Abx 2 (inhibitors of cell wall synthesis) Flashcards

1
Q

Penicillin G (Benzathine)

A
  • Beta Lactam
  • Standard narrow spectrum
  • G+
  • Parenteral
  • DOC for syphilis
  • Repository prep- 1 IM dose producing persistent but low blood levels
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2
Q

Penicillin V

A
  • Beta Lactam
  • Standard narrow spectrum
  • G+
  • PO
  • DOC for syphilis
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3
Q

Nafcillin

A
  • Beta Lactam
  • Penicillin resistant narrow spectrum
  • Used against Pen G resistant staphylococcal (MSSA)
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4
Q

Amoxicillin

A
  • Beta Lactam
  • Aminopenicillins broad spectrum
  • G+
  • G- due to increased penetration through porins
  • Orally often with B-lactamase inhibitors
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5
Q

Ticarcillin

A
  • Beta Lactam
  • Antipseudomonal extended spectrum
  • Spectrum includes aminopenicillins PLUS Pseudomonas aeruinosa
  • Used IV for serious hospital aquired G- infections
  • Ticarcillin of large IV dose = Na+ overload = CHF
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6
Q

Piperacillin

A
  • Beta Lactam
  • Antipseudomonal extended spectrum
  • Spectrum includes aminopenicillins PLUS Pseudomonas aeruinosa
  • Used IV for serious hospital aquired G- infections
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7
Q

Clavulanic Acid

A
  • Beta Lactam
  • Fixed dose with B-lactamase inhibitors
  • Amoxicillin/Clavulanate
  • Ticarcillin/Clavulanate
  • Restores spectrum of activity against B-lactamase producing bacteria (but not altered PBPs)
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8
Q

Cefazolin

A
  • 1st generation
  • G+ MSSA (but not MRSA)
  • Commonly used immediately before surgery
  • Alternative to Penicillins when mild allergy exists
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9
Q

Cefoxitin

A
  • 2nd generation
  • G- bacteria
  • Largely replaced by 3rd generation
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10
Q

Ceftriaxone

A
  • 3rd generation
  • G-
  • Penetrates into CNS
  • Tx meningitis and gonorrhea
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11
Q

Cefepime

A
  • 4th generation
  • Good CNS penetration
  • Empirical Tx of hospitalized pts when resistance due to extended spectrum B-lactamase
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12
Q

Imipenem/Cilastatin

A
  • Beta Lactam
  • Broad spectrum
  • Resistant to B-Lactamase except class A KPC and B NDM-1 carbapenemases
  • Parenterally
  • Fixed dose to prevent renal inactivation
  • Tx for multi drug resisteant infections
  • Risk of seizures with Imipenem
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13
Q

Aztreonam

A
  • Beta Lactam (but not fused with second ring)
  • Narrow spectrum
  • G- & Pseudomonas
  • IV (poor oral absorption)
  • Renal excretion
  • Resistant to B-Lactamase (except KPC)
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14
Q

Vancomycin

A
  • Glycopeptide
  • Reserved for serious infection
  • Prevents polymerization of cell wall precursors (binds D-Ala-D-Ala terminus of the NAM monomer)
  • Only G+ (too large for G-)
  • VRE and VRSA due to D-Ala-D-lactate decreasing binding affinity
  • IV (PO if GI infection)
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15
Q

Fosfomycin

A
  • Glycopeptide
  • Phosphoenolpyruvate analogue
  • Tx G- UTIs
  • Inhibits production of murein monomers (blocks synthesis of UDP-NAM)
  • Enters bacteria via glycerophosphate transporter (not found in host cells)
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16
Q

Bacitracin

A

-Glycopeptide
-Inhibits bactoprenol dephosphorylation (carrier across inner membrane, must be dephos to return to carry another monomer)
-G+
-Acquired resistance uncommon
Available in topical fixed dose with neomycin/polymyxin (neosporin)
-Highly nephrotoxic is admin systemically

17
Q

Pharmokinetics of Beta Lactams

A
  • Not orally well absorbed –> diarrhea
  • Short half lives; given frequently
  • Blocked by probenecid so concentrations high in urine
18
Q

Adverse reactions of Beta Lactams

A
  • Least toxic of all Abx (pregnancy use ok)
  • Jarisch-Herxheimer
  • CNS toxicity with high doses
  • Repository preps fatal if given IV (benzathine)
  • Rashes not allergy related (Amoxicillin)
19
Q

Penicillin Allergy

A
  • Can occur in absence of prior drug exposure (unknown exposure through moldy bread)
  • Urticarial rash, fever, bronchospasm, SJS, anaphylaxis
  • Immediate hypersensitivity (angioedema/anaphylaxis) may be fatal; Tx with Epi
20
Q

Cephalosporins Overall

A

From 1st to 5th generation:

  • Increasing activity against G-/anaerobes
  • Increasing resistance to B-Lactamase
  • Increasing penetration into CNS
21
Q

Vancomycin Treatment Uses:

A
  • Parenteral (MRSA)
  • Combo with 3rd generation for meningitis
  • PO for severe CDAD (used if metronidazole is ineffective)
  • Severe G+ alternative to Penicillin
22
Q

Vancomycin Adverse Reactions:

A
  • Ototoxic
  • Nephrotoxic
  • “red man syndrome” with rapid infusion due to histamine release
  • Thrombophlebitis with IV (admin dilute slowly)