GNUR413, Antimicrobial lecture

jennifer12345's version from 2017-10-17 01:41

Section 1

Question Answer
macrophagesantigen presenting cells, surveillance of antigens
neutrophils defense against bacteria and fungus
eosinophilsdefense against parasites, response against allergic reactions
basophilsallergic response
B lymphocyteantibody production
T lymphocytecellular immunity against viruses and tumors, regulation of the immune system

Section 2

Question Answer
enterococcus, e.colGI tract
enterobacteriaceaegenital tract

Section 3

Question Answer
Features of bacteria that have gram positive stainsurrounded by thick, rigid, porous cell wall of peptidoglycan
Features of bacteria that have gram negative stainadditional outer membrane lipopolysaccharide, thin peptidoglycan layer
Examples of gram positive coccistaphylococcus aureus, pneumococci, streptococcus pneumoniae
Examples of gram positive bacillilisteria, corynebacterium, clostridium, nocardia
Examples of gram negative coccineisseria rheningitidis, veillonella
Examples of gram negative bacilliaeromonas, vibrio, e. coli, klebsiella, enterobacter, pseudomonas
Ziehl-Neelsen stainused for acid-fast bacilli, mycobacterium (TB)
India ink stainfungi

Section 4

Question Answer
Antimicrobials that inhibit cell wall synthesiscycloserine, vancomycin, bacitracin, penicillins, cephalosporins, carbapenems,
Antimicrobials that prevent synthesis of folic acidsulfonamides, dapsone
Antimicrobials that inhibit dihydrofolate reductasetrimethoprim
Antimicrobials that inhibit protein synthesis at 30s ribosome siteaminoglycosides, tetracyclines
Antimicrobials that inhibit protein synthesis at 50s ribosome sitechloramphenicol macrolides, clindamycin
Antimicrobials with cationic detergent-like activitypolymixins
Antimicrobials that disrupt cytoplastic membranesbacitracin
Antimicrobials that inhibit nucleic acid synthesis (DNA)quinolones, metronidazole
Antimicrobials that inhibit nucleic acid synthesis (RNA) rifampin, bacitracin
Bacteriostatic drugsdecrease growth of the bacteria, immune system takes over from there (tetracyclines, macrocodes, chloramphenicol)
Bactericidal drugskill the organism ex: beta-lactams, ahminoglycosides
Intrinsic antimicrobial resistancebuilt-in resistance to an antibiotic, ex: gram neg bacteria with PCN resistance
Acquired antimicrobial resistancetransfer of resistance from bacteria to bacteria, ex: plasmids, transposons
Beta-lactamase resistant penicillinsnafcillin, methicillin, cloxacillin, dicloxacillin
Aminopenicillins (adds gram negative coverage for h. influenzae, e.coli, proteus mirabilis)ampicillin, amoxicillin
Carboxypenicillins (gram neg coverage for pseudomonas, enterobacter, proteus & some anaerobic)carbenicillin, ticarcillin
Ureidopenicillins (superior against pseudomonas, activity against klebsiella & some anaerobic)piperacillin
Beta-lactamase inhibitors (used in combo with PCN)clavulonic acid, sulbactam, tazobactam
Kinetics of penicillinswidely distributed in body water, excreted mostly unchanged in urine, some are acid labile
Adverse effects of penicillinshypersensitivity (common), neutropenia (beta-lactamase resistant drugs), rash, GI upset
Long-acting penicillins (give IM)penicillin procaine, penicillin benzathine
Cephalosporins- mechanism of actionidentical to PCN, inhibit cel wall sythesis
What is the spectrum of activity of first generation cephalosporins? GPC, some gram negative coverage, some anaerobic coverage
What changes in the spectrum of activity for second & third generation cephalosporins?Increasing gram-negative coverage
First generation cephalosporinscephalothin (keflin), cefazolin (ancef), cephalexin (keflex), cefadroxil (duricef), cephradine (velocef)
Second generation cephalosporinscefuroxime (ceftin), cefoxitin (mefoxin), cefaclor (ceclor), cefotetan (cefotan), cefprozil (cefzil)
Third generation cephalosporinsceftazidime (fortaz), ceftriaxone (rocephin), cefotaxime (claforan), cefpodoxime (vantin), cefepime (maxipime)
