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Pharmacotherapy IV > Cell Wall Inhibitors > Flashcards

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
Q

Which beta lactam class is less susceptible to beta lactamase degradation?

A

Cephalosporins
**except ESBLs

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26
Q

Describe the spectrum of cephalosporin activity based on generation

A

Gen 1-3: increasing generation = losing positive, gaining negative
Gen 4-5: gaining positive and negative

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27
Q

List the gram positive bugs

A

GAS
GBS
VGS
Strep pneumoniae
MSSA
MRSA
CoNS
VSE
VRE
Bacillus
Listeria

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28
Q

List the gram negative bugs

A

Enterobacterales
Non enterobacterales
H. influ/M. cat
N. meningitidis
N. gonorrhea
C. trachometis

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29
Q

List the first generation cephalosporins

A

Cefazolin
Cephalexin

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30
Q

Bug coverage of first generation cephalosporins

A

MSSA
Strep
Entero

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31
Q

Clinical uses of first generation cephalosporins

A

Surgical prophylaxis
SSTIs from staph/strep

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32
Q

List the second generation cephalosporins (non cephamycins)

A

Cefuroxime
Cefaclor
Cefprozil

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33
Q

List the second generation cephalosporins (cephamycins)

A

Cefoxitin
Cefotetan

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34
Q

How do the second generation non cephamycins differ from cephamycins?

A

Cephamycins have the same bug coverage PLUS anaerobic coverage

35
Q

Clinical uses of second generation cephalosporins

A

Community acquired infections – SSTI, RTI, gynecologic

36
Q

List the third generation cephalosporins

A

Cefotaxime
Ceftazidime
Ceftriaxone
Ceftolozane
Cefdinir
Cefditoren
Cefixime
Cefpodoxime
Ceftibuten

37
Q

Which third generation cephalosporin covers Pseudomonas?

A

Ceftazidime

38
Q

Bug coverage of third generation cephalosporins

A

Strep
Entero
MSSA

39
Q

What are the two most potent cephalosporins against PCN resistant pneumococci?

A

Cefotaxime
Ceftriaxone

40
Q

List the fourth generation cephalosporins

A

Cefepime

41
Q

Bug coverage of fourth generation cephalosporins

A

MSSA
Strep
Pseudomonas
Entero
Non entero
Anaerobes

42
Q

Clinical uses of fourth generation cephalosporins

A

Empiric: bacteremia, pneumonia, SSTI, complicated UTIs, meningitis
- used for hospital infections

43
Q

Adverse effect of fourth generation cephalosporins

A

Neurotoxicity – seizure risk

44
Q

List the fifth generation cephalosporins

A

Ceftaroline

45
Q

Bug coverage of fifth generation cephalosporins

A

MSSA
MRSA
Strep
Entero

46
Q

Clinical uses of fifth generation cephalosporins

A

SSTIs
CAP

47
Q

Which cephalosporin generation has the highest gram positive activity?

A

1st generation

48
Q

Which cephalosporin generation has the most gram negative activity?

A

3rd-5th generations

49
Q

List examples of carbapenems

A

Imipenem
Meropenem
Ertapenem

50
Q

List the bugs carbapenems cover

A

Staph
Strep
Gram +/- Anaerobes
Gram negatives
ESBLs

51
Q

Which carbapenems cover Pseudomonas?

A

Imipenem
Meropenem

52
Q

What are the toxicity risks associated with carbapenems?

A

CNS – seizures
(may increase metabolism of valproic acid)

53
Q

Which cell wall inhibitor classes have the highest risk of seizures?

A

Carbapenems
Cephalosporins

54
Q

Examples of monobactams

A

Aztreonam

55
Q

Bugs covered by aztreonam

A

Pseudomonas
Gram negatives

56
Q

Which beta lactams can be used safely in hypersensitivity to other beta lactams?

A

Aztreonam&raquo_space; Cephalosporins > carbapenems

57
Q

Describe a type I hypersensitivity reaction?

A

Immediate anaphylactic reaction medicated by IgE

58
Q

What are the risk factors for a severe beta lactam reaction?

A

Persistent beta lactam specific IgE response
Recent beta lactam exposure
Parenteral administration
History of PCN reactions
Adults

59
Q

List the general adverse effects of beta lactams

A

Nephrotoxicity
CNS toxicity
N/V/D, C diff potential
Thrombocytopenia

60
Q

Which beta lactams do NOT require renal dose adjustments?

A

Oxacillin
Nafcillin
Dicloxacillin
Ceftriaxone

61
Q

Potential interactions of all beta lactams

A

Oral cephalosporin prodrugs with H2RAs/PPIs (cefpodoxime, cefuroxime, cefditoren)
Cefaclor, cefdinir, cefpodoxime, cefditoren and antacids
Beta lactams + probenecid = risk toxicity

62
Q

What potential impacts do beta lactams have on other drugs?

A

Oral estrogens – potential reduced efficacy
Vitamin K – reduced production = increased risk bleed

63
Q

MOA of vancomycin

A

Binds to D-Ala-D-Ala to inhibit cell wall synthesis

64
Q

Clinical uses of vancomycin

A

SSTIs, bacteremia, endocarditis, meningitis, pneumonia, C. diff (PO), osteomyelitis

65
Q

Bug coverage of vancomycin

A

MSSA
MRSA
Strep
C. diff (PO)
Enterococci

66
Q

Adverse reactions of vancomycin

A

Nephrotoxicity
Histamine induced infusion reaction (SLOW infusion)
Thrombocytopenia

67
Q

Maximum recommended dose of vancomycin to prevent infusion reaction

A

1 gram per hour

68
Q

Bug coverage of bacitracin

A

Gram positives – topical

69
Q

MOA daptomycin

A

binds to cell membrane and punches holes to efflux potassium leading to bacterial apoptosis

70
Q

Daptomycin is a bacteri______ antibiotic

A

bactericidal

71
Q

Bug coverage of daptomycin

A

MSSA
MRSA
Strep
VSE
VRE

72
Q

In what situations should daptomycin be avoided?

A

Pneumonia inactivated by lung surfactant
CSF infxnpoor penetration

73
Q

Adverse effects of daptomycin

A

Elevated creatinine kinase (hold statin)
Eosinophilic pneumonia/pneumonitis

74
Q

What is the only approved use of dalbavancin and oritavancin?

A

ABSSSI
(acute bacterial skin and skin structure infection)

75
Q

Bug coverage of dalbavancin

A

MSSA
MRSA
Strep
VSE
VRE

76
Q

Bug coverage of oritavancin

A

MSSA
MRSA
Strep
VSE
VRE
(same as dalbavancin!)

77
Q

Significant drug interactions of oritavancin

A

AVOID:
heparin - falsely increased aPTT
warfarin - unpredictable INR

78
Q

Fosfomycin is a bacteri_____ antibiotic

A

bactericidal

79
Q

Bug coverage of fosfomycin

A

E. coli
MSSA
MRSA
VSE
VRE

80
Q

Which cell wall inhibitor is safe in pregnancy?

A

Fosfomycin

81
Q

Bug coverage of polymixins

A

Entero
Non entero

82
Q

Clinical uses of polymixins

A

MDR VAP
bacteremia
meningitis
GI infections

83
Q

Adverse reactions of polymixins

A

Nephrotoxicity
Neurotoxicity
Oral paresthesia
Peripheral neuropathy

Pharmacotherapy IV (3 decks)

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