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2.1 Antimicrobial Pharm > Cell Wall Inhibitors > Flashcards

Cell Wall Inhibitors Flashcards

1
Q

What are the Beta-Lactam Antibiotic classes?

A

Penicillins, Cephalosporins, Carbapenems, Monobactams

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2
Q

What are the Oddball Cell wall Inhibitors?

A
  • Bacitraicin
  • Vancomycin
  • Daptomycin
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3
Q

What are the Beta-Lactamase Inhibitors?

A
  • Clavulonic Acid
  • Sulbactam
  • Tazobactam
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4
Q

What are the 2 most important aspects of Beta-Lactam antibiotic structure?

A
  • Lactam Ring (a high-tension square; site for cleavage+resistance)
  • Sulfur containing (enhances lipid solubility, but also protein binding, thus allergy potential)
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5
Q

All Beta-Lactams and Cephalosporins exhibit what MOA (use 3 terms!)?

A
  • bind BPBs
  • this inhibits CROSSLINKING in bacteria
  • aka inhibits TRANSPEPTIDATION
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6
Q

Describe the 3 big mechanisms of bug resistance to Penicillins and Cephalosporins.

A
  • Penicillinases/B-Lactamases (cleave ring)
  • PBP structural change (ex: MRSA)
  • change in porin structure (obv only in G- like Pseudomonas)
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7
Q

Penicillin G and V are two beta-lactamase sensitive drugs, that really are only used for what type of infection?

A

-syphilis (Treponema pallidum)

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8
Q

Methicillin, Nafcillin, and the -Oxacillins are narrow spectrum, beta-lactamase RESISTANT penicillins primarily for what infection?

A

Staph aureus (now some are MRSA!)

-link B-lactamase resistant with Staph aureus damnit (SA=MON)

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9
Q

The two ‘workhorse’ penicillins that work for many bacteria (G+, G-, Listeria, Borrelia) are what?

A

-Amoxicillin and Ampicillin

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10
Q

The extended spectrum penicillins used primarily as Anti-Pseudomonals are?

A

-Ticarcillin, Piperacillin, Azlocillin

Pseudomonas found in wATer PIPEs

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11
Q

Describe the 2 classes of drug that show synergistic effects with Penicillins.

A
  • enhanced action with beta-lactamase inhibitors (ex: clavulanic acid)
  • synergy with Aminoglycosides (esp vs. Pseudomonas and enterococcal)
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12
Q

Penicillins are eliminated by ______, so require ________. The two exceptions are?

A
  • Eliminated by kidneys, adjust in pt with renal fail

- Nafcillin and Oxacillin (for Staph aureus) are highly lipid soluble, bile elim, therefore adjust in Liver failure

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13
Q

All antibiotics, including Penicillins, can cause what side effects?

A
  • hypersensitivity/allergy reactions (use Macrolide/Aztreonam if so)
  • GI distress (often kill normal flora/C diff!)

-penicillins may also cause Warm Agglutinin/IgG Autoimmune Hemolytic Anemia (FA p.385)

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14
Q

Describe the Jarisch-Herxheimer reaction.

A
  • only seen in Penicillin G and V
  • only in treatment of SYPHILIS
  • LPS released from T. pallidum after administering drug: fever, joint pain, swelling
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15
Q

All Beta-Lactams and Cephalosporins exhibit what MOA (use 3 terms!)?

A
  • bind BPBs
  • this inhibits CROSSLINKING in bacteria
  • aka inhibits TRANSPEPTIDATION
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16
Q

Describe the 3 big mechanisms of bug resistance to Penicillins and Cephalosporins.

A
  • Penicillinases/B-Lactamases (cleave ring)
  • PBP structural change (ex: MRSA)
  • change in porin structure (obv only in G- like Pseudomonas)
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17
Q

What drugs are included in the first generation cephalosporins?

A

-Cefazolin + any Ceph

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18
Q

What are the uses for First Gen Cephalosporins?

A 
G+, some G- action 
surgical prophylaxis (long half lives)
19
Q

What separates the Second from First Generation Cephalosporins?

A
  • better G- coverage (Cefotetan, Cefaclor)

- may cross the BBB (Cefuroxime)

20
Q

Third Generation Cephalosporins are the ‘workhorses’ of the cephalosporins because?

