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Host and Defense 2020 > 1/30/17 SMITH Antibiotics 1 TEST #1 > Flashcards

1/30/17 SMITH Antibiotics 1 TEST #1 Flashcards

1
Q

What are the two types of antimicrobial classes that target the cell wall synthesis?

A
  • Beta Lactams
  • Vancomycin
  • Bacitracin
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2
Q

What must the B-lactam drugs bind to, to be effective?

A

-Transpeptidase enzyme (penicillin-binding protein) on the bacteria’s cytoplasmic membrane

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3
Q

What must B-lactam drugs evade to be effective?

A

-Bacterial defenses

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4
Q

What must B-lactam drugs pentrate to be effective?

A

-Outer cell layers to reach inner cytoplasmic membrane

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5
Q

What must B-lactams keep in their structure to be efective?

A

B-lactam ring structure

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6
Q

What on the B-lactam drugs resembles the D-ala-D-ala end of the peptidie that serves as a substrate for transpeptidase enzymes?

A

B-lactam region

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7
Q

What are 6 subclasses of B-lactam antimicrobials?

A
  • Natural Penicillins
  • Aminopenicillins
  • Penicillinase-resistant penicillins
  • Anti-Pseudomonal
  • Cephalosporins
  • Carbapenems: Impinem
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8
Q

What is the ultimate goal of the B-lactam antibiotics?

A

-Reach the transpeptidase enzyme

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9
Q

What does the binding of the B-lactam drugs to the transpeptidase penicillin binding proteins prevent?

A

-Transpeptidation (last step in new peptidoglycan (cell wall) synthesis)

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10
Q

Are B-lactam drugs bacterocidal or bacteriostatic?

A

-Bacterocidal

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11
Q

What do all B-lactam drugs require?

A

-Active proliferating microorganisms to maximally effective

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12
Q

What are B-lactam drugs inactive against?

A

-Organisms devoid of peptidoglycans (virus, mycobacteria, and fungi)

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13
Q

What type of drug is a B-lactam drug?

A

-Type II

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14
Q

What are two examples of Natural Penicillins?

A
  • Penicillin G

- Penicillin V

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15
Q

What are natural penicillins highly active against?

A

-Gram + organisms

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16
Q

What are natural penicillins very susceptible to?

A

-Bacterial B-lactamases

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17
Q

What are two examples of Aminopenicillins?

A
  • Ampicillin

- Amoxicillin

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18
Q

What did the aminopenicillins add to the penicillins?

A

-An amine group

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19
Q

What did the addition of the amino group on the penicllins to create aminopenicillins do for the targets of aminopenicillins?

A

-Extended spectrum to include the Gram - as well as the Gram +

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20
Q

T/F Aminopenicillins are still susceptible to B-lactamases

A

-True

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21
Q

What are 4 examples of penicillinase-resistant penicillins (anti-staphylococcal penicillin)?

A
  • Methicillin
  • Nafcillin
  • Oxacillin
  • Dicloxacicillin
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22
Q

What are the Penicillinase resistant penicillins relatively resistant to?

A

-B-lactamases

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23
Q

What penicillinase resistant penicillins is used as a first line treatment of choice for staphylococcal endocarditis?

A

-Nafcillin

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24
Q

What are 3 examples of Anti-Pseudomonal penicillins?

