Antibiotics

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Bacteriostatic

Back 1

Reversible inhibitmetabolic processes of bacteria that can recommence if the level of the antibiotic becomes sub-inhibitory

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Bactericidal

Back 2

Kill susceptible bacteria without the intercession of the immune system
Typically used in immunocomrimized patients
Ex: Beta-lactam antibiotics

Front 3

Spectrum of activity

Back 3

Range of the activity of an antibiotic.
Describes genera and species against which an antibiotic is typically active

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Extened Spectrum

Back 4

Effective against Gram + and most Gram - bacteria

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Broad Spectrum

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Active against gram + and -
Can drastically affect normal flora causeing superinfections

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Inhibitors of Cell Wall Synthesis
1

Back 6

Bacteria must be actively growing
Primarily against Gram +
Least toxic and first considered

Front 7

Beta Lactams
1

Back 7

Penicillin, Cephamycin
Inhibit enzymes that build and catalyze cross linking of NAG and NAM (interferes with peptidoglycan crosslinking)
Primarily Gram +

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Beta Lactamase Inhibitors
1

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Beta Lactam that bind Beta Lactamases
Cleaves B lactam ring
Clavulanic Acid, Sulbactam, Tazobactam

Front 9

Vancomycin
1

Back 9

Inhinbits cross linkage of peptidoglycan layers by interacting with D-Alanine
Primarily Gram +

Front 10

Isoniazid Ethionamide
1

Back 10

Inhibits mycolic acid synthesis (Mycobacteria)
Narrow specturm antibiotic

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Polymyxin
1

Back 11

Insert in bacterial membranes by interacting with LPS
Narrow Spectrum
Primarily Gram - Rods

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Bacitracin
1

Back 12

Inhibits cell wall synthesis
Prevents movements of peptidoglycan precursors
Very Selective for Streptococcus Phylogeny

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Inhibitors of Protein Synthesis
2

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Second group considered for treatment
Tend to be more toxic thne inhibitors of cell wall synthesis

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Aminoglycosidases
2

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Irreversibly binds sites on 30S and 50S ribosome
Must be used IV
Auto-toxicity in new borns
Prevents tRNA from forming initiation complex and elongation

Front 15

Tetracyclines
2

Back 15

Blocks aminoacyl-tRNA binding to 30S
Bacteriostatic
DO NOT give to pregnant women will effect bone formation
GI distubnce due to normal flora alteration

Front 16

Macrolides
2

Back 16

Revesible binds 50S subunit to prevent translocation
Ex: Erthromycin, clarithromycin
Bacteriostatic

Front 17

Clindamycin
2

Back 17

Similar to macrolides
added activity against anaerobes
Extened spectrum

Front 18

Streptogramins
2

Back 18

Bind 50S ribosome to inhibit peptide chain elongation and peptidyl transferase activity
Used in ratio for the treament of vancomycin-resistant enterococci

Front 19

Quinolones and Ciprofloxins
3

Back 19

Inhibits Nucleic Acid Synthesis
Binds DNA Gyrase
Interferes with DNA replication
Favorable pharmacologic properties

Front 20

Rifampin
3

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Inhibits Nucleic Acid Synthesis
Binds to Beta subunit of DNA dependent RNA polymerase.
Inhibits RNA synthesis
Active against Mycobacterium
Resistance Common

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Antimetabolites
4

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First 2 commonly used together to prevent furthur resistance
Commonly used for UTI's
Folate Inhibitors: Sulfonamides, Trimethoprim

Front 22

Sulfonamides
4

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Analog of PABA
Blocks folic acid synthesis
Affects nucleic Acid synthesis
Bacteriostatic
Resistance is common

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Trimethoprim
4

Back 23

Inhibits Dihydrofolate reductase
used in conjunction with sulfonamides

Front 24

Broth Dilution Method

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Quantitative
MIC: lowest conc. able to inhibit growth
MBC: conc. of ABX required to kill an organism; required when a pt. has an impaired immune system

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Agar Disk Diffusion Method

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Qualitative: Susceptible, Intermediate, Resistant
Standadized: Look up results in table

Front 26

For what drugs is serum concentration monitored?

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Aminoglycosides
Vancomycin
Flucytosine

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What groups have frequent adverse reactions to drugs?

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Neonates
Elderly
AIDS Pts.
Renal failure

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When to use combination of drugs

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Traetment of polymicrobial infections/anaerobic
Decrease the emergence of antibiotic resistant strains
reduce dose related toxicity
obtain enhanced inhibition 4 fold or greatr reduction in MIC or MBC

Front 29

ABX inhibitors of Cell Wall Synthesis

Back 29

B-Lactams (penicillin, Cephamycin, Carbapenem)
Beta-Lactanase inhibitors
Vancomycin
Isoiazid Ethionamide
Ethambutol
Cycloserine
Polymyxin
Bacitracin

Front 30

ABX inhibitors of Protein Synthesis

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Aminoglycosides
Tetracyline
Chloramphenicol
Macrolides (erythromycin, anything ending in mycin)
Clindamycin
Streptogramins (quinupristin and dalfopristin)

Front 31

ABX inhibitors of Nucleic Acid Synthesis

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Quinolones (ciprofloxin, or anyhting ending in -floxin)
Rifampin

Front 32

ABX that are antimedtabolites or folate inhibitors

Back 32

Sulfonamides
Trimethoprim

Front 33

What bacteria have unpredictable susceptibility patterns?

Back 33

Gram (-) bacilli, enterococci, and staphylococci
Susceptibility testing is required

Front 34

Bacteriostatic vs. Bactericidal ABX

Back 34

Work equally as well in immunocompetent pts.

Front 35

What type of ABX are typically protein synthesis inhibiting

Back 35

Bacteriostatic

Front 36

What type of ABX are typically Cell Wall agents?

Back 36

Bactericidal

Front 37

Bactericidal Agents

Back 37

Kill bacteria in pateint unlike bacteriostatic which arrest the growth
Used when host defenses are impaired

Front 38

Time Dependent Killing

Back 38

Activily continues as longas conc. greater then MBC
If drug lacks a Post antibiotic effect (PAE) then needs to above MIC

Front 39

Post Antibiotic Effect (PAE)

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Persistant suppression of growth after levels have fallen ABX levels have fallen below MIC

Front 40

What two determinants have a significant effect on frequency of dosing?

Back 40

Concentration Dependent Killing and PAE

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When does access of ABX increase in CSF?

Back 41

Cases of meningitis

Front 42

What ABX will have a mechanism of resistance die to passage through porin b/c of large size?

Back 42

Vancomycin

Front 43

What ABX will have a mechanism of resistance due to active efflux of antibiotic?

Back 43

Tetracycline resistance

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What is most common form of acquired resistance to ABX due to Horizontal Gene Transfer

Back 44

Conjugation
The most common method of transferring MULTIDRUG resistance

Front 45

Integrons

Back 45

Found on plasmids or transposons
Contains the genes and the site for incorporatig resistance