Phar 342 - Material For Midterm 1 (Kumar Part 1/3)

Front 1

What are Antibioitcs ?

Back 1

Antibiotics are the molecules that kill, or stop the growth of microorganisms.

Front 2

What are the characteristics of Gram (+ve) Bacteria?

Back 2

1) Gets dyed Purple with gram stain

2) Has a thick peptidoglycan layer (50-100 layers thick)

3) Cell wall has Teichoic Acid

Front 3

What are the characterissitcs of Gram (-ve) Bacteria?

Back 3

1) Gets dyed Pink with gram stain

2) Less prominent Peptidoglycan layer (1-2 layers thick)

3) Has porins in the outer membranes

4) Has Periplasmic Space

5) Has a lipopolysaccarhide layer

Front 4

What are Toxins?

Back 4

Proteins (i.e. effectors) injected into target host cells allowing bacteria to persist and cause disease.

Front 5

What are th two categories of Toxins?

Back 5

Exotoxins and Endotoxins

Front 6

Define Broad Spectrum Antibiotic

Back 6

Antibiotics that can kill or inhibit a wide range of Gram Positive and Gram Negative bacteria

Front 7

Define Narrow Spectrum Antibiotcs

Back 7

Antibiotics are effective mainly against Gram Positive OR Gram Negative bacteria [Not completely one or the other]

Front 8

Define Limited Spectrum Antibioitcs

Back 8

Antibiotics are effective against a single organism or disease

Front 9

Define Bactericidal Antibiotics

Back 9

Antibiotics that can kill bacteria

Front 10

Define Bacteriostatic Antibiotcs

Back 10

Antibiotics that stop the growth of bacteria

Front 11

What are examples of some drugs that are '-static' at low doses and '-cidal' at higher doses?

Back 11

Sulfonamides and Tetracyclines

Front 12

What are the mechanisms of actions of Antimicrobials?

Back 12

1) Inhibition of Cell Wall Synthesis

2) Inhibition of Protein Synthesis

3) Inhibition of Nucleic Acid (DNA/RNA) Synthesis 4) Inhibition of Synthesis of Essential Metabolites

Front 13

What are examples of antibiotics that inhibit cell wall synthesis?

Back 13

Penicillin and Vancomycin

Front 14

What are examples of antibiotics that inhibit protein synthesis?

Back 14

Tetracycline, Chloramphenicol, Erythromycin and Streptomycin

Front 15

What are examples of antibiotics that inhibit Nucleic Acid (DNA/RNA) Synthesis?

Back 15

Rifampin and Quinolones

Front 16

What are examples of antibiotics that inhibit Syntheisis of Essential Metabolites?

Back 16

Sulfa Drugs which inhibit syntheisis of Folic Acid

Front 17

What is the MOA of Penicillins?

Back 17

Inhibits cell wall synthesis using a Beta Lactam ring, killing the bacteria actively growing in the cell

Front 18

What is the toxcity of Penicilins?

Back 18

Non-Toxic but do produce allergic reactions sometimes

Front 19

What are the characteristics of Penicillins?

Back 19

Bactericidal, Broad Spectrum (+ve and -ve), (works with -ococus species)

Front 20

What are examples of Penicillins?

Back 20

Penicillin, Ampicillin and Cloxacillin

Front 21

What are the four classifications of Penicillins?

Back 21

1) Natural Penicillins

2) Pencillinase Resistant Penicillin

3) Extended Spectrum Penicillins (Aminopenicillins)

4) Antipseudomonal Penicillins

Front 22

What condition would you treat with Benzathaine Penicillin G?

Back 22

Scarlet Fever

Front 23

What condition would you treat with Procaine Penicillin G?

Back 23

Latent Syphillis

Front 24

Penicillin G was the first drug of choice for:

Back 24

1) Pneumocci(penumonia)

2)Streptocci

3) Meningeocacci

4) Spirochetes (treponema pallidum)

5)Non Beta lactamase producing staphylcocci 6)Clostridum(Actinomyces Species)

7)Non Beta Lactamase producing Gram(-ve) bacteria

8)Staph Aureus(NOW RESISTANT)

Front 25

What are examples of Penicillinase Resistant Penicillin?

Back 25

Methicillin, Naficillin, Isoxazolyl Penicillins (oxacillin and cloxacillin)

Front 26

What are examples of Extended Spectrum Penicillins?

Back 26

Ampicillin and Amoxacillin

Front 27

Are Penicillinase Resistant Penicillins sensitive to Beta Lactamases?

