Anaphylaxis and Penicillin Allergy Review
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What is the difference between an antibiotic and an antimicrobial drug?

  • Antibiotics are synthetic, while antimicrobial drugs are natural.
  • Antibiotics have a broader spectrum of activity compared to antimicrobial drugs.
  • Antibiotics are produced by one microbe, while antimicrobial drugs can be natural or synthetic. (correct)
  • Antibiotics are produced by humans, while antimicrobial drugs are naturally occurring.

    • Why are narrow-spectrum antibiotics generally preferred over broad-spectrum antibiotics?

  • Narrow-spectrum antibiotics have less microbial activity.
  • Broad-spectrum antibiotics target only specific microorganisms.
  • Broad-spectrum antibiotics are more effective against a wide variety of microbes.
  • Narrow-spectrum antibiotics are less likely to disrupt the normal microbiota. (correct)

    • What is one of the challenges mentioned in the text regarding current antibiotic effectiveness?

  • Evolving microbial resistance (correct)
  • Limited availability of broad-spectrum antibiotics
  • Lack of toxicity in effective drugs
  • Microorganisms that respond well to available drugs

    • How have modern antimicrobial agents impacted morbidity and mortality from infection?

    <p>Reduced morbidity and mortality</p> Signup and view all the answers

    Why is continued progress needed in antimicrobial therapy despite impressive advances?

    <p>Due to microbial resistance, limited drug use, and poor drug response in organisms</p> Signup and view all the answers

    What characteristic defines a broad-spectrum antibiotic?

    <p>Active against a wide variety of microbes</p> Signup and view all the answers

    Which group of drugs disrupt specific biochemical reactions by either decreasing the synthesis of essential cell constituents or synthesizing nonfunctional analogs of normal metabolites?

    <p>Antimetabolites</p> Signup and view all the answers

    Which drugs promote bacterial lysis and death by weakening the cell wall?

    <p>Drugs that cause lethal inhibition of bacterial protein synthesis</p> Signup and view all the answers

    Which microorganism is currently a serious problem due to drug resistance?

    <p>Staphylococcus aureus</p> Signup and view all the answers

    What is the mechanism through which microbes can resist antimicrobial drugs by altering the structure of drug target molecules?

    <p>Altering drug target molecules</p> Signup and view all the answers

    Which gene encodes a powerful form of β-lactamase that can inactivate various β-lactam antibiotics?

    <p>NDM-1 gene</p> Signup and view all the answers

    In what way do antimicrobial drugs mostly act on microbes?

    <p>Intracellularly</p> Signup and view all the answers

    Which mechanism do microbes use to reduce the concentration of certain drugs at their site of action?

    <p>Ceasing active uptake of drugs</p> Signup and view all the answers

    Which type of resistance mechanism involves producing a drug antagonist?

    <p>Producing a drug antagonist</p> Signup and view all the answers

    Which group of drugs disrupts bacterial DNA and RNA synthesis by binding directly to nucleic acids or interacting with enzymes?

    <p>Drugs that disrupt DNA function</p> Signup and view all the answers

    What is the main concern associated with acquired resistance to antibiotics?

    <p>Clinical crisis and need for new antimicrobial agents</p> Signup and view all the answers

    What is the primary reason why antibiotics promote resistance?

    <p>Antibiotics kill off sensitive organisms, favoring the growth of drug-resistant organisms.</p> Signup and view all the answers

    How do spontaneous mutations contribute to resistance in microbes?

    <p>They produce random changes in DNA that gradually increase resistance.</p> Signup and view all the answers

    What is a characteristic of conjugation in bacteria?

    <p>It requires unique DNA segments for both drug resistance and DNA transfer mechanisms.</p> Signup and view all the answers

    How do broad-spectrum antibiotics contribute to the emergence of resistance compared to narrow-spectrum antibiotics?

    <p>Narrow-spectrum antibiotics kill more normal flora.</p> Signup and view all the answers

    What is the role of R factors in antibiotic resistance?

