Anti-Cell Wall/Membrane Agents Flashcards
1
Q
what is the #1 thing to consider before prescribing abx?
A
do we need them?
2
Q
what is the 1st line abx family
A
B-lactams
3
Q
what abx do ID professionals hate
A
FQ
macrolides
4
Q
when do we use macrolides or FQ?
A
pts who can’t have B-lactams
killing specific microbes
when specific Pk/Pd properties are vital
5
Q
what does azirthromycin kill?
A
mycoplasma (no cell wall)
6
Q
what does ciprofloxacin kill?
A
salmonella (intracellular)
7
Q
what are the 4 PO PCNs?
A
PCN VK
Dicloxacillin
Amoxicillin
Augmentin (amox/clav)
8
Q
what are the 5 IV PCNs?
A
PCN G Naficillin Ampicillin Amp/Sulbactam Pip/Tazo
9
Q
what PCN’s kill staph
A
dicloxacillin
Naficillin
10
Q
what PCN’s are aminopenicillins
A
amoxicillin
ampicillin
11
Q
what PCN’s are natural
A
PCN VK
PCN G
12
Q
what is the MOA of penicillins?
A
STOP cell wall synthesis by binding to penicillin binding proteins
13
Q
what needs to be occurring for PCN’s to work?
A
bacteria need to actively divide
14
Q
what are the 3 mechanisms of resistance of B-lactams?
A
- destruction of abx by B-lactamases
- failure of abx to penetrate to PBP target
- low affinity binding of abx to PBP (bug mutates to stay hidden)
15
Q
what are the pharmacology characteristics of B-lactams?
A
renal excretion
time-dependent killing
bactericidal
16
Q
what coverage do PCNs have?
A
natural PCN and anti-staph= good gram +
as you increase in generation–lose g+ and gain g -
17
Q
ADR’s to PCN’s in general
A
hypersensitivity drug fever phlebitis (naf) AIN (naf) hypokalemia (naf)
18
Q
what PCN compound causes diarrhea and hepatotoxicity?
A
clavulanate
19
Q
the 3 natural PCNS
A
G (IV
VK (sol/tab)
Benzathine (IM)
20
Q
microbial coverage of natural PCNs
A
s. pyogenes
T. pallidum
21
Q
indications for PCN V,G, Benzathine
A
strep pharyngitis/cellulitis
syphillis
22
Q
Naf/Dicloxacillin microbial coverage
A
s. aureus
s. poygenes
23
Q
indications for Naf/Dicloxacillin
A
SSTI
24
Q
Amino PCN microbial coverage
A
s. pyogenes S. pneumoniae S. agalactiae Enterococci B. burgdorferi P. multocida Proteus Listeria
25
common indications for amino PCN's
URTI (pharngitis, AOM)
Strep Skin infection
Endocarditis--prophylaxis w/ dental procedures
lyme disease
26
2 Augmented amino PCN's
ampicillin/sulbactam (IV)
| amoxicillin/clavulanate (susp, tab)
27
microbial coverage of augmented amino PCNs
amino pcn coverage + M. catarrhalis, H. flu, anaerobes, e.coli, klebsiella
28
indications for augmented amino PCNs
```
bites
amoxicillin failure w/ URTI--(AE-COPD, AOM, sinutitis)
recurrent strep
SSTI
dental infection
```
29
if we have failed amoxicillin what microbe do we suspect?
H. flu
30
normal dose for amoxicillin
80-90mg/kg BID
31
what enzyme do anarobes make?
b lactamases
32
what is the extended spectrum PCN
pip/tazo (IV)
33
what is pip/tazo's microbial coverage
GPC: s. pyogenes, s. pneumo, s. agalac. enterococci
GNB: m. catarrhalis, H. flu, Proteus, E. coli, Kleb, pseudomonas
anaerobes
34
clinical indications for pip/tazo
nosocomial infections
35
3 oral cephalosporins
cephalexin (1st)
cefuroxime (2nd)
cefpodoxime (3rd)
36
are there any 4/5th gen oral cephalosporins?
no
37
5 IV cephalosporins
```
cefazolin (1st)
Cefuroxime(2nd)
Ceftriaxone (3rd)
Cefepime (4th)
Ceftaroline (5th)
```
38
MOA of cephalosporins
arrest cell wall synthesis by bindin to penicillin binding proteins
39
what needs to be occurring for cephalosporins to work
bacteria need to be actively dividing
40
what microbial coverage do cephalosporins have?
