微生物感染与抗生素基础
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细菌是单细胞微生物，它有两个外部层，即革兰氏阳性菌，或三个外部层，即革兰氏阴性菌。细菌壁的结构不同。杆菌是细长或棒状的；球菌是球形的。

  • 正确 (correct)
  • 错误

    • 病毒是最小的病原体，同时也是最坚韧的。

    True (A)

    真菌可以感染皮肤或皮下组织，主要的类型是什么？

    酵母菌 或霉菌

    哪些药物会抑制细菌的生长？

    <p>抑菌药 (B)</p> Signup and view all the answers

    哪些药物会杀死细菌？

    <p>杀菌药 (A)</p> Signup and view all the answers

    以下哪种描述是正确的？

    <p>两种抗生素的协同作用是指两种抗生素的效果之和 (A), 如果一种抗生素是杀菌剂而另一种是抑菌剂，则它们的组合效果会降低 (B), 两种抗生素的增效作用是指一种抗生素增强另一种抗生素的效果 (D)</p> Signup and view all the answers

    什么是窄谱抗生素？

    <p>主要对一种类型的细菌有效</p> Signup and view all the answers

    以下哪些因素会导致抗生素耐药性？

    <p>以上都是 (A)</p> Signup and view all the answers

    以下哪种抗生素耐药性指的是在没有接触过抗菌药物的情况下发生的？

    <p>自然或内在耐药性 (A)</p> Signup and view all the answers

    以下哪种抗生素耐药性指的是在接触过抗菌药物后发生的？

    <p>获得性耐药性 (B)</p> Signup and view all the answers

    以下哪种抗生素耐药性指的是当抗生素具有相似的作用时发生的？

    <p>交叉耐药性 (A)</p> Signup and view all the answers

    以下哪种感染是指在没有最近住院经历（1 年）的情况下获得的？

    <p>社区获得性感染 (B)</p> Signup and view all the answers

    以下哪种感染是指在患者在诊所或医院期间获得的？

    <p>医院获得性感染 (A)</p> Signup and view all the answers

    以下哪些是抗生素的常见副作用？

    <p>以上都是 (D)</p> Signup and view all the answers

    磺胺类药物的主要药物是什么？

    <p>甲氧苄啶-磺胺甲唑（复方新诺明）</p> Signup and view all the answers

    磺胺类药物的作用机制是什么？

    <p>抑制细菌叶酸的合成 (C)</p> Signup and view all the answers

    以下哪些情况是磺胺类药物的禁忌症？

    <p>以上都是 (A)</p> Signup and view all the answers

    以下哪些是磺胺类药物的副作用？

    <p>以上都是 (A)</p> Signup and view all the answers

    以下哪些药物与磺胺类药物相互作用？

    <p>以上都是 (E)</p> Signup and view all the answers

    以下哪些药物属于对青霉素酶耐药的青霉素？

    <p>以上都是 (A)</p> Signup and view all the answers

    青霉素的作用机制是什么？

    <p>β-内酰胺环干扰细菌细胞壁的合成，通过抑制细菌细胞生长和分裂所需的细菌酶</p> Signup and view all the answers

    以下哪些情况是青霉素的禁忌症？

    <p>以上都是 (D)</p> Signup and view all the answers

    以下哪些是青霉素的副作用？

    <p>以上都是 (C)</p> Signup and view all the answers

    以下哪些药物与青霉素相互作用？

    <p>以上都是 (D)</p> Signup and view all the answers

    第一代头孢菌素的药物有哪些？

    <p>头孢氨苄、头孢唑林</p> Signup and view all the answers

    头孢菌素的作用机制是什么？

    <p>头孢菌素具有β-内酰胺结构，通过抑制细菌细胞壁合成发挥作用，导致细菌死亡。</p> Signup and view all the answers

    以下哪些情况是头孢菌素的禁忌症？

    <p>以上都是 (D)</p> Signup and view all the answers

    以下哪些是头孢菌素的副作用？

    <p>以上都是 (B)</p> Signup and view all the answers

    以下哪些药物与头孢菌素相互作用？

    <p>以上都是 (C)</p> Signup and view all the answers

    如果患者对青霉素过敏，他们就更有可能对头孢菌素过敏。

    <p>True (A)</p> Signup and view all the answers

    如何正确静脉输注头孢菌素？

    <p>静脉输注头孢菌素应在 30 分钟内完成，以减少疼痛和刺激。</p> Signup and view all the answers

    红霉素类药物有哪些？

    <p>红霉素、克拉霉素、阿奇霉素</p> Signup and view all the answers

    红霉素类药物的作用机制是什么？

    <p>结合 50S 核糖体亚基并抑制蛋白质合成</p> Signup and view all the answers

    以下哪些情况是红霉素类药物的禁忌症？

    <p>以上都是 (E)</p> Signup and view all the answers

    以下哪些是红霉素类药物的副作用？

    <p>以上都是 (B)</p> Signup and view all the answers

    以下哪些药物与红霉素类药物相互作用？

    <p>以上都是 (B)</p> Signup and view all the answers

