Id #1

Front 1

ATCC

Back 1

American Type Culture Collection


Antibiotic panels use these strains for quality control

Front 2

Mycobacteria

Back 2

- Acid fast bacteria
- Weakly gram (+) bc of thick mycolic fatty acids.
- Must use acid-fast stain.
- Ex. M. Tuberculosis.

Front 3

Mycoplasma

Back 3

- CANNOT gram stain.
- lacks cell wall.
- atypical pneumonia
- pleomorphic in appearance
- aka pleuropneumonia-like organisms.

Front 4

Numbers of flora at different sites.

Back 4

Mouth and Colon - 10^9
Small Intestine - 10^5-7
Stomach - 10^3-6
Skin - 10^3
Eye - 10^1-3

Front 5

Indigenous bacteria on skin.

Back 5

Stalph. Epidermidis - potential pathogen of bacteremia and endocarditis.

Front 6

Indigenous bacteria in mouth.

Back 6

- Strep
- Candida albicans (yeasts - white film)
- Anaerobes in crevices --> gram (-)
- Potential bacteremia (tooth extraction)

Front 7

Indigenous bacteria in nose/nasopharynx.

Back 7

- Strep pneumoniae
- H. influenzae
- N. meningitidis
- Stalph
- Alpha hemolytic strep.

Front 8

Indigenous bacteria in respiratory tract.

Back 8

NONE!!!

Front 9

Helicobacter pylori

Back 9

Microaerophilic
Responsible for gastric ulcers.

Front 10

Indigenous bacteria in stomach.

Back 10

There should be none. However, if illness or medication (omeprazole, H2 blockers) that raises gastric pH may allow colonization of H. pylori.

Front 11

Which part of the small intestine is normally sterile?

Back 11

Duodenum.

Front 12

Indigenous bacteria in small intestine.

Back 12

Mainly in ileum and jejunum...
Anaerobes
Candida albicans
Enterobacteriaceae (Facultative anerobes)
- Escherichia spp.,
- Klebsiella spp.,
- Serratia spp.,
- Enterobacter spp.

Front 13

Indigenous bacteria in large intestine.

Back 13

Indigenous flora help prevent colonization & infection by exogenous organisms such as Vibrio cholerae, Shigella spp. and Salmonella spp.
- Anaerobes > Facult. Anaerobes
- Enterococci
- Bacteriodes
- Clostridium difficile

Front 14

Most antibiotic-resistant bacteria known.

Back 14

Enterococci

Front 15

Bacteria that can produce abscesses in nearly any organ

Back 15

Bacteriodes

Front 16

Indigenous bacteria in urogenital tract.

Back 16

Lactobacilli, Enterococci, C. albicans, Clostridium perfringens.

Menstrual cycle affects flora.
Oral contraceptive alter population of Lactobacilli --> may cause overgrowth of C. albicans.

Front 17

Clostridium difficile

Back 17

Gram (+), anaerobe, spore forming

- Colitis
- Most common nosocomial GI infection following antibiotic use or hospitalization
- Antibiotic-associated diarrhea

Front 18

CLSI

Back 18

Clinical and Laboratory Standards Institute

Determine breakpoint.

Antimicrobial therapy objective
Least toxic
Most cost-effective
Most clinically appropriate

Front 19

T/F. Direct susceptibility tests on body fluids are NOT recommended

Back 19

True.

Front 20

Standardized inoculum of broth microdilution tests.

Back 20

1.5 x 10^5 CFU/ml

Front 21

Standardized inoculum of broth macrodilution tests.

Back 21

5 x 10^5 CFU/ml

Front 22

Standardized inoculum of Kirby-Bauer tests.

Back 22

1.5 x 10^8 organisms/ml

Front 23

Broth Microdilution Tests Special Considerations

Back 23

trailing: Heavy growth in wells, followed by greatly reduced growth. Common with sulfonamides, trimethoprim.

