Antimicrobials 2

Question 1

What are the cell wall synthesis inhibitors?

Answer 1

fosfomycin, beta lactams, bacitracin, daptomycin, vancomycin

Question 2

cephalosporins MOA?

Answer 2

cephalosporins are beta lactams

• binds to PBP
• activate autolytic enzymes

Question 3

cephalosporins spectrum?

Answer 3

generation 1 –> 3
increasing activity against gram negative
decreasing activity against gram positive

generation 4 = broad
generation 5 = similar to gen 3 plus effective against MRSA

IMPORTANT: INACTIVE against CLAME
chlamydia, listeria, legionella, actinobacter, mycoplasma, enterococci

Question 4

cephalosporins vs penicillins? (beta lactamase resistant? bacteriocidal?

Answer 4

more resistant to beta lactamases
ie. next step

beta lactams so yes bacteriocidal

Question 5

cephalosporins resistance mech?

Answer 5

modify PBPs

Question 6

1st gen cephalosporins? used for?

Answer 6

cephalexin, cefazolin

Used as a penicillin G subsitute because they are still effective against organisms with penicillinase (a beta lactamase) ie. s. aureus

Question 7

Cefazolin DOC

Answer 7

surgical prophylaxis

Question 8

1st gen cephalosporins used to treat?

Answer 8

gram positive
E coli
Klebsiella pneumoniae
P. mirabilis (proteus)

Question 9

2nd gen cephalosporins? what are they? active against what organisms?

Answer 9

more gram negatives, less gram positives

H. influenza
Enterobacter
Neisseria

2nd gen:
aman is eating a dole cup and suddenly he HEARS something and he thinks it’s an OX coming IN, but no sadly its just an ACTOR

cefamandole
cefotetan
cefoxitin
cefaclor

Question 10

which 2nd generations treat abd and pelvic cavity infections?

Answer 10

Cefotetan
Cefoxitin

both ones with Os
O looks like a belly

Question 11

what are the 3rd generation cephalosporins? what are they active against?

Answer 11

cef-triaxone
cef-operazone
-cef-otaxime
-cef-tazidime
-cef-fixime

active against same 2nd gen (HEN) -
H. influenza
Enterobacter
Neisseria

active against more gram negatives, and less gram postiives

Question 12

Which cephalosporins are active against pneumococci?

Answer 12

3rd generation: all the T ones

cef triaxone
cefo taximine
cef tazidime

*recall penicillin G also active against pneumococci

Question 13

Which cephalosporins are active against pseudomonas?

Answer 13

3rd gen: cefoperazone and ceftazidime

also active against pseudomonas: antipseudomal penicilins

Question 14

4th generation cephalosporins?

Answer 14

cefipime

parenteral only

wide spectrum:
Hemophilus, enterobacter, neisseria (HEN), (2nd and 3rd)
E Coli, P mirabilis (1st)
Pseudomonas aeruginosa (3rd: operazone, tazidime)
Pneumococcus: (3rd: Ts: triaxone, taxidime, taximime)

Question 15

cefipime treats?

Answer 15

4th gen

mixed infections - broad spec

complicated UTIs
complicated intra abd infections
febrile neutropenia

Question 16

5th gen cephalosporin?

Answer 16

ceftaroline
Parenteral only

MRSA!!!!!!!!

similar spectrum to generation 3

Question 17

cephalosporins admin?

Answer 17

most = paraenteral
except

cephalexin, ceflacor, cefixime

Question 18

do cephalosporins get to CSF?

Answer 18

only 3rd gen

Question 19

cephalosporins elimination?

Answer 19

kidneys

EXCEPTION: bile: ceftriazone and cefoperazone

Question 20

which beta lactams cause disulfiram like side effects? what other side effect is caused by these drugs ?

Answer 20

cephalosporins:
cefamandole
cefotetan
cefoperazone

*also cause low prothrombin

Question 21

If allergic to penicillin, can you prescribe cephalosporins?

Answer 21

minor allergy: go tru

severe: no

Question 22

What are some AE of cephalosporins?

Answer 22

kernicterus: ceftriaxone binds albumin
allergic reactions
pain at infection site

SUPERINFECTIONS - CLOSTRIDIUM DIFICILE

Question 23

Carbapenems? Beta lactamase resisitent? MRSA resistant?

Answer 23

Yes. resistant against beta lacatmase (so are monobactams) (as you go down the list of beta lactams, more resistant)

Not MRSA resistant

Question 24

Carbapenems ?

Answer 24

doripenem
ertapenem
imipenem (AMY in sketchy)
meropenem

Question 25

Carbapenems spectrum?

Answer 25

very broad spectrum

gram pos
gram neg
aerobes
anaerobes

Pseudomonas aeruginosa (except ertapenem) 
remember em rata is skinny ie less broad

Question 26

Carbapenem AE?

Answer 26

partial cross sensitivity with penicilins

High IMIPENEM: seizures

Question 27

Which carbapenem has to be given with something else in order to prevent it’s degradation?

Answer 27

imipenem

cilastatin (keep it lastin with cilastin)
cilastin : dehydropeptidase inhibitor

if not, imipenem is degraded by
dehydropeptidase 1

Question 28

When are carbapenems prescribed?

Answer 28

usually restricted to avoid resistance

only given for LIFE THREATENING infections that req beta lactamase activity

Question 29

Monobactams? names? resistant to beta lactamases?

Answer 29

aztreonam

yes resistant

Question 30

can you give monobactam to patients with penicillin allergies?

Answer 30

yes.

monobactam is the most structurally different one of the Beta lactams - little cross hypersensitivity

Question 31

monobactam spectrum?

Answer 31

narrow

only give to

aerobic, gram negative rods
pseudomonas

*weird because most drugs treat gram postive

Question 32

monobactams active against pseudomonas?

Answer 32

yes

Question 33

when are monobactams prescribed?

Answer 33

gram negative infections (already hard to treat) in patients allerfic to penicillin

UTIs, intraabdominal, gynceological infections, etc

Question 34

monobactams rote of admin?

Answer 34

IV, IM, can even be inhaled for cystic fibrosis patients

Question 35

monobactam penetrate CSF? excretion?

Answer 35

yes, when inflamed

excreted via urine