A
  • Monobactams (aztreonam)
  • Ureidopenicillins (piperacillin)
  • Carboxypenicillins (Ticarcillin, indanyl carbenicillum)
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25
What type of bacteria do Anti-Psudomonal penicillins have no activity against?
- Gram + | - Anaerobes
26
Of all the anti-psudomonal penicillins what two have the broadest spectrums of activity?
- Ticarcillin | - Peperacillin
27
T/F Cephalosporins are built on a 7-aminocephalosporanic acid instead of penicillins traditional 6-aminopenecillinic acid
True
28
Cephalosporins: Bacteriostatic or Bacteriocidal
Bactericidal
29
What is the broadest antibacterial available?
-Carbapenems
30
Of the two natural penicillins what is the only true naturally occurring penicillin?
-Penicillin G
31
What separates Penicillin G and Penicillin V?
-Penicillin V is acid stable so you can take it orally because the acid won't chew it up
32
Are penicillins considered broad or narrow spectrum?
-Narrow
33
What is Penicillin G rapidly hydrolyzed by?
-Penicillinase enzymes (B-lactamase enzymes)
34
What is the drug of choice when prolonged low concentrations are required for example syphilis?
-Benzathine penicillin (Durapen)
35
What is the drug of choice for listeria monocytogenes, prophylaxis of infective endocarditis, or treatment of UTIs caused by susceptible enterococci?
-Aminopenicillins
36
Which of the aminopenicillins has a higher oral absorption?
-Amoxicillin
37
What aminopenicillins has a longer half-life and is less likely to cause adverse GI effects?
-Amoxicillins
38
What gram - strains does aminopenicillins work against?
- H. influenzae | - Enterics
39
What aminopenicillins dose-dependently inhibits renal tubular excretions of methotrexate that results in prolonged high serum levels of methotrexate?
-Amoxicillin
40
What is the drug of choice for standard prophylactic prevention of bacterial endocarditis?
-Oral Amoxicillin
41
What is the alternative drug for prophylactic prevention of bacterial endocarditis if there is a case of non-anaphylactic allergy?
-Cephalexin (cephalosporin)
42
What are some alternatives in cases of serious allergy requiring non-B-lactams to do a prophylactic prevention of bacterial endocarditis?
- Clindamycin - Azithromycin - Clarithromycin
43
What is the drug of choice in patients unable to take oral medication so long as they are not allergic to penicilin?
-Ampicillin
44
What is an adverse effect of ampicillin?
-Pseudomembranous coliitis
45
Which of the aminopenicillins has better absorption orally and is not influenced by food consumption?
-Amoxicillin
46
What type of aminopenicillin can have different effects depending on food consumption?
-Ampicillin
47
How is ampicillin primarily delivered?
-IV
48
If you have Hydrocortisone and ampicillin delivered at the same time in an IV solution what occurs?
-THe Hydrocortisone inactivates the ampicillin
49
What are Penicillinase-resistant penicillins (Anti staphylococcal penicillins) active against?
- Staphylococci | - Streptococci
50
T/F The Penicillinase-resistant penicillin (Methicillin, nafcillin, oxacillin, and dicloxacillin) are less potent than Pen G
True
51
What is the drug of choice for serious S. aureus infetcions (non-MRSA)?
-Nafcillin (use Naf for Staph)
52
How are most B-lactams excreted?
-Renally
53
If you give a B-lactam drug with probenecid (uric acid reducer to treat gout) what happens to the serum levels and half-lives?
- Increased | - Prolonged
54
What B-lactam drugs do not interact with probenecid?
-Nafcillin -Oxacillin -Dicloxacillin (these undergo biliary excretion)
55
How do you administer Anti-psudomonal penicillins?
IM or IV
56
What is one of the few antibiotics capable of treating Stenotrophomonas maltophilia infections on mechanical devices such as for ventilation or urinary catheters?
-Ticarcillin (Anti-pseudomonal penicillins)
57
What type of Anti-pseudomonal penicillin has the broadest spectrum?
-Piperacillin
58
What is a great drug of choice for patients that have IgE-mediated penicillin allergies?
-Aztreonam (Monobactams) (Anti-pseudomonal penicillins)
