Term
| What is a natural substance produced by one microbe to kill other microbes? |
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Definition
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Term
| What are three types of antimicrobials? |
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Definition
| antibacterial antifungal antiviral |
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Term
| What are some factors to consider when choosing an agent to treat an infection? |
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Definition
cost
drug toxicity
drug kinetics
type of infection
host defense
microbe susceptibility to drug
drug dynamics |
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Term
| What is an agent that inhibits growth of a microbe but does not kill microbes? |
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Definition
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Term
| Do bacteriostatic agents reduce the number of viable microbes? |
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Definition
| does not reduce number of viable microbes |
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Term
| What kills remaining microbes after a bacteriostatic agent has been administered? |
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Definition
| need functional immune system to reduce remaining microbes |
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Term
| Drugs that reversibly inhibit bacterial protein are examples of what type of agent? |
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Definition
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Term
| What type of agent kills susceptible microbes as well as reducing the number of viable microbes? |
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Definition
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Term
| What type of agent is exemplified by drugs that inhibit bacterial cell wall synthesis? |
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Definition
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Term
| In what conditions might a drug be bacteriostatic and bactericidal? |
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Definition
Many bacterial agents are bacteriostatic at low concentrations and bactericidal at higher concentrations
(A few antimicrobial agents are bactericidal against some microbes but bacteriostatic against others) |
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Term
| The ability to *kill* microbes depends on the length of *time* concentration of antimicrobial is above what? |
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Definition
| above the minimum *bactericidal* concentration (MBC) |
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Term
| The ability to *inhibit* further microbe growth depends on the length of *time* concentration of antimicrobial is above what? |
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Definition
| above the minimum *inhibitory* concentration (MIC) at the site of infection |
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Term
| The ability to kill microbes increases as what aspect of an antimicrobial drug increases? |
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Definition
| concentration of antimicrobial |
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Term
| Aminoglycoside and fluoroquinolone antibiotics exhibit what pharmacodynamic principle? |
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Definition
| concentration-dependent killing rate |
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Term
| What pharmacodynamic principle is displayed as microbial death or inhibition of growth continues for a period of time after concentration of drug drops below the MBC or MIC at site of infection |
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Definition
| PAE post antibiotic effect |
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Term
| On what aspect of infection does the post-antibiotic effect depend? |
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Definition
| Depends on antimicrobial and specific bacterial species |
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Term
| When dealing with severe infection or immunosuppressed pts, would a bacteriostatic or bactericidal agent be more effective? |
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Definition
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Term
| Combination antimicrobial therapy involves two or more agents with what characteristics? |
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Definition
| two or more agents with different mechanisms of action |
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Term
| When dealing with particularly resistant microbes, infections at sites that are difficult to reach, polymicrobial infections, or when it is necessary to decrease emergence of resistance, what type of antimicrobial therapy should be used? |
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Definition
| Combination antimicrobial therapy |
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Term
| What type of effect is desirable when using combination antimicrobial therapy? |
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Definition
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Term
| Do most antibacterial agents use time-dependent or concentration dependent mechanisms? |
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Definition
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Term
| A pt presents with an infection involving gram (+), gram (-), and anaerobic bacteria. What type of antimicrobial therapy is indicated? |
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Definition
| combination antimicrobial therapy or broad-spectrum antibiotic |
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Term
| A pt presents with a diabetic foot infection and intra-abdominal wound infection. What type of antimicrobial therapy is indicated? |
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Definition
| combination antimicrobial therapy or broad-spectrum antibiotic |
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Term
| What are 4 ways in which pathogens can be identified? |
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Definition
site of infection
gram stain
adequate culture
host factors |
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Term
| Community, nosocomial (hospital), age, immune status are examples of what method of identifying pathogens? |
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Definition
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Term
| Disk diffusion, broth dilution, and Etest method test what? |
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Definition
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Term
| Regarding the inoculum effect, susceptibility testing is done on what? |
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Definition
| Susceptibility testing done on standard concentration (inoculum) of bacterial isolate (10^5-10^6 bacteria per mL) |
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Term
| Regarding the inoculum effect, actual infections may have greater or lower concentration than tests? |
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Definition
| Actual infection (usually severe) may have greater concentration |
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Term
