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Pharm Kay Exam 2 > Anti-Cell Wall/Membrane Agents > Flashcards

Anti-Cell Wall/Membrane Agents Flashcards

1
Q

what is the #1 thing to consider before prescribing abx?

A

do we need them?

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2
Q

what is the 1st line abx family

A

B-lactams

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3
Q

what abx do ID professionals hate

A

FQ

macrolides

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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

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5
Q

what does azirthromycin kill?

A

mycoplasma (no cell wall)

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6
Q

what does ciprofloxacin kill?

A

salmonella (intracellular)

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7
Q

what are the 4 PO PCNs?

A

PCN VK
Dicloxacillin
Amoxicillin
Augmentin (amox/clav)

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8
Q

what are the 5 IV PCNs?

A 
PCN G
Naficillin
Ampicillin
Amp/Sulbactam
Pip/Tazo
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9
Q

what PCN’s kill staph

A

dicloxacillin

Naficillin

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10
Q

what PCN’s are aminopenicillins

A

amoxicillin

ampicillin

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11
Q

what PCN’s are natural

A

PCN VK

PCN G

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12
Q

what is the MOA of penicillins?

A

STOP cell wall synthesis by binding to penicillin binding proteins

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13
Q

what needs to be occurring for PCN’s to work?

A

bacteria need to actively divide

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14
Q

what are the 3 mechanisms of resistance of B-lactams?

A
  1. destruction of abx by B-lactamases
  2. failure of abx to penetrate to PBP target
  3. low affinity binding of abx to PBP (bug mutates to stay hidden)
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15
Q

what are the pharmacology characteristics of B-lactams?

A

renal excretion
time-dependent killing
bactericidal

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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 -

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17
Q

ADR’s to PCN’s in general

A 
hypersensitivity
drug fever
phlebitis (naf)
AIN (naf)
hypokalemia (naf)
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18
Q

what PCN compound causes diarrhea and hepatotoxicity?

A

clavulanate

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19
Q

the 3 natural PCNS

A

G (IV
VK (sol/tab)
Benzathine (IM)

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20
Q

microbial coverage of natural PCNs

A

s. pyogenes

T. pallidum

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21
Q

indications for PCN V,G, Benzathine

A

strep pharyngitis/cellulitis

syphillis

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22
Q

Naf/Dicloxacillin microbial coverage

A

s. aureus

s. poygenes

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23
Q

indications for Naf/Dicloxacillin

A

SSTI

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24
Q

Amino PCN microbial coverage

A 
s. pyogenes
S. pneumoniae
S. agalactiae
Enterococci
B. burgdorferi
P. multocida
Proteus
Listeria
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25
Q

common indications for amino PCN’s

A

URTI (pharngitis, AOM)
Strep Skin infection
Endocarditis–prophylaxis w/ dental procedures
lyme disease

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26
Q

2 Augmented amino PCN’s

A

ampicillin/sulbactam (IV)

amoxicillin/clavulanate (susp, tab)

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27
Q

microbial coverage of augmented amino PCNs

A

amino pcn coverage + M. catarrhalis, H. flu, anaerobes, e.coli, klebsiella

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28
Q

indications for augmented amino PCNs

A 
bites
amoxicillin failure w/ URTI--(AE-COPD, AOM, sinutitis)
recurrent strep
SSTI
dental infection
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29
Q

if we have failed amoxicillin what microbe do we suspect?

A

H. flu

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30
Q

normal dose for amoxicillin

A

80-90mg/kg BID

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31
Q

what enzyme do anarobes make?

A

b lactamases

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32
Q

what is the extended spectrum PCN

A

pip/tazo (IV)

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33
Q

what is pip/tazo’s microbial coverage

A

GPC: s. pyogenes, s. pneumo, s. agalac. enterococci
GNB: m. catarrhalis, H. flu, Proteus, E. coli, Kleb, pseudomonas
anaerobes

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34
Q

clinical indications for pip/tazo

A

nosocomial infections

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35
Q

3 oral cephalosporins

A

cephalexin (1st)
cefuroxime (2nd)
cefpodoxime (3rd)

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36
Q

are there any 4/5th gen oral cephalosporins?