    <p>R factors combine DNA segments for drug resistance and DNA transfer mechanisms.</p> Signup and view all the answers

    Why are health care-associated infections (HAIs) particularly difficult to treat?

    <p>Resident organisms in hospitals are extremely drug-resistant.</p> Signup and view all the answers

    What is a superinfection?

    <p>A new infection that arises during treatment for a primary infection due to elimination of normal flora.</p> Signup and view all the answers

    How do antimicrobial drugs contribute to the overgrowth of resistant pathogens?

    <p>They eliminate sensitive organisms, favoring the growth of resistant ones.</p> Signup and view all the answers

    Why is it important for providers not to prescribe antibiotics casually or indiscriminately?

    <p>To prevent the emergence of resistance and superinfections.</p> Signup and view all the answers

    What should be the therapeutic objective when treating infections with antibiotics?

    <p>To produce maximal antimicrobial effects while minimizing harm to the host.</p> Signup and view all the answers

    What is one of the drawbacks of using multiple antibiotics?

    <p>Increased risk for toxic and allergic reactions</p> Signup and view all the answers

    Why should antimicrobial combinations be used only when clearly indicated?

    <p>To avoid drug-resistant bacteria selection</p> Signup and view all the answers

    What percentage of antibiotics used in the United States are administered for prophylaxis?

    <p>30% to 50%</p> Signup and view all the answers

    Why is misuse of antibiotics common according to the text?

    <p>Due to improper dosage and treatment of viral infections</p> Signup and view all the answers

    How are penicillins classified within the antibiotic family?

    <p>As beta-lactam antibiotics</p> Signup and view all the answers

    What is the primary mechanism of action of beta-lactam antibiotics on bacteria?

    <p>Weakening and rupture of the cell wall</p> Signup and view all the answers

    What adverse effects are commonly associated with penicillins?

    <p>Allergic reactions</p> Signup and view all the answers

    Why are penicillins considered ideal antibiotics?

    <p>Because they have low direct toxicity and wide bacterial activity</p> Signup and view all the answers

    What are the three principal factors that must be considered when choosing an antibiotic?

    <p>Identity of the infecting organism, drug sensitivity of the infecting organism, and host factors</p> Signup and view all the answers

    What is the first rule of antimicrobial therapy?

    <p>Match the drug with the bug</p> Signup and view all the answers

    What is a potentiative interaction in terms of antimicrobial therapy?

    <p>An interaction where the effect of the combination is greater than the sum of individual effects</p> Signup and view all the answers

    What technique is recommended for identifying microorganisms quickly and simply?

    <p>Gram-stained microscopic examination</p> Signup and view all the answers

    In what cases would a broad-spectrum antibiotic be initially used?

    <p>When treatment must be initiated before culture results are available</p> Signup and view all the answers

    What should be adjusted in dosages to ensure effective antimicrobial therapy?

    <p>Drug concentration equal to MIC levels or greater</p> Signup and view all the answers

    When should positive identification of an infecting organism be established?

    <p>As soon as possible after beginning treatment without a definitive diagnosis</p> Signup and view all the answers

    'Matching the drug with the bug' in antimicrobial therapy refers to:

    <p>'Choosing an antibiotic that targets the infecting organism'</p> Signup and view all the answers

    Which drug is the first broad-spectrum penicillin in clinical use?

    <p>Ampicillin</p> Signup and view all the answers

    What is the most common side effect associated with ampicillin?

    <p>Rash</p> Signup and view all the answers

    Which penicillin is preferred for oral therapy due to its acid stability?

    <p>Amoxicillin</p> Signup and view all the answers

    What is the mechanism of action of cephalosporins and penicillins?

    <p>Disruption of cell wall synthesis</p> Signup and view all the answers

    Which microorganism is susceptible to piperacillin but not to most extended-spectrum penicillins?

    <p>Pseudomonas aeruginosa</p> Signup and view all the answers

    Why are ampicillin and amoxicillin ineffective against most infections caused by S. aureus?

    <p>Low resistance to β-lactamases</p> Signup and view all the answers

    What differentiates amoxicillin from ampicillin in terms of diarrhea side effects?

