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Pharm main > Beta lactams and cell wall inhibitors > Flashcards

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
Q

Classes of beta- lactams

A

penicillins
cephalosporins
Monobactams
Carbapenems

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26
Q

Vancomycin- MOA

A

Binds to D-Ala-D-Ala inhibiting transglycosylase= inhibition of transglycosylation = elongation is blocked and damages membranes

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27
Q

Vancomycin- MOR

A

plasmid mediated changes of D-Ala-D-Ala to D-Ala-D-lactate.

plasmid mediated changes in permeability

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28
Q

Vancomycin- uses

A

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

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29
Q

Daptomycin- clearance and monitoring

A

cleared by kidney

monitor CPK levels b/c can cause myopathy

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30
Q

Daptomycin- uses

A

VRE

VRSA

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31
Q

Fosfomycin- MOA

A

inhibits enolpyruvate transferase- prevents formation of N-Acetylmuramic acid

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32
Q

Fosfomycin- uses

A

Concentrates well in the Urinary tract system, and is excreted at levels greater than MIC therefore is good for UTI

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33
Q

fosfomycin- MOR

A

dec in intracellular concentration

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34
Q

Cefazolin- class

A

1st generation Cephlosporin

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35
Q

Cefazolin method of admin

A

IV

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36
Q

Cefazolin Uses

A

Clean surgical prophylaxis
UTI- Staph Saprophyticus, strep, or E.Coli
PEcK- Proteus, E Coli, Klebsiella

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37
Q

Cephalexin- class

A

1st generation Cephalosporin

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38
Q

Cephalexin- administration

A

Oral

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39
Q

Cephalexin- uses

A

skin & soft tissue infections

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40
Q

oral Cephalosporins- excretion, how well are they absorbed, AE

A

renal excretion
Absorbed well
superinfection, pseudomembranous colitis

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41
Q

Narrow Spectrum Penicillins- Uses

A 
Strep Penumo- pharyngitis and meningitis
non penicillinase staph
anaerobes- closridia, actinomycosis
niserria menigitidis
treponemes
GAS
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42
Q

narrow spectrum penicillins- which organ failure prompts dose change

A

Renal

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43
Q

penicillin G- class

A

narrow spectrum penicillin

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44
Q

penicillin G- how well is it absorbed, route of admin

A

IV

poorly absorbed

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45
Q

Types of Penicillin G- repository forms

A

Have additive that helps them hang around in muscle and last longer
Procaine
Benzocaine

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46
Q

Penicillin V- route of admin

A

Oral

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47
Q

Penicillin V- AE

A

Neurologic changes and acting funny

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48
Q

Pehnoxyethyl Penicillin- admin

A

Oral

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49
Q

Very narrow spectrum metabolism, exception

A

All are metabolized by the liver except for Methicillin,

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50
Q

Methicillin- what organ failure requires dose decrease

A

Renal

51
Q

Methicillin- AE

A

Interstial nephritis= eosinophiluria, rash, arthralgias, eosinophilia, fever
NO LONGER USED

52
Q

Nafcillin- Excretion

A

Bile

53
Q

Nafcillin- AE

A

Neutropenia

Phlebitis

54
Q

Oxacillin- AE

A

Neutropenia

LFT’s

55
Q

Extended Specrum Penicillins- what organ has to fail to change dose

A

Kidney

56
Q

Amoxicillin- admin

A

Oral

57
Q

Ampicillin- uses

A

DOC for listeria when paired with an aminoglycoside (Amp Gent)

58
Q

Amoxicillin/ Ampicillin uses

A

Infections of:Ear, Nose, Throat, and Lungs

Pen G sensitive organisms- H flu, proteus, Ecoli

59
Q

What drug is always including when treating an elderly person for meningitis

A

Ampicillin b/c Listeria meningitis is a common cause of meningitis in this age group

60
Q

Amoxicillin- AE

A 
#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
Q

Pipercillin- route of admin

A

IV

62
Q

Ticarcillin- route of admin

A

IV

63
Q

Pipercilin/ Ticarcillin- uses

A

Use with aminoglycosides for- serious gram negatives- E. Faecalis, Pseudomonas
bacteroides fragilis, proteus

64
Q

Extended spectrum penicillins + beta lactamases- uses

A

bacteroides
moraxella
beta lactamase producing strains of - staph auerus and H. Flu

65
Q

Amoxicillin + Clavulanic acid- route of admin

A

Oral

66
Q

Amoxicillin + Clavulanic acid- uses

A

upper and lower respiratory infections

67
Q

Amoxicillin and Clavulonic Acid- AE

A

diarrhea, more than amoxicillin alone

68
Q

Ampicillin + Sublactam- route of admin

A

IV

69
Q

Ampicillin + Sublactam- uses

A

mixed non resistant aerobe/ anaerobe ie. dirty surgical infection, aspiration pneumonia

70
Q

Pipercillin + Tazobactam- route of admin

A

IV

71
Q

Ticarcillin + Clavulanic acid- route of admin

A

IV

72
Q

Pipercillin + Tazobactam

Ticarcillin + Clavulanic acid- uses

A

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
Q

2nd generation Cephalosporins- Uses

A

Surgical prophylaxis
Community acquired adult pneumonia
Gram -: HENPEcK- H.Flu, Enetrobacter, Nisseria, Proteus, E.Coli, Klebsiella

