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Beta lactams and cell wall inhibitors Flashcards

1
Q

Penicillins- MOA

A

D-Ala-D-Ala analog –> inhibit the enzyme transpeptidase resulting in inhibition of the transpeptidation rxn. activating autolysis.

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2
Q

Penicillins- MOR

A

MRSA/PRSP- change PBP
Salmonella- efflux pump
Pseudomonas- change porin structure so drug cant penetrate
staph and gram neg- plasmid betalactamases.

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3
Q

Penicillin- classifications

A

Narrow spectrum- penicillinase susceptible
Very narrow spectrum- penicillinase resistant
Extended spectrum- penicillinase resistant

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4
Q

Narrow Spectrum penicillins- drugs

A

Penicillin G
Penicillin V
pehnoxyethyl penicillin

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5
Q

Narrow Spectrum penicillins- resistant strains

A

S. aureus

N. gonorrhea

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6
Q

Very narrow spectrum- drugs

A 
Methicillin
Nafcillin
Oxacilin
cloxacillin
dicloxacillin
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7
Q

Very narrow spectrum- uses

A

Staph

Penicillinase resistant

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8
Q

Extended spectrum- drugs

A

amoxicillin
ampicillin
pipercillin
ticarcillin

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9
Q

extended spectrum- prenicillinase resistant?

A

No they are susceptible to penicillinase thus are used with beta lactamase inhibitors

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10
Q

extended spectrum + beta lactamase inhibitor pairings

A

amoxicillin- clavulonic acid
ampicillin- sublactam
pipercillin- tazobactam
ticarcillin- clavulonic acid

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11
Q

Cephalosporins- how many generations

A

4

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12
Q

Cephalosporins- What are the characteristics of the generations

A

Gram + coverage dec as you move up
Gram - coverage inc as you move up
resistance to beta-lactamases inc as you move up
CNS penetration- inc as you go up

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13
Q

Cephalosporins- MOR

A

inactivated by beta-lactamases esp staphylococci
Modificatino of PBP
MRSA / PRSP drug permeability

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14
Q

Cephalosporins- 1st generation - drug names

A

Cefazolin

Cephalexin

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15
Q

Cephalosporins- 2nd generation- drug names

A

Cetotetan
Cetoxitin
Cefuroxime
Cefaclor

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16
Q

Cephalosporins- 3rd generation - drug names

A

cetoxamine
ceftazadime
cetraixone
ceoperazone

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17
Q

Cephalosporins- 4th generation- drug names, characteristics and uses

A

Cerfepime

combines gram positive spectrum of 1st generation with the characteristics of the other generations

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18
Q

Monobactams- MOA

A

binds to PBP3

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19
Q

Monobactams- names

A

Aztreonam

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20
Q

Monobactams- uses

A

Aerobic Gram negative rods including pseudomonas

synergistic with aminoglycosides

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21
Q

Carbapenems- MOA

A

similar to other beta lactams

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22
Q

Carbapenems- Uses

A 
Broad spectrum- So thy are used as a shotgun approach
gram + cocci: Staph and strep 
Gram - rods: pseudomonas
Anaerobes
doesn't work agaisnt MRSA and listeria
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23
Q