    <p>Amoxicillin causes milder diarrhea</p> Signup and view all the answers

    What is the role of β-lactamase inhibitors in extending the spectrum of penicillins?

    <p>Inhibit bacterial β-lactamases</p> Signup and view all the answers

    Why must piperacillin be administered parenterally?

    <p>Drug's acid lability</p> Signup and view all the answers

    Which drug can cause bleeding secondary to disrupting platelet function?

    <p>Piperacillin</p> Signup and view all the answers

    What is the term used to refer to the combination between a small molecule and a larger molecule that stimulates antibody formation?

    <p>Hapten-protein</p> Signup and view all the answers

    What is the general rule for patients with a history of anaphylaxis or severe allergic reactions to penicillin regarding cephalosporin therapy?

    <p>Avoid cephalosporins</p> Signup and view all the answers

    Why are nafcillin, oxacillin, and dicloxacillin used selectively against penicillinase-producing strains of staphylococci?

    <p>Narrow antimicrobial spectrum</p> Signup and view all the answers

    What is the primary difference between penicillin V and penicillin G?

    <p>Acid stability</p> Signup and view all the answers

    Why should penicillin V be taken with meals?

    <p>To improve acid stability</p> Signup and view all the answers

    What is the purpose of desensitization in administering penicillin?

    <p>To eliminate allergic reactions</p> Signup and view all the answers

    Why are ampicillin and amoxicillin classified as broad-spectrum antibiotics?

    <p>Activity against many types of bacteria</p> Signup and view all the answers

    What is the reason for avoiding nafcillin, oxacillin, and dicloxacillin in infections caused by non–penicillinase-producing staphylococci?

    <p>Less activity than penicillin G</p> Signup and view all the answers

    What factor differentiates penicillin V from penicillin G regarding their stability?

    <p>Acid stability</p> Signup and view all the answers

    Why are cephalosporins often considered an appropriate alternative for patients with mild penicillin allergy?

    <p>Lack of cross-sensitivity with penicillins</p> Signup and view all the answers

    What are the three primary factors that determine bacterial resistance to penicillins?

    <p>Inability of penicillins to reach their targets, inactivation of penicillins by bacterial enzymes, and production of PBPs with low affinity for penicillins</p> Signup and view all the answers

    Which type of MRSA is more prevalent, health care-associated MRSA or community-associated MRSA?

    <p>Health care-associated MRSA</p> Signup and view all the answers

    What is the most useful classification of penicillins based on?

    <p>Antimicrobial spectrum</p> Signup and view all the answers

    Which type of bacteria is Penicillin G active against?

    <p>Both gram-positive and gram-negative bacteria</p> Signup and view all the answers

    What reaction is the principal concern associated with Penicillin usage?

    <p>Allergic reactions</p> Signup and view all the answers

    Which of the following drugs is generally not active against gram-positive bacteria and anaerobes?

    <p>Aztreonam</p> Signup and view all the answers

    What is the mechanism of action of Fosfomycin against bacteria?

    <p>Disrupts peptidoglycan synthesis</p> Signup and view all the answers

    Which characteristic makes Aztreonam a suitable antibiotic for patients with allergies to other β-lactam antibiotics?

    <p>Unique structure and low cross-allergenicity</p> Signup and view all the answers

    Which bacterial species is NOT included in the susceptible organisms to Aztreonam?

    <p>Streptococcus pyogenes</p> Signup and view all the answers

    What adverse effect is commonly associated with Aztreonam administration?

    <p>Thrombophlebitis</p> Signup and view all the answers

    What makes Telavancin a drug that should be used with caution in certain patients?

    <p>Interactions with drugs damaging the kidneys or prolonging QT interval</p> Signup and view all the answers

    What is the principal cause of cephalosporin resistance?

    <p>Production of β-lactamases</p> Signup and view all the answers

    Which generation of cephalosporins is highly resistant to destruction by β-lactamases?

    <p>Third-generation</p> Signup and view all the answers

    What is the classification of cefiderocol among cephalosporins?

