Uti- Antibacterial Agents

Front 1

What type of agent are Penicillins

Back 1

Cell wall active agents

Front 2

Name the 4 classes of penicillins

Back 2

-natural penicillins

-antistaphylococcal penicillins

-amino-penicillins

-Extended spectrum penicillins

Front 3

Name 2 amino-penicillins

Back 3

-ampicillin

-amoxicillin

Front 4

Name 5 extended spectrum penicillins

Back 4

-carbenicillin

-ticarcillin

-azlocillin

-mezlocillin

-piperacillin (main one he wants us to know)

Front 5

What is the general structure of penicillin

Back 5

It is made of a 4 membered beta-lactam ring and 5 membered thizolidine ring

Front 6

Name the bacterial enzyme that penicillins target

Back 6

transpeptidase

Front 7

What is the mechanism of action of penicillins

Back 7

They bind to and acylate the bacterial transpeptidase enzyme and irreversibly inhibit it

Front 8

True or False: The acylation of transpeptidases by penicillins is a reversible process?

Back 8

FALSE.

Front 9

Bacterial enzyme transpeptidase is part of which family of proteins

Back 9

It is part of the Penicillin-Binding protein family

Front 10

True or False: Penicillins work on both static and actively growing bacteria in most cases

Back 10

FALSE. only work on actively growing bacteria

Front 11

Describe 2 ways bacteria confer resistance against penicillins

Back 11

-Some bacteria have a plasmid-encoded beta-lactamase which degrades the beta-lactame penicillins

- Bacteria can alter the target (PBP2 to PBP2a) of the penicillin thereby decreasing susceptibility to those agents

Front 12

Name 4 Gram- negative bacteria that most commonly cause UTIs

Back 12

- E. coli

- Klebsiella

- Proteus

-Pseudomonas

Front 13

Name 2 Gram-positive bacteria that cause UTIs

Back 13

-Enterococcus (group D strep)

-Staph. saprophyticus

Front 14

True or False: Ampicillin or Amoxicillin (aminopenicillins) can be used effectively against a range of gram-negative bacteria

Back 14

FALSE. most gram-negative bacteria are resistant, instead aminopenicillins should be used for the less common entercoccal (gram+) infections

Front 15

True or False: extended spectrum penicillins can be used effectively against a range of gram-negative bacteria including pseudomonas arginosa

Back 15

TRUE.

Front 16

What are the adverse effects (2) of using extended-spectrum penicillins

Back 16

- commonly causes allergic reactions (allergic interstitial nephritis), could be avoided by de-sensitiazation

- diarrhea, nausea, vomiting

Front 17

True or False: Beta-lactams can commonly cause allergic interstitial nephritis

Back 17

TRUE.

Front 18

True or False: beta-lactam/beta-lactamase inhibitors are often single antibiotic drugs

Back 18

FALSE. they are a combo of an beta-lactame with a beta-lactamase inhibitor

Front 19

Name two combo B-lactams/B-lactamase inhibitor

Back 19

amoxicillin/clavulanic acid (Augmentin)

piperacillin/tazobactam (Zoysn)

Front 20

True or False: Beta-lactamase inhibitors bind irreversibly to beta-lactamases

Back 20

TRUE

Front 21

What type of agents are cephalosporins

Back 21

cell wall active agents

Front 22

What do first generation cephalosporins effectively cover/treat

Back 22

staph, strep, and a few (wimpy) gram negative bacteria

Front 23

Name a first generation cephalosporin

Back 23

Cefazoline

Front 24

What do third generation cephalosporins effectively cover/treat

Back 24

most gram-negatives except pseudomonas

Front 25

What do third generation cephalosporins with pseudomonas activity effectively cover/treat

Back 25

most gram negatives including pseudomonas

Front 26

What do four generation cephalosporins effectively cover/treat

Back 26

gram negatives including pseudomonas

Front 27

Name a third generation cephalosporin

Back 27

ceftriaxone

Front 28

Name a third generation cephalosporin with pseudomonas activity

Back 28

ceftazidime

Front 29

Name a fourth generation cephalosporin

Back 29

Cefipime

Front 30

True or False: Third generation cephalosporins effectively treat gram negative bacteria and pseudomonas

Back 30

FALSE. third generation cephalosporins with pseudomonas activity treat gram negatives and pseudomonas, as well as fourth gen. cephalosporins

Front 31

True or False: Ceftriaxone is a third generation cephalosporin

Back 31

TRUE

Front 32

Name a cephalosporin (and its generation) that effectively covers step and staph infections as well as some gram negatives