    四环素类药物的主要药物是什么？

    <p>多西环素</p> Signup and view all the answers

    四环素类药物的作用机制是什么？

    <p>抑制蛋白质合成 (B)</p> Signup and view all the answers

    以下哪些情况是四环素类药物的禁忌症？

    <p>以上都是 (D)</p> Signup and view all the answers

    以下哪些是四环素类药物的副作用？

    <p>以上都是 (B)</p> Signup and view all the answers

    以下哪些药物与四环素类药物相互作用？

    <p>以上都是 (D)</p> Signup and view all the answers

    氨基糖苷类药物有哪些？

    <p>链霉素、庆大霉素、卡那霉素、妥布霉素、阿米卡星</p> Signup and view all the answers

    氨基糖苷类药物的作用机制是什么？

    <p>抑制细菌蛋白质合成 革兰氏阴性菌 杀菌剂</p> Signup and view all the answers

    以下哪些是氨基糖苷类药物的副作用？

    <p>以上都是 (C)</p> Signup and view all the answers

    以下哪些药物与氨基糖苷类药物相互作用？

    <p>以上都是 (C)</p> Signup and view all the answers

    如何静脉输注氨基糖苷类药物？

    <p>在 50-200 毫升生理盐水中稀释，并在 30-60 分钟内输注。</p> Signup and view all the answers

    氟喹诺酮类 (喹诺酮类) 药物有哪些？

    <p>左氧氟沙星、莫西沙星、环丙沙星</p> Signup and view all the answers

    氟喹诺酮类 (喹诺酮类) 药物的作用机制是什么？

    <p>干扰细菌 DNA 回旋酶</p> Signup and view all the answers

    以下哪些情况是氟喹诺酮类 (喹诺酮类) 药物的禁忌症？

    <p>以上都是 (D)</p> Signup and view all the answers

    以下哪些是氟喹诺酮类 (喹诺酮类) 药物的副作用？

    <p>以上都是 (A)</p> Signup and view all the answers

    氟喹诺酮类 (喹诺酮类) 药物的“黑盒警告”指的是什么？

    <p>以上都是 (C)</p> Signup and view all the answers

    以下哪些药物与氟喹诺酮类 (喹诺酮类) 药物相互作用？

    <p>以上都是 (A)</p> Signup and view all the answers

    糖肽类: 万古霉素的作用机制是什么？

    <p>抑制细胞壁合成，革兰氏阳性菌，杀菌剂</p> Signup and view all the answers

    以下哪些情况是糖肽类: 万古霉素的禁忌症？

    <p>肾功能损害 (A)</p> Signup and view all the answers

    以下哪些是糖肽类: 万古霉素的副作用？

    <p>以上都是 (D)</p> Signup and view all the answers

    以下哪些药物与糖肽类: 万古霉素相互作用？

    <p>以上都是 (A)</p> Signup and view all the answers

    硝基咪唑类: 甲硝唑的作用机制是什么？

    <p>破坏 DNA 和蛋白质合成</p> Signup and view all the answers

    以下哪些是硝基咪唑类: 甲硝唑的副作用？

    <p>以上都是 (E)</p> Signup and view all the answers

    硝基咪唑类: 甲硝唑与酒精一起服用会导致双硫仑样反应。

    <p>True (A)</p> Signup and view all the answers

    阿昔洛韦主要用于哪些疾病？

    <p>单纯疱疹病毒 1 型和 2 型、带状疱疹（水痘带状疱疹病毒）</p> Signup and view all the answers

    奥司他韦的服用时间有什么要求？

    <p>必须在症状出现后 48 小时内开始服用。</p> Signup and view all the answers

    以下哪些是 HIV 感染的阶段？

    <p>以上都是 (B)</p> Signup and view all the answers

    什么是 HAART？

    <p>高度活跃抗逆转录病毒疗法</p> Signup and view all the answers

    HAART 的目标是什么？

    <p>以上都是 (B)</p> Signup and view all the answers

    两性霉素 B 是什么？

    <p>一种强效抗真菌药物，但有危险性</p> Signup and view all the answers

    制霉菌素是什么？

    <p>口服或局部使用</p> Signup and view all the answers

    以下哪些是制霉菌素的常见用途？

    <p>以上都是 (B)</p> Signup and view all the answers

    制霉菌素可以直接吞服。

    <p>False (B)</p> Signup and view all the answers

    Flashcards

    微生物感染 - 细菌

    单细胞微生物，分为革兰氏阴性和阳性，形态有细杆和球状。

    微生物感染 - 病毒

    最小的病原体，抵抗力最强。

    微生物感染 - 真菌

    酵母或霉菌，主要感染皮肤或皮下组织。

    抗生素基础 - 抑菌药物

    抑制细菌生长。

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    抗生素基础 - 杀菌药物

    杀死细菌。

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    抗生素基础 - 组合使用

    协同增效、拮抗作用在抗生素组合中发挥不同效果。

