clithromycin
    • Azithromycin
  35. What is the drug of choice for Legionella and Chlamydia?
  36. What are 2 booby traps for macrolides?
    • Hepatotoxicity
    • P450 inhibition
  37. What type of antibiotics are aminoglycosides?
    Bacteriocidal antibiotics that alter protein synthesis
  38. Which class of antibiotics are tobramycin, gentamycin and amakacin?
  39. What do aminoglycosides NOT work on?
  40. What is sulfamethoxazole-trimethoprim?
  41. What is Bactrim’s MOA?
    Blocks enzymes that help build DNA/RNA/proteins
  42. What drug causes kidney stones, blood dysacrasias, psychosis and Stevens-Johnson Syndrome?
  43. What is MOA of Fluoroquinones?
    Inhibit enzymes that replicates DNA (DNA gyrase)
  44. What are fluoroquinones active against?
    Aerobic organism (both gram + and gram -)
  45. What should you not take with fluoroquinones?
    Aluminum, iron, calcium, iron or zinc supplements
  46. Which antibiotic causes irreversible join disease in children, photosensitivity, candid suprainfections, and tendon rupture in adults?
  47. Which antibiotic targets anaerobic organisms, including parasites and bacteria?
  48. Which antibiotic can cause darkening of urine, CNS effects, and interacts with P450s?
  49. Which infection is always treated with 2 or more drugs to avoid emergence of resistant strains?
  50. What kinds of patients are extremely succeptible to TB?
    HIV patients
  51. What are 4 TB drugs?
    • Isoniazid
    • Rifampin
    • Pyrazinamide
    • Ehambutol
  52. Which TB drug is used alone to treat latent TB?
  53. Which TB drug is NOT hepatotoxic?
  54. Which TB drug decreases levels of birth control pills and turns body fluids red?
  55. What kind of drugs are Amphoteracin B and Ketaconazole?
  56. Which antifungal is a strong inhibitor of P450?
  57. Which antifungal is toxic to mammalian cells?
    Amphoteracin B
  58. Which antifungal can be used topically?
  59. Which antiviral is active against all herpes viruses?
  60. Which antiviral has serious toxicities?
  61. What is a prodrug of acyclovir?
  62. What is the MOA of antivirals?
    Suppress synthesis of viral DNA
  63. What drugs are used as prophylaxis during flu epidenmics?
    Amantadine and Rimantadine
  64. Why is it important to look up HIV drugs?
    They may have overlapping toxicities
  65. What is ARV?
  66. What is ART?
    Anti-retroviral therapies
  67. What is HAART?
    Highly active antiretroviral therapy
  68. Why is multiple therapy used for HIV?
    To avoid resistance
  69. What are 5 classes of HIV drugs?
    • NRTIs
    • NNRTIs
    • PIs
    • Attachment inhibitors
    • Integrase inhibitors
  70. What are NRTIs?
    Nucleoside reverse transcriptase inhibitors
  71. What are NNRTIs?
    Non-nucloside reverse transcriptase inhibitors
  72. What are PIs?
    Protease inhibitors
  73. What are two types of attachment inhibitors?
    • fusion
    • CCR5 antagonist
  74. What are PMTCT programs?
    Prevention of mother to child transmission
  75. What drugs are given during and after labor to reduce HIV transmission to baby?
    RT inhibitors
  76. Which RT inhibitor does not affect human DNA polymerase?
  77. What is the MOA of NRTIs?
    Inhibit viral reverse transcriptase by terminating growing DNA strand
  78. What is the MOA of NNRTIs?
    Bind to active site of reverse transcriptase
  79. Which class of HIV drugs are AZT, ddi, ddc, 3tc, d4t?
  80. Which HIV drug causes lipoatrophy?
  81. Which drugs have negative interaction with St. John’s wart?
    NNRTIs and PIs
  82. What is the MOA of PIs?
    Inhibit viral protease
  83. What kind of HIV drugs are indinavir, ritonavir, sauinavir, nelfinavir, amprenavir, foamprenair, atazanavir, tipronavir and lopinavir?
  84. Which HIV drugs cause hyperglcemia, fat redistribution, hyperlipidemia, increased bleeding in hemopheliacs, reduced bone density, elevation of liver enzymes and ECG changes?
    Protease Inhibitors
  85. What is the MOA of fusion inhibitors and attachment inhibitors?
    Inhibits the entry of HIV into CD4 positive cells
  86. What is the only fusion inhibitor currently on the market?
  87. Which HIV drugs block the CCR5 receptor so HIV does not attach to the CD4 cell?
    Atatcment inhibitors
  88. What kind of drug is Maraviroc?
    Attachment inhibitor
  89. What is the only approved integrase inhibitor?
  90. What is the MOA of Integrase inhibitors?
    Prevents integration of viral DNA into host DNA
  91. What is the daily replication rate of HIV?
    Between 1 and 10 billion virons per day
  92. What percent of adherence is recommended to prevent HIV resistance?
    Greater than 95%
Card Set
PathoPharm lecture on antimicrobials