| Regarding the inoculum effect, if the actual MIC at site of infection is much higher than reported by lab (as sometimes happens), what could result? |
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Definition
| this could lead to antibiotic failure |
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Term
| Do susceptibility reports usually list whether bacteria is sensitive or resistant to antibiotics tested, or do they usually report actual MIC for each antibiotic? |
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Definition
| Usually susceptibility reports only list whether bacteria is sensitive or resistant to antibiotics tested; do not list actual MIC for each antibiotic |
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Term
| Are bacteria usually reported as being sensitive to a single antibiotic or multiple antibiotics? |
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Definition
| Usually bacteria is reported to be sensitive to multiple antibiotics |
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Term
| In selecting an agent and dose is it more desirable to have a wide or narrow margin between achievable serum concentration and the MIC or MBC? |
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Definition
| wide margin between achievable serum concentrations and the MIC or MBC |
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Term
| Is it more desirable to select the most narrow or the broadest spectrum agent? |
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Definition
| *Always try to select most narrow spectrum agent* |
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Term
| Is the resistance seen in many bacterial species over the last 50 years of antibiotic era and example of acquired or intrinsic resistance? |
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Definition
| Acquired resistance via gene transfer; a new 'gene pool' has been created |
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Term
| Resistance of gram-negative bacteria to vancomycin is an example of what type of resistance? |
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Definition
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Term
| Enteric bacterial resistance to penicillin is an example of what type of resistance? |
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Definition
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Term
| Anaerobic bacterial resistance to aminoglycosides is an example of what type of resistance? |
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Definition
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Term
| Experiments demonstrating multiple drug resistance processes involved newly hatched chickens fed how much oxytetracycline? |
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Definition
| *subtherapeutic* amounts of oxytetracycline |
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Term
| In the experiment demonstrating multiple drug resistant processes, what occurred in human intestinal E. coli of farm family members after 6 mos? |
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Definition
| human intestinal E. coli now MDR (multi-drug resistant) although family not taking antibiotics or eating chickens. (Intestinal flora of control chickens and farm neighbors remained normal) |
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Term
| According to Stuart Levy, MD, "Antibiotics are unique among pharmaceuticals in that they treat" who? |
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Definition
| "populations as well as individuals. One's bacteria is not solely one's own. Rather they are shed, excreted, and otherwise spread into the environment, where they become part of a common pool." |
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Term
| Regarding genetics of bacterial resistance, are point mutations on a chromosome a fast or slow process? |
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Definition
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Term
| Regarding genetics of bacterial resistance, is genetic transfer via plasmids a fast or slow process? |
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Definition
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Term
| Regarding genetics of bacterial resistance, is transfer of genetic information via transposons a fast or slow process? |
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Definition
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Term
| What are strands of DNA with 100-300 genes that are able to duplicate and pass between cells of like or unlike species? |
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Definition
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Term
| What effect involves differences in concentrations in vitro and in vivo samples? |
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Definition
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Term
| What are small gene strands able to jump from chromosome to plasmid and from cell to cell? |
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Definition
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Term
| Where do multiple drug resistant (MDR) genes link together? |
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Definition
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Term
| What are the 3 mechanisms of antibiotic resistance? |
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Definition
1. Decreased drug entry into the cell
2. Inactivation of drug
3. Alteration of drug target site |
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Term
| What mechanism of antibiotic resistance involves less penetration through porons and greater efflux of antibiotics from cell (tet M)? |
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Definition
| decreased drug entry to cell |
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Term
| What mechanism of antibiotic resistance involves beta-lactamase enzymes in periplasmic space and acetylating enzymes against aminoglycosides? |
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Definition
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Term
| What mechanism of antibiotic resistance involves penicillin binding proteins (PBP), ribosomes, and DNA gyrase? |
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Definition
| alteration of drug target site |
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Term
| Is an oral or parental route of administration safer? |
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Definition
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Term
| Bioavailablity, drug/nutrient interactions preventing absorption, and GI irritability are limitations of what route of administration? |
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Definition
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Term
| What is the fastest route of administration giving the highest concentrations? |
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Definition
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Term
| Toxicity (including catheter infections), complexity of care, and cost are limitations of what route of administration? |
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Definition
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Term
| What route of administration is ideal? |
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Definition
Ideally, use effective parenteral agent that can also be directy converted to oral form.
