Chemotherapy Bacterial

Front 1

Chemotherapy lecture

Back 1

Correct

Front 2

What is breakpoint?

Back 2

The mic that determines if an organism is classified as susceptible or resistant

Front 3

Do you have to stay above the MIC all the time to maintain stasis?

Back 3

No, there is a post antibiotic effect.

Front 4

What are two killing patterns?

Back 4

Concentration dependent
time-dependent(concentration independent)

Front 5

Concentration dependent pharmacokinetic

Back 5

Auc/MIC ratio or Peak/MIC ratio

Front 6

Time dependent pharmacokinetic correlate

Back 6

Time above mic

Front 7

What would each graph look like?

Back 7

you know this

Front 8

concentration dependent example

Back 8

levofloxacin

Front 9

time depend ex

Back 9

b-lactams

Front 10

adverse rctns

Back 10

superinfection: candidiasis
amoxicillin kills lactobacillus and allows inc in ph of vagina allowing candida to grow.

Front 11

What is most common nosocomial infeciton?

Back 11

antibiotic induced pseudomembranous colitis from clostridium dificile.

Front 12

Resistance mechs trhough anatomy ex?

Back 12

penicillin g can't get through

Front 13

example of mutational pattern graph?

Back 13

looks like a stair step

Front 14

ex of mutational pattern resistance

Back 14

Penicillin G

Front 15

Large step mutational pattern graph

Back 15

ONE BIG JMP
pseudomonas is an example

Front 16

Example of transfer of genetic resistance

Back 16

s pneumoniae resistance spreading from new guinea to australia

Front 17

biochemical mechanisms

Back 17

intracell decreased concentration
drug inactivation
decreased affinity of receptor/enzyme

Front 18

mnemonic for resistant pathogens

Back 18

eskape
enterococcus faecium
staph aureus
kleb pneum
acinetobacter baumanii
pseud aerug
enterobacter species

Front 19

synergistic combinations

Back 19

cws inhib+aminoglycosides
sulfonamids plus folic acid reductase
quinupristin and dalfopristin

Front 20

What are stages of cell wall synthesis? there are three

Back 20

1: intracellular
2: cytoplasmic membrane
3: extracelluar

Front 21

stage one antibiotics
3 listed

Back 21

bacitracin
cycloserine
fosfomycin

Front 22

stage two

Back 22

vancomycin
telavancin

Front 23

stage three

Back 23

b-lactams
vancomycin
telavancin

Front 24

What happens at second stage?

Back 24

The acceptor strand of peptidoglycan

Front 25

stage three reaction thats important?

Back 25

There is a 5 glycine chain on the Lysine of MurNAc that binds to the delta D alanine on another murnac

Front 26

What do B lactams do (big thing)?
Any other thing?

Back 26

The b lactam square bind to the transpeptidase covalently.
Also stimulate bacterial autolysis

Front 27

Mech of resistance:
Can this get outside

Back 27

B lactamase
yes for gram pos
builds up in periplasmic space in gram neg

Also can alter pbp
s pneumon
mrsa

Front 28

How do b lactams get into the bacterial cell wall

Back 28

They use channels: OMP d, f, and c

Front 29

So what could another type of resistance be?

Back 29

Changing the pore sizes

Front 30

If give pen G orally, what happens

Back 30

most destroyed in stomach. (1/3 abosrbed)

Front 31

AFter absorption what happens if meninges is inflamed?

Back 31

Penicllin G can get in.

Front 32

Excretion: Pen G?

Back 32

Organic ion exrection in kidney.

Front 33

How can you inc the residence time of pen G in body?

Back 33

block urinary secretion with Probenecid

Also give repository formulations and slow absorption ofrom IM injection site. (Procaine pen G and Benzathine pen G)

Front 34

What do you effect when you give repository formulations?

Back 34

Blood levels

Front 35

Pen G spectrum?

Back 35

gm + few gm -, spirochetes (especially treponema pallidum!!!) anaerobes of oral cavity

Front 36

Different groups of penicillins

Back 36

follow along

Front 37

Natural penicillins

Back 37

pen G and pen V

Front 38

What's different about pen v and g?

Back 38

pen v gives greater blood level after oral dose. pen v more acid resistant

Front 39

Penicillinase-resistant penicillins

Back 39

dicloxacillin
nafcillin
oxacillin
cloxacillin
methicillin

Front 40

What are the penicllinase resistnt pens used for
How are they resistant.

Back 40

antistaphylococcal!
Have altered R groups which confer less affinity for the B lactamase (km goes out the roof)

Front 41

MRSA
2 kinds?

Back 41

Nosocomial
Community aquired

Front 42

What are similarities?

Back 42

Both are resistant to methicillin due to altered pbp. The alteration confers less affinity for B lactam.

Front 43

Differences between nosocomial and commun acquired?

Back 43

Nosocomial has plasmids that make it resistant to other drugs as well.

Front 44

Which is more pathogenic?
Why?

Back 44

Community acquired
It produces a "leukosidin"
(there was an example of kids with holes chewed in their lungs)

Front 45

What are the two classes of extended spectrum penicillins?
What does extended spectrum mean?
Constituents?

Back 45

Aminopenicillins: ampicillin and amoxicillin
Antipseudomonal penicillins: ticarcillin, piperacillin
It means that these also can treat gram - effectively

Front 46

Ampicillin issues?

Back 46

ampicillin is not well absorbed

Front 47

Are amoxicillin or ampicillin stable to penicillinase?
what is penicillinase?

Back 47

NO
B lactamase

Front 48

Antipseudomonal penicllins
Are they B lactamase resistant?

Back 48

ticarcillin
piperacillin
NO

Front 49

Which antipseudomonal is more potent?

Back 49

piperacillin

Front 50

B Lactamase inhibitors
How are these given?
Can these block all the b lactamases?

Back 50

Preformulated with penicillins
No

Front 51

What are the B lactamase inhibs?

Back 51

clavulanic acid
sulbactam
tazobactam

Front 52

What is augmentin?

Back 52

amoxicillin plus clavulanic acid

Front 53

Does this work well against pseudomonas?

Back 53

No

Front 54

Cephalosporin
What will they all start with?

Back 54

Cef or ceph

Front 55

ceph mech of action?
resistance mechanisms as compared to penicillins?

Back 55

same as penicillin
Same except for B lactamase sensitivity. Cephs are stable to true penicillinases.

Front 56

General pattern of ceph generations?

Back 56

Each progressive generation has greater activity against gram neg.

Front 57

When would be a time you wanted to use a 3rd or 4th generation ceph?

Back 57

When the meninges are inflamed.