    <p>Fifth generation</p> Signup and view all the answers

    Which statement is true regarding the susceptibility of second-generation cephalosporins to β-lactamases?

    <p>They are destroyed at a lower rate than first-generation cephalosporins.</p> Signup and view all the answers

    Which type of enzymes cleave the β-lactam ring of penicillins in addition to cephalosporins?

    <p>β-lactamases</p> Signup and view all the answers

    What is the primary mechanism by which β-lactamases confer resistance to cephalosporins?

    <p>Cleaving the β-lactam ring</p> Signup and view all the answers

    What reaction should be expected if a patient taking cefotetan or cefazolin ingests alcohol?

    <p>Disulfiram-like reaction</p> Signup and view all the answers

    Which class of cephalosporins is the preferred choice to treat meningitis?

    <p>Third-generation</p> Signup and view all the answers

    Why should carbapenems like imipenem be reserved for specific patients?

    <p>To delay the emergence of resistance</p> Signup and view all the answers

    Which factor contributes to the effectiveness of imipenem against bacterial pathogens?

    <p>Binding to two PBPs</p> Signup and view all the answers

    Which drug is most effective against anaerobic bacteria?

    <p>Imipenem</p> Signup and view all the answers

    What is the primary cause of a disulfiram-like reaction when alcohol is ingested with certain cephalosporins?

    <p>Inhibition of alcohol metabolism</p> Signup and view all the answers

    How do carbapenems contribute to bacterial cell lysis and death?

    <p><strong>Weakening the cell wall</strong></p> Signup and view all the answers

    What distinguishes first-generation cephalosporins from third-generation cephalosporins?

    <p>Cover staphylococci and streptococci</p> Signup and view all the answers

    Which drug inhibits destruction of imipenem by renal enzymes?

    <p>Cilastatin</p> Signup and view all the answers

    What is the most widely used antibiotic in US hospitals?

    <p>Vancomycin</p> Signup and view all the answers

    Which type of bacteria is vancomycin specifically active against?

    <p>Gram-positive</p> Signup and view all the answers

    What adverse effect is commonly associated with vancomycin?

    <p>Renal failure</p> Signup and view all the answers

    Which antibiotic disrupts the cell wall synthesis of bacteria by binding to molecules precursors?

    <p>Vancomycin</p> Signup and view all the answers

    What is the primary indication for using telavancin?

    <p>Methicillin-resistant Staphylococcus aureus (MRSA)</p> Signup and view all the answers

    What distinguishes vancomycin from β-lactam antibiotics in terms of their mechanism of action?

    <p>It binds to cell wall precursor molecules.</p> Signup and view all the answers

    What is the recommended course of action when treating CDI according to guidelines from the Infectious Disease Society of America (IDSA)?

    <p>Stop the antibiotic causing C. difficile overgrowth and start another antibiotic.</p> Signup and view all the answers

    What is a common adverse effect associated with telavancin therapy?

    <p>Taste disturbance</p> Signup and view all the answers

    What should be monitored to adjust vancomycin dosage and prevent renal toxicity?

    <p>Serum creatinine levels</p> Signup and view all the answers

    Why should telavancin be reserved for specific cases rather than used routinely?

    <p>To delay the development of resistance.</p> Signup and view all the answers

    How do tetracyclines primarily suppress bacterial growth?

    <p>By inhibiting protein synthesis</p> Signup and view all the answers

    What is the primary difference between aminoglycosides and tetracyclines in terms of effect?

    <p>Aminoglycosides are bacteriostatic, while tetracyclines are bacteriocidal.</p> Signup and view all the answers

    What is the mechanism of action through which tetracyclines inhibit bacterial growth?

    <p>Interfering with protein synthesis</p> Signup and view all the answers

    Which term best describes the effect of tetracyclines at clinically achieved concentrations?

    <p>Bacteriostatic</p> Signup and view all the answers

    What is a unique characteristic of tetracyclines among antibiotics?

    <p>Broad-spectrum activity</p> Signup and view all the answers

    How do tetracycline antibiotics inhibit bacterial protein synthesis?