59
What are some common side effects of Penicillins?
- Hypersensitivity (anaphylactic reaction) - Confusion - Lethargy - Twitching - Seizures - Kidney failure - Coma
60
T/F 10% of people are allergic to penicillins and these people are usually cross sensitive to all other B-lactams including cephalosporins
True
61
What are 4 B-lactam drugs that are broad spectrum that could lead to superinfections?
- Aminopenicillins (ampicillin) - Piperacillin - Cephalosporins - Aztreonam
62
What is the most important drug from the first generation cephalosporins?
-Cefazolin
63
What first generation cephalosporin is used for prophylaxis prior to surgery?
-Cefazolin
64
What are three 2nd generation cephalosporins?
- Cefaclor - Cefoxitin - Cefuroxime
65
What 2nd gen cephalosporin drug is used to treat oral sinusitis and otitis caused by H.influenzae?
-Cefaclor
66
What 2nd gen cephalosporin has enhanced anaerobe activity and extended B-lactamse resistance?
-Cefoxitin
67
What 2nd Gen cephalosporin is unique since it can cross the blood brain barrier?
-Cefuroxime
68
What generation has the broadest spectrum of all the cephalosporins and are extremely effective against Gram - organisms?
-3rd generation
69
What are three 3rd generation cephalosporin drugs?
- Cefotaxime or ceftriaxone - Ceftazidime - Cefdinir
70
What is unique about the 3rd gen cephalosporin drugs?
- Activity against gram - rods | - Most can cross the Blood Brain Barrier
71
What 3rd gen cephalosporin drug is used to treat Pseudomonas aeruginosa?
-Ceftazidime
72
What is an example of a 4th generation cephalosporins?
-Cefepime
73
What is an example of a 5th generation cephalosporin?
-Ceftaroline
74
What cephalosporin has activity greater that ceftazidime against streptococci and methicillin-susceptible staph?
-Cefepime (4th generation)
75
What cephalospring is active against MRSA?
-Ceftaroline (5th generation)
76
What drug is the broadest spectrum coverage available to man?
-Imipenem
77
What type of drug is very stable in the presence of B-lactamases, including penicillinase and cephalorsporinase that are resistant to most B-lactam antibiotics?
-Carbapenems:Imipenem
78
What are four Non-B-lactam antibacterials that are also cell wall inhibitors/disrupters?
- Bacitracin (topical) - Vancomycin (IV) - Polymyxins - Daptomycin (IV)
79
What does vancomycin inhibit cell wall synthesis in?
-Gram + bacteria at an earlier stage that B-lactams
80
What drug do you use to treat endocarditis in penicillin allergic patients?
-Vancomycin
81
What are the three types of allergic reactions to penicillins/B-lactams?
- Immediate/acute onset - Accelerated onset - Delayed onset
82
If a patient was given Penicillin VK less that 15 minutes ago and develops laryngeal edema, urticaria, severe hypotension, GU disturbance, bronchoconstriction and shock what does the patient have going on?
-Anaphylactic reaction
83
What are Polymyxins bactericidal against?
-Gram - bacteria
84
What are Daptomycin bactericidal against?
-Gram + bacteria
85
What is the 1st line IV treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis cause by MRSA?
-Vancomycin
86
T/F | Vancomycin should be used to treat methicillin-sensitive S. aureus because it is superior to nafcillin
False | -Vancomycin is inferior to nafcillin and shouldn't be used
87
T/F | Vancomycin has traditionally been considered a nephrotoxic and ototoxic drug.
True
88
What type of bacteria does Bacitracin disrupt?
-Gram + and Gram -
89
Bacitracin is Bactericidal or bacteriostatic?
-Bactericidal
90
Vancomycin is Bactericidal or bacteriostatic?
-Bactericidal
91
What type of bacteria does Vancomycin disrupt?
-Gram + but not gram -
92
T/F Daptomycin is a cyclic lipopeptide
True
93
What drug causes Red Man Syndrome as an adverse effect?
-Vancomycin
94
What drug is active against MRSA and Vancomycin resistant Enterococcus?
-Daptomycin
95
What drug can cause myopathy, arthalgia, and eosinophylic pneumonia as adverse effects?
-Daptomycin

Host and Defense 2020 (61 decks)

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