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    窄谱抗生素

    主要对一种细菌有效，如青霉素。

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    广谱抗生素

    对多种细菌有效，包括革兰氏阴性和阳性。

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    抗生素抵抗 - 自然抵抗

    没有接触过抗生素的细菌自带的抵抗力。

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    抗生素抵抗 - 获得性抵抗

    之前接触过抗生素后获得的抵抗力。

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    抗生素抵抗 - 交叉抵抗

    对相似作用机制的抗生素抵抗。

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    抗生素抵抗 - 社区感染

    未近期住院的人获得的感染。

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    抗生素抵抗 - 医院感染

    在医院或诊所中获得的感染，常因耐药细菌。

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    常见抗生素副作用

    过敏、超级感染、器官毒性、肠道不适等。

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    青霉素耐药性青霉素

    加入Beta-内酰胺酶抑制剂防止青霉素失效。

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    青霉素 - 结构与作用

    β-内酰胺环通过阻止细菌细胞壁合成起效。

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    头孢菌素 - 第五代药物

    ceftaroline，是唯一对MRSA有效的头孢菌素。

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    氟喹诺酮类 - 药物

    左氧氟沙星、莫西沙星、环丙沙星。

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    氟喹诺酮类 - 作用

    干扰DNA旋转酶，广谱消灭细菌。

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    氟喹诺酮类 - 黑框警告

    与伴随肌腱撕裂、副作用风险相关。

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    抗病毒药物 - 阿昔洛韦

    用于单纯疱疹和带状疱疹，可能致使局部炎症。

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    HIV阶段

    分为无症状期、早期、适中症状、重症期。

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    Study Notes

    Microbial Infections

    • Bacteria: Single-celled microorganisms; Gram-positive (2 outer layers) or Gram-negative (3 outer layers). Bacterial cell walls differ in structure. Shapes include bacilli (rod-shaped) and cocci (spherical).

    • Viruses: Smallest pathogens, considered tough.

    • Fungi: Yeasts or molds; infect skin or subcutaneous tissue.

    Antibiotic Basics

    • Bacteriostatic drugs: Inhibit bacterial growth.

    • Bactericidal drugs: Kill bacteria.

    • Combinations:

      • Additive: Combined effect is the sum of individual antibiotics.
      • Potentiative: One antibiotic enhances the other's effect.
      • Antagonistic: One bactericidal and one bacteriostatic; overall effect is reduced.

    • Narrow-spectrum antibiotics: Primarily effective against a single type of bacteria. Examples include penicillin and erythromycin.

    • Broad-spectrum antibiotics: Effective against both Gram-positive and Gram-negative bacteria. Examples include tetracyclines and cephalosporins.

    Antibiotic Resistance

    • Natural/Inherent resistance: Resistance occurs without prior exposure to antibiotics.

    • Acquired resistance: Resistance developed due to prior exposure to antibiotic treatment. A prime example is MRSA, resistant to many penicillins and most cephalosporins.

    • Cross-resistance: Resistance to similar antibiotics (penicillin and cephalosporins).

