Abx- part 1 Flashcards
_____ layer - provides structural integrity of the cell wall
Peptidoglycan (PG)
______ - found in the periplasmic space function to crosslink the peptidoglycan chains
Transpeptidase Enzymes
_____ binding layers are kept together by transpeptidase enzymes
penicillin
_______ MOA involves breaking down cell wall synthesis
Beta lactams
Beta lactams include what 4 types of abxs?
What generation of cephalosporin?
1st generation
What generation of cephalosporin?
2nd generation
What generation of cephalosporin?
Cefepime is what generation of ceph?
4th generation
Ceftaroline is what generation of cephalosporin?
5th generation
What kind of abx class have a ring in their structure?
Beta-Lactam
This inhibits bacterial peptidoglycan synthesis preventing bacterial replication is known as _____
bacteriostatic
Binding to PBP activates bacterial autolytic enzymes that cause cell wall lysis is known as ______
bactericidal
How are gram + bacteria becoming more resistant?
reduced binding affinity to PCN binding proteins
production of B-lactamases
How are beta lactamase increasing their methods of resistance?
Breaks PCN ring
What are the 2 most commonly prescribed abxs?
Azithromycin and amoxicillin are MC prescribed
PCN are indicated for gram (+/-) bacteria
mostly Gram +
PCN are first line treatment for ______ and ______
Strep throat and Syphilis
**What is the bacteria that causes strep throat?
Group A Beta-Hemolytic Streptococcus
** What is the bacteria that causes Syphilis?
Treponema pallidum
Which PCNs are considered Antistaphylococcal PCN’s?
dicloxacillin, nafcillin, oxacillin
**When are Antistaphylococcal PCN’s indicated? Are they effective against MRSA?
Only indicated in the treatment of skin and soft tissue staphylococcal infections
Not effective against MRSA infections
Which Antistaphylococcal PCN’s are PO only? IV only?
dicloxacillin PO only
nafcillin IV only
oxacillin IV only
What is the coverage of an aminopenicillin?
same as natural PCN plus better gram - coverage
**What 3 bacteria are the likely source of otitis media?
Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis
What is the first line treatment for otitis media?
amoxicillin
What are the advantages of using an aminopenicillin vs a natural PCN?
Higher oral absorption and longer half life = less frequent dosing
Better penetration through Gram - cell wall porins (superior gram - coverage)
PCN/Beta-Lactamase Inhibitors include ____ and _____
Augmentin and Unasyn
What is the first line treatment for sinusitis?
Augmentin
What is the first line treatment for Pneumonia?
Augmentin
What is the first line treatment for COPD exacerbations?
Augmentin
**Augmentin is first line treatment for what 3 bacterial infections? (give the bacteria names)
S. pneumo
H. flu
S. aureus
**______ has good pseudomonas coverage. What forms does it come in?
piperacillin/tazobactam
IV ONLY!
What abx has the same as PCN plus increased Gram - coverage including Pseudomonas and Proteus (Broad Spectrum)?
piperacillin
What would you give a pt who has a severe polymicrobial infection?
piperacillin/tazobactam
_____ have the same MOA as PCN but tend to be more resistant to B-lactamase
Cephalosporins
What phrase is true when talking about the generations of cephalosporins and their coverage?
The greater the generation, the better the Gram - coverage.
The lower the generation, the better the Gram + coverage
What are the 3 first generation cephalosporins?
cephalexin (Keflex)
cefazolin (Ancef)
cefadroxil (Duricef, Ultracef)
What abx can you give to a pt with a E. coli infection who is preg?
cephalexin (Keflex)
What are the 2nd generation cephalosporins?
cefuroxime (Ceftin, Zinacef)
cefoxitin (Mefoxin)
cefotetan (Cefotan)
cefaclor (Ceclor)
cefprozil (Cefzil)
**____ have better Gram - coverage, can be used as surgical prophylaxis for “dirty” procedures
cefoxitin/cefotetan
**_____ are often used as 2nd line for pharyngitis, sinusitis, OM, upper & lower respiratory tract infections
cefuroxime/cefaclor/cefprozi
What are the 2 most common 3rd generation cephalosporins?
ceftriaxone (Rocephin)
cefdinir (Omnicef)
**_____ First line treatment for Neisseria gonorrhoeae
ceftriaxone (Rocephin)
**_____ has good pneumococcal coverage,
Often used in combination for pneumonia
ceftriaxone (Rocephin)
____ and ____ are second line treatment for upper and lower respiratory tract infections
cefdinir(Omnicef)
cefixime (Suprax)
____ has the broadest spectrum
Gram +, Gram -, Pseudomonas for cephalosporins. Only used in very sick people. IV/IM route only
cefepime (Maxipime)
**_____ is the only Beta-Lactam with MRSA coverage. IV only
ceftaroline (Teflaro)
Draw the cephalosporin coverage diagram
____ have good gram - coverage, including Pseudomonas. Virtually no coverage against Gram + or anaerobes
Monobactams:
aztreonam (Azactam)
**____ are inhaled and are used in severe cystic fibrosis respiratory infections
Monobactams:
aztreonam (Azactam)
Why are monobactams not often used?
3rd & 4th generation cephalosporins with same/better coverage and less side effects
In the combo abx imipenem/Cilastatin, why is cilastatin added?
cilastatin added to imipenem to prevent inactivation in renal tubule of kidney
____ are very broad spectrum, Good Gram -, Gram +, and anaerobes, Susceptible to beta lactamase, Reserved for severe infections , IV/IM Only. NOT indicated for MRSA
Carbapenems
(meropenem, ertapenem,
doripenem)
What are some common SE of beta-lactams? Which groups are the most common?
GI (N/V/D): more likely with Amoxicillin/Clavulanate and higher generation Cephalosporins
Vaginal candidiasis
If a patient has a hypersensitivity reaction to one beta lactam, will they react to all beta lactams?
Depends on how severe was the reaction, if it was just a rash. probably okay
What is considered a true reaction to PCN?
-Occurs immediately or within an hour
-Hives
-Angioedema
-Wheezing or SOB
-Anaphylaxis
What are the 3 PKs associated factors with beta-lactams?
Minimal liver metabolism
Minimal interaction with CYP450
Renal Excretion: may need to dose adjust with renal impairments
What labs do you need to monitor with Beta-lactams?
-CBC with prolonged treatment
-Monitor kidney function with prolonged treatment
-Pregnancy Category B
-Drug Interactions: decrease effectiveness of oral contraceptives
____ and ____ are considered to be more costly
PCN/Beta-lactamase inhibitors
Higher generation cephalosporins
