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antibiotics 1 Flashcards

1
Q

4 classes of beta-lactams

what do they all target?

A

penicillins
cephalosporins
carbecephams
monobactams

–all target cell wall biosynthesis

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2
Q

what two types of drugs target cell wall biosynthesis?

A

beta lactams and glycopeptides

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3
Q

what class of drugs target membrane potential?

A

lipopeptides

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4
Q

what class of drugs target cell membrane disruption?

A

polymyxins

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5
Q

sulfonamides target…?

A

nucleic acid biosynthesis

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6
Q

trimethoprim targets…?

A

nucleic acid biosynthesis

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7
Q

What do fluoroquinolones target?

A

DNA replication/transcription

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8
Q

bacteriostatic

A

inhibits bacterial growth without causing cell death

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9
Q

MIC vs MBC

A

MIC - lowest {} that inhibits growth after 18-24 hrs in vitro
MBC - lowest [] at which 99.9% of culture is killed after 18-24 hours in vitro

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10
Q

PAE

A

post antibiotic effect

suppression of bacterial growth continues after [ ] falls below MIC

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11
Q

gram + stains ___?

gram negative stains ____?

A

+ blue

- pink

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12
Q

3 aerobic gram + cocci

A

staphylococci
streptococcus
enterococcus

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13
Q

3 aerobic gram + bacilli

A

bacillus
cornyebacterium
listeria monocytogenes

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14
Q

3 aerobic gram - cocci

A

acinetobacter
moraxella catarhallis
neisseria

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15
Q

aerobic gram - bacilli

A 
acinetobacter
citrobacter
enterobacter
helicobacter
e coli
H. influenzae
klebsiella
proteus
pseudomonas
salmonella
shigella
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16
Q

gram - spirochetes

A

borrelia burgdorfera

treponema pallidum

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17
Q

above diaphragm anaerobe

A

peptostreptocuccus

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18
Q

below diaphragm anaerobes

A

gram + clostridium perfringens, tetani, and dificile

gram - bacterioides and fusobacterium

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19
Q

acid fast bacteria

A

mycobacterium and nocardia species that produce myolic acid = stain purple

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20
Q

do human cells have cell walls?

A

no…this is why we can target them

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21
Q

B lactams mechanism

A

inhibit peptidoglycan layer of cell wall synthesis

  • inhibits crosslinks between disaccharide units
  • can inhibit transpeptidase or PBPs
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22
Q

how to overcome penicillinase resistance?

A

combine penicillin with an inhibitor of B lactamase

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23
Q

side effects of beta lactams except monobactams

A

diarrhea
CV overload due to increased salts (v overload)
in renal failure –> hallucinations/convulsions
coagulation defects d/t inhibition of platelet activation and conversion of fibrinogen to fibrin

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24
Q

are penicillins and cephalosporins antigenic?

A

no, but their polymers and metabolites can react with bacterial or tissue proteins to form antigenic conjugates –> causing allergic reactions