    • Community-associated infections: Infections acquired by individuals not recently hospitalized (within 1 year).

    • Healthcare-associated infections: Infections acquired during a hospital or clinic stay. A significant cause of death in the US.

    General Antibiotics Side Effects

    • Allergy/Hypersensitivity
    • Superinfection (e.g., thrush, C. difficile-associated diarrhea [CDAD])
    • Organ toxicity
    • Gastrointestinal distress
    • Stevens-Johnson Syndrome

    Sulfonamides

    • Drugs: Trimethoprim-sulfamethoxazole (Bactrim).

    • Mechanism of Action: Inhibit bacterial folic acid synthesis. It is bacteriostatic. Effective against a number of gram-negative bacteria such as Klebsiella and E. coli.

    • Contraindications: Allergy, severe kidney or liver disease, pregnancy/breastfeeding, infants.

    • Side effects: Stomatitis, photosensitivity, crystalluria, blood dyscrasias, skin reactions.

    • Drug Interactions: Increased anticoagulant effect with warfarin, increased hypoglycemic effect with oral hypoglycemics, increased potassium with ACE inhibitors & potassium-sparing diuretics. Increases digoxin levels; decreases effect of oral contraceptives.

    Penicillins

    • Penicillinase-resistant penicillins: Contain beta-lactamase inhibitors (e.g., amoxicillin-clavulanate, piperacillin-tazobactam, ticarcillin-clavulanate, ampicillin-sulbactam); designed to prevent inactivation of penicillin by bacterial enzymes; not given alone. Combinations like amoxicillin-clavulanate (Augmentin) orally, and piperacillin-tazobactam (Zosyn) parenterally extend the spectrum.

    • Structure & Action: Beta-lactam ring interferes with bacterial cell wall synthesis.

    • Contraindications: Allergy, asthma, severe colitis (pseudomembranous, ulcerative), IBD. Use caution in patients with impaired kidney function.

    • Side Effects: Seizures, anemia, leukopenia.

    • Drug Interactions: Decreased effect of oral contraceptives; increased bleeding with anticoagulants; decreased effect with tetracyclines and erythromycin; additive effect with aminoglycosides.

    Cephalosporins

    • Generations: Vary in their spectrum of coverage against various bacteria.

      • First-generation: Cephalexin, cefazolin; Primarily Gram-positive.
      • Second-generation: Cefaclor, cefoxitin; Some Gram-negative activity.
      • Third-generation: Cefoperazone, ceftriaxone; broader spectrum.
      • Fourth-generation: Cefepime, broad spectrum.
      • Fifth-generation: Ceftaroline; effective against MRSA.

    • Structure & Mechanism of Action: Beta-lactam structure, inhibits bacterial cell wall synthesis.

    • Contraindications: Allergy, gallbladder disease, severe colitis.

    • Side Effects: Pancytopenia, nephrotoxicity (especially in patients with pre-existing kidney issues).

    • Drug Interactions: Increased nephrotoxicity with loop diuretics; increased bleeding with anticoagulants; crystallization risk if given with calcium salts in the same IV line.

    • General Info: Common allergy exists in patients with penicillin allergies. IV infusions should be administered over 30 minutes to minimize discomfort and potential irritation.

    Macrolides

    • Drugs: Erythromycin, clarithromycin, azithromycin.

    • Mechanism of Action: Binds to 50S ribosomal subunits, inhibiting protein synthesis. Broad spectrum, primarily effective against Gram-positive and some Gram-negative bacteria. Bacteriostatic at low/moderate doses; bactericidal at high doses.

    • Contraindications: Allergy, bradycardia, hypokalemia, hypomagnesemia; Use caution in liver/kidney dysfunction, lactation.

    • Side Effects: Hearing impairment (ototoxicity), liver damage (hepatotoxicity).

    • Drug Interactions: Increased digoxin and warfarin effects; decreased penicillin and clindamycin effects.

    Tetracyclines

    • Drugs: Doxycycline

    • Mechanism of Action: Inhibits protein synthesis; broad spectrum (bacteriostatic or bactericidal).

    • Contraindications: Allergy, pregnancy, severe liver or kidney disease.

    • Side Effects: Photosensitivity, liver and kidney damage; permanent teeth discoloration, bone/teeth softening (avoid use in children).