A

no

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37
Q

5 IV cephalosporins

A 
cefazolin (1st)
Cefuroxime(2nd)
Ceftriaxone (3rd)
Cefepime (4th)
Ceftaroline (5th)
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38
Q

MOA of cephalosporins

A

arrest cell wall synthesis by bindin to penicillin binding proteins

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39
Q

what needs to be occurring for cephalosporins to work

A

bacteria need to be actively dividing

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40
Q

what microbial coverage do cephalosporins have?

A

1st/2nd gen–good gram +

increase gen–lose g+ and grain g - (except 5th gen)

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41
Q

what 2 microbes do cephalosporins never cover?

A

enterococci

Listeria

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42
Q

ADR’s of cephalosporins

A

hypersensitivity
drug fever
serum sickness (cefaclor)

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43
Q

what specific ADR occurs w/ infants and ceftriaxone?

A

calcium can precipitate–> pseudocholelithiasis

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44
Q

what are the 2 1st gen cephalosporins

A

cefazolin

cephalexin

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45
Q

what do 1st gen cephalosporins cover

A

s. pyo
s. aureus
some; E.coli, Klebsiella, Proteus

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46
Q

clinical indications for cefazolin and cephalexin

A

SSTI
Strep. pharyngitis
Lower UTI (cystitis)
perioperative prophylaxis

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47
Q

what ceph is used for perioperative prophylaxis?

A

cefazolin

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48
Q

what is the main use for 2nd gen cephalosporins?

A

respiratory–to kill strep pneumo

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49
Q

2nd gen cephalosporin

A

cefuroxime

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50
Q

what additional microbial coverage does cefuroxime have?

A 
What 1st gen covers (S. pyogenes, S. aureus, most E. coli, Klebsiella, proteus)
s. pneumo
M. catarrhalis
H. flu
Pasterella
51
Q

clinical indications of cefuroxime

A

Amoxicillin failure w/ URTI (aom, sinusitis, AE-COPD)

SSTI

52
Q

what does cefuroxime mimic?

A

augmentin coverage!

53
Q

oral 3rd gen ceph

A 
Cefpodoxime
cefdinir (NEVER EVER USE)
54
Q

microbial coverage of cefpodoxime?

A

more GNB than cefuroxime

55
Q

clinical indications of cefpodoxime?

A

Amoxicillin failure w/ URTI (aom, sinusitis, AE-COPD)

SSTI

56
Q

IV/IM 3rd gen cephalosporins

A

Ceftriaxone

57
Q

microbial coverage of ceftriaxone?

A 
wimpy GNB (E. coli, Klebsiella, Proteus)
GPC (s. pneumo and other streps)
58
Q

clinical indications of ceftriaxone?

A 
refractory AOM
CAP (w/ azithromycin)
Meningitis
Gonorrhea
Intra adbominal infections
serious lyme disease
59
Q

what intraabdominal infections is ceftriaxone used for?

A

pyelonephritis

diverticulitis

60
Q

new 3rd generation of cephalosporins?

A

ceftolozane/tazo

ceftazidime/avibactam

61
Q

what is different about the new 3rd gen cephs?

A

more pseudo coverage

no real gram + or anaerobic coverage

62
Q

main use of ceftolozane/tazo and ceftazidime/avibactam

A

nosocomial infections

63
Q

4th gen ceph

A

Cefepime

64
Q

cefepime microbial coverage

A 
resistant GNB (pseduo, enterobacter, serratia)
s. pneumo
65
Q

clinical indications for cefepime

A

nosocomial infections

66
Q

5th gen ceph

A

ceftaroline

67
Q

why is ceftaroline special

A

MRSA activity

68
Q

how does ceftaroline work on MRSA?

A

strong affinity for PBP2a & PBP2x

69
Q

does ceftaroline cover more GNB than cefepime?

A

no! even though its a higher generation

70
Q

what is the IV monobactam we use?

A

aztreonam

71
Q

what type of allergic rxn can we not use aztreonam?

A

ceftazidime

72
Q

can we use aztreonam if a pt anaphylaxis to PCN?

A

yes

73
Q

microbial coverage of aztreonam

A

resistant GNB–pseudomonas

74
Q

what does aztreonam not cover?