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25
penicillins structure 3 roles of the beta lactam ring
beta lactam ring + thiazolide ring = 6 aminopenicillanic acid beta-lactam ring: 1) the active center of abx, 2) site of action for bacterial enzymes, and 3) site of formation of antigenic determinants
26
B lactamases and penicillinases
bacterial enzymes that allow resistance against penicillins
27
do penicillins have good solubility?
no; they are ionized free acids at physiological pH so to improve solubility they are given as Na or K salts
28
do peniciliins enter csf?
no, only during inflammation
29
penicillin G and penicillin V
natural penicillins - made from the fungus penicillium broad gram + bacteria (non penicillinase)
30
penicillin G
``` acid labile (not stable in acid) only a third of dose is absorbed ```
31
penicillin V
acid stable form better oral absorption than penicillin G broad spectrum gram +
32
penicilin G vs V coverage
G is more active against neisseria and some anaerobes
33
two ways to prolong penicillin G blood levels?
1) delay absorption by adding organic base like procaine or benzathine --> poorly soluble form 2) delay elimination by adding probenacid (blocks tubular secretion)
34
penicillinase resistant penicillins (5) | use when bacteria are resistant to penicillin
``` "i met nasty oxen" methicillin nafcillin oxacillin cloxacilin dicloxacillin ```
35
i met nasty oxen (penicillinase resistant penicillins) are not active against
NOT active against gram -
36
MRSA
methicillin resistant related to failure to bind penicillin binding proteins (PBPs)
37
first line treatment for B lactamase producing staph?
penicillinase resistant penicillins - methacillin - nafcillin - oacillin, cloxacillin, dicloxacillin
38
extended range penicillins
ampicillin amoxicillin "am" extended first penicillins effective against gram - (better penetration of outer membrane) less susceptibility to to gram - penicillinases but more suseptibility to gram + penicillinases
39
amoxicillin or ampicillin: which extended penicillin is more completely absorbed orally?
amoxicillin
40
amoxicillin and ampicillin are active against which specific 6 orgs?
``` e coli p mirabilis h influenzae salmonella shigella neisseria ```
41
anti pseudomonal penicillins
--carboxylated derivatives (ticarcillin) extend the range of ampicillin to P aeruginosa, indole-positive proteus and enterobacter
42
ticarcillin
used with pulmonary infections extends ampicillin range from 6 gram - (epnssh) and adds p aeruginosa proteus and enterobacter
43
cephalosporins
similar structure and mechanism as penicillins wider activity range 4 generations
44
side effects of cephalosporins
GI issues and | BLEEDING
45
1st gen cephalosporins
cephalexin cefazolin - narrow spectrum (staph and strep) (gram + >gram -) - use for SURG prophylaxis; -NOT for active infection - dont penetrate CNS - not effective against MRSA
46
what is recommended for mild foot infections in diabetics?
first gen cephalosporin --> cephalexin
47
second gen cephalosporin
cefoxitin used for B fragilis and other anerobics prophylaxis for abdominal surgery
48
prophylaxis for abdominal surgery?
cefoxitin (2G cephalosporin)
49
3rd gen cephalosporins
ceftriaxone and ceftazidime broad; penetrates CNS highly active against gram - enteric orgs
50
ceftriaxone used for what 3 bacteria?
--> N gonorrheae, N meningitis, and B burgdorferi
51
ceftazidime used for what?
--> multidrug resistant gram - infections (like P aeruginosa)
52
what is the first B lactam approved for MRSA infections?
ceftaroline fosamil | a 3G cephalosporin
53
cefepime
4G cephalosporin similar to ceftazidime against P aeruginosa and other gram - better than 3g against gram + due to resistant to chromosomally encoded B lactamases
54
ertapenem
a carbapenem resistant to B lactamases, but NOT resistant to metallo B lactamases BROAD ( +, -, and anaerobics) CNS and renal toxicity
55
aztreonam
a monobactam gram - can be inhaled; little cross allergenicity with other B lactam abx
56
vancomycin
a glycopeptide abx that prevents d-ala attachment to cell wall (binds substrate) must give by IV; no cross-allergenicity! bactericidal against gram + rods (including penicillinase producers and MRSA) LAST resort for c dificile
57
when can vancomycin be given orally?
abx-resistant pseudomembranous colitis and staph enterocolitis
58
what resistance canbe developed against vancomycin?
van HAX genes | replaces D-ala with D lactate
59
vancomycin side effects
"Red man syndrome" -- hypersensitivity skin flushing or rash tissue necrosis if given IM neutropenia and nephrotoxicity
60
daptomycin
lipopeptide; inhibits cell membrane potential by forming ca-dep membrane channels used for skin infections and endocarditis by aerobic, gram + works against resistant strains (VRSA, MRSA)
61
vancomycin and daptomycin: can they be given IM?
no --> they cause tissue necrosis!
62
polymyxins
polymyxins A and B (colistin) cationic detergents that disrupt cell membrane used topically or in eye/ear drops NEPHROTOXIC
63
what drug is used for acinetobacter from middle east
polymyxins (colistin)

Multisystem 1st Half (23 decks)

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