74
Q

Cefotetan- Class

A

2nd Generation Cephalosporin

75
Q

Cefotetan- Uses

A

bacteroides

mixed intraabdominal/ pelvic infxns

76
Q

Cefotetan- AE

A

Antabuse type rxn w/ EtOH

77
Q

Cefoxitin- Use

A

BACTEROIDES

mixed intraabdominal/ pelvic infxns

78
Q

Cefoxitin- Class

A

2nd Gen Cephalosporin

79
Q

Cefuroxime- ROA and uses

A

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
Q

Cefaclor- class

A

2nd gen Cephalosporin

81
Q

Cefaclor- ROA

A

Oral

82
Q

Cefaclor- AE

A

Serum Sickness

83
Q

3rd generation Cephalosporin- Uses

A 
CNS INFXNS
Hospital acquired Gram negatives
gram negative infections- PS HEN PEcK
Pseudomonas, Serratia
H.Flu, Enterobacter, Niseeria
Proteus, Ecoli, Klebsiella
84
Q

Cefotaxime- Class

A

3rd Gen Cephalosporin

85
Q

Cefotaxime- metabolism

A

Hepatic

86
Q

Ceftazidime- uses

A

ONLY 3RD GEN WITH AXN AGAINST Pseudomonas when used synergistically with Aminoglycosides

87
Q

Ceftriaxone- excretion

A

billary

88
Q

Ceftriaxone- Use

A

DOC in Gonorrhea and MENINGITIS

community acquired infxns for coverage against strep pneumo

89
Q

Why is Ceftriaxone used for meningitis

A

Good CNS penetration and good activity agaisnt meningococcus and strep pneumo

90
Q

Ceftriaxone- Class

A

3rd Gen Cephalosporin

91
Q

Cefoperazone- class

A

3rd Gen Cephalosporin

92
Q

Cefoperazone- AE

A

antabuse like rxn w/ EtoH

93
Q

4th gen Cephalosporin- uses

A

good for pretty much everything EXCEPT- Listeria, Enterococcus VRE, and MRSA

94
Q

Cefepime- class

A

4th gen Cephalosporin

95
Q

Cefepime- use

A

Pseudomonas

H.Flu

96
Q

Can you use monobactams if the person had a penicillin allergy

A

Yes it should be fine

97
Q

Imipenem- class

A

Carbepenems

98
Q

Imipenem- what drug is it given with

A

Cilstatin- blocks its breakdown by dipeptidase in the renal tubules–> effective urinary concentrations of the drug

99
Q

Imipenem- AE

A

seizures if there is impaired renal function that interferes with clearance

100
Q

Procaine AE

A

Procaine Brain- when Procaine is injected into a muscle but accidentally hits a vein so it goes to the brain

101
Q

Nafcillin/ Oxacillin ROA

A

Mostly IV

102
Q

Cefotetan- t1/2

A

longest t1/2 of 2nd gen cephalosporins

103
Q

Cefoxitn - t1/2

A

shortest t1/2 of the 2nd gen cephalosporins

104
Q

Cefotaxime and Cefriaxone- use

A

Meningitis

Pneumonia

105
Q

How is Cefoperazone different than other 3rd gen cephalosporins as far as distribution

A

NO CNS penetration

106
Q

5th gen cephalosporin

A

Cefteroline

107
Q

Ceftarroline- ROA

A

IV

108
Q

Ceftaroline- CNS coverage

A

Maybe

109
Q

Ceftaroline- clearance

A

Renal

110
Q

Ceftaroline- Use

A

MRSA- ONLY CEPHALOSPORIN THAT CAN ATTACK MRSA

enterococcus, listeria, staph/ strep. comm aq pneumonia

111
Q

Ertapenem

A

long t1/2

112
Q

Cephalosporin, monobactam, carbepenem- AE

A 
N/D- Antibiotic assoc Colitis
Allergey- IgE cross reactivity with penicillin drugs EXCEPT MONOBACTAMS
neutropenia, hemolytic anemia
interstial nephritis
SUPER INFXN
113
Q

Vancomycin - distribution

A

distributed everywhere except- CNS, eye, prostate

114
Q

vancomycin- AE

A

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
Q

vancomycin- what levels should be measured when giving vanco

A

peak and trough levels

renal fxn

116
Q

Telavancin- type of drug

A

derivative of vancomycin

117
Q

telavancin- use

A

inc activity against MRSA

118
Q

Telavancin- AE

A

more nephrotoxicity than vanco
nausea
taste perversion

119
Q

Telavancin- pregnancy

A

CI in pregnancy

120
Q

Telavancin vs vanco t1/2

A

telavancin has a longer t 1/2

121
Q

Daptomycin- effect in the body

A

concentration dependent killing

long post antibiotic effect

122
Q

Daptomycin- inactivated by what endogenous compound

good test question

A

Surfactant- thus is not active against lung infections

good test question

123
Q

Daptomycin- AE

A

skeletal muscle toxicity= myalgias, weakness, elevated enzymes
synergisitc effect with statins

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