(some antibiotics can only be given parenterally or orally) |
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Term
| Are high or low antibiotic concentrations expected in well-perfused tissues (plasma, mm, kidney, etc.)? |
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Definition
| High antibiotic concentrations and successful treatment expected in well-perfused tissues (plasma, mm, kidney, etc.) |
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Term
| Are high or low antimicrobial concentrations expected at infection sites not readily penetrated by most antimicrobials (bone, brain, prostate, abscesses, infected heart valves, etc.)? |
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Definition
| Low antimicrobial concentrations and increased failure rates expected at infection sites not readily penetrated by most antimicrobials (bone, brain, prostate, abscesses, infected heart valves, etc.) |
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Term
| What are 2 ways antimicrobials are excreted? |
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Definition
| Some antimicrobials metabolized by liver while many are excreted unchanged through bile tract or kidney |
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Term
| What is the relevance of the CYP 450 enzyme system for metabolism? |
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Definition
| Some antimicrobials may induce or inhibit the metabolism of other drugs that depend on the CYP 450 enzyme system for metabolism. |
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Term
| What condition requires adjustment of doses of antimicrobials that are renally excreted? |
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Definition
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Term
| When treating lower UTIs, are drugs preferred that are excreted via the kidneys or the biliary tract? |
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Definition
| renally excreted antimicrobials preferred |
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Term
| Are drugs for UTIs generally given in higher or lower doses than drugs given for systemic infections? |
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Definition
| Doses generally lower than for systemic infections due to high concentrations in the urine- reduces chances for toxicity |
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Term
| Regarding toxicity, how must antimicrobial drugs be balanced? |
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Definition
| Must balance enough dose to kill microbe at site of infection but not enough to be toxic to human cells |
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Term
| What type of reactions to antimicrobial drugs is most common? |
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Definition
| HSN rxn most commmon (sulfa, penicillin) |
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Term
| Toxicity is usually related to what aspect of drugs? |
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Definition
| dose of antimicrobial agent |
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Term
| Phlebitis from parenteral agents, photosensitivity rxns, and GI intolerance result from what aspect of antimicrobial medications? |
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Definition
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Term
| Is renal failure a side effect of drug toxicity? |
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Definition
| Renal failure possible for select drugs |
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Term
| What is defined as an infection secondary to use of broad spectrum agents over a period of time? |
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Definition
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Term
| What are the most common superinfections? |
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Definition
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Term
| Hepatotoxicity and serum sickness are examples of what type of reaction to antimicrobial drugs? |
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Definition
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Term
| What determines the choice of antimicrobial, dose, route, duration, and whether to use a combination regimen? |
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Definition
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Term
| What type of infections involve bacteria that have spread to multiple organ systems and involves a greater chance of sepsis? |
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Definition
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Term
| Fever, chills, hypotension, shock, organ failure secondary to production of endotoxins produced by bacteria are characteristic of what condition? |
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Definition
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Term
| Do blood, brain, and bone infections require mild or aggressive treatment? |
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Definition
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Term
| What condition is defined by an absolute neutrophil count (ANC) < 500/mL^3? |
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Definition
| immuno-incompetence (can occur after chemo, with immunosuppresive drugs such as steroids or monoclonal Ab's) |
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Term
| Advanced diabetics being more prone to infections is an example of what type of disease state? |
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Definition
| concomitant disease state |
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Term
| How do infected prosthesis (jt replacements, etc) usually need to be treated? |
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Definition
| usually need to be removed- difficult to sterilize with antimicrobials |
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Term
| How do infected catheters usually need to be treated? |
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Definition
| Infected catheters need to be removed- difficult to sterilize (catheters provide entry site for surface bacteria) |
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Term
| Is the acquisition cost of drugs an example of direct or indirect costs? |
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Definition
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Term
| Do direct or indirect costs depend on the cost of individual unit and duration of therapy? |
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Definition
direct costs
(can range from pennies to thousands of dollars) |
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Term
| Are labor costs for parenteral administration (nursing and pharmacy time, bags, tubing, infusion devices, etc) examples of indirect or direct costs? |
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Definition
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Term
| Are monitoring costs (chemistries, cultures, pharmacokinetic analysis, etc) examples of direct or indirect costs? |
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Definition
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Term
| Do adverse rxns cause direct or indirect costs? |
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Definition
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Term
Drug resistance,
Drug selection,
Subtherapeutic dosing,
Monotherapy,
Poor penetration at site of infection, and Inadequate duration
should be considered to prevent what? |
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Definition
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Term
| What type of therapy is used during dental and oral procedures to prevent endocarditis in pts with valvular heart disease? |
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Definition
| prophylactic antibacterial therapy |
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Term
| What type of therapy is used during surgical procedures to prevent systemic infection from bacteria on the skin or in the GI tract? |
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Definition
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Term
| What type of therapy is used in prevention of infection during invasive procedures? |
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Definition
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Term
| When should prophylactic antibacterial therapy be given? |
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Definition
| *Give before procedure, not during!* |
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Term
| What type of therapy is given to prevent disease transmission to close contacts of infected persons? |
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Definition
| prophylactic antibacterial therapy (meningococcal infection, TB, influenza) |
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