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Antimicrobials: Cell Wall Inhibitors Flashcards

1
Q

The only anti tb medication that is bacteristatic

A

Ethambutol

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2
Q

Genetic material in bacteria that confers antibiotic resistance

A

Plasmids

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3
Q

Bactericidal

A

Kills bacteria
Cell wall synthesis inhibitors
Narrow spectrum

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4
Q

Bacteriostatic

A

Inhibits growth
Protein synthesis
Broad spec

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5
Q

Methicilin causes

A

Interstitial nephritis

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6
Q

doc for atypical pneumonia

A

Macrolide (Erythromycin)

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7
Q

DOC for all stages of syphilis

A

Penicillin

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8
Q

Penicillin interferes with the last step of bacterial cell wall synthesis:

A

Transpeptidase

transpeptidation or cross-linking of peptidoglycan chains

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9
Q

Beta lactam attached to thiazolidine ring

A

Penicillin

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10
Q

Nucleus of penicillin

A

aminopenicillanic acid

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11
Q

Penicllin can only penetrate meninges if they are

A

inflamed

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12
Q

enzyme responsible for peptidoglycan cross-linking which is the final step in cell wall synthesis

A

Transpeptidase

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13
Q

Only oral pen

A

Pen V

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14
Q

thin walled

A

Gram negative

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15
Q

Most common cause of atypical pneumoniae

A

M pneumoniae

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16
Q

DOC for M pneumoniae

A

Macrolide:

Erythromycin

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17
Q

Given IV because not effective orally due to poor absorption from the intestinal tract

Oral doses must be very large

A

Pen G (benzyl penicillin)

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18
Q

Repository form of Pen G due to rapid elimination from blood stream

A

Pen G Procaine

Pen G Benzanthine

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19
Q

Pen G Notorious for hypersensitivity

Cross allergenecity
Anaphylaxis

A

Penicillin G Procaine

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20
Q

Acid stable penicillin

A

Penicillin V (phenoxymethylpenicillin)

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21
Q

Drug of choice for all stages of syphyllis

A

Penicillin

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22
Q

Prototype drug of Penicillase-resistant Penicillin/Antistaphylococcal Penicllin but off the market due to high incidence of interstitial nephritis

A

Methicillin (2.6 dimethoxyphenylpenicillin)

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23
Q

Methicillin causes

A

interstitial nephritis

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24
Q

Penicllin SE

A 
Seizure - renal problem or newborn
Hypersensitivity 
Diarrhea
Hemolytic anemia
Hypernatremia 
Hyperkalemia
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25
Q

Antistaph Penicillin

A 
Methicillin
Nafcillin
Oxacillin
Dicloxacillin
Cloxacillin
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26
Q

Adverse effect of antistaphylococcus penicillin

A

granulocytopenia

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27
Q

Small amounts excreted in kidneys and majority in the bile hence can be given in patients with renal problems

A

Nafcilin (2-ethoxy-l-phenylpenicillin)

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28
Q

Isoxazolyl penicillins

best absorbed

A

Oxacillin
Cloxacillin
Dicloxacillin

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29
Q

Have antibacterial spectrum similar to pen G but are more effective against gram negative bacilli

A

Aminopenicillin

Ampicillin
Amoxicillin

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30
Q

Poor GI absorption

More frequent Parenterally

A

Ampicillin

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31
Q

Better GI absorption aminopenicillin

A

Amoxicillin

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32
Q

Ampicillin is notorious for

A

Pseudomembranous colitis

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33
Q 
Helps kill enterococci
Haemophilis
E coli
Listeria 
Proteus
Salmonella
Enterococci
A

Ampicillin

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34
Q

Prodrug of ampicillin

A

Hetacillin
Bacampicillin
Cyclacillin

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35
Q

If patient is allergic to penicillin you may give

A

Erythromycin

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36
Q

Unstable in gastric acid hence given IM/IV

A

Antipseudomonal penicillins

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37
Q

Antipseudomonal penicillin

A 
Mezlocillin
Piperacillin
Azlocillin
Carbenicillin
Ticarcillin
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38
Q

For gram negative esp Pseudomonas except Klebsiella

nosocomial infections

A

Antipseudomonal Penicillin

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39
Q

Ticarcillin/Carbenicillin is known to cause

A

Platelet dysfunction

use cautiously in septic patients

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40
Q

Carboxypenicillin

A

Carbenicillin

Ticarcillin

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41
Q

Most potent ureidopenicillin

A

Piperacillin

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42
Q

Ureidopenicillin

A

Piperacillin
Azlocillin
Mezlocillin

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43
Q

Structurally related to the beta lactam ring of penicillin but do not have significant antibacterial activity

Instead, they bind to and inactivate beta lactamases

A

Beta lactamase inhibitors

Clavulanic acid
Sulbactam
Tazobactam

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44
Q

Prevent bacteria from destroying amoxicillin

A

Clavulanic acid

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45
Q

Acid resistant penicillin

A 
V Pen
Oxacillin
Dicloxacillin
K (c) Cloxacillin
Amoxicillin/Ampicillin

VODKA

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46
Q

Penicillinase resistant penicillin

A 
Cloxacillin
Oxacillin
Nafcillin
Dicloxacillin
Oxacillin
Methicillin

CONDOM

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47
Q

Penicillin SE

A 
Abdominal pain/Anaphylaxis
Black tongue
Diarrhea
Skin rash
Stomach upset
Seizure

