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PT2 ID 1-6 > antibiotics med chem > Flashcards

antibiotics med chem Flashcards

1
Q

mutualistic relationship

A

both organisms benefit

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2
Q

opportunistic relationship

A

under normal conditions the microbe does not cause disease, but can if certain conditions are met

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3
Q

features of gram positive bacteria

A
  • Outer peptidoglycan layer

- stains purple

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4
Q

features of gram negative bacteria

A
  • out lipopolysaccharide layer
  • porins provide channels through LPS
  • stains pink
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5
Q

antibiotics that are from manmade sources

A

sulfa drugs
fluoroquinolones
linezolid

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6
Q

bacteriocidal

A 
kills bacteria
(technically all antibiotics are bacteriocidal at high doses)
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7
Q

bacteriostatic

A

inhibits growth of bacteria

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8
Q

sugar with the peptide attached for cross linking in peptidoglycan

A

NAM

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9
Q

amino acids needed to form cross-link

A
  • D-Ala D-Ala on NAM

- pentaglycine chains linking the NAMs

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10
Q

steps of forming peptidoglycan cross-link

A

in cytoplasm

  1. synthesize NAM
  2. attach NAG and prenyl
  3. add peptide side chain
  4. flipping into periplasm

in periplasm
5. form crosslink

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11
Q

enzyme that makes crosslinks

A

transpeptidase

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12
Q

what facilitates transport of NAG and NAM into periplasm

A

bactoprenol

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13
Q

how does transpeptidation take place?

A
  1. penicillin binding protein has an active Ser that attacks the non-terminal D-Ala forming an ester bond
  2. Ester bond can be attacked by an amine in the pentaglycine chain via transpeptidation, forming a cross link
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14
Q

beta-lactam MoA

A

mimic D-Ala D-Ala to form a bond with PBP and prevent it from being used to make cross links, thus opening the cells wall

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15
Q

definition of a lactam ring

A

an intramolecular ring with an amine and a carboxylic acid linked with varying amounts of carbons (alpha=1, beta=2, and so on)

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16
Q

what part of beta-lactams mimics the D-Ala D-Ala peptide

A

the acidic withdrawing group on the lactam ring

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17
Q

Problems with beta lactams

A
  • degraded by water and stomach acid due to its instability

- resistance via beta-lactamase, penicillinase, and other mechanisms

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18
Q

beta-lactamase function

A

hydrolysis of penicillins

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19
Q

location of beta-lactamase in gram positive bacteria

A

outside the peptidoglycan

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20
Q

location of beta-lactamase in gram negative bacteria

A

periplasmic space, between LPS and cytoplasmic membraine

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21
Q

general SAR of penicillins

A
  • required S in ring
  • ring system
  • no substitution on ring
  • “west end” has amide linkage
  • aromatic or cyclic function in “west end” R group
  • dimethyl on east end
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22
Q

penicillin G features

A
  • early penicillin
  • very Gm+ (no staph)
  • little Gm-
  • unstable when given orally
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23
Q

penicillin V features

A
  • early penicillin
  • very Gm+ (no staph)
  • little Gm-
  • given orally b/c of ether electron withdrawing group
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24
Q

early penicillins

A

Pen G

Pen V

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25
Q

methicillin features

A
  • ortho groups prevent beta-lactamase attack
  • ok GM+
  • little GM-
  • given IV
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26
Q

nafcillin features

A
  • ortho groups prevent beta-lactamase attack
  • ok GM+ (staph)
  • little GM-
  • given IV
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27
Q

oxacillins feature

A
  • ortho groups prevent beta-lactamase attack
  • ok GM+ (staph)
  • little GM-
  • given oral
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28
Q

penicillinase-resistant penicillins

A
  • methicillin
  • nafcillin
  • oxacillins (oxacillin, cloxacillin, dicloxacillin)
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29
Q

ampicillin/amoxicillin features

A
  • amino group good for passing through porins
  • good Gm-
  • good Gm+
  • good substrate for beta-lactamase
  • ineffective against pseudomonas
  • given orally
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30
Q