Skipped wells: repeat test

Front 24

Standardized inoculum in agar dilution tests

Back 24

10^4 CFU/ml

Front 25

Reference method for antimicrobial susceptibility testing of anaerobes and Neisseria gonorrhoeae

Back 25

Agar dilution tests.

Front 26

Mechanism of Cellular Death Induced by Bactericidal Antibiotics

Back 26

Increase TCA cycle
Increase ETC and Ox-Phox.
Increase ROS (superoxide)
Free Fe binds with oxygen to create hydroxyl radical --> damage membrane lipids, proteins, and DNA.

Front 27

Plasmids

Back 27

- circular, dsDNA.
- parasitic/symbiotic relationshipw with host cell.
- role in antibiotic resistance.

Front 28

selfish DNA

Back 28

Transposons - act in its own self interest.

Front 29

Transposons vs. Integrons

Back 29

Transposons: large DNA

Integrons: smaller DNA; aka "gene cassette" containing genes that induce drug resistance to the bacterial cell.

Front 30

"Acute" Vaccines

Back 30

Small molecules that block "Multiple Adaptational Response" operon (MAR operon)...a master switch to control protein expression.

Front 31

Basic structure of penicillin

Back 31

Thiazolidine ring fused to a Beta lactam ring with a variable side chain R group attached through an amide bond from the B-lactam ring.

Front 32

Site of action of penicillinase?

Back 32

Beta-lactam ring.

Front 33

Another word for penicillinase?

Back 33

Beta-lactamase.

Front 34

Name two natural penicillins.

Back 34

Penicillin G and Penicillin V.

Front 35

Name 3 types of semisynthetic penicillin.

Back 35

- Antistaphylococcal
- Aminopenicillin
- Extended Spectrum penicillins

Front 36

Antistaphyloccal Penicillin

Back 36

- Penicillinase resistant.
- Dicloxacillin
- Oxacillin
- Cloxacillin
- Nafcillin
- Methicillin (too toxic for clin. use)
- Not substitutes for Pen G in diseases susceptible to Pen G.
- Mainly for staph infections.
- NOT for Gnegs, atypicals, or anerobes.
- About half of dose eliminated by renal system, so generally do not require dose adjustment in renal failure

Front 37

- Dicloxacillin
- Oxacillin
- Cloxacillin
- Nafcillin
- Methicillin

Back 37

Antistaphylococcal Penicillin (Penicillinase resistant)

Front 38

Aminopenicillins

Back 38

- ampicillin and amoxacillin
- amino R group that increases lipid solubility.
- broader spectrum of activity than natural penicillins.
- Amoxicillin greater bioavailability than ampicillin.
- NOT penicillinase resistant.

- HELPS Enterococcus
- Haemophilus influenzae
- E. coli
- Listeria
- Proteus
- Spirochetes/Streptococcus
- Gpos and Gneg anaerobes (not C. difficile)
- not active on Pseudomonas or atypical organisms.

Front 39

Ampicillin and amoxacillin

Back 39

Aminopenicillins

Front 40

Aminopenicillin/β-lactamase Inhibitor Combinations

Back 40

ampicillin/sulbactam or amoxicillin/clavulanate

Front 41

ampicillin/sulbactam or amoxicillin/clavulanate

Back 41

Aminopenicillin/β-lactamase Inhibitor Combinations

Front 42

Extended Spectrum Penicillins

Back 42

- Largest R side chains that increase penetration via porins into gram (-) organisms.
- Less sensitive to B-lactamase.
- aka antipseudomonal penicillins
- most active against Pseudomonas aerguinosa.
- carbenicillin, ticarcillin (2nd best), mezlocillin and piperacillin (best).
- poor oral absorption

Front 43

Carbenicillin
A
Mezlocillin
Piperacillin.
Ticarcillin

Back 43

Extended spectrum penicillins.

Front 44

piperacillin/tazobactam or ticarcillin/clavulanate

Back 44

Extended Spectrum Penicillin/ β-lactamase Inhibitor Combinations

Front 45

Which kind of penicillin works best against Pseudomonas?