A

gram +

anarobes

75
Q

clinical indications of aztreonam

A

nosocomial infections

76
Q

3 pseudomonal carbapenems

A

imipenem
meropenem
doripenem

77
Q

non-pseudo carbapenem

A

ertra

78
Q

what is the formulation of carbapenems

A

IV

79
Q

what is the role of vaporbactam

A

protects from b-lactamases

80
Q

what do carbapenems not cover

A

MRSA
CRE
VRE
C. diff

81
Q

clinical indications for carbapenems

A

nosocomial infections (VAP, CAUTI)

82
Q

what is the glycopeptide abx we use?

A

vancomycin

83
Q

when do we use vancomycin?

A

when we is desperate

84
Q

MOA of glycopeptides

A

inhibition of cell wall synthesis

85
Q

MOR of glycopeptides

A

alternation in binding site

86
Q

pharmacology characteristics of glycopeptides

A

renal toxicity
time & conc. dependent killing
no oral aborpsortion of PO formulation
bactericidal

87
Q

how do we avoid red-man syndrome

A

infuse over 60min

88
Q

what is the only indication for oral vanco?

A

C. diff

89
Q

step 1 to dose vanco

A

identify site of infection and goal trough

90
Q

step 2 to dose vanco

A

dose appriratley

91
Q

what are most doses of vanco

A

15mg/kg

92
Q

what infections need 20mg/kg of vanco

A

life-threatening infections

93
Q

how often should vanco be fiven

A

q12 or q8

94
Q

if you have abnormal renal function how often should vanco be dosed?

A

q48 or q72

95
Q

step 3 of dosing vanco

A

measure trough @ 30min prior to 4th dose

96
Q

step 4 of dosing vanco

A

adjust dose

97
Q

step 5 of dosing vanco

A

get pharmacy involved

98
Q

ADR of glycopeptides

A

red man syndrome
nephrotoxicity
ototoxicitiy

99
Q

clinical indications for parenteral vannco

A

MRSA infection

MSSA, Strep, Enterococci if PCN allergic

100
Q

cyclic lipopeptide abx

A

daptomycin (IV)

101
Q

MOA of daptomyxin

A

binds to component of cell membrane–> rapid depolarization, inhibiting intracellular synthesis of DNA, RNA & protein
**punctures membrane

102
Q

what drugs should be avoided w/ daptomycin?

A

statins/fibrates

103
Q

how is daptomycin excreted

A

renal

104
Q

what type of killing dose daptomycin do?

A

conc. dependent bactericidal killing

105
Q

what is daptomycin inactivated by?

A

surfactant

106
Q

ADR of daptomycin

A

myopathy

107
Q

microbial coverage of daptomycin

A

MRSA
VRE
MSSA, strep, enterococci in PCN allergic pts

108
Q

clinical indications of daptomycin

A

MRSA

VRE

109
Q

1st gen lipoglycopeptide

A

telavancin (IV)

110
Q

2nd gen lipoglycopeptide

A

dalbavancin (IV)

oritavancin (IV)

111
Q

MOA of lipoglycopeptides

A

inhibit bacterial cell wall synthesis

disrupts bacterial cell membrane fcn

112
Q

drug interaction of telavancin

A

additive QTc prolongation w/ other QTc drugs

113
Q

drug interaction of dalbavancin

A

none! we love this drug

114
Q

drug interaction of ortiavancin

A

UFH use= bad w/ in 48hrs

115
Q

pharm characteristics of lipoglycopeptides

A

renal excretion
conc. dependent killing
infuse slow
bactericidal

116
Q

contraindications to 1st gen lipoglycopeptide (telavancin)

A

QT interval issues

women of childbearing years

117
Q

contraindication to 2nd gen lipoglycopeptides

A

none

118
Q

ADR of 1st gen lipoglyco (telavancin)

A

taste disturbance
foamy urine
QTc prolongation
renal dysfunction

119
Q

do we use telavancin?

A

no

120
Q

2nd gen lipoglycopeptide ADR (dalba/ortiavancin)

A

N/V/D

hypersensitivity rxn

121
Q

clinical indication for vancins?

A

SSTI caused by susceptible G+ bacteria (MRSA, VISA/VRSA, some VRE)

122
Q

which vancin is most commonly used? why?

A

ortiovancin

1 dose & microbial activity best

123
Q

What should we suspect in a pt. fails amoxicillin? (assume it is dosed & diagnosed properly)

A
  • 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)

Pharm Kay Exam 2 (3 decks)

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