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Unit 6 Pharm - MEEE > ANTIBIOTICS--Cell Wall Inhibitors > Flashcards

ANTIBIOTICS--Cell Wall Inhibitors Flashcards

1
Q

What are the natural penicillins?

A

penn G and Penn V

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2
Q

How is Penn V available?

A

PO - by mouth

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3
Q

What is the spectrum of Penn V/ Penn G?

A

Strep
Anerobes
Syphilis

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4
Q

Where/When would you use Penn V/G?

A

Strep throat
non-purulent Cellulitis
Syphillis

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5
Q

What are the side effects of natural penicillins?

A

hypersensitivity

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6
Q

What is the name of the next generation of penicillins after natural penicillins?

A

anti-Staphylococcal penicillins

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7
Q

What are the anti-staphylococcal penicillins?

A

Oxacillin
Nafcillin
Dicloxacillin
“Don the Ox is my anti-Staph”

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8
Q

What is the spectrum of Anti-Staph penicillins?/ When are they used?

A

MSSA and strep

MSSA infection MSSA infection MSSA infection MSSA infection

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9
Q

What is important to know about the anti-staphylococcal penicillins?

A

bulky side chain shields beta lactam ring from penicillinase

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10
Q

Who are the aminopenicillins?

A

Ampicillin and Amoxicillin

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11
Q

Can Ampicillin be given IV?

A

yes

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12
Q

What is the spectrum of the amoxicillin and ampicillin?

A

strep
enterococci
listeria
–some gram negatives such as proteus, E.coli

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13
Q

When do you use amoxicillin (PO)?

A

for Upper Resp Tract Infections

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14
Q

What is the drug of choice for Enterococcus infections?

A

Ampicillin (IV)

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15
Q

What else can you use Ampicillin IV for?

A

listeria meningitis

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16
Q

The combination of ampicillin and an IV aminoglycoside can be used to treat what?

A

enterococcal endocarditis

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17
Q

What are the side effects of the aminopenicillins (amox and ampicillin)?

A

hypersensitivity both non-IGE (delayed) and IgE (Type 1) rashes

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18
Q

Why were penicillin/Beta Lactamase inhibitor combinations created?

A

to cover more gram negatives (Enterobacteriaceae), MSSA and anerobes includine B. fragilis

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19
Q

Where is Pip/Taz (Zoosyn) or Ticar/Clav (Timentin) used?

What is the side effect of Pip/Taz

A

PSEUDOMONAS
nosocomial infections including pneumonia,intrabdominal infections and wounds

SE of Pip/Taz?–> thrombocytopenia, interstitial nephritis

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20
Q

Where is Amox/ Clav (Augmentin) or Amp/Sulb (Unasyn) used?

Side effect?

A

animal or human bites
URI
Diabetic Foot Infection

SE: diarrhea

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21
Q

First generation Cephalosporins include?

A

Cefazolin and Cephalexin

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22
Q

What is the spectrum of the first gen cephs?

A

strep
MSSA
non-beta lactamase producing gram negatives (do not use empirically) for UTI (eg. E.coli sensitive to Cephazolin)

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23
Q

What conditions were first gen cephs used to treat?

A
  1. UTIs caused by E. coli and Klebsiella
  2. MSSA bacteremia
  3. Strep cellulitis
  4. surgical prophylaxis
24
Q

Which of the cephs was used for surgical prophylaxis?

Which generation has more cross-reactivitity with penicillins?

A

first gen - cephalexin and cefazolin

first gen

25
Q

Within the second gen of cephs, which were considered true cephalosporins?

A

cefuroxime, cefaclor, loracarbef and cefprozil

26
Q

What was special about the second gen true cephs?

A

they were BETTER for S. pneumo than first gen and had better gram neg coverage - great for ANEROBES

27
Q

What were the cephamycins?

A

Cefoxitin or Cefotan

28
Q

cephamycins are special because…

A

they destroy E. coli and Kleb and the have activity against ANEROBES

29
Q

Which two 2nd gen cephs are the only ones that cover ANEROBES?

A

CEFOXITIN and CEFOTAN (cephamycins)

30
Q

What conditions are the 2nd gen cephs used to Tx?

A

URI/ pneuomonia from community

31
Q

What are the cephamycins used to Tx?