Adverse effects of cephalosporinshypersensitivity, thrombocytopenia, rash, GI upset
kinetics of cephalosporinswidely distributed in body, 3rd generation good CSF penetration, mostly excreted unchanged urine
Carbapenemsimipenem/cilastatin (primaxin), ertapenem (invanz), meropenem (merrem), doripenem (doribax)
What is the spectrum of activity of carbapenems?broad-spectrum (GN, GP, anaerobic), resistant to beta-lactamases: meropenem=ertapenem> imipenem
Adverse effects of carbapenemscross-reactivity w/ pcn, rash, seizure, diarrhea, nausea/vomiting, edema
Aztreonamconsidered beta-lactase, covers gram negatives, no cross-reactivity w/ pcns
Quinolonesinhibits DNA gyrase, covers GP, GN, and some anaerobes. Ex: cipro, levofloxacin, ofloxacin
Sulfonamides- spectrum of activitycover gram positive, gram negative
Kinetics of sulfonamidesgood aborption, highly plasma protein bound, some liver metabolism, renal excretion
Adverse effects of sulfonamidesrash, GI distress, renal toxicity, stevens-johnson
Examples of sulfonamidessulfisoxazole/erythromycin (pediazole), sulfamethoxazole/trimethoprim (bactrim)
Aminoglycosides- spectrum of activitygram negative aerobes
Aminoglycosides- kineticsnot orally absorbed, excreted unchanged by kidney
Adverse effects of aminoglycosidesrenal toxicity, ototoxicity, rash, neuromuscular blockage
Examples of aminoglycosidesgentamicin, tobramycin, amikacin, streptomycin, neomycin, netilmicin, paromycin
Macrolides- spectrum of activitygram positive, gram negative, some anaerobes
Kinetics of macrolideswell absorbed, highly protein bound, metabolized in the liver (CYP)
Adverse effects of macrolidesGI upset, rash, hepatotoxicity
Examples of macrolideserythromycin, azithromycin, clarithromycin, azithromycin
Tetracyclines- spectrum of activitygram positive, gram negative, some anaerobes
Adverse effects of tetracyclinesGI upset, rash, tooth discoloration, photosensitivity
Examples of tetracyclinesdoxycycline (vibramycin), minocycline (minocin), demeclocyline (declomycin), tigecycline
Metronidazole - spectrum of activityanaerobes, amoeba
Adverse effects of metronidazolenausea, flushing, diarrhea, metallic taste, peripheral neuropathy, thrombocytopenia
Drug interactions of metronidazoleCYP450, increase levels of: warfarin, benzos, calcium channel blockers
Cautions with metronidazoledo not ingest alcohol, hepatic or renal disease
Clindamycin- spectrum of activitygram positive, anaerobes
Adverse effects of clindamycinrash, GI upset, c.diff colitis
Vancomycin- spectrum of activitygram positives, MRSA
Adverse effects of vancomycinred-man syndrome, nephrotoxicity, rash
Linezolid- spectrum of activitystaph. and strep. including MRSA, MRSE. VRE
Adverse effects of linezoliddiarrhea, rash, anemia
Quinupristin/Dalfopristin (synercid)- spectrum of activitygram positives, including VRE
Adverse effects of quinupristin/dalfopristin (synercid)nausea, diarrhea, arthralgia
Examples of azolesfluconazole, ketoconazole, itraconazole, voriconazole, clotrimazole
Adverse effects of azolesGI upset, liver enzyme elevation, topical- burning or stinging
Azole mechanism of actioninhibit fungal cell membrane formation
Nystatin adverse effectshypersensitivity, rash
Adverse effects of amphotericinchills, fever, myalgias, arthralgias, thrombophlebitis, renal toxicity, hypokalemia, hypomagnesemia
Adverse effects of flucytosinerash, GI distress, diarrhea, reversible elevation in hepatic enzymes
Adverse effects of caspofunginelevated LFTs, rash, itching, facial swelling, pulmonary edema, ARDS
Anti-RNA mechanism of actionblocks the un-coating of the virus
Examples of anti-RNA and spectrum of activityamantadine (influenza A only), rimantadine (influenza A & B)
Examples of neuroaminidase inhibitorszanamivir (relenza), aseltamivir (tamiflu)
Mechanism of action of neuraminidase inhibitorsselective inhibitor of influenza A & B, inhibits release of newly formed virus from infected cells