Back 32

first generation cefazolin

Front 33

Name 2 cephalosporins that effectively cover pseudomonas infections

Back 33

Ceftazidime

Cefipime

Front 34

What is Ceftazidime used to treat and what is it administered with

Back 34

Ceftazidime is usually administered with a amino glycoside or quinolone

Front 35

In which cases would we use Cefipime (4th gen cephalosporin) instead of Ceftazidime (3rd gen ceph + pseud activity)

Back 35

It is used against strains that have inducible resistance

Front 36

What is the mechanism of action of cephalosporins

Back 36

cephalosporins typically have similar mechanism of action as penicillin- inhibit the transpeptidation reaction and D-alanine D-alanine cross-linking

Front 37

What is the structural similarities between cephalosporins and penicillins

Back 37

They both contain a beta-lactam ring

Front 38

What is the mechanism of resistance to cephalosporins

Back 38

beta-lactamases (cephalosporinases)

Front 39

True or False: Majority of the resistance to cephalosporins is chromosomally mediated

Back 39

False. majority is plasmid mediated

Front 40

Name the five bacteria that are hyper-producing beta-lactamase activity with is chromosomally mediated (SPICE)

Back 40

Serriatia, Providentia, Indole-positive Proteus, Citrobacter, and Enterobacter

Front 41

What are some adverse reactions that people have to cephalosporins

Back 41

there has been noted cross-reactivity with patients allergic to penicillin

Front 42

Name a Monobactam

Back 42

Aztreonam

Front 43

What class of agents does monobactam fall into

Back 43

cell-wall active agent

Front 44

True or False: Monobactams are effective in treating gram-positive infections and anaerobes

Back 44

FALSE. it is not useful in treating strep, staph, or anaerobes

Front 45

True or False: Monobactams are useful in the treatment of Pseudomonas

Back 45

True. They treat pseudomonas and enterobacteraceae

Front 46

True or False: Patients who have penicillin allergy could be given monobactams (aztreonam) instead since there is no cross reactivity

Back 46

TRUE. monobactams are good alternatives to those who have allergies to penicillins

Front 47

Name one carbapenem

Back 47

Imipenem

Front 48

What kind of agents are carbapenems

Back 48

they are beta-lactams and are cell wall active agents

Front 49

True or False: Carbapenems are hydrolyzed by Beta-lactamases

Back 49

FALSE. they are resistant to the activity of beta-lactamases, but are sensitive to metallo-beta-lactamases

Front 50

True or False: Resistance to imipenem does not confer resistance to cephalosporins

Back 50

True. cephalosporins are sensitive to beta-lactamases, whereas imipenems are sensitive to metallo-beta-lactamases

Front 51

True or False: Carbapenems are effective against most aerobes and anaerobes

Back 51

TRUE

Front 52

True or False: Carbapenems are very effective to use in treatment of abscesses and other anaerobic infections

Back 52

TRUE. carbapenems have an excellent anaerobic spectrum

Front 53

True or False: Imipenem is rapidly degraded by the brush border of the distal tubule by the enzyme dehydropeptidase

Back 53

False. Imipenem is hydrolyzed by the brush border in the proximal tubule by the enzyme dehydropeptidase.

Front 54

What is imipenem usually administered with to prevent degradation by dehydropeptidase

Back 54

cilistatin

Front 55

Name a side effect of Imipenem

Back 55

It has seizure activity

Front 56

True or False: Imipenem is clinically used mostly to treat resistant infections

Back 56

True. although it has a wide spectrum of action it is mainly used to treat resistant infections

Front 57

Name 3 carbapenems that are inherently stable against dehydropeptidase

Back 57

Meropenem, Ertapenem, Doripenem

Front 58

What class of antibiotic agents does Fosfomycin fall into

Back 58

It is a cell-wall active agent

Front 59

What condition is fosfomycin used to effectively treat.

Back 59

Cystitis

Front 60

What are sulfonamideas analogs of

Back 60

para-aminobenzoic acid used by bacteria in the synthesis of dihydrofolate

Front 61

What is the action of trimethoprim

Back 61

Trimethoprim inhibits the activity of bacterial enzyme dihydrofolate reductase in the synthesis of tetrahydrofolate

Front 62

True or False: Trimethoprim/Sulfas are effective against BOTH gram+ and gram- bacteria

Back 62

TRUE

Front 63

What are two ways that bacteria can be resistant to the actions of trimethoprim/sulfa

Back 63

- The dihydrotheorate synthase that is used in the first step can be genetically coded to have a weaker affinity for sulfonamide (plasmid mediated)

- Some bacteria may lack the enzymes required for TH4 synthesis and therefore be completely unaffected by trimethoprim/sulfas

Front 64

What are some drug interactions that trimethoprim/sulfas can have

Back 64

They have significant interactions with agents carried on plasma proteins such as Warfarin and bilirubin

Front 65

True or False: A person taking Warfarin should not take trimethoprim/sulfas because of increased risk of bleeding in these patients