ABCDSSS

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48
Q

Beta lactam attached to dihydrothiazine ring

A

Cephalosporin

5-10% cross reactivity with penicillin

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49
Q

Nucleus of cephalosporin

A

7 Amino Cephalosporanic acid

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50
Q

cephalosporins are known for this SE

A

Nephrotoxicity

Disulfiram like effects with ETOH

51
Q

First to third gen cephalosporins have

A

dec in gram positive coverage
inc in gram negative coverage
inc in CNS penetration
inc in beta lactamase

52
Q

First gen cephalosporins can be

A

Pen G substitutes

53
Q

Resistant to staphylococcal penicillinase
Inferior activity against Gram positive
Enhanced activity against Gram negativd

A

Second gen cephalosporin

54
Q

3rd Gen Cephalosporins

A 
Cefotaxime
Ceftriaxone
Cefixime
Ceftazidime
Cefbuten
Cefoperazone
55
Q

DOC for meningitis

A

Ceftriaxone

Cefotaxime

56
Q

3rd Gen active against P aeruginosa

A

Ceftazidime

also Cefoperazone

57
Q

Fourth gen Cephalosporin

A

Enhanced activity against gram positive and gram negative, pseudomonas

Ex: cefipime

58
Q

1st Gen Cephalosporin

A 
Cefalexin
Cefazolin
Cefadroxil
Cephapirin
Cephradine
59
Q

2nd Gen Cephalosporin

A 
Cefuroxime
Cefoxitin
Cefaclor
Cefamandole
Cefpodoxime 
Cefprozil
60
Q

3rd Gen Cephalosporin

A 
Ceftriaxone
Cefotaxime
Ceftazidime (Tazicef, Tazidime)
Ceftibuten
Cefoperazone
61
Q

4th Gen Cephalosporin

A

Cefipime

Cefpirome

62
Q

Lab work for cephalosporin

A

Creatinine due to risk for nephrotoxicity

63
Q

Metronidazole also has this effect

Sulfonylureas

A

Nephrotoxicity

Disulfiram-like reaction

64
Q

Serious Klebsiella infections
For patients with mild allergy

Coverage: Proteus, E coli, Klebsiella
(UTI)

A

1st Gen Cephalosporin

PEK

65
Q

Coverage:

H influenzae
Enterobacter aerogenes
Neisseria species
Sereatia marcenses
\+
PEK
A

2nd Gen Cephalosporin

HENPEKS

66
Q

For otitis media and sinusitis

67
Q

For mixed aerobic and anaerobic infections

68
Q

CAP

A

Cefuroxime

69
Q

Causative agent for:
Cherry red colonies
UTI
Red diaper syndrome

A

Serratia marcenses

70
Q

Penetrates CSF (DOC Meningitis)
Sepsis of unknown organism
Empiric therapy of life threatening conditions

Inferior against gram positive but has enhanced activity against gram negative

A

3rd Gen Cephalosporin

71
Q

Administration of vaccines against these organisms dec severity of COVID

A

H influenza

PCV

72
Q

Empiric therapy in febrile neutropenic patients

UTI, pneumonia, skin infections

A

4th Generation Cephalosporin

73
Q

Best penetrates BBB

A

Ceftriaxone

74
Q

MRSA
VRSA
Acute bacterial skin infection, CAP

A

5th Gen Cephalosporin

Ceftaroline
Ceftobiprole

75
Q

Anti pseudomonal coverage

A

Ceftazidime

76
Q

Renal dihydropeptidase inhibitor

77
Q

Broadest in activity
Resistant to beta lactamase
Inactivated by dihydropeptidase in the kidney

A

Carbapenem

78
Q

Undergoes cleavage by dihydropeptidase

79
Q

Dihydropeptidase is inhibited in the brushborder of the proximal tubule by

80
Q

Imipinem

Carbapenem SE

A

Seizure

GI effect

81
Q

The beta lactam ring is not fused to another ring

Resembles aminoglycosides but does not cause ototoxicity and nephrotoxicity

Preserved Gram positive and anaerobic flora activity
Active against Gentamycin resistant organism

No cross allergenicity with Penicillin

A

Monobactam

82
Q

Bactericidal

Active against Gram negative organisms including Enterobacter and P aeruginosa

83
Q

Intraabdominal infections

Septicemia

84
Q

Empiric therapy

Severe infection caused by drug resistant organisms

85
Q

Anti pseudomonas coverage

A

Meropenem

Aztreonam

86
Q

Clinical use has been limited by their undesirable side reactions especially renal toxicity

Lack systemic activity hence only used topically except Vancomycin used for systemic infections