    <p>By interfering with amino acid addition to peptide chains</p> Signup and view all the answers

    Which antibiotics have seen a decline in use due to increasing bacterial resistance and the availability of more selective and less toxic options?

    <p>Tetracyclines</p> Signup and view all the answers

    What is a common adverse effect of tetracyclines that results from their binding to calcium in developing teeth?

    <p>Discoloration and hypoplasia of enamel</p> Signup and view all the answers

    Which antibiotic is considered the treatment of choice for acute diphtheria and for eliminating the diphtheria carrier state?

    <p>Erythromycin</p> Signup and view all the answers

    What is the primary concern associated with erythromycin usage, especially in terms of potential cardiac complications?

    <p>Sudden cardiac death from QT prolongation</p> Signup and view all the answers

    Which antibiotic should not be combined with verapamil, diltiazem, HIV protease inhibitors, and azole antifungal drugs?

    <p>Erythromycin</p> Signup and view all the answers

    Which antibiotic carries a significant risk for promoting severe Clostridium difficile-associated diarrhea (CDAD)?

    <p>Clindamycin</p> Signup and view all the answers

    What is a common adverse effect associated with tetracyclines that results from their binding to calcium in developing teeth?

    <p>Discoloration and hypoplasia of enamel</p> Signup and view all the answers

    Which antibiotic has a mechanism of action involving inhibition of protein synthesis and is typically bacteriostatic but can be bactericidal?

    <p>Clindamycin</p> Signup and view all the answers

    Which antibiotic is used as a first-line treatment for certain chlamydial infections and for pneumonia caused by Mycoplasma pneumoniae?

    <p>Tetracyclines</p> Signup and view all the answers

    Which antibiotic should be administered at least 1 hour before or 2 hours after ingestion of substances containing calcium, iron, magnesium, aluminum, or zinc?

    <p>Tetracyclines</p> Signup and view all the answers

    Which antibiotic is specifically mentioned as the drug of choice for severe group A streptococcal infection?

    <p>Clindamycin</p> Signup and view all the answers

    What is a common side effect associated with Linezolid and Tedizolid?

    <p>Headache</p> Signup and view all the answers

    Which bacteria are susceptible to Linezolid according to the text?

    <p>Streptococcus agalactiae</p> Signup and view all the answers

    Why is Clindamycin considered bacteriostatic but can also become bactericidal under certain circumstances?

    <p>It inhibits protein synthesis</p> Signup and view all the answers

    Which antibiotic is mentioned to have activity against vancomycin-resistant Enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA)?

    <p>Linezolid</p> Signup and view all the answers

    What is a side effect unique to Linezolid and not mentioned for Clindamycin or Tedizolid?

    <p>Optic neuropathy</p> Signup and view all the answers

    What distinguishes Linezolid from Clindamycin in terms of bacterial targets?

    <p>Linezolid targets aerobic and facultative gram-positive bacteria; Clindamycin targets anaerobes.</p> Signup and view all the answers

    Which antibiotic is highlighted for the treatment of Methicillin-sensitive Staphylococcus aureus (MSSA) infections?

    <p>Clindamycin</p> Signup and view all the answers

    Why should patients with phenylketonuria avoid Linezolid oral suspension?

    <p>It contains phenylalanine</p> Signup and view all the answers

    Which class of antibiotics is telithromycin a part of?

    <p>Macrolides</p> Signup and view all the answers

    What is the principal indication for Dalfopristin?

    <p>Vancomycin-resistant enterococcus</p> Signup and view all the answers

    What is the main mechanism of action of aminoglycosides?

    <p>Disrupting protein synthesis</p> Signup and view all the answers

    Which bacteria are aminoglycosides primarily used against?

    <p>Aerobic gram-negative bacilli</p> Signup and view all the answers

    Why must aminoglycosides be administered parenterally to treat systemic infections?

    <p>Due to their positive charges and poor absorption from the GI tract</p> Signup and view all the answers

    What is the black box warning associated with chloramphenicol?

