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Cell Wall Inhibitors Flashcards

1
Q

What are the three general considerations of PCN based antibiotics?

A

Very short half lives (< 2 hours)
Risk hypersensitivity, diarrhea
Poorly absorbed

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2
Q

MOA of PCNs

A

Inhibit transpeptidation with binding PBPs = bactericidal

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3
Q

Examples of natural PCNs

A

Penicillin G
Penicillin V

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4
Q

Bug coverage of natural PCNs

A

Treponema pallidum (syphilis)
Strep
Enterococci

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5
Q

Clinical uses of natural PCNs

A

Strep pyogenes (strep throat)
Syphilis
Strep pneumoniae
N. meningitidis
Enterococcus
Infections of mouth anaerobes

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6
Q

Examples penicillinase resistant PCNs

A

Nafcillin
Oxacillin
Dicloxacillin

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7
Q

MOA of penicillinase resistant PCNs

A

Inhibit transpeptidation with binding PBPs = bactericidal
*but resistant to penicillinase degradation

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8
Q

Bug coverage of penicillinase resistant PCNs

A

MSSA
Strep
Gram positive anaerobes

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9
Q

Clinical uses of penicillinase resistant PCNs

A

Staph infections
Nafcillin = IV
Oxacillin = IV, IM
Dicloxacillin = PO

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10
Q

Which antibiotic class does NOT require renal adjustment since it is hepatically excreted?

A

Penicillinase resistant PCNs

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11
Q

Examples of aminopenicillins

A

Ampicillin
Amoxicillin

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12
Q

Bug coverage of aminopenicillins

A

Strep
Enterococci
Gram positive anaerobes
Entero
H. influ/M. catt
Listeria
N. meningitidis

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13
Q

Clinical uses of aminopenicillins

A

URIs, LRIs
Meningitis

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14
Q

What is the first line therapy for otitis media?

A

Amoxicillin

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15
Q

Which aminopenicillin has better absorption?

A

Amoxicillin

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16
Q

Which aminopenicillin is the drug of choice for susceptible enterococci?

A

Ampicillin

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17
Q

Examples of PCN/beta lactamase inhibitors

A

Piperacillin/tazobactam
Amoxicillin/clavulanate
Ampicillin/sulbactam

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18
Q

Bug coverage of PCN/beta lactamase inhibitors

A

MSSA
Strep
Enterococci
Anaerobes
Entero
ESBLs

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19
Q

What are the common extended spectrum beta lactamases?

A

Staph
H. influ
M. cat
Entero

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20
Q

Which PCN/beta lactamase inhibitor covers Pseudomonas?

A

Piperacillin/tazobactam

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21
Q

Clinical uses of amoxicillin/clavulanate

A

URIs, otitis media, polymicrobial infections, SSTIs

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22
Q

Clinical uses of ampicillin/sulbactam

A

IV equivalent to amox/clav
Polymicrobial infections

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23
Q

Clinical uses of piperacillin/tazobactam

A

HA infections – gram positive, negative, anaerobes
Pseudomonas and Acineto

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24
Q

Which beta lactam class has low cross reactivity with PCN allergies?