Back 45

Extended spectrum penicillins.

Front 46

Two molecules used to form bacterial peptidoglycans

Back 46

N-Acetylglucosamine and N-Acetylmuramic acid.

Only the NAM units have peptides hanging down

Front 47

What enzyme mediates a cross-linking rxn that strengthens the cell wall?

Back 47

glycopeptide transpeptidase

Penicillin blocks this step through formation of suicide inhibitor complex with the enzyme.

Front 48

MOA of penicillin

Back 48

Penicillin beta lactam ring binds to and competitively inhibits the transpeptidase enzyme (AKA penicillin-binding protein)

Front 49

t/f. glycopeptide transpeptidase is a penicillin binding protein.

Back 49

True.

Front 50

Do penicillins work on mycobacteria, protozoa, fungi, or viruses?

Back 50

No due to lack of cell wall.

Front 51

Penicillin's structure resembles what sequence of the native bacterial glycopeptide?

Back 51

D Ala - D Ala dipeptide.

Front 52

What is the key AA residue in the glycopeptide transpeptidase enzyme that forms a covalent bond to the opened B-lacta ring of penicillin and causes the cross linking rxn to stop?

Back 52

Serine.

Front 53

Mechanisms of Resistance to Penicillins - The 6 P's.

Back 53

Penetration
Porins (outher membrane)
Pumps
Penicillinase
Penicillin Binding Proteins
Peptidoglycan

Front 54

Bacteria targeted by natural penicillins.

Back 54

CESS

- C. perfringens - Gpos anaerobes (not difficile)
- Enterococci (Gpos)
- Spirochetes (syphilis)
- Streptococci (Gpos)

- gram (+): Listeria
- gram (-): Neisseria
- NOT gram (-) anaerobes

Front 55

Spectrum activity of natural penicillins

Back 55

Gpos: work well
Gneg: not as well; depend on outer membrane porins.

Don't work for intracellular organisms.

Front 56

Absorption of Penicillin G

Back 56

LOW oral absorption.
Only IV/IM routes.

Front 57

Absorption of Penicillin V

Back 57

Better oral stability and absorption.

Front 58

Distribution of penicillins

Back 58

- mostly ECF
- 60% bound to proteins.

-Poor penetration to CNS (however, inflamed meninges are more permeable to penicillin...thus more penicillin in serum on first day of treatment)

Front 59

Excretion of penicillins

Back 59

- Fairly rapid
- t1/2 = 30 - 60min
- eliminated by kidney
- PROBENECID can block active secrtion.
- Renal failure can elevate t1/2.
- require dose adjustment.

Front 60

Adverse rxns of penicillins

Back 60

hypersensitivity (Rash)
diarrhea
neurotoxicity (rare)

Front 61

Structure of Cephalosporins

Back 61

Similar to Penicillin
However, 2 R chains

R1 - antibacterial activity
R2 - PK and metabolism

Front 62

MOA of Cephalosporins

Back 62

Similar to penicillins
Inhibit last step of cell wall synthesis (transpeptidation)

Front 63

Cephalosporins don't work on what organisms?

Back 63

methicillin-resistant S. aureus (MRSA) or methicillin-resistant enterococcus

Front 64

2 advantages of cephalosporins over penicillins

Back 64

1. more resistance to B-lactamases
2. two R sites

Front 65

1st gen cephalosporin

Back 65

Dr FAZ and FAD did PHD in 1st class

CeFAZolin
CeFADroxil
CePHalexin
CePHradine

Front 66

Spectrum of activity and uses for 1st gen cephalosporin.

Back 66

- potential sub. for Pen G.
- Susceptible against Gneg (PEck)
- Proteus, E. coli, Klebsiella
- Not active against intracellular bacterias nor anaerobes.
- Used for skin and soft tissue infections and surgical prophylaxis.

Front 67

2nd gen cephalosporin

Back 67

The FACtory CAR PRObably ran over FUR.