A
  • Very broad spectrum (manage all SEPSIS and MENINGITIS)

- all cross BBB

21
Q

Name the most important 3rd Gen Cephalosporin, with some others.

A

CEFTRIAXONE

Cefotaxime, cefdinir, cefixime

22
Q

What acronym is used for the bacteria that do NOT respond well to 3rd Gen Cephalosporins?

A

LAME

Listeria, Atypicals, MRSA, and Enterococci

23
Q

Describe the drugs commonly used for the LAME bacteria.

A

Listeria: a penicillin workhorse (ex: amoxicillin)
Atypicals: cell walls are shitty, so use Macrolides
MRSA: Vancomycin
Enterococci: Amoxicillin, +aminoglycoside

24
Q

The single Fourth Generation Cephalosporin is ________ and exhibits what characteristics?

A
  • Cefepime

- IV, beta-lactamase resistant+broad spectrum

25
Q

Describe Cephalosporin pharmacokinetics.

A
  • renal clearance (dose modification renal failure)

- 2 exceptions: Cefoperazone, Ceftriaxone (bile, adjust in liver failure)

26
Q

All antibiotics, including Cephalosporins, include what 2 side effects?

A
  • hypersensitivity (use Macrolides, Aztreonam if so)

- GI distress (normal flora/C diff!)

27
Q

If a patient exhibits hypersensitivity to a Penicillin or Cephalosporin, what alternate drugs should be used?

A
  • Macrolides if G+

- Aztreonam only if GNR

28
Q

Carbapenems (Imipenem, Meropenem) are just like Penicillins and Cephalosporins except one big benefit:

A

they are resistant to Beta-Lactamases

29
Q

When are Carbapenems used?

A
  • NOSOCOMIAL life-threatening infections

- pretty much everything but MRSA

30
Q

The 2 most important features that separate Imipenem from other Carbapenems are:

A
  • MUST be given with Cilastatin (renal dehydropeptidase inhibitor, lengthens 1/2 life)
  • HUGE association with SEIZURES
31
Q

All antibiotics, including Carbapenems, include what 2 side effects?

A
  • hypersensitivity

- GI distress

32
Q

Monobactams (AZTREONAM) are very similar to Carbapenems, but have what key differences?

A

-only IV and against GNRs

33
Q

What is the one situation where Aztreonam is commonly used?

A

-pt has a Penicillin/Cephalosporin allergy and has an infection with a G- rod

34
Q

What are the 3 buzzwords for the mechanism of action of Vancomycin?

A
  • binds to D-ala-D-ala muramyl pentapeptide
  • sterically hinders TRANSGLYCOSYLATION
  • blocks ELONGATION of peptidoglycan chains
35
Q

What 3 big infections use Vancomycin as an indication?

A
  • MRSA
  • Enterococci
  • Clostridium difficile (not doc, Metronidazole is)

-only G+!

36
Q

Describe the resistance to Vancomycin.

A

-Enterococci (VRE) mutate to form D-ala-D-lactate targets!

similar to MRSA changing its target/PBP

37
Q

What drugs are used for Vancomycin resistant Staph and/or Enterococci?

A
  • Linezolid

- or Streptogramins

38
Q

Describe the pharmacokinetics of Vancomycin.

A
  • IV or oral (not absorbed, for colitis)

- renal clearance (dose adjust)

39
Q

All antibiotics, including Vancomycin, can have what side effects?

A
  • Hypersensitivity (here, called Red Man syndrome)
  • GI distress

-also OTOTOXICITY+ nephrotoxic with Vanco

40
Q

Describe Red Man syndrome

A

-Type I ‘like’ HSR (DIRECT mast cell degranulation=histamine release=vasodilation)

  • flushing/shock/pruritis/hypotension
  • avoid by slowing infusion
41
Q

Daptomycin is used for what types of infections?

A

Resistant G+ infections (MRSA, VRE, etc.)

42
Q

What is the MOA of Daptomycin?

A
  • Induces rapid DEPOLARIZATION of the bug membrane

- this prevents synthesis of DNA, RNA, and proteins

43
Q

What side effects are characteristic for Daptomycin?

A

-constipation, diarrhea/N/V, insomnia, elevated liver enzymes, elevated CPK (possible muscle toxic)

2.1 Antimicrobial Pharm (9 decks)

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