broad-spectrum penicillins

A

ampicillin

amoxicillin

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31
Q

broad-spectrum penicillins for pseudomonas

A

carbenicillin

ticarcillin

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32
Q

carbenicillin features

A
  • has alpha-acidic group
  • broad Gm-
  • reduced Gm+
  • useful against pseudomonas
  • given IV
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33
Q

ticarcillin features

A
  • has alpha-acidic group
  • broad Gm-
  • reduced Gm+
  • useful against pseudomonas
  • given orally
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34
Q

broad spectrum ureido penicillin

A

piperacillin

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35
Q

piperacillin features

A
  • has urea-like group linker
  • piperazine ring gives great Gm- penetration
  • resistant to Gm- beta-lactamases
  • susceptible to Staph beta-lactamase
  • given IV
  • good for pseudomonas and anaerobes
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36
Q

clavulanic acid features

A
  • similar structure to penicillins, except has O in place of S and unsaturated C-2
  • given with other beta-lactams to deal with beta-lactamase resisitance
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37
Q

clavulanic acid MoA

A

irreversible inhibitor of beta-lactamase

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38
Q

penem drugs

A

thienamycin
imipenem
meropenem
ertapenem

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39
Q

penem features

A
  • very broad Gm-
  • PBP binder
  • no S or O in lactam ring
  • long N and S based chain from ring
  • anaerobes
  • pseudomonas
40
Q

cilastatin features

A
  • taken with imipenem to prevent degradation

- don’t give w/ drugs that have methyl on lactam ring

41
Q

monobactam drug

A

aztreonam

42
Q

aztreonam features

A
  • no intramolecular ring attached to lactam
  • sulfate EWG group
  • PBP binder
  • good Gm-
  • pseudomonas
  • given IV
43
Q

features of cephalosporins

A
  • 6 member ring attached to lactam
  • “west end” like penicillin
  • leaving group attached to 6 mem ring
  • acidic group required on 6 mem ring
44
Q

1st gen cephalosporin drugs

A

cefalexin

cefazolin

45
Q

cefalexin features

A
  • broad Gm+
  • limited Gm-
  • none for MRSA
  • given orally, ampicillin like side chain
46
Q

cefazolin features

A
  • broad Gm+
  • limited Gm-
  • none for MRSA
  • given IV/IM
47
Q

2nd gen cephalosporin drugs

A

cefuroxime
cefoxitin
cefotetan

48
Q

cefuroxime features

A
  • broad Gm+
  • ok Gm-
  • some beta lactamase resistance
  • prodrug required for oral, IV
49
Q

cefoxitin features

A
  • broad Gm+
  • ok Gm-
  • some beta lactamase resistance
  • anaerobes
  • has methoxy to protect from beta lactam
  • IV
50
Q

cefotetan features

A
  • broad Gm+
  • ok Gm-
  • some beta lactamase resistance
  • anaerobes
  • toxic tetrazole group that can case BLEEDING
51
Q

drug that can cause bleeding

A

cefotetan

52
Q

3rd gen cephalosporin drugs

A

cefdinir
cefixime
ceftriaxone
ceftazidime

53
Q

cefdinir features

A
  • good Gm+
  • broadest Gm- of cephalosporins
  • some beta-lactamase resistance
  • poor leaving group (double bonded C’s) makes it good for oral
54
Q

cefixime features

A
  • good Gm+
  • broadest Gm- of cephalosporins
  • some beta-lactamase resistance
  • poor leaving group (double bonded C’s) makes it good for oral
55
Q

ceftriaxone features

A
  • good Gm+
  • broadest Gm- of cephalosporins
  • some beta-lactamase resistance
  • no pseudomonas
  • IV
56
Q

ceftazidime features

A
  • poor Gm+
  • broadest Gm- of cephalosporins, including pseudomonas
  • some beta-lactamase resistance
  • given with avibactam
  • IV
57
Q

avibactam

A

suicide inhibitor of beta-lactamase, given with ceftazidime

58
Q

why is MRSA resistant

A

uses PBP2a instead of usual PBP

59
Q

ceftaroline fosamil features

A
  • 5th gen cephalosporin

- active against PBP2a MRSA

60
Q

fosfomycin features

A
  • similar to phosphoenolpyruvate
  • inhibits enolpyruvyl transferase which makes NAM sugar
  • broad spectrum
  • uses a Cys residue to work
61
Q

how to get resistance to fosfomycin

A

change Cys to an Asp in enolpyruvyl transferase

62
Q

2 subunits that make up the prokaryotic ribosome

A

30S and 50S

70S together

63
Q

activity sites in ribosome

A

EPA

64
Q

2 subunits that make up the eukaryotic robosome

A

40S and 60S

80S together

65
Q

aminoglycosides MoA

A

bind to 30S subunit of the ribosome, blocking initiation of translation or promoting misreading of the code