1st/2nd gen--good gram +
| increase gen--lose g+ and grain g - (except 5th gen)
41
what 2 microbes do cephalosporins never cover?
enterococci
| Listeria
42
ADR's of cephalosporins
hypersensitivity
drug fever
serum sickness (cefaclor)
43
what specific ADR occurs w/ infants and ceftriaxone?
calcium can precipitate--> pseudocholelithiasis
44
what are the 2 1st gen cephalosporins
cefazolin
| cephalexin
45
what do 1st gen cephalosporins cover
s. pyo
s. aureus
some; E.coli, Klebsiella, Proteus
46
clinical indications for cefazolin and cephalexin
SSTI
Strep. pharyngitis
Lower UTI (cystitis)
perioperative prophylaxis
47
what ceph is used for perioperative prophylaxis?
cefazolin
48
what is the main use for 2nd gen cephalosporins?
respiratory--to kill strep pneumo
49
2nd gen cephalosporin
cefuroxime
50
what additional microbial coverage does cefuroxime have?
```
What 1st gen covers (S. pyogenes, S. aureus, most E. coli, Klebsiella, proteus)
s. pneumo
M. catarrhalis
H. flu
Pasterella
```
51
clinical indications of cefuroxime
Amoxicillin failure w/ URTI (aom, sinusitis, AE-COPD)
| SSTI
52
what does cefuroxime mimic?
augmentin coverage!
53
oral 3rd gen ceph
```
Cefpodoxime
cefdinir (NEVER EVER USE)
```
54
microbial coverage of cefpodoxime?
more GNB than cefuroxime
55
clinical indications of cefpodoxime?
Amoxicillin failure w/ URTI (aom, sinusitis, AE-COPD)
| SSTI
56
IV/IM 3rd gen cephalosporins
Ceftriaxone
57
microbial coverage of ceftriaxone?
```
wimpy GNB (E. coli, Klebsiella, Proteus)
GPC (s. pneumo and other streps)
```
58
clinical indications of ceftriaxone?
```
refractory AOM
CAP (w/ azithromycin)
Meningitis
Gonorrhea
Intra adbominal infections
serious lyme disease
```
59
what intraabdominal infections is ceftriaxone used for?
pyelonephritis
| diverticulitis
60
new 3rd generation of cephalosporins?
ceftolozane/tazo
| ceftazidime/avibactam
61
what is different about the new 3rd gen cephs?
more pseudo coverage
| no real gram + or anaerobic coverage
62
main use of ceftolozane/tazo and ceftazidime/avibactam
nosocomial infections
63
4th gen ceph
Cefepime
64
cefepime microbial coverage
```
resistant GNB (pseduo, enterobacter, serratia)
s. pneumo
```
65
clinical indications for cefepime
nosocomial infections
66
5th gen ceph
ceftaroline
67
why is ceftaroline special
MRSA activity
68
how does ceftaroline work on MRSA?
strong affinity for PBP2a & PBP2x
69
does ceftaroline cover more GNB than cefepime?
no! even though its a higher generation
70
what is the IV monobactam we use?
aztreonam
71
what type of allergic rxn can we not use aztreonam?
ceftazidime
72
can we use aztreonam if a pt anaphylaxis to PCN?
yes
73
microbial coverage of aztreonam
resistant GNB--pseudomonas
74
what does aztreonam not cover?