A

Cephalosporins

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25
Which beta lactam class is less susceptible to beta lactamase degradation?
Cephalosporins **except ESBLs
26
Describe the spectrum of cephalosporin activity based on generation
Gen 1-3: increasing generation = losing positive, gaining negative Gen 4-5: gaining positive and negative
27
List the gram positive bugs
GAS GBS VGS Strep pneumoniae MSSA MRSA CoNS VSE VRE Bacillus Listeria
28
List the gram negative bugs
Enterobacterales Non enterobacterales H. influ/M. cat N. meningitidis N. gonorrhea C. trachometis
29
List the first generation cephalosporins
Cefazolin Cephalexin
30
Bug coverage of first generation cephalosporins
MSSA Strep Entero
31
Clinical uses of first generation cephalosporins
Surgical prophylaxis SSTIs from staph/strep
32
List the second generation cephalosporins (non cephamycins)
Cefuroxime Cefaclor Cefprozil
33
List the second generation cephalosporins (cephamycins)
Cefoxitin Cefotetan
34
How do the second generation non cephamycins differ from cephamycins?
Cephamycins have the same bug coverage PLUS anaerobic coverage
35
Clinical uses of second generation cephalosporins
Community acquired infections -- SSTI, RTI, gynecologic
36
List the third generation cephalosporins
Cefotaxime Ceftazidime Ceftriaxone Ceftolozane Cefdinir Cefditoren Cefixime Cefpodoxime Ceftibuten
37
Which third generation cephalosporin covers Pseudomonas?
Ceftazidime
38
Bug coverage of third generation cephalosporins
Strep Entero MSSA
39
What are the two most potent cephalosporins against PCN resistant pneumococci?
Cefotaxime Ceftriaxone
40
List the fourth generation cephalosporins
Cefepime
41
Bug coverage of fourth generation cephalosporins
MSSA Strep Pseudomonas Entero Non entero Anaerobes
42
Clinical uses of fourth generation cephalosporins
Empiric: bacteremia, pneumonia, SSTI, complicated UTIs, meningitis - used for hospital infections
43
Adverse effect of fourth generation cephalosporins
Neurotoxicity -- seizure risk
44
List the fifth generation cephalosporins
Ceftaroline
45
Bug coverage of fifth generation cephalosporins
MSSA MRSA Strep Entero
46
Clinical uses of fifth generation cephalosporins
SSTIs CAP
47
Which cephalosporin generation has the highest gram positive activity?
1st generation
48
Which cephalosporin generation has the most gram negative activity?
3rd-5th generations
49
List examples of carbapenems
Imipenem Meropenem Ertapenem
50
List the bugs carbapenems cover
Staph Strep Gram +/- Anaerobes Gram negatives ESBLs
51
Which carbapenems cover Pseudomonas?
Imipenem Meropenem
52
What are the toxicity risks associated with carbapenems?
CNS -- seizures (may increase metabolism of valproic acid)
53
Which cell wall inhibitor classes have the highest risk of seizures?
Carbapenems Cephalosporins
54
Examples of monobactams
Aztreonam
55
Bugs covered by aztreonam
Pseudomonas Gram negatives
56
Which beta lactams can be used safely in hypersensitivity to other beta lactams?
Aztreonam >> Cephalosporins > carbapenems
57
Describe a type I hypersensitivity reaction?
Immediate anaphylactic reaction medicated by IgE
58
What are the risk factors for a severe beta lactam reaction?
Persistent beta lactam specific IgE response Recent beta lactam exposure Parenteral administration History of PCN reactions Adults
59
List the general adverse effects of beta lactams
Nephrotoxicity CNS toxicity N/V/D, C diff potential Thrombocytopenia
60
Which beta lactams do NOT require renal dose adjustments?
Oxacillin Nafcillin Dicloxacillin Ceftriaxone
61
Potential interactions of all beta lactams
Oral cephalosporin prodrugs with H2RAs/PPIs (cefpodoxime, cefuroxime, cefditoren) Cefaclor, cefdinir, cefpodoxime, cefditoren and antacids Beta lactams + probenecid = risk toxicity
62
What potential impacts do beta lactams have on other drugs?
Oral estrogens -- potential reduced efficacy Vitamin K -- reduced production = increased risk bleed
63
MOA of vancomycin
Binds to D-Ala-D-Ala to inhibit cell wall synthesis
64
Clinical uses of vancomycin
SSTIs, bacteremia, endocarditis, meningitis, pneumonia, C. diff (PO), osteomyelitis
65
Bug coverage of vancomycin
MSSA MRSA Strep C. diff (PO) Enterococci
66
Adverse reactions of vancomycin
Nephrotoxicity Histamine induced infusion reaction (SLOW infusion) Thrombocytopenia
67
Maximum recommended dose of vancomycin to prevent infusion reaction
1 gram per hour
68
Bug coverage of bacitracin
Gram positives -- topical
69
MOA daptomycin
binds to cell membrane and punches holes to efflux potassium leading to bacterial apoptosis
70
Daptomycin is a bacteri______ antibiotic
bactericidal
71
Bug coverage of daptomycin
MSSA MRSA Strep VSE VRE
72
In what situations should daptomycin be avoided?
Pneumonia **inactivated by lung surfactant CSF infxn**poor penetration
73
Adverse effects of daptomycin
Elevated creatinine kinase (hold statin) Eosinophilic pneumonia/pneumonitis
74
What is the only approved use of dalbavancin and oritavancin?
ABSSSI (acute bacterial skin and skin structure infection)
75
Bug coverage of dalbavancin
MSSA MRSA Strep VSE VRE
76
Bug coverage of oritavancin
MSSA MRSA Strep VSE VRE (same as dalbavancin!)
77
Significant drug interactions of oritavancin
AVOID: heparin - falsely increased aPTT warfarin - unpredictable INR
78
Fosfomycin is a bacteri_____ antibiotic
bactericidal
79
Bug coverage of fosfomycin
E. coli MSSA MRSA VSE VRE
80
Which cell wall inhibitor is safe in pregnancy?
Fosfomycin
81
Bug coverage of polymixins
Entero Non entero
82
Clinical uses of polymixins
MDR VAP bacteremia meningitis GI infections
83
Adverse reactions of polymixins
Nephrotoxicity Neurotoxicity Oral paresthesia Peripheral neuropathy

Pharmacotherapy IV (3 decks)

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