Back 27

No, they are Beta Lactamase Resistant

Front 28

Are Extended Spectrum Penicillins sensitive to Beta Lactamases?

Back 28

Yes

Front 29

What are examples of Antipseudomonal Penicillins?

Back 29

Carbenicillin, Ticarcillin, Piperacillin and Mezlocillin

Front 30

Are Antipsuedomonal Penicillins effective against Staph Aureus?

Back 30

No, they are ineffective against Staph Aureus

Front 31

Which penicillins are not effective orally?

Back 31

Methicillin, Carbenicillin and others

Front 32

"Pen V, Amoxicillin and Amoxicillin/Clav are used orally only" True or False?

Back 32

TRUE

Front 33

"Cloxacillin is used orally only" True or False?

Back 33

False, it is used both orally and parenteral

Front 34

"Oral Penicillin is unaffected by Foods" True or False?

Back 34

False, It is impaired by food

Front 35

How does probenecid prevent the excretion of Penicillin?

Back 35

Probenecid uses the same steps of kidney excretions like penicillin and so competes with antibiotics for excretion and so they last longer in our bodies

Front 36

"Penicillins are generally non-toxic" True or False?

Back 36

TRUE

Front 37

How does high dose of Peniciilins cause Seizures?

Back 37

Accumulation of penicillin occurs with high doses and renal failure then the drug can penetrate into the CNS and this has an effect on the GABA receptors making them more active and this causes seizures

Front 38

How can Penicillins cause Hypokalemia?

Back 38

Occurs with rapid intravenous doses of potassium penicillin G in patients with renal failure (also, excess sodium can also lead to Hypokalemia)

Front 39

What are the mechanisms of antibiotic resistance?

Back 39

1) Inactivation of Beta Lacatmases

2) Modifications of Target Penicillin Binding Protein (PBP)

3) Impaired Penetration of Drug to Target PBP

4) Efflux pump mechanisms to remove drug from the bacterial cell

Front 40

"Beta Lactamase Inhibitors have antibacterial action" True or False?

Back 40

False, but remember that when adminstered alone with bacteria there is a slight decrease in bacterial growth.

Front 41

What are the components of Augmentin?

Back 41

Amoxicillin + Clavulinic Acid

Front 42

What are the components of Timentin ?

Back 42

Ticarcillin + Clavulinic Acid

Front 43

What is the MOA of Cephalosporins?

Back 43

[Same as Penicillin] Beta Rings are used to break the cell walls of bacteria.

Front 44

What is the toxcity of Cephalosporins?

Back 44

[Same as Penicillin] Non-Toxic but can cause allergic reactions sometimes

Front 45

What are the characteristics of Cephalosporins?

Back 45

Bactericidal, Broad Spectrum (Gram +ve and -ve) [better activity against gram +ve]

Front 46

"Cephalosporins are semisynthetic derivatives of fungus discovered in organisms isolated from a sewer in Sardinia" True or False?

Back 46

True

Front 47

What class of Cephalosporins is Cefazolin?

Back 47

1st Generation

Front 48

What class of Cephalosporins is Cefuroxime?

Back 48

2nd Generation

Front 49

What class of Cephalosporins is Ceftriaxone?

Back 49

3rd Generation

Front 50

What class of Cephalosporins is Cefixime?

Back 50

3rd Generation

Front 51

What class of Cephalosporins is Cefepime?

Back 51

4th Generation

Front 52

What are the properties of 1st Gen Cephalosporins?

Back 52

Active against against Gram +ve and Gram -ve bacteria, and does not work on meningitis.

Front 53

What are the properties of 2nd Gen Cephalosporins?

Back 53

Less active against gram(+ve) and more active against gram(-ve). Not active against Enterocci and Psuedomonas aurgonisa.

Front 54

What are the properties of 3rd Gen Cephalosporins?

Back 54

Even Less active against gram(+ve) than 2nd Gen. But with greater activity against gram(-ve) organisms. Good penetration into CNS.

Front 55

What are the properties of 4th Gen Cephalosporins?

Back 55

Highest activity against gram(+ve) organisms, especially against penicillin resistant strain of streptocooci.

Front 56

What are the theraputic uses of 1st Gen Cephalosporins?

Back 56

Oral: UTI infections, minor polymicrobial infections. Systemic: Surgical Prophylaxis

Front 57

What are the theraputic uses of 2nd Gen Cephalosporins?

Back 57

Lower respiratory tract infections, or Meningitis.

Front 58

What are the theraputic uses of 3rd Gen Cephalosporins?

