Term
| Clindmycin and Gentamycin |
|
Definition
| Empiric therapy- combination antibiotics |
|
|
Term
|
Definition
| Single broad-spectrum antibiotic |
|
|
Term
|
Definition
| Single broad-spectrum antibiotic |
|
|
Term
|
Definition
| Weaken cell wall and promote bacterial lysis |
|
|
Term
|
Definition
| Weaken cell wall and promote bacterial lysis |
|
|
Term
|
Definition
| Weaken cell wall and promote bacterial lysis |
|
|
Term
|
Definition
| Inhibit and enzyme that is needed for bacterial production of Folic Acid (from PABA) |
|
|
Term
|
Definition
| Inhibits dihydrofolate release and chokes off the reaction from Dihydrofolic acid to Tetrahydrofolic acid in bacteria |
|
|
Term
| Sulfonamides and Trimethoprim |
|
Definition
| Combo drugs given for pneumonia |
|
|
Term
|
Definition
|
|
Term
|
Definition
Narrow spectrum, high specificity
GRAM POSITIVE COCCI, GRAM NEGATIVE BACILLI |
|
|
Term
|
Definition
| Penicillanase-resistant penicillin for Gram-positive cocci and gram-negative bacilli |
|
|
Term
|
Definition
| Penicillanase-resistant penicillin for Gram-positive cocci and gram-negative bacilli |
|
|
Term
|
Definition
| Narrow-spectrum antibiotic for Gram-positive cocci and Gram-negative bacilli |
|
|
Term
|
Definition
| Narrow-spectrum antibiotic for Gram-positive cocci and Gram-negative bacilli |
|
|
Term
|
Definition
| Narrow-spectrum antibiotic for Gram-positive cocci and Gram-negative bacilli |
|
|
Term
| Aminoglycosides-gentamycin |
|
Definition
| Narrow-spectrum antibiotic for Gram-negative aerobes |
|
|
Term
|
Definition
| Narrow-spectrum antibiotic for Gram-negative aerobes |
|
|
Term
| Drugs for mycobacterium tuberculosis (RIPE) |
|
Definition
| Rifampin, Isoniazid, Pyrazinamide, Ethambutol |
|
|
Term
|
Definition
| Broad spectrum for Gram positive and negative microorganisms |
|
|
Term
|
Definition
| Extended-spectrum penicillin for gram positive and negative microorganisms |
|
|
Term
|
Definition
| A sulfonamide- inhibits production of folic acid |
|
|
Term
|
Definition
| Fluoroquinolone for broad spectrum |
|
|
Term
|
Definition
| Fluoroquinolone for broad spectrum |
|
|
Term
|
Definition
| Doesn't metabolize well- use in urinary tract infections |
|
|
Term
|
Definition
| Doxorubicin, bleomycin, vinblastine, dacarbazine- ANTI CANCER |
|
|
Term
|
Definition
| Calcium Channel Blocker specific to heart |
|
|
Term
|
Definition
Serotonin-receptor antagonist- drug to treat nausea and vomiting
FIRST LINE |
|
|
Term
|
Definition
Serotonin-receptor antagonist- drug to treat nausea and vomiting
FIRST LINE |
|
|
Term
|
Definition
Serotonin-receptor antagonist- drug to treat nausea and vomiting
FIRST LINE |
|
|
Term
|
Definition
Antidopaminergic drug for nausea and vomiting
SECOND LINE |
|
|
Term
|
Definition
Antidopaminergic drug for nausea and vomiting
SECOND LINE |
|
|
Term
|
Definition
Antidopaminergic drug for nausea and vomiting
SECOND LINE |
|
|
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 |
|
|
Term
|
Definition
| Spread to secondary sites |
|
|
Term
| From what do cancer cells arise? |
|
Definition
| Normal-renewal stem cells (tumor stem cells; ancestral cells) |
|
|
Term
| What part of the life cycle of a cell do cancer cells fail at that normal cells accomplish? |
|
Definition
|
|
Term
| What are 3 alterations found in cancer cells? |
|
Definition
Cell surface antigens are different;
Enzymes are different
Oncogenes |
|
|
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 |
|
|
Term
| How do cancer cells produce nutritional deficits and weight loss? |
|
Definition
| They have a high metabolic rate |
|
|
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 |
|
|
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 |
|
|
Term
| What is myelosuppression? |
|
Definition
| Chemotherapy that reduces bone marrow |
|
|
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) |
|
|
Term
| Name 2 M-phase drug classes: |
|
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 |
|
|
Term
| What shape is the growth curve of tumors and what does signify? |
|
Definition
| Sigmoid-shaped- doubling time varies with tumor size |
|
|
Term
|
Definition
| Killing of 90% of tumor cells |
|
|
Term
|
Definition
| Killing of 99% of tumor cells |
|
|
Term
| What is clinical remission? |
|
Definition
| When an effective drug kills 99.9% of clonogenic tumor cells |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
Term
| What is an example of a type of tumor that exhibits primary resistance? |
|
Definition
| Non-small cell lung cancer; colon cancer |
|
|
Term
| What is primary resistance? |
|
Definition
| Absence of response on first exposure |
|
|
Term
| What is acquired resistance? |
|
Definition
| Resistance that develops in previously drug-sensitive tumors |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
Term
| What are 2 classes of drugs given to treat nausea and vomiting in chemotherapy? |
|
Definition
Serotonin receptor antagonists
Antidopaminergics |
|
|
Term
| In what two regions of the medulla do antiemetics appear to act? |
|
Definition
Chemoreceptor trigger zone (CTZ)
Vestibular Apparatus |
|
|
Term
| What class of drugs is most effective in managing nausea and vomiting associated with chemotherapy or radiotherapy? |
|
Definition
| Serotonin-receptor antagonists- FIRST LINE |
|
|
Term
| What are the two important receptors in the chemoreceptor trigger zone? |
|
Definition
D2- dopamine 2 receptors
5HT3- serotonin receptors |
|
|
Term
| How is significant thrombocytopenia managed in cancer patients? |
|
Definition
| Transfusion of platelet concentrates |
|
|
Term
| What is the definition of an antibiotic? |
|
Definition
| A chemical produced by a microorganism that has the ability to harm other microbes |
|
|
Term
|
Definition
Presumptive- use of antimicrobials before the pathogen for a particular illness is known
Based on experience with a CLINICAL ENTITY |
|
|
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 |
|
|
Term
| What are the two lines of empiric therapy (drugs)? |
|
Definition
Combo- clinamycin and gentamycin
Single- imipenem or cilastatin |
|
|
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 |
|
|
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 |
|
|
Term
| If you give empiric therapy and the culture report is mixed, what do you do? |
|
Definition
| Continue therapy as initiated |
|
|
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 |
|
|
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 |
|
|
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) |
|
|
Term
| What happens if there is a mutation in bacterial porin? |
|
Definition
| The drug can get to, but not INTO the microbe |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
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 |
|
|