66
Q

nonsense mutation

A

mutation that stops function of the gene

67
Q

aminoglycosides use

A

broad spectrum, but mostly Gm- including pseudomonas

68
Q

aminoglycoside side effects

A
  • ototoxicity (organ of corti; irreversible)
  • kidney toxicity (proximal tubule; reversible)
  • small therapeutic window*
69
Q

aminoglycoside general structure

A

amine sugar that does not have an O in the ring;

is attached to a sugar

70
Q

aminoglycoside drugs

A

streptomycin
gentamicin
tobramycin
amikacin

71
Q

streptomycin use

A
  • Gm-
  • tuberculosis and plague
  • lots of resistance
  • oral
72
Q

gentamicin use

A
  • Gm-
  • UTI
  • bone/joint infection
73
Q

gentamicin unique feature

A

can be given with beta-lactams, but they cannot be in the same solution or they will inactivate each other

74
Q

tobramycin use

A

Gm-

pseudomonas

75
Q

amikacin use

A

Gm-
pseudomonas
tuberculosis
(only aerobic infections)

76
Q

quinolones MoA

A

inhibit DNA gyrase

77
Q

quinolone structure features

A
  • double ring, must have a double bond and ketone on right side
  • can’t give with multivitamins or Ca because of chelation
78
Q

quinolone drugs

A

nalidixic acid
ciprofloxacin
levofloxacin
moxifloxacin

79
Q

nalidixic acid use

A

Gm-
UTI
not very potent so high doses are needed leading to AEs like rash and GI

80
Q

ciprofloxacin use

A
  • Gm-
  • pseudomonas
  • atypicals
  • PO/IV
81
Q

ciprofloxacin side effects

A
  • possibly erosion of joints
  • damaging in 1st trimester of pregnancy
  • CNS effects b/c of GABA activity
82
Q

levofloxacin use

A
  • broad, improved Gm+ over other quinolones
  • pseudomonas
  • once a day dosing
  • PO/IV
83
Q

two targets in folate synthesis inhibition

A
  • dihydropteroate synthesis (unique in bacteria)

- tetrahydrofolate reductase inhibitors

84
Q

role of folates

A

used for methylation of nucleosides and synthesis of purines and AAs

85
Q

sulfonamide MoA

A

inhibit dihydropteroate synthase

86
Q

sulfonamides in pregnancy

A

avoid near term because of neonatal jaundice

87
Q

general sulfonamide adverse effects

A
  • crystalluria
  • agranulocytosis
  • aplastic anemia
  • stevens johnson
  • skin rashes
88
Q

trimethoprim MoA

A

dihydrofolate reductase inhibitor

89
Q

trimethoprim use

A

given with sulfamethoxazole because of their different targets in folate synthesis and similar half lives (11 hr)

90
Q

Bactrim

A

sulfamethoxazole and trimethoprim

-used for Gm+ and Gm-

91
Q

imiprenem and meropenem use

A
  • Gm+
  • Gm-
  • pseudomonas
  • anaerobes
92
Q

what should we never treat enterococcus with

A

carbapenems or cephalosporins

93
Q

ertapenem lacks what activity

A

pseudomonas
acinetobacter
enterococcus

94
Q

Cefipime features

A
  • Gm+
  • Gm-
  • psuedomonas
  • no anaerobes (preferred over zosyn when none present)
  • IV
95
Q

ceftaroline features

A
  • Gm+
  • Gm- (no pseudomonas)
  • MRSA
  • IV
96
Q

TMP/SMZ combo use

A
  • Gm+
  • Gm-
  • MRSA
97
Q

TMP/SMZ side effects

A
  • GI
  • rash
  • hyperkalemia

PT2 ID 1-6 (7 decks)

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