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Antimicrobial Therapy 2 Flashcards

1
Q

What is the MOA for Beta-lactam antibiotics?

A

Blocks the transpeptidation of PG; Targets PBP on inner surface of cell wall; Osmotic fragility and cell lysis

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2
Q

What are the classes of Beta-lactams?

A
  1. Penicillins
  2. Cephalosporins
  3. Carbapenems
  4. Monobactams
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3
Q

What are the Pharmacokinetics of Beta-lactams?

A

Bactericidal, Time dependent killing

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4
Q

What are the side effects of Beta-lactams?

A

Rash, diarrhea, vaginitis

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5
Q

Describe Beta-lactam resistance

A
  1. Beta lactamase
  2. ESBLs
  3. Mutations to binding site on PBPs(MRSA)
  4. Impaired penetration and Efflux pumps
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6
Q

How do we overcome Beta-lactamases?

A

Clavulanic acid

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7
Q

What are the pharmacokinetics of Penicillin?

A

Widely distrubuted in most tissues except the prostate; Renally cleared

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8
Q

Specific side effects of Penicillins?

A
  1. Sodium or Potassium overload with IV
  2. Beta-lactamase inhibitors increase diarrhea
  3. Ampicillin/Amoxicillin increase risk of rash if concurrent viral infection
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9
Q

What are the allergies associated with Penicillins?

A
  1. Hypersensitivity reaction
  2. Serum sicknes
  3. Seizures in patients with renal failure.
  4. Cross reactivity to all penicillins and beta-lactams except Monobactam and aztreonam.
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10
Q

What is the MOA of cephalosporins?

A

In addition to its Beta-lactam MOA, it also INCOPORATES itself into the cell wall once bound to PBP.

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11
Q

What side effects are specific to cephalosporins?

A
  1. Enterocolitis
  2. Cefotetan Can block alcohol metabolism by inhibiting aldehyde dehydrogenase
  3. Ceftriaxone causes biliary sludging (Bilirubin)
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12
Q

Are cephalosporins vulnerable to beta-lactamases?

A

NO; Their structure prevents beta-lactamase enzymatic destruction. Extended spectrum antibiotic

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13
Q

Discuss resistance to cephalosporins?

A
  1. ESBLs; ESBLs do NOT affect cefotetan or Carbapenems.
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14
Q

Describe First generation of cephalosporins

A

First generation cephalosporins cant penetrate the CNS good penetration into urine.

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15
Q

Describe Second generation cephalosporins

A

Poor CNS penetration, Cefotetan maintains activity against ESBL-producing organisms; No PSA activity.

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16
Q

Describe Third Generation cephalosporins

A

Used to treat meningitis; Penetrates CNS well

  1. Low MW
  2. Non-ionized at physiological pH
  3. Highly lipid soluble
17
Q

When do you NOT use a third generation cephalosporin?

A
  1. Neonates with hyperbilirubenemia

2. Not renally cleared; secreted into bile and excreted in feces.

18
Q

Discuss Fourth Generation Cephalosporins

A
  1. Good CNS penetration.

2. Good activity in PSA

19
Q

What are the pharmacokinetics specific to Carbapenems?

A
  1. Broadest spectrum of activity
  2. Resistance can develop when treating PSA
  3. Renally cleared
20
Q

What are the side effects of Carbapenems?

A
  1. Leukopenia, Neutropenia, and thrombocytopenia

2. Imipenem decreases seizure threshold

21
Q

Describe resistance to Carbapenems?

A

Mutation resulting in abscence of OM porin in gram -

22
Q

Explain administration of Imipenem

A
  1. Hydrolyzed by dehydropeptidase

2. Must be given with cilastatin

23
Q

What is the side effect of Monobactams?

A

Increase in liver function test and transient eosinophilia.

24
Q

What are the 5 inhibitors of cell wall synthesis?

A

Inhibit formation of PG

  1. Vancomycin
  2. Telavancin
  3. Dalbavancin
  4. Oritavancin
  5. Bacitracin
25
Q

What are the pharmacokinetics of Vancomycin?

A
  1. Bactericidal
  2. Concentration-dependent killing
  3. Widely distributed
  4. Cant cross BBB
26
Q

What are the side effects of Vancomycin?

A
  1. Nephrotoxicity
  2. Chills
  3. Fever
  4. Rash
  5. Red neck syndrome
27
Q

Discuss the resistance to Vancomycin.

A
  1. Prolonged use

2. Modification to binding site.

28
Q

Discuss Telavancin side effects

A
  1. Taste disturbances
  2. Vomiting
  3. Insomnia
  4. Foamy urine
  5. Prolonged QT-interval
29
Q

What are the pharmacokinetics of Bacitracin?

A
  1. Gram + only

2. Topical application

30
Q

Side effects of Bacitracin?

A

Nephrotoxicity

31
Q

What is the MOA of Daptomycin?

A

Binds to CM via calcium dependent insertion of its lipid tail; Disrupts ionic gradient.

32
Q

What are the pharmacokinetics of Daptomycin?

A
  1. Minimum CNS penetration
  2. Gram + only
  3. Bacteriocidal
33
Q

Side effects of Daptomycin?

A
  1. Constipation
  2. Myopathy
  3. Headache

Pharmacology (25 decks)

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