    • Drug Interactions: Decreased effectiveness with antacids, decreases oral contraceptives' effect; increased digoxin absorption could lead to toxicity.

    • Food Interactions: Interactions with milk products, iron, and antacids.

    Aminoglycosides

    • Drugs: Streptomycin, gentamicin, kanamycin, tobramycin, amikacin

    • Action: Inhibit bacterial protein synthesis; effective against Gram-negative bacteria, bactericidal. Are toxic and dangerous.

    • Side Effects: Photosensitivity, hearing loss (ototoxicity), kidney damage (nephrotoxicity), nerve damage (peripheral neuropathy).

    • Drug Interactions: Increased nephrotoxicity with nonsteroidal anti-inflammatory drugs (NSAIDs), cephalosporins, loop diuretics, and vancomycin; increased ototoxicity with loop diuretics.

    • IV Administration: Dilute in 50-200 mL of D5W and infuse over 30-60 minutes.

    Fluoroquinolones

    • Drugs: Levofloxacin, moxifloxacin, ciprofloxacin

    • Action: Interfere with DNA gyrase; effective against both Gram-positive and Gram-negative bacteria, bactericidal.

    • Contraindications: Allergy, severe kidney disease, myasthenia gravis, pregnancy/breastfeeding. Use caution in seizure disorders, kidney/liver impairment, children under 14, older adults, and cardiac arrhythmias.

    • Side Effects: Hearing problems (tinnitus), heightened sensitivity to sunlight (photosensitivity), kidney damage (nephrotoxicity), potential for formation of crystals in urine (crystalluria); QT prolongation (rarely, severe).

    • Black Box Warning: Rare but serious adverse effects include tendon rupture, central nervous system effects, worsening myasthenia gravis, and peripheral neuropathy.

    • Drug Interactions: Increased effects of oral hypoglycemics and theophylline. Concurrent use with corticosteroids potentially increases risk of tendon rupture.

    Glycopeptides (Vancomycin)

    • Mechanism of Action: Inhibits cell wall synthesis; effective against Gram-positive bacteria; bactericidal.

    • Contraindications: Significant kidney impairment (requires dose adjustment if creatinine clearance <80 mL/min).

    • Side Effects: "Red man syndrome" (hypotension) with rapid IV administration, ototoxicity, nephrotoxicity.

    • Drug Interactions: Increased risk of nephrotoxicity with loop diuretics; masking of ototoxicity by some antihistamines.

    Nitroimidazoles (Metronidazole)

    • Action: Disrupts DNA and protein synthesis; effective against bacteria, amoebas, and Trichomonas; bactericidal, amoebicidal, trichomonacidal.

    • Side Effects: Headache, dizziness, discoloration of urine, peripheral neuropathy.

    • Alcohol Interaction: Disulfiram-like reaction (flushing, headache, visual disturbances, confusion, dyspnea, tachycardia, syncope, collapse)

    Other Drugs

    • Acyclovir: Oral, topical, and IV; treating herpes simplex 1 & 2, herpes zoster. Infuse slowly to avoid phlebitis. Side effects include phlebitis, injection site pain, headache, dizziness, nausea, vomiting, diarrhea.

    • Oseltamivir: Oral; treating influenza A & B. Must be started within 48 hours of symptoms onset.

    HIV

    • Stages: Asymptomatic, early, moderate, severe.

    • HAART (Highly Active Antiretroviral Therapy): Combination drug therapy that increases survival rates while decreasing symptoms, preventing opportunistic infections. Requires high levels of patient compliance (90%+).

    • HAART Goals: CD4 count > 200 cells/µL (ideally > 500). Viral load <50 copies/mL (undetectable).

    Antifungal Agents

    • Amphotericin B: Potent antifungal, administered intravenously in an ICU setting. Involves slow infusion (2-6 hours) and is associated with significant side effects: cardiac dysrhythmias, hypokalemia, hypomagnesemia. Pre-medication (acetaminophen, antiemetics, antihistamines, corticosteroids) is often used.

    • Nystatin: Oral and topical treatment for fungal infections. Various forms (powder, ointment) require specific application and administration procedures.

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    Description

    本测验涵盖微生物感染的基本知识，重点讨论细菌、病毒和真菌。还将探讨抗生素的类型及其作用机制，包括抑菌药和杀菌药。通过此测验，您将更好地理解抗生素的分类和应用。

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