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Infectious disease > antibiotics 1 > Flashcards

antibiotics 1 Flashcards

1
Q

provides structural integrity of the cell wall

A

Peptidoglycan (PG) layer

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2
Q

found in the periplasmic space function to crosslink the peptidoglycan chains

A

Transpeptidase Enzymes

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3
Q

what are the 4 bacterial targets

A

cell membrane
cell wall
NA synthesis
protein synthesis

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4
Q

4 abx that affect beta lactams

A
  1. penicillins
  2. cephalosporins
  3. carbapenems
  4. monobactams
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5
Q

PCN-G

A

natural PCN

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6
Q

PCN-V

A

natural PCN

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7
Q

methicillin

A

anti-staphylococcal PCN

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8
Q

dicloxacillin

A

anti-staphylococcal PCN

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9
Q

nafcillin

A

anti-staphylococcal PCN

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10
Q

oxacillin

A

anti-staphylococcal PCN

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11
Q

amoxicillin

A

aminopenicillin

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12
Q

ampicillin

A

aminopenicillin

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13
Q

piperacillin/tazobactam

A

Extended-spectrum (PCN’s + BLI combo)

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14
Q

amoxicillin/clavulanate

A

Extended-spectrum (PCN’s + BLI combo)

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15
Q

ampicillin/sulbactam

A

Extended-spectrum (PCN’s + BLI combo)

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16
Q

aztreonam

A

monobactam

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17
Q

imipenem

A

carbapenems

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18
Q

meropenem

A

carbapenems

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19
Q

ertapenem

A

carbapenems

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20
Q

doripenem

A

carbapenems

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21
Q

MOA of beta-lactam Abx

A

Inhibit Bacterial Cell Wall Synthesis
1. Drug binds to transpeptidase (aka Penicillin-Binding Proteins [PBP’s])
2. This inhibits bacterial peptidoglycan synthesis preventing bacterial replication (Bacteriostatic)
3. Binding to PBP activates bacterial autolytic enzymes that cause cell wall lysis (Bactericidal)

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22
Q

5 methods of resistance for beta-lactams

A
  1. Beta-Lactamase inactivates drug
    - β-Lactamases are a large family of hydrolases that catalyze the hydrolysis of the amide bond in the β-lactam ring of penicillins and cephalosporins.
  2. Increased number of beta-lactamases
  3. Decreased PBP binding affinity for drug - PCP mutation (“MRSA”)
  4. Diminished cell wall permeability with a loss of porins - (Gram -)
  5. Development of efflux pump
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23
Q

what must we do about abx resistances

A
  1. We MUST be careful in antibiotic selection and use
  2. We MUST educate patients on completion of antibiotic
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24
Q

spectrum of natural PCN

A
  1. g+
    - Streptococcus pneumoniae
    - some staphylococcus
    - bacillus anthracis
    - anaerobes (Clostridium perfringens)
  2. g-
    - Neisseria meningitides
  3. spirochetes (Treponema pallidum)
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25
Q

natural PCN is first line treatment for ?

A
  1. Strep Throat
    - Group A Beta-Hemolytic Streptococcus
  2. Syphilis
    - Treponema pallidum

cellulitis, meningitis

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26
Q

pros and cons of natural PCN

A
  • Cons
    1. Susceptible to hydrolysis by beta lactamase
    2. Resistance increasing
  • Pros
    1. Cheap
    2. Relatively safe
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27
Q

susceptibility/indications to use antistaphylococcal PCN

A
  1. Susceptible to B-lactamase
    - Not effective against MRSA infections
  2. Only indicated in the treatment of skin and soft tissue staphylococcal infections**
    - Staph aureus and Staph epidermidis
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28
Q

Susceptibility/Indications for aminopenicillins

A

Same as natural PCN, with better g- coverage

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29
Q

aminoPCN first line treatment

A

(Amoxicillin)
1. Otitis media
- Haemophilus influenzae
- Streptococcus pneumoniae
- Moraxella catarrhalis
2. Prophylaxis for endocarditis

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30
Q

using aminoPCN alone makes pts more susceptible to ____. combo forms with ____ available

A

beta lactamase
BLi

31
Q

2 advantages of aminoPCN over natural PCN

A
  1. higher oral absorption = less frequent dosing
  2. better g- penetration thru cell wall porins = superior g- coverage
32
Q

amoxicillin/clavulanic acid

A

PCN/BLi
augmentin

33
Q

ampicillin/sulbactam

A

PCN/BLi
unasyn

34
Q

spectrum of PCN/BLi

A

same as amoxicillin but better staph coverage
(better g-, pseudomonas, anaerobes)