A

prophylaxis for colon surgery

32
Q

What are the third gen cephs?

A 
cefotaxime 
ceftriaxone
ceftazidime
cefdinir
cefpodoxime
ceftibutin
cefixime
33
Q

Which two third gens cephs are used to Tx S. pneumo, H. flu and M.cat?

A

ceftriaxone and cefotaxime - used most often

34
Q

which third gen ceph is best for pseudomonas?

A

ceftazidime

35
Q

are the thrid gen cephs good for enterococcus?

A

no

36
Q

what conditions are third gen cephs good for treating?

A

pneumonia from S. pneumo and H. flu and
meningitis - CEFTRIAXONE
Nosocomial infections w. Pseudomonas
intra-abdominal infections

UTI

37
Q

Which gen of Cephalosporins is assoc w. C. dificile?

which third gen is used to treat lyme disease?

A

THIRD GEN

ceftriaxone

38
Q

which generation of cephs is a zwitterion?

A

fourth gen - Cefipime (IV)

39
Q

What is Cefipime (4th gen) good for?

A

pseudomonas and nosocomial infections for pneuomonia

1) Neutropenic fever (better as monotherapy than ceftaz due to improved gram + activity)
(2) Meningitis, especially post-neurosurgical or hospital acquired
(3) Ceftazidime-resistant Enterobacteriaceae
(4) Similar to 3rd-generation cephalosporins
post surgical meningitis

40
Q

side effects of fourth gen cephs?

A

seizures

41
Q

what are the fifth gen cephs?

A
  1. ceftaroline - it possesses a side chain that mimics a portion of the cell wall structure ad a Trojan horse allowing access to PBP2a
  2. ceftobirole
42
Q

Could the fifth gen cephs be used to Tx MRSA and Enterococcus?

A

yep. It is the only gen that could do this

43
Q

what conditions can it treat?

A

complicated skin and soft tissue infection

44
Q

What class is Aztreonam? a monobactam or a carbapanem?

A

monobactam

45
Q

Aztreonam is good against gram negatives only.

never use it alone

A

Pseudomonas and combined for nosocomial infections esp in patients w. Pen allergy (where you don’t want to use an aminoglycoside) and kidney dysfunction

46
Q

What class do imipenem, meropenem, ertapenem and doripenem used for?

A

carbapenems

47
Q

what are the carbapenems used for?

A

ANEROBES

**Ertapanem is the worst for Pseudomonal or Acinetobacter activity

48
Q

What are they used to treat?

A

Ertapanem - for intrabdominal infections
nosocomial infections
polymicrobial infections that doesn’t involve Pseudomonas
outpatient dosing

Meropenem for ESBLs

49
Q

what is the important side effect of carbapenems and which one causes it?

A

seizures - imipenem

50
Q

Vancomycin mechanism of action

A

binds too D-Ala-D-Ala which prevents elongation of peptidoglycan and cross linking

51
Q

Mechanisms of resistance

A

VRE where enterococcus changes peptidoglucan to D-ALA-D-Lactose

52
Q

spectrum of Vancomycin?

A 
MRSA
Coag-Neg Staph
Strep
Enterococci
----all gram positives
53
Q

side effect of Vancomycin

A

kidney failure and hypersensitivity

54
Q

use of which antibiotic will cause Redman Syndrome?

A

Vancomycin

55
Q

beta lactam spectrum review notes

A
  1. Pen V/ G- strep then Ceftriaxone to avoid resistance
  2. Aminopenicilins made to cover gram negatives
  3. Anti-Staph for MSSA
  4. Antipseudomals are combined w. a beta lactamase inhibitor (pip/tax) for nosocomial, gram neg
  5. first gen cephs–> Strep, MSSA, UTI
  6. second gen cephs–> outpatient - UTI (Cephamycins for ANEROBES)
  7. third gen for gram neg, Ceftaz for Pseudomonas. Add Metronidazole for anerobic coverage
  8. fourth gen, Cefipime, great GP, broad gram neg
  9. Carbapanem- for multi-drug resistance in ICU or if they have used a lot of antibiotics already
  10. Vancomycin- a glycopeptide

Unit 6 Pharm - MEEE (12 decks)

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