Term
Clindmycin and Gentamycin |
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Definition
Empiric therapy- combination antibiotics |
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Term
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Definition
Single broad-spectrum antibiotic |
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Term
|
Definition
Single broad-spectrum antibiotic |
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Term
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Definition
Weaken cell wall and promote bacterial lysis |
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Term
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Definition
Weaken cell wall and promote bacterial lysis |
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Term
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Definition
Weaken cell wall and promote bacterial lysis |
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Term
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Definition
Inhibit and enzyme that is needed for bacterial production of Folic Acid (from PABA) |
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Term
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Definition
Inhibits dihydrofolate release and chokes off the reaction from Dihydrofolic acid to Tetrahydrofolic acid in bacteria |
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Term
Sulfonamides and Trimethoprim |
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Definition
Combo drugs given for pneumonia |
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Term
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Definition
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Term
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Definition
Narrow spectrum, high specificity GRAM POSITIVE COCCI, GRAM NEGATIVE BACILLI |
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Term
|
Definition
Penicillanase-resistant penicillin for Gram-positive cocci and gram-negative bacilli |
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Term
|
Definition
Penicillanase-resistant penicillin for Gram-positive cocci and gram-negative bacilli |
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Term
|
Definition
Narrow-spectrum antibiotic for Gram-positive cocci and Gram-negative bacilli |
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Term
|
Definition
Narrow-spectrum antibiotic for Gram-positive cocci and Gram-negative bacilli |
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Term
|
Definition
Narrow-spectrum antibiotic for Gram-positive cocci and Gram-negative bacilli |
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Term
Aminoglycosides-gentamycin |
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Definition
Narrow-spectrum antibiotic for Gram-negative aerobes |
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Term
|
Definition
Narrow-spectrum antibiotic for Gram-negative aerobes |
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|
Term
Drugs for mycobacterium tuberculosis (RIPE) |
|
Definition
Rifampin, Isoniazid, Pyrazinamide, Ethambutol |
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Term
|
Definition
Broad spectrum for Gram positive and negative microorganisms |
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Term
|
Definition
Extended-spectrum penicillin for gram positive and negative microorganisms |
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Term
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Definition
A sulfonamide- inhibits production of folic acid |
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Term
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Definition
Fluoroquinolone for broad spectrum |
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Term
|
Definition
Fluoroquinolone for broad spectrum |
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Term
|
Definition
Doesn't metabolize well- use in urinary tract infections |
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Term
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Definition
Doxorubicin, bleomycin, vinblastine, dacarbazine- ANTI CANCER |
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Term
|
Definition
Calcium Channel Blocker specific to heart |
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Term
|
Definition
Serotonin-receptor antagonist- drug to treat nausea and vomiting FIRST LINE |
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Term
|
Definition
Serotonin-receptor antagonist- drug to treat nausea and vomiting FIRST LINE |
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|
Term
|
Definition
Serotonin-receptor antagonist- drug to treat nausea and vomiting FIRST LINE |
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Term
|
Definition
Antidopaminergic drug for nausea and vomiting SECOND LINE |
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Term
|
Definition
Antidopaminergic drug for nausea and vomiting SECOND LINE |
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Term
|
Definition
Antidopaminergic drug for nausea and vomiting SECOND LINE |