Back 65

TRUE. the antibiotic will displace warfarin on albumin thus making the warfarin more active

Front 66

What are 2 side effects that people may have to trimethoprim/sulfa

Back 66

Allergy (fever, skin rashes, exfoliative dermatitis, photosensitivity, Steven-Johnson syndrome)

Front 67

Side effects of which antibiotic could produce Steven-Johnson syndrome

Back 67

Trimethoprim/Sulfonamide

Front 68

What is the mechanism of action of quinolones

Back 68

quinolone are DNA-gyrase and topoisomerase-IV inhibitors

Front 69

True or False: Quinolones are bacteriostatic

Back 69

FALSE. they are bactericidal

Front 70

True or False: Quinolones are effective in both static and actively replicating bacteria

Back 70

TRUE

Front 71

Describe the mechanism of resistance to quinolones

Back 71

Quinolones act on DNA-gyrase and topoisomeras-IV. Resistance would be confered via alteration in binding of the drug to the gyrase or topoisomerase

Front 72

What type of bacteria do Quinolones effectively treat

Back 72

Quinolones are effective against gram negative bacteria and pseudomonas infections

Front 73

True or False: Quinolones are effective against pseudomonas infections

Back 73

TRUE. Quinolones is the most active for pseudomonas infections

Front 74

Name a Quinolone

Back 74

Ciprofloxacin

Front 75

What are some of the side effects to Quinolones such as ciprofloxacin

Back 75

Can cause cartilage damage. Current Black Box warning for tendon damage

Front 76

What class of agents are aminoglycosides

Back 76

Amino glycosides are protein synthesis inhibitors

Front 77

True or False: Aminoglycosides are effective in treatment of abscesses and anaerobic infections

Back 77

FALSE. aminoglycosides require O2 dependents active transport process therefore they are not effective in oxygen poor environments

Front 78

True or False: Aminoglycoside activity is inhibited at low pH

Back 78

TRUE. transport of amino glycoside is coupled to proton pump, therefore low pH would inhibit the movement

Front 79

What is the mechanism of action of aminoglycosides

Back 79

interfere with the initiation complex of peptide formation at the 30S ribosomal subunit

Front 80

Are ahminoglycosides bacteriostatic or bactericidal

Back 80

Bactericidal

Front 81

Name two side-effects of aminoglycosides

Back 81

-nephrotoxicity

-ototoxicity and vestibular toxicity

Front 82

True or False: Pertaining to Aminoglycosides efficacy is related to the peak of concentration while toxicity is related to the trough of concentrations

Back 82

TRUE

Front 83

How do you minimize toxicity (trough) and increase efficacy (peak) of aminoglycosides

Back 83

You would push a larger dose less frequently, rather than a smaller dose more frequently

Front 84

Name 2 aminoglycoside and what do they all typically end in

Back 84

streptomycin & amikacin

-they all typically end in -cin

Front 85

What is unique about streptomycin

Back 85

It is administered IM

Front 86

What are the indication for use of aminoglycosides

Back 86

-treatment of gram negative rod infections

-used in combination therapy with beta-lactams for pseudmonas and enterococcus infections

Front 87

Which of the ahminoglycosides is most effective against gram negative bacteria

Back 87

amikacin

Front 88

True or False: Aminoglycosides are effective for use in systemic infections

Back 88

FALSE. useful only in the treatment of cystitis

Front 89

Trur or False: Nitrofurantion is an antiseptic rather than a antibiotic

Back 89

TRUE

Front 90

What is nitrofurantoin used to treat, and how do it chemical properties contribute to its effectiveness

Back 90

- used to treat cystitis

-It has good oral absorption, and renal excretion, and does not accumulate in tissue, rather effective concentration levels are only reached in the bladder

Front 91

What are the adverse effects of nitrofurantoin

Back 91

-could cause chronic pulmonary fibrosis which has no treatment and is life threatening (1/40,000 cases)

Front 92

What is Methanamine

Back 92

It is a urinary tract antiseptic

Front 93

True or False: Methenamine is an antiseptic that could used to treat upper UTI's

Back 93

FALSE.

Front 94

Name 6 drugs/ drug classes that can be used for treatment of Pseudomonas infections

Back 94

-Extended-spectrum penicillin

-Ceftazadime

-Cefepime

-Aztreonam

-Ciprofloxacin (Quinolone)

-Aminoglycosides (in combo with beta-lactams)

Front 95

True or False: Aminoglycosides have both renal and GI excretion

Back 95

FALSE. Renal only

Front 96

True or False: Aminoglycosides have minimal adverse effects hence monitoring and dosing adjustments are readily needed as with other drug classes

Back 96

FALSE. aminoglycosides can be very nephrotoxic and therefore doing adjustment and close monitoring is required.