Back 58

1st line drug for N.gonorrhoeae, used for sinusitis, meningitis and lower respiratory tract infections

Front 59

What are the theraputic uses of 4th Gen Cephalosporins?

Back 59

[Same as 3rd Gen] and Pseudomonas aeruginosa

Front 60

Which antibiotic is the only 1st Gen paraentral Cephalosporin?

Back 60

Cefazolin

Front 61

"All Cepalosporins are inactive against MRSA" True or False?

Back 61

TRUE

Front 62

Which generation of Cephalosporins are 1st Line for the treatment of N.gonrrhoeae

Back 62

3rd Generation {4th as well?}

Front 63

What are the side effects of Cephalosporins?

Back 63

1)Hypersensitivity

2)Neurotoxcity

3)Diarrhea

4)Nephritis

5)Cation toxcity

6)Hematologic toxcity [for 3rd gen]

Front 64

What is a "Super Infection"?

Back 64

When the infection gets worse by being infected with a second strand while treating the first and the second is not as susceptible to the same antibiotic.

Front 65

What are the interactions of Cephalosporins?

Back 65

1) Disulfiram effect with Alcohol

2)H2 Antagonists and Antacids decrease absorption by changing pH

3)Probenecid increases/prolongs effects of Cephalosporins [like penicillin]

Front 66

What is an example of a MonoBactam antibiotic?

Back 66

Aztreonam

Front 67

What are the properties of Azetronam?

Back 67

Narrow Spectrum, active against gram(-ve) but NOT gram(+ve) or anerobic activity.

Front 68

What are the side effects of Azetronam?

Back 68

Well tolerated, with little or no cross activity allergic reactions with Penicillins and Cephalosporins

Front 69

What are the therapeutic uses of Azetronam?

Back 69

Replacement for Aminoglycoside antibiotics.

Front 70

What is an example of Carbapenems?

Back 70

Imipenem, Meropenem

Front 71

What are the properties of Carbapenems?

Back 71

Most are broad spectrum and resistant to most beta lactamases

Front 72

What are the side effects of Carbapenems?

Back 72

1)Nausea

2)Vomitting

3)Diarrhea

4)Skin Rashes

5)Comprimised renal function can give seizures

Front 73

Why is Cilastatin co-administered with Carbapenems ?

Back 73

To inhibit peptidases which results in increased drug conc and to prevent cleavage and toxic metabolite formation

Front 74

What is the MOA of Vancomycin?

Back 74

Inhibits cell wall synthesis in sensitive bacteria by binding with high affinity to D-Alanyl-D-Alanine

Front 75

What are the characteristics of Vancomycin?

Back 75

Gram(+ve) bacteria only, small glycoprotein water soluble and quite stable.

Front 76

What are the therapeutic uses of Vancomycin?

Back 76

1) Gram (+ve) penicillin resistant disease and C.difficile

2)DOC for MRSA

3) Used with precaution in patients with true Beta Lactam allergy

Front 77

"Vancomycin is used routinely for Surgical Prophylaxis" True or False?

Back 77

False, only used when the patient is allergic to Beta Lactams

Front 78

"Vacomycin SHOULD NOT be used for systmeic/local prophylaxis of infections or colonization of indwelling central/peripheral IV catheters" True or False?

Back 78

TRUE

Front 79

"Vancomycin can be used for the empirical therapy of Febrile Neutropenia" True or False?

Back 79

False, unless there is strong evidence of gram(+ve) infection

Front 80

"Vancomycin SHOULD NOT be used in tretment with response of a single blood culture positve for coagulase negative Staphylococci" True or False?

Back 80

TRUE

Front 81

"Vacomycin SHOULD NOT be used for the primary treatment of antibiotic associated colitis" True or False?

Back 81

True, only when resistant to Metronidazole

Front 82

What is the one situation where Vancomycin is adminstered orally instead of IV?

Back 82

Except for C.difficle

Front 83

What are the side effects of Vancomycin?

Back 83

1)Ototoxcity

2)Nephrotoxcity

3)Fever, Chills, Phlebitis at infusion site

4)Rash

Front 84

Why does Vancomycin need to be administered slowly via IV?

Back 84

Because it causes histamine release hypotension [red man's syndrom]

Front 85

How does Vancomycin resistance develop?

Back 85

1) Production of peptidoglycan precursor that Vancomycin cannot recognize.

2) Mutation in D-Alanyl D Alanine changes to D-Alanyl D Lactate or Serine, with low affinity to the loss of H-bonds