Carbapenems- MOR

A

resistant to most beta lactamases

BUT is synthetic to metalo-beta-lactamases

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24
Q

Carbapenems- drugs

A

Imipenem
Meropenem
Ertapenem

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25
Classes of beta- lactams
penicillins cephalosporins Monobactams Carbapenems
26
Vancomycin- MOA
Binds to D-Ala-D-Ala inhibiting transglycosylase= inhibition of transglycosylation = elongation is blocked and damages membranes
27
Vancomycin- MOR
plasmid mediated changes of D-Ala-D-Ala to D-Ala-D-lactate. | plasmid mediated changes in permeability
28
Vancomycin- uses
Gram +'s- MRSA and PRSP Endocarditis beta-lactamase producers in people with a penicillin allergy- E. Faecalis Oral is used to tx pseudomembranous colitis b/c it gets to colon unchanged
29
Daptomycin- clearance and monitoring
cleared by kidney | monitor CPK levels b/c can cause myopathy
30
Daptomycin- uses
VRE | VRSA
31
Fosfomycin- MOA
inhibits enolpyruvate transferase- prevents formation of N-Acetylmuramic acid
32
Fosfomycin- uses
Concentrates well in the Urinary tract system, and is excreted at levels greater than MIC therefore is good for UTI
33
fosfomycin- MOR
dec in intracellular concentration
34
Cefazolin- class
1st generation Cephlosporin
35
Cefazolin method of admin
IV
36
Cefazolin Uses
Clean surgical prophylaxis UTI- Staph Saprophyticus, strep, or E.Coli PEcK- Proteus, E Coli, Klebsiella
37
Cephalexin- class
1st generation Cephalosporin
38
Cephalexin- administration
Oral
39
Cephalexin- uses
skin & soft tissue infections
40
oral Cephalosporins- excretion, how well are they absorbed, AE
renal excretion Absorbed well superinfection, pseudomembranous colitis
41
Narrow Spectrum Penicillins- Uses
``` Strep Penumo- pharyngitis and meningitis non penicillinase staph anaerobes- closridia, actinomycosis niserria menigitidis treponemes GAS ```
42
narrow spectrum penicillins- which organ failure prompts dose change
Renal
43
penicillin G- class
narrow spectrum penicillin
44
penicillin G- how well is it absorbed, route of admin
IV | poorly absorbed
45
Types of Penicillin G- repository forms
Have additive that helps them hang around in muscle and last longer Procaine Benzocaine
46
Penicillin V- route of admin
Oral
47
Penicillin V- AE
Neurologic changes and acting funny
48
Pehnoxyethyl Penicillin- admin
Oral
49
Very narrow spectrum metabolism, exception
All are metabolized by the liver except for Methicillin,
50
Methicillin- what organ failure requires dose decrease
Renal
51
Methicillin- AE
Interstial nephritis= eosinophiluria, rash, arthralgias, eosinophilia, fever NO LONGER USED
52
Nafcillin- Excretion
Bile
53
Nafcillin- AE
Neutropenia | Phlebitis
54
Oxacillin- AE
Neutropenia | LFT's
55
Extended Specrum Penicillins- what organ has to fail to change dose
Kidney
56
Amoxicillin- admin
Oral
57
Ampicillin- uses
DOC for listeria when paired with an aminoglycoside (Amp Gent)
58
Amoxicillin/ Ampicillin uses
Infections of:Ear, Nose, Throat, and Lungs | Pen G sensitive organisms- H flu, proteus, Ecoli
59
What drug is always including when treating an elderly person for meningitis
Ampicillin b/c Listeria meningitis is a common cause of meningitis in this age group
60
Amoxicillin- AE
``` #1 cause of pseudomembranous colitis b/c it is broad spectrum and kills off natural flora- thus C. diff is no longer contained this is b/c is the most commonly prescribed penicillin ```
61
Pipercillin- route of admin
IV
62
Ticarcillin- route of admin
IV
63
Pipercilin/ Ticarcillin- uses
Use with aminoglycosides for- serious gram negatives- E. Faecalis, Pseudomonas bacteroides fragilis, proteus
64
Extended spectrum penicillins + beta lactamases- uses
bacteroides moraxella beta lactamase producing strains of - staph auerus and H. Flu
65
Amoxicillin + Clavulanic acid- route of admin
Oral
66
Amoxicillin + Clavulanic acid- uses
upper and lower respiratory infections
67
Amoxicillin and Clavulonic Acid- AE
diarrhea, more than amoxicillin alone
68
Ampicillin + Sublactam- route of admin
IV
69
Ampicillin + Sublactam- uses
mixed non resistant aerobe/ anaerobe ie. dirty surgical infection, aspiration pneumonia
70
Pipercillin + Tazobactam- route of admin
IV
71
Ticarcillin + Clavulanic acid- route of admin
IV
72
Pipercillin + Tazobactam | Ticarcillin + Clavulanic acid- uses