35
Q

first line treatment for sinusitis, pneumonia/COPD exacerbations

A

PCN/BLi (augmentin)
- s. pneumo
- h. flu
- s. aureus

often reserved for more severe or refractory infections

36
Q

piperacillin/tazobactam

A

extended spectrum PCN - antipseudomonal PCN

37
Q

spectrum of extended spectrum penicillins

A

same as PCN PLUS increased g- including
- pseudomonas*
- proteus*

piperacillin = pseudomonas

38
Q

indications for antipseudomonal

A

severe infections

39
Q

cephalexin

A

1st gen cephalo

40
Q

cefazolin

A

1st gen cephalo

41
Q

cefadroxil

A

1st gen cephalo

42
Q

cefuroxime

A

2nd gen cephalo

43
Q

cefoxitin

A

2nd gen cephalo

44
Q

cefotetan

A

2nd gen cephalo

45
Q

cefaclor

A

2nd gen cephlo

46
Q

cefprozil

A

2nd gen cephalo

47
Q

ceftriaxone

A

3rd gen cephalo

48
Q

cefdinir

A

3rd gen cephalo

49
Q

cefixime

A

3rd gen cephalo

50
Q

ceftaroline

A

5th gen cephalo

51
Q

greater cephalo generation = ? coverage
lower cephalo generation = ? coverage

A

better g-
better g+

52
Q

which abx is safe in pregnancy for simple UTI/cystitis

A

cephalexin

53
Q

what beta lactam has indications for surgicial prophylaxis and serious MSSA infections

A

cefazolin (1st gen)

54
Q

what cephalos have better g- that is commonly used as surgical prophylaxis for vaginal and colorectal procedures?

A

cefoxitin/cefotetan (2nd)

55
Q

what abx are often used for 2nd line pharyngitis, sinusitis, OM, upper and lower rsp tract infections

A

cefuroxime, cefaclor, cefprozil (2nd gen)

56
Q

what abx is first line treatment for Neisseria gonorrhoeae

A

ceftriaxone

57
Q

indications for ceftriaxone (4)

A
  1. N. gonorrhoeae*
  2. pneumococcal coverage*
  3. abd surgical prophylaxis
  4. meningitis* - can cross BBB
58
Q

what is the second line treatment for upper and lower rsp tract infections (2)

A

3rd gen cephalo - cefdinir, cefixime

59
Q

indications for 4th gen cephalo

A

cefepime - severe infections, meningitis - penetrates CSF very well
pseudomonas*

60
Q

what is the only beta lactam with MRSA and VRE coverage

A

5th gen cephalo - ceftaroline

61
Q

spectrum of monobactams

A

g- only
pseudomonas
NO G+ OR ANAEROBES

62
Q

Indications for monobactams

A

severe infections:
- UTI
- bacteremia/sepsis
- inhalation* - CF, rsp infections

63
Q

imipenem/cilastatin

A

carbapenems

64
Q

what is the importance of adding cilastatin to imipenem

A

prevents inactivation in renal tubule

65
Q

spectrum of carbapenems

A

very broad
- g+, g-, anaerobes
- pseudomonas
- susceptible to beta lactamase - not indicated for MRSA

66
Q

indications for carbapenems

A

severe infections
- UTI
- meningitis
- chronic DM wounds
- osteomyelitis
- peritonitis/intra-abd infections

67
Q

what is the most common SE of beta-lactams

A

GI - N/V/D
more likely with amoxicillin/clavulanate and higher gen cephalo

68
Q

may need dosage adjustment for beta lactams with…

A

renal impairment

69
Q

drug interactions with beta lactams

A

minimal but can decrease effectiveness of oral contraceptives

70
Q

what beta lactams cover pseudomonas

A
  1. piperacillin/tazobactam (ESP)
  2. Ceftazidime (3rd)
  3. cefepime (4th)
  4. aztreonam (monobactam)
  5. meropenem (carbepenem)
  6. doripenem (carbepenem)
  7. imipenem (Carbapenem)
71
Q

what carbapenem does not cover pseudomonas

A

ertapenem

72
Q

aztreonam

A

monobactam

73
Q

what beta lactams have anaerobic coverage

A
  1. PCN (g+)
  2. AminoPCN (g+)
  3. PCN/BLi
  4. cefotetan (2nd)
  5. cefoxitin (2nd)
  6. carbapenems
74
Q

cefepime

A

4th cephalo

Infectious disease (15 decks)

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