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|
Term
Recombinant thrombopoietin |
|
Definition
For cytopenias- reduces need for transfusion due to reduced Hct in chemo patients |
|
|
Term
What is selective toxicity? |
|
Definition
Trying to target the cell cycle of only cancer drugs while minimizing damage to healthy cells SELECTIVE KILLING |
|
|
Term
How do cancer cells invade surrounding tissue? |
|
Definition
Secretion of proteolytic enzymes |
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Term
|
Definition
Spread to secondary sites |
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|
Term
From what do cancer cells arise? |
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Definition
Normal-renewal stem cells (tumor stem cells; ancestral cells) |
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|
Term
What part of the life cycle of a cell do cancer cells fail at that normal cells accomplish? |
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Definition
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|
Term
What are 3 alterations found in cancer cells? |
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Definition
Cell surface antigens are different; Enzymes are different Oncogenes |
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|
Term
How can cell alterations in cancer cells be used to our advantage as doctors? |
|
Definition
Immunologic techniques to use the changes as tumor markers for diagnosis and treatment |
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|
Term
How do cancer cells produce nutritional deficits and weight loss? |
|
Definition
They have a high metabolic rate |
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|
Term
What is the origin of the vast majority of cancer cells? |
|
Definition
Clonal origin- they arise as a consequence of a series of mutations on critical genes |
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|
Term
What is the definition of clonogenic as relates to tumor cells? |
|
Definition
Colony-forming capacity- a small subpopulation of cells undergoes repeated cycles of proliferation and can migrate to different sites in the body |
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|
Term
What is myelosuppression? |
|
Definition
Chemotherapy that reduces bone marrow |
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|
Term
What is chemotherapeutic index? |
|
Definition
A way to describe selective toxicity The ratio of a drugs toxicity to cancer cells over its toxicity to normal cells (Toxicity is measured in LD50- the lethal dose for 50% of the cell population) |
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|
Term
Name 2 M-phase drug classes: |
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Definition
|
|
Term
What are 3 factors in tumor growth rate? |
|
Definition
-proportion of actively dividing cells (Growth Fraction) -length of the cell cycle (Doubling Time) -Rate of cell loss- wear and tear- apoptosis |
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|
Term
What shape is the growth curve of tumors and what does signify? |
|
Definition
Sigmoid-shaped- doubling time varies with tumor size |
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|
Term
|
Definition
Killing of 90% of tumor cells |
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|
Term
|
Definition
Killing of 99% of tumor cells |
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|
Term
What is clinical remission? |
|
Definition
When an effective drug kills 99.9% of clonogenic tumor cells |
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|
Term
How do we overcome the limited log kill of individual cancer drugs? |
|
Definition
Administer combinations of drugs with different toxicities and mechanisms of action |
|
|
Term
What is a pharmacologic sanctuary? |
|
Definition
A place, like the CNS or testes, where effective drug concentrations are difficult to achieve |
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|
Term
What is required for the use of CCS drugs? (Cell Cycle Specific) |
|
Definition
The tumor stem cells must be in the sensitive phase of the cell cycle for that drug |
|
|
Term
In what types of cancer are frequent treatments most effective? |
|
Definition
Leukemia, Hodgkins Disease, Testicular Cancer, Lymphoma- tumor cell kill exceeds regrowth |
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|
Term
What are the 3 things that combination chemotherapy accomplishes that single-agent therapy does not? |
|
Definition
-maximum cell kill within the range of drug toxicity -broader range of coverage of resistant cell lines in a heterogenous tumor -prevents or slows development of new drug-resistant cell lines |
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|
Term
What is an example of a type of tumor that exhibits primary resistance? |
|
Definition
Non-small cell lung cancer; colon cancer |
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|
Term
What is primary resistance? |
|
Definition
Absence of response on first exposure |
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|