gram +
| anarobes
75
clinical indications of aztreonam
nosocomial infections
76
3 pseudomonal carbapenems
imipenem
meropenem
doripenem
77
non-pseudo carbapenem
ertra
78
what is the formulation of carbapenems
IV
79
what is the role of vaporbactam
protects from b-lactamases
80
what do carbapenems not cover
MRSA
CRE
VRE
C. diff
81
clinical indications for carbapenems
nosocomial infections (VAP, CAUTI)
82
what is the glycopeptide abx we use?
vancomycin
83
when do we use vancomycin?
when we is desperate
84
MOA of glycopeptides
inhibition of cell wall synthesis
85
MOR of glycopeptides
alternation in binding site
86
pharmacology characteristics of glycopeptides
renal toxicity
time & conc. dependent killing
no oral aborpsortion of PO formulation
bactericidal
87
how do we avoid red-man syndrome
infuse over 60min
88
what is the only indication for oral vanco?
C. diff
89
step 1 to dose vanco
identify site of infection and goal trough
90
step 2 to dose vanco
dose appriratley
91
what are most doses of vanco
15mg/kg
92
what infections need 20mg/kg of vanco
life-threatening infections
93
how often should vanco be fiven
q12 or q8
94
if you have abnormal renal function how often should vanco be dosed?
q48 or q72
95
step 3 of dosing vanco
measure trough @ 30min prior to 4th dose
96
step 4 of dosing vanco
adjust dose
97
step 5 of dosing vanco
get pharmacy involved
98
ADR of glycopeptides
red man syndrome
nephrotoxicity
ototoxicitiy
99
clinical indications for parenteral vannco
MRSA infection
| MSSA, Strep, Enterococci if PCN allergic
100
cyclic lipopeptide abx
daptomycin (IV)
101
MOA of daptomyxin
binds to component of cell membrane--> rapid depolarization, inhibiting intracellular synthesis of DNA, RNA & protein
**punctures membrane
102
what drugs should be avoided w/ daptomycin?
statins/fibrates
103
how is daptomycin excreted
renal
104
what type of killing dose daptomycin do?
conc. dependent bactericidal killing
105
what is daptomycin inactivated by?
surfactant
106
ADR of daptomycin
myopathy
107
microbial coverage of daptomycin
MRSA
VRE
MSSA, strep, enterococci in PCN allergic pts
108
clinical indications of daptomycin
MRSA
| VRE
109
1st gen lipoglycopeptide
telavancin (IV)
110
2nd gen lipoglycopeptide
dalbavancin (IV)
| oritavancin (IV)
111
MOA of lipoglycopeptides
inhibit bacterial cell wall synthesis
| disrupts bacterial cell membrane fcn
112
drug interaction of telavancin
additive QTc prolongation w/ other QTc drugs
113
drug interaction of dalbavancin
none! we love this drug
114
drug interaction of ortiavancin
UFH use= bad w/ in 48hrs
115
pharm characteristics of lipoglycopeptides
renal excretion
conc. dependent killing
infuse slow
bactericidal
116
contraindications to 1st gen lipoglycopeptide (telavancin)
QT interval issues
| women of childbearing years
117
contraindication to 2nd gen lipoglycopeptides
none
118
ADR of 1st gen lipoglyco (telavancin)
taste disturbance
foamy urine
QTc prolongation
renal dysfunction
119
do we use telavancin?
no
120
2nd gen lipoglycopeptide ADR (dalba/ortiavancin)
N/V/D
| hypersensitivity rxn
121
clinical indication for vancins?
SSTI caused by susceptible G+ bacteria (MRSA, VISA/VRSA, some VRE)
122
which vancin is most commonly used? why?
ortiovancin
| 1 dose & microbial activity best
123
What should we suspect in a pt. fails amoxicillin? (assume it is dosed & diagnosed properly)
- Strep pneumo is NOT present, other bugs may be (M. catarrhalis, H. flu)
- Infection may not have been eradicated (deep in tonsillar crypts, B-lactamases present blocking amox from infection)