CeFAClor
LoraCARbef
CefPROzil
CeFURoxime

Front 68

Spectrum of activity and uses for 2nd gen cephalosporin.

Back 68

- True cephalosporins
- No activity on anaerobes or atypicals.
- Target 3 more Gneg organisms in addition to PeCK.
- HENPeCK
- Haemophilus
- Enterobacter
- Neisseria
- Proteus
- E. coli
- c
- Klebsiella
- Used to treat respiratory infections.

Front 69

Cephamycins

Back 69

- Subgroup of 2nd gen cephs
- Methoxy group on B-lactam ring.
- limited activity against Gpos
- Parenterally ONLY.
- some anaerobic and falc. Gneg infections can be treated due to methoxy group

XITIN TETAN

CefoXITIN
CefoTETAN.

Front 70

Spectrum of activity and uses of 3rd gen cephalosporins.

Back 70

- Enhanced activity against Gneg bacteria. (HENPEcK)
- Weaker Gpos activity than 1st gen.
- Cefotaxime/Ceftriaxone - strep pneumo.
- Ceftriaxone - 1/day
- Ceftizoxime - anaerobes
- Ceftazidime - Pseudomonas
- Cefdinir, Cefixime

May suffer from susceptibility to the inducible β-lactamases of Enterobacter, Citrobacter, Providencia, Morganella and Serratia. Use 2nd gen first.

Cephalosporins May Prove Sub-Efficacious

Front 71

Ceftazidime

Back 71

- 3rd gen Cephalosporins.
- PARENTERALLY
- 95% renal excretion (dose adjustment required)
- Increased activity against Pseudomonal, but decreased Stalph/Strep efficacy.
- Not active on anaerobes or atypical.

Front 72

Ceftriaxone

Back 72

3rd gen cephalosporin
1/day
strep pneumo

Front 73

Cefotaxime

Back 73

3rd gen cephalosporin
strep pneumo

Front 74

Ceftizoxime

Back 74

3rd gen cephalosporin
Gpos and Gneg anaerobes

Front 75

Spectrum of activity and uses of 4th gen cephalosporins

Back 75

- modified R2.
- Extended spectrum of activity against Gpos and Gneg.
- Greater resistance to B-lactamase.
- PARENTERALLY
- Not active against MRSA, anaerobe, or atypical.
- Cefepime - pseudomonas, strep, and nosocomial infections.

Front 76

Cefepime

Back 76

4th gen. cephalosporin
Pseudomonas, Strep, and nosocomial infections.

Front 77

Adverse rxns to cephs

Back 77

Hypersensitivity, RASH
Nephrotoxicity (if combined with aminoglycosides)
Diarrhea - possibility of C. difficile overgrowth.

Front 78

Ceftobiprole

Back 78

- 5th gen ceph.
- Activity against MRSA, penicillin resistant Strep pnemuo, Pseudomonas, and Enterococci.
- No activity on anaerobes.
- PARENTERALLY.

Front 79

Bacteroides

Back 79

Gneg Anaerobes

Front 80

Clostridium

Back 80

Gpos Anaerobes

Front 81

Peptococcus & Peptostreptococcus

Back 81

Gpos anaerobes

Front 82

Stalph
Strep
Enterococcus
Listeria
Bacillus

Back 82

Gpos bugs

Front 83

HENPeCK

Haemophilus
E.coli
Neiseria
Proteus
Enterobacter
c
Klebsiella

Morganella, Shigella, Serratia, Citrobacter, Salmonella, Providencia, Campylobacter, Helicobacter, Bordetella, Vibrio

Back 83

Gneg bugs

Front 84

Acid-fast staining bugs

Back 84

Mycobacteria
Nocardia

Front 85

Chlamydia species
Mycoplasma species
Legionella pneumophila
Brucella species (G-)
Francisella tularensis (G-)
Rikettsia species (G- like)
Mycobacteria

Back 85

Atypical bugs.

Front 86

5th gen Ceph

Back 86

Ceftobiprole