    <p>Aplastic anemia</p> Signup and view all the answers

    Which antibiotic is indicated for impetigo and is also used in the nostrils for MRSA carriers?

    <p>Retapamulin</p> Signup and view all the answers

    What severe adverse effect is associated with telavancin therapy?

    <p>Prolonged QT interval</p> Signup and view all the answers

    What is the main drug interaction associated with telithromycin?

    <p>Drugs metabolized by CYP3A4 system</p> Signup and view all the answers

    What is a common adverse effect associated with tigecycline?

    <p>Increased mortality</p> Signup and view all the answers

    What is a major concern when administering aminoglycosides with other ototoxic or renal toxic drugs such as NSAIDS?

    <p>Worsening of kidney and ear toxicity</p> Signup and view all the answers

    Why is it important to measure both peak and trough levels of aminoglycosides when divided doses are employed?

    <p>To monitor and prevent toxic levels of the drug</p> Signup and view all the answers

    Which bacterium is gentamicin primarily used to treat due to its effectiveness and cost compared to alternatives like tobramycin and amikacin?

    <p>Pseudomonas aeruginosa</p> Signup and view all the answers

    What distinguishes amikacin from other major aminoglycosides such as gentamicin and tobramycin?

    <p>It has a broader spectrum of activity against gram-negative bacilli</p> Signup and view all the answers

    What is a notable adverse effect associated with tobramycin administration, making it important to avoid concurrent therapy with other similar drugs?

    <p>C.difficile-associated diarrhea</p> Signup and view all the answers

    Why should gentamicin not be mixed in the same parenteral solution with penicillins?

    <p>Due to direct chemical inactivation</p> Signup and view all the answers

    In what way does amikacin differ from other major aminoglycosides regarding bacterial enzyme inactivation?

    <p>It is less vulnerable to inactivation</p> Signup and view all the answers

    What makes tobramycin more active than gentamicin against Pseudomonas aeruginosa but less active against enterococci and Serratia species?

    <p>Increased susceptibility to inactivation by enzymes</p> Signup and view all the answers

    What precaution should be taken regarding concurrent therapy when administering any aminoglycoside to patients?

    <p>Caution must be exercised when combining with other nephrotoxic or ototoxic drugs.</p> Signup and view all the answers

    What distinguishes once-daily dosing from divided doses when monitoring a patient's aminoglycoside therapy?

    <p>Peak levels are measured only in once-daily dosing.</p> Signup and view all the answers

    Why is amikacin the preferred agent for initial treatment in hospitals with common resistance to gentamicin and tobramycin?

    <p>It delays the emergence of organisms resistant to amikacin.</p> Signup and view all the answers

    What is the mechanism by which sulfonamides suppress bacterial growth?

    <p>Inhibition of tetrahydrofolate synthesis</p> Signup and view all the answers

    Why are sulfonamides harmless to mammalian cells but effective against bacteria?

    <p>Bacteria synthesize tetrahydrofolate from precursors.</p> Signup and view all the answers

    What adverse effect can sulfonamides cause specifically in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency?

    <p>Hemolytic anemia</p> Signup and view all the answers

    Why are sulfonamides considered less commonly used today compared to the past?

    <p>They have severe toxicity compared to newer antibiotics.</p> Signup and view all the answers

    What distinguishes amikacin from other aminoglycosides, making it suitable for use in certain settings?

    <p>Delayed emergence of resistance to amikacin</p> Signup and view all the answers

    Why should patients taking sulfonamides avoid prolonged sun exposure?

    <p>To minimize photosensitivity reactions</p> Signup and view all the answers

    What is the most severe hypersensitivity response associated with sulfonamides?

    <p>Stevens-Johnson syndrome</p> Signup and view all the answers

    What role do sulfonamides play in the treatment of urinary tract infections?

    <p>They are an antibiotic choice for empiric therapy.</p> Signup and view all the answers

    What distinguishes bacteria from mammalian cells regarding folate acquisition in the context of sulfonamide action?

    <p>Bacteria synthesize their own folate, while mammalian cells uptake it directly.</p> Signup and view all the answers

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