VERY BROAD SPECTRUM- esp for gram negative used for shotgun therapy use with aminoglycosides for spectrum and synergy switch to something different when you can
73
2nd generation Cephalosporins- Uses
Surgical prophylaxis Community acquired adult pneumonia Gram -: HENPEcK- H.Flu, Enetrobacter, Nisseria, Proteus, E.Coli, Klebsiella
74
Cefotetan- Class
2nd Generation Cephalosporin
75
Cefotetan- Uses
bacteroides | mixed intraabdominal/ pelvic infxns
76
Cefotetan- AE
Antabuse type rxn w/ EtOH
77
Cefoxitin- Use
BACTEROIDES | mixed intraabdominal/ pelvic infxns
78
Cefoxitin- Class
2nd Gen Cephalosporin
79
Cefuroxime- ROA and uses
IV= CNS- staph, strep, gram -, and serious pediactric pneumonia (b/c protects from meningitis)- ONLY 2ND GEN CEPHALOSPORIN W/ CNS COVERAGE Oral- RTI, UTI
80
Cefaclor- class
2nd gen Cephalosporin
81
Cefaclor- ROA
Oral
82
Cefaclor- AE
Serum Sickness
83
3rd generation Cephalosporin- Uses
``` CNS INFXNS Hospital acquired Gram negatives gram negative infections- PS HEN PEcK Pseudomonas, Serratia H.Flu, Enterobacter, Niseeria Proteus, Ecoli, Klebsiella ```
84
Cefotaxime- Class
3rd Gen Cephalosporin
85
Cefotaxime- metabolism
Hepatic
86
Ceftazidime- uses
ONLY 3RD GEN WITH AXN AGAINST Pseudomonas when used synergistically with Aminoglycosides
87
Ceftriaxone- excretion
billary
88
Ceftriaxone- Use
DOC in Gonorrhea and MENINGITIS | community acquired infxns for coverage against strep pneumo
89
Why is Ceftriaxone used for meningitis
Good CNS penetration and good activity agaisnt meningococcus and strep pneumo
90
Ceftriaxone- Class
3rd Gen Cephalosporin
91
Cefoperazone- class
3rd Gen Cephalosporin
92
Cefoperazone- AE
antabuse like rxn w/ EtoH
93
4th gen Cephalosporin- uses
good for pretty much everything EXCEPT- Listeria, Enterococcus VRE, and MRSA
94
Cefepime- class
4th gen Cephalosporin
95
Cefepime- use
Pseudomonas | H.Flu
96
Can you use monobactams if the person had a penicillin allergy
Yes it should be fine
97
Imipenem- class
Carbepenems
98
Imipenem- what drug is it given with
Cilstatin- blocks its breakdown by dipeptidase in the renal tubules--> effective urinary concentrations of the drug
99
Imipenem- AE
seizures if there is impaired renal function that interferes with clearance
100
Procaine AE
Procaine Brain- when Procaine is injected into a muscle but accidentally hits a vein so it goes to the brain
101
Nafcillin/ Oxacillin ROA
Mostly IV
102
Cefotetan- t1/2
longest t1/2 of 2nd gen cephalosporins
103
Cefoxitn - t1/2
shortest t1/2 of the 2nd gen cephalosporins
104
Cefotaxime and Cefriaxone- use
Meningitis | Pneumonia
105
How is Cefoperazone different than other 3rd gen cephalosporins as far as distribution
NO CNS penetration
106
5th gen cephalosporin
Cefteroline
107
Ceftarroline- ROA
IV
108
Ceftaroline- CNS coverage
Maybe
109
Ceftaroline- clearance
Renal
110
Ceftaroline- Use
MRSA- ONLY CEPHALOSPORIN THAT CAN ATTACK MRSA | enterococcus, listeria, staph/ strep. comm aq pneumonia
111
Ertapenem
long t1/2
112
Cephalosporin, monobactam, carbepenem- AE
``` N/D- Antibiotic assoc Colitis Allergey- IgE cross reactivity with penicillin drugs EXCEPT MONOBACTAMS neutropenia, hemolytic anemia interstial nephritis SUPER INFXN ```
113
Vancomycin - distribution
distributed everywhere except- CNS, eye, prostate
114
vancomycin- AE
dose related nephrotoxicity- when combined with aminoglycosides ototoxicity narrow therapeutic range red neck syndrome- due to histamine release- red, itchy, hypotension- give with an antihistamine. Occurs when you infuse vanco to rapidly
115
vancomycin- what levels should be measured when giving vanco
peak and trough levels | renal fxn
116
Telavancin- type of drug
derivative of vancomycin
117
telavancin- use
inc activity against MRSA
118
Telavancin- AE
more nephrotoxicity than vanco nausea taste perversion
119
Telavancin- pregnancy
CI in pregnancy
120
Telavancin vs vanco t1/2
telavancin has a longer t 1/2
121
Daptomycin- effect in the body
concentration dependent killing | long post antibiotic effect
122
Daptomycin- inactivated by what endogenous compound | good test question
Surfactant- thus is not active against lung infections | good test question
123
Daptomycin- AE
skeletal muscle toxicity= myalgias, weakness, elevated enzymes synergisitc effect with statins

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