Term
What is acquired resistance? |
|
Definition
Resistance that develops in previously drug-sensitive tumors |
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|
Term
What is drug resistance usually based on? |
|
Definition
Change in the genetic apparatus of the tumor with amplification or increased expression of one or more genes |
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|
Term
What is usually involved in multi-drug resistance to chemotherapy? |
|
Definition
MDR1 gene has increased expression- codes for P GLYCOPROTEIN -involved in drug efflux- uses ATP to expel foreign molecules |
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|
Term
|
Definition
A transport molecule responsible for multi-drug resistance in cancer cells -2 binding sites for ATP- only one is involved in drug transport |
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|
Term
What types of drugs can reverse multi-drug resistance experimentally? |
|
Definition
Calcium Channel Blockers- verapamil, quinidine, cyclosporin |
|
|
Term
What is the consequence of overexpression of MRP? |
|
Definition
Multidrug Resistance Protein- ATP-binding transmembrane transporter -INCREASES RESISTANCE TO anthracylcines, vinca alkyloids |
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|
Term
Can you name six anticancer drugs susceptible to MDR-1 resistance? |
|
Definition
Anthracyclines Vinca Alkyloids Paclitaxel (Taxol) Etoposide Mitomycin (Mutamycin) Plicamycin (Mithramycin) |
|
|
Term
For what types of cancer would you administer endocrine therapy? |
|
Definition
Prostate, breast, endometrium |
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|
Term
|
Definition
Biologic response modifiers to enhance endogenous immune cell kill; tumor vaccines |
|
|
Term
What is important about reproductive gland tumors as far as treatment? |
|
Definition
Reproductive glands are steroid sensitive and their tumors are too |
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|
Term
What are some symptoms of low WBC counts as a result of myelosuppression? |
|
Definition
fever, sore throat, cough, SOB, congestion, dysuria, shaking chills, redness and swelling at the site of an injury |
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|
Term
What are some symptoms of low RBC counts as a result of myelosuppression? |
|
Definition
Fatigue, dizziness, headaches, irritability, SOB, increase in heart rate and breathing |
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|
Term
What are the consequences of low platelet count in chemotherapy? |
|
Definition
Bruising easily, bleeding longer than normal, bleeding gums and nose bleeds, large bruises, petechiae, serious internal bleeding |
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|
Term
What are 2 classes of drugs given to treat nausea and vomiting in chemotherapy? |
|
Definition
Serotonin receptor antagonists Antidopaminergics |
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|
Term
In what two regions of the medulla do antiemetics appear to act? |
|
Definition
Chemoreceptor trigger zone (CTZ) Vestibular Apparatus |
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|
Term
What class of drugs is most effective in managing nausea and vomiting associated with chemotherapy or radiotherapy? |
|
Definition
Serotonin-receptor antagonists- FIRST LINE |
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|
Term
What are the two important receptors in the chemoreceptor trigger zone? |
|
Definition
D2- dopamine 2 receptors 5HT3- serotonin receptors |
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|
Term
How is significant thrombocytopenia managed in cancer patients? |
|
Definition
Transfusion of platelet concentrates |
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|
Term
What is the definition of an antibiotic? |
|
Definition
A chemical produced by a microorganism that has the ability to harm other microbes |
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|
Term
|
Definition
Presumptive- use of antimicrobials before the pathogen for a particular illness is known Based on experience with a CLINICAL ENTITY |
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|
Term
What justifies empirical therapy? |
|
Definition
Risk of death, causes no harm, if disease is contagious, if early intervention works better, for process of elimination |
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|
Term
What are the two lines of empiric therapy (drugs)? |
|
Definition
Combo- clinamycin and gentamycin Single- imipenem or cilastatin |
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|
Term
If you give empiric therapy and the culture report is gram positive, what do you do? |
|
Definition
Continue gram positive coverage, discontinue gram negative and anaerobic coverage |
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|
Term
If you give empiric therapy and the culture report is gram negative only, what do you do? |
|
Definition
Continue gram negative coverage and discontinue gram positive and anaerobic coverage |
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|
Term
