T2 - Micro - Pharm - Antibiotics

Front 1

what's MIC and MBC?

Back 1

minimum inhibitory concentration and minimum bacteriosidal concentration.

note that these are values given by a lab when culturing an infectious organism.

note also that bacteriostatic drugs have the MIC (they're not bacteriosidal, except in the case of chloramphenocol, which can become killer at high concentration)

bacteriosidal drugs can have an MIC and an MBC - at lower concentrations, they might be bacteriostatic.

Also note - in immune compromised patients, it's better to use bacteriosidal drugs - that way you're not depending on their immune system to clean up.

Front 2

what's interesting about folic acid?

Back 2

bacteria can't uptake folic acid from the environment - they must produce it on their own. this makes the synthesis of folic acid a reasonable target for bacteria while not harming the human host.

Front 3

what's unique about aminoglycosides?

Back 3

they bind IIREVERSIBLY to their target, which just happens to be the 30s ribosomal subunit. Recall that bateria have 70s ribosomes, broken up into 50s and 30s.

(for fun, remember that humans have 80s ribosomes broken up into 40s and 60s subunits).

Front 4

how are cell walls created? what enzyme? how does it work? what targets it?

Back 4

cell walls depend on the D-Ala-D-ala tail to be cros linked with other tails from other peptidoglycan molecules.

this linking is done by TRANSPEPTIDASE - this is

Front 5

how does MRSA get resistant?

Back 5

mutated PBP sites.

Front 6

what's weird about benzathine and procaine?

Back 6

these can be given intramuscularly and maintain a useful concentration for weeks at a time.

Front 7

can penicillin cross the BBB?

Back 7

only when there's an active infection going on - active transport of WBC's and such into the CNS - then, useful concentrations of penicillin can get into the brain

Front 8

what's naficillin? what other drugs are cleared the same way?

Back 8

naficillin is a penicillin like drug that's also useful against staph infection (naf = staph). This is one of our beta lactamase resistant super penicillins.
they're resistant to the beta lactimases in staph.

also note that it's excreted mostly into the bile - so it's safer for people with kidney failure.

The other drug listed that you don't have to worry about AT ALL with kidney patients (excreted into the bile) is CEFTRIAXONE.

So, Naficillin and CefTriaxOne are fine to use in people with kidney problems.

Note the corollary - you can't use these for UTI's because they won't reach the site of infection.

in addition to naficillin, oxacillin, dicloxacillin, and cloxacillin are excreted by both kidney and bile - so people with kidney problems can take it.

Front 9

what antibiotics can be taken orally?

Back 9

amoxacillin, ampicillin, and dicloxacillin.

cloxacillin too, i think. Pen V.

Vancomycin (only in C-diff)

Cephalosporins (first gen)

Front 10

what can be treated with penicillin G?

what's the oral version of penicillin G? all reasonable info:

what's probenecid?

Back 10

streptococcus, enterococcus, meningococcus.

gram negative cocci - these are the neisserias (gonorrhea and meningitis)

bacillus

clostridium (not dificil)

spirochetes.

oral version of penicillin G is penicillin V


from notes: lysis from high internal osmotic pressure. also inactivates repressor of intrinsic AUTOLYSINS in the bacteria.

little activity against gram - rods.

has IgE mediated hypersensitivity = anafalaxis, or IgM mediated = delayed, rash/urticaria.

serum halflife = 35 minutes.
Probenecid can prolong life (most is secreted into tubules, stop this).

Front 11

what are some drugs related to nafricillin? what class is this? what do they fight

Back 11

this class of drugs is the penicillins which are resistant to certain beta lactamases.

naficillin is related to methycillin, and the iso-xazolyl penicillins).

these include oxacillin, cloxacillin, dicloxacillin (remember that these are excreted by the bile and the kidney).

good for staph infections.

Front 12

so we've talked about normal penicillins, those with beta lactamase resistance...what's the last kind, and what make them up? diseases treated?

Back 12

extended spectrum antibiotics - these are better at gram negatives and have the ability to cross the outer membrane.


NOTE - big addition here is the ability to kill H. Influenze!!!!! Also H. Pylori.
these include the amino-penicillins (amoxacillin and ampicillin). note that amoxacillin is better when taken orally.

Also include here Carbinicillin (indaryl = UTI)
and Ticaricillin.

And pipericillin.

We're adding klebsiella and pseudomonas aeruginosa with the last couple.

Front 13

methycillin - important info from the notes?

Back 13

It's used for determining drug resistances to penicillins (MRSA)

Front 14

what are we supposed to know about amoxicillin?

Back 14

used to treat UTI's, sinusitis, otitis, and lower respiratory tract infections.

Front 15

indanyl carbinicillin - what to know?

Back 15

used to treat UTI's.

Front 16

ticarcillin? to know?

Back 16

given with clavulanate to inhibit beta lactamases.

Front 17

what's clavulanate related to? used with what?

Back 17

clavulanate is related to tazobactam and sulbactam. these are beta lactamase inhibitors and can be given with drugs that need this feature - often includes ampicillin, amoxicillin, and ticarcillin.

Front 18

what's a carbapanem?

Back 18

imipeneman and meropenem.

imipenem is highly resistant to beta lactamase, lots of activity. given with CILASTIN to keep it from being digested by the kidney.

Meropanem - all about gram negative aerobes.

Front 19

aztreonam?

Back 19

monobactam - good ONLY against gram negative rods, no activity against the usual gram positive targets of antibiotics.

Front 20

so what's the difference between monobactams and carbepenems?

Back 20

monobactams are ineffective against gram positive and aerobes.

carbepenems are pretty broad spectrum.

Front 21

If we want to start killing anerobes, what should we be using?

Back 21

Clindimycin

Even Pen can do C. Perfinges.

Metronidazole (C. Diff) + Vancomycin Orally.

Ticaricillin
Piperacillin
Imipenem (kills everything)

Cefoxitin
Chloremphenocol (in a pinch)

Front 22

What don't you take if you're preggers?

Back 22

Metronidazole (uses DNA damage mechanism = flippers).

Tetracycline (retardation of bone growth)

Fluroquinolones (cartilege toxcisity in lots of babies).

Chloramphenocol (unless you like gray babies).

Front 23

what are our cell wall inhibitors that are okay in Pen allergies?

Back 23

Aztreonam and vancomycin. Note negative and positive coverage, respectively.

Front 24

What inhibits p450? Induces?

Back 24

our inducer is RIFAMPICIN.

Inhibitors include:

erythromycin, clarithromycin, ketoconazole. Grisiofulvan too