A

Polypeptide

87
Q

Mild clostridi dificille (pseudomembranous colitis) infection DOC

A

Metronidazole

88
Q

Moderate to Severe Clostridium dificille

A

Vancomycin

89
Q

Glycopeptide active against Gram positive and MRSA
From streptomyces orientalis

Slow IV infusion employed for treatment of systemic infections

A

Vancomycin

90
Q

Vancomycin AE

A

Red Man Syndrome

91
Q

Vancomycin binds to the

A

D-alanyl-D-alanine portion DADA of cell wall inhibiting peptidoglycan polymerization

92
Q

Vancomycin causes

A

Ototoxicity and hypersensitivity

93
Q

Vancomycin also causes the notorious

A

Red Man Syndrome

94
Q

Rate dependent infusion reaction (and not a true allergic reaction) involving

Flushing
Erythema
Pruritus
Affects upper body, neck and face > lower body
Myalgia, dyspnea, hypotension

Mx:
Stop infusion
Administer diphenhydramine
Can restart at slower rate once symptoms resolve

A

Red Man Syndrome

95
Q

Vancomycin causes Red Man Syndrome because it directly activates

A

Mast cells causing histamine release

96
Q

Cyclic peptide or mixture of a polypeptide from Bacillus subtilis

Blocks transfer of peptidoglycan unit to growing cell wall

Poorly absorbed

Active against a wide variety of Gram + organisms

Limited to topical use due to toxicity

A

Bacitracin

97
Q

Made from bacillus polymyxa
Effective primarily against gram positive organisms

Alterates cell membrane permeability of bacteria and fungi

A

Polymyxin

Polymyxin B
Colistin (Polymyxin E)

98
Q

Useful against gram negative organisms

From Bacillus brevis

A

Gramicidin

99
Q

Organisms without cell wall or not actively growing are not susceptible to

A

Penicillin

ex Mycoplasma

100
Q

Pen AE

A

Hypersensitivity
Seizure
Diarrhea
Hemolytic anemia

101
Q

Hypersensitivity to penicillins:

A

Cross allergenecity

Anaphylaxis

102
Q

For staph thay produces penicillinase

AE

A

granulocytopenia

103
Q

Methillin AE

A

interstitial nephritis

104
Q

Antipseudomonal Pens are given IV/IM because

A

unstable in gastric acid

105
Q

For gram negative bacilli esp Pseudomonas EXCEPT Klebsiella

Ticarcillin/carbenicillin SE

A

platelet dysfunction

careful in septic

106
Q

Ampicillin Amoxicillin coverage

A 
Enterococci
HELPS
Haemophilus
E coli
Listeria
Proteus
Salmonella
Enterococci
107
Q

5th Gen Cephalosporin

A

Ceftaroline

Ceftobiprole

108
Q

Ceftolozane + Tazobactam

109
Q

Disulfiram reactions

A

Cephalosporin (cefotetan and cefoperazone)

Sulfonylurea (Chlorpropamide)

Griseofulvin

Metronidazole

Procarbazine

110
Q

Beta lactamase resistance to B lactam antibiotics such as Pen, Ceph, Carba

inhibitors

A

Clavulanic acid (Co-Amox)
Sulbactam (Ampi-sul)
Tazobactam (PipTaz)

111
Q

Prevenrs bacteria from destroying amoxicillin

Beta lactamase inhibitor

A

Clavulanic acid

112
Q

Beta lactamase producing organisms

A 
S aureus
H influenzae
Neisseria 
Moraxella
Legionella
113
Q

Monobactam resistant to beta lactamase
Inhibits cell wall synthesis
Synergistic with aminoglycoside

No cross allergenecity with penicillin

A

Aztreonam - Monobactam

114
Q

Allergy to Linezolid give

Also renal failure cannot give Vanco

A

Daptomycin

Pen - Erythro - Vanco - Linezolid

115
Q

Advantages of Aztreonam

A

Resembles aminoglycosides but does not cause Ototoxicity and Nephrotoxicity
Preserve G+ and anaerobic flora
Active against Gentamicin-resistant organism
No cross allerginicity with Penicillin

116
Q

Antineoplastic Ototoxicity and Nephrotoxicity

A

Cisplatin

Aminoglycoside

117
Q

Beta lactam that binds to penicillin binding proteins

Broadesr activity
Severe infections causes by drug resistant organisms

A

Carbapenem

Imipenem
Meropenem
Ertapenem

118
Q

Inactivates carbapenem in proximal tubules of kidneys

A

Dihydropeptidase enzyme

119
Q

Inhibits dihydropeptidase enzyme

A

Cilastin

combined with Imipenem for polongation

120
Q

Vacomycin inhibition on D-Ala-D-Ala

A

Transglycosylation

Transpeptidation

121
Q

Red Man’s Syndrome

A 
Nicotinic acid
Niacin
Nifedipine
Amphotericin
Vancomycin

NNNAV

122
Q

Bacitracin SE

A

Nephrotoxicity (hematuria, proteinuria, Na retention)

Hypersensitivity

123
Q

Analog of D alanine

Cell wall synthesis inhibitor

2nd line for Tuberculosis

A

Cycloserine

124
Q

Polymyxin hyperpigmentation is caused by

A

Melanocyte Stimulating Hormone MSH

Pharma (26 decks)

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