If you give empiric therapy and the culture report is mixed, what do you do? |
|
Definition
Continue therapy as initiated |
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|
Term
If you give empiric therapy and the culture report is anaerobic only, what do you do? |
|
Definition
Continue anaerobic coverage, discontinue gram positive and gram negative coverage |
|
|
Term
What is culture and sensitivity? |
|
Definition
A measure of how susceptible or resistant a bug is to a drug |
|
|
Term
What are 3 ways that selective toxicity is achieved? |
|
Definition
Disrupt bacterial cell wall Disrupt bacterial protein synthesis (macrolides) Inhibit an enzyme unique to bacteria |
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|
Term
How do cephalosporins and penicillins work on bacteria? |
|
Definition
They weaken the cell wall and promote bacterial lysis INHIBIT MUREIN SYNTHESIS |
|
|
Term
How is mammalian folic acid acquired? |
|
Definition
Nutritional/dietary sources |
|
|
Term
How is bacterial folic acid acquired? |
|
Definition
|
|
Term
How do sulfonamides suppress bacterial growth? |
|
Definition
Inhibit the synthesis of folic acid from PABA |
|
|
Term
What enzyme do sulphonamides inhibit and how? |
|
Definition
Dihydropteroate synthase, by competing with PABA |
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|
Term
What inhibits Diydrofolate reductase and what does it accomplish? |
|
Definition
Trimethoprim- chokes off the synthesis of tetrahydrofolic acid |
|
|
Term
What class of drugs inhibits DNA gyrase? |
|
Definition
|
|
Term
|
Definition
Minimum Inhibitory Concentration- an antimicrobial should be present in concentrations such that it can either inhibit growth or kill the organism (minimum bactericidal concentration, MBC) |
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|
Term
What happens if there is a mutation in bacterial porin? |
|
Definition
The drug can get to, but not INTO the microbe |
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|
Term
What are 3 factors determining resistance or limited susceptibility? |
|
Definition
Failure of a drug to reach its target, drug inactivation, target alteration |
|
|
Term
What is important about the outer membrane of gram negative bacteria? |
|
Definition
It is a barrier that excludes large polar molecules from entering the cell |
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|
Term
How do small polar molecules enter gram negative bacteria? |
|
Definition
|
|
Term
How do bacteria become resistant to Gentamicin? |
|
Definition
A deficiency in transport of the drug by mutating the pathway that maintains the electrochemical gradient required to move it into the cell |
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|
Term
How is the electrochemical gradient generated that is required for the transport of Gentamicin and other drugs into the bacterial cell? |
|
Definition
Specific enzymes couple electron transfer and oxidative phosphorylation |
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|
Term
What are 5 drugs for which resistance can be established by bacterial expressing efflux pumps to transport them out of the cell? |
|
Definition
Tetracyclines, chloramphenicol, fluoroquinolones, macrolides, beta lactam antibiotics |
|
|
Term
What do the MDR gene make? |
|
Definition
The efflux pump that aids in bacterial drug resistance |
|
|
Term
Why is levofloxacine used in UTIs? |
|
Definition
It doesn't metabolize well so winds up intact in the urinary tract |
|
|
Term
How is resistance to aminoglycosides and Beta lactam antibiotics established? |
|
Definition
Bacterial production of enzymes that modify or destroy the antibiotic |
|
|
Term
What is unique about resistance of TB against Isoniazid? |
|
Definition
Typically, TB converts isoniazid from a prodrug to its active form. If it loses this ability, resistance develops |
|
|
Term
What type of drug most promotes resistance? |
|
Definition
Broad spectrum antibiotics |
|
|
Term
What is superinfection and how is it defined? |
|
Definition
A new infection that appears during the course of treatment for a primary infection -antibiotic use limits the inhibitory influence of normal flora, allowing a second bug to flourish |
|
|
Term
What type of drugs are most likely to cause superinfection? |
|
Definition
Broad spectrum antibiotics |
|
|
Term
What are the 3 principle factors in selecting antibiotics? |
|
Definition
Identity of organism Drug sensitivity of organism Host factors (site of infection, status of host defenses) |
|
|
Term
What characterizes a "drug of choice" in antibiotic administration? |
|
Definition
Greater efficacy, lower toxicity, very narrow spectrum (rifle) |
|
|
Term
What happens if sulfonamides are given to newborns? |
|
Definition
Kernicterus, a neurological disorder caused by displacement of bilirubin from plasma proteins |
|
|
Term
What causes kernicterus in newborns? |
|
Definition
|
|
Term
What do tetracyclines do to developing teeth? |
|
Definition
|
|
Term
What causes discoloration in developing teeth? |
|
Definition
Tetracyclines; too many oreos |
|
|
Term
What is an additive response? |
|
Definition
The antimicrobial effect of a combination is equal to the sum of the effects of the drugs alone |
|
|
Term
What is a potentiative/synergistic interaction? |
|
Definition
The effect of the combination of drugs is GREATER than the sum of the individual drugs- one drug must show at least a 4fold increase in antibacterial activity |
|
|
Term
What is the synergistic action of Trimethoprim and sulfamethoxazole? |
|
Definition
Blockade of sequential steps in metabolic sequence of folic acid |
|
|
Term
What is the synergistic action of beta-lactams and beta-lactamase inhibitors? |
|
Definition
Kill, and promote enzymatic inactivation of the killer |
|
|
Term
How do penicillins synergize with aminoglycosides? |
|
Definition
They enhance the uptake of aminoglycosides in staphylococci and enterococci |
|
|
Term
What is an antagonistic response? |
|
Definition
The combo of two agents is less effective than one of the agents by themselves |
|
|
Term
Chloramphenicol and penicillin together are examples of ... |
|
Definition
Antagonistic agents in the treatment of pneumococcal meningitis |
|
|
Term
Tetracycline is________ to penicillin |
|
Definition
|
|
Term
Where are mixed infections most common? |
|
Definition
Brain abscesses, pelvic infections, and perforation of abdominal organs |
|
|
Term
What is the main disease in which combinations are always employed? |
|
Definition
|
|
Term
What is the mechanism of action of penicillins? |
|
Definition
Binding to penicillin binding proteins |
|
|
Term
What is the mechanism of action of tetracyclines? |
|
Definition
Attack bacterial 30S ribosome |
|
|
Term
What is the mechanism of action of aminoglycosides? |
|
Definition
|
|
Term
What is the mechanism of action of quinolones? |
|
Definition
|
|
Term
What is the mechanism of action of cephalosporins? |
|
Definition
|
|
Term
What is the mechanism of action of macrolides? |
|
Definition
Attack bacterial 50S ribosome |
|
|
Term
What is the most commonly used method to test susceptibility to antibiotics? |
|
Definition
|
|
Term
What antibiotics inhibit cell wall synthesis? |
|
Definition
Penicillins, cephalosporins, imipenem, vancomycin |
|
|
Term
What antibiotics disrupt cell wall membranes? |
|
Definition
Amphotericin B, ketoconazole |
|
|
Term
What antibiotics are bacteriostatic inhibitors of protein synthesis? |
|
Definition
Clindamycin, erythromycin, tetracyclines |
|
|
Term
What antibiotics interfere with bacterial DNA or RNA synthesis? |
|
Definition
Fluoroquinolones, rifampin |
|
|
Term
What antibiotic inhibits mycolic acid synthesis? |
|
Definition
|
|
Term
What is a bacteriostatic drug? |
|
Definition
It inhibits bacterial GROWTH (does not kill) |
|
|
Term
What is the cause of staphylococcal resistance to methicillin? |
|
Definition
Production of low-affinity variant of penicillin binding proteins (PBPs) |
|
|
Term
How is resistance transmitted horizonatally between individual bacteria? |
|
Definition
|
|
Term
By what mechanism can multiple resistance genes be transferred in a single event? |
|
Definition
Direct transfer of resitant genes by cell to cell contact through a sex pilus or bridge (CONJUGATION_ |
|
|
Term
What is conjugation, and in what type of bugs is it most common? |
|
Definition
Direct transfer of resitant genes by cell to cell contact through a sex pilus or bridge -gram negatives |
|
|
Term
What two DNA segments constitute the resistance factor (R factor)? |
|
Definition
One that codes for the mechanism of resistance One that codes for the sexual apparatus needed to transfer the DNA |
|
|
Term
Resistance to fluoroquinolone is seen in.... |
|
Definition
|
|
Term
Resistance to penicillin is seen in... |
|
Definition
|
|
Term
Resistance to vancomycin is seen in... |
|
Definition
|
|
Term
What type of antimicrobials are best in an immunocompromised host? |
|
Definition
|
|
Term
Why is endocarditis hard to treat? |
|
Definition
Bacterial vegetations in the heart are difficult to penetrate |
|
|
Term
Why are infected abscesses hard to target/treat? |
|
Definition
Poor vascularity and the presence of pus and other material |
|
|
Term
At what speed do neonates eliminate drugs and why? |
|
Definition
Slowly due to poorly developed kidney and liver functions |
|
|
Term
What is the main adverse reaction to using gentamycin during pregnancy? |
|
Definition
|
|
Term
What are the consequences of using tetracyclines during pregnancy? |
|
Definition
Hepatic necrosis, pancreatitis, renal damage |
|
|
Term
What are 3 antibiotics associated with a high incidence of allergic response? |
|
Definition
Sulfonamides, trimethoprim, erythromycin |
|
|
Term
What happens if patients whose RBCs are deficient in G6PD take sulfonamides? |
|
Definition
|
|
Term
What two gram-positive bacteria transfer antibiotic resistance via conjugation? |
|
Definition
|
|
Term
What two gram-positive bacteria transfer antibiotic resistance via conjugation? |
|
Definition
|
|
Term
Under what 3 clinical circumstances is it best to administer prophylactic antibiotics? |
|
Definition
Surgery Bacterial Endocarditis Neutropenia |
|
|