Cell Wall inhibitors

Question 1

What is the mechanism of action of B lactams?

Answer 1

1. Bind PBPs
2. inhibit transpeptidation
3. inhibit cross linking

Question 2

What are the three mechanisms of resistance

Answer 2

1. enzymatic destruction -B lactamase -PBP
2. alternation in porin channel
3. change affinity of PBPs

Question 3

What is the drug of choice for MRSA?

Answer 3

vancomycin

Question 4

What are the two drugs of the narrow spectrum penicillins?

Answer 4

penicillin G - parenteral

penicillin V - oral

Question 5

What is the main therapeutic use for narrow spec?

Answer 5

syphillis
strep (s pneum, s viridans have resistance)
mouth anaerobes - actinomyces

Question 6

What are the three drugs of “very narrow spectrum” penicillins?

Answer 6

1. methicillin
2. naficillin
3. oxacillin

Question 7

What are the main therapeutics of M,N,O?

Answer 7

S aureus (NOT MRSA)

Question 8

What are the two aminopenicillins?

Answer 8

amoxicillin and ampicillin

Question 9

Why are the two aminopenicillins considered “broad spectrum”

Answer 9

able to enter porin channels

Question 10

What are the therapeutics of aminopenicillins? What are they specifically the drug of choice for?

Answer 10

HHELPSS

H - h pylori
H - H flu
E - ecoli, enterococcus - DRUG OF CHOICE
L - listeria
P - proteus
S - salmonella
S - shigella

Question 11

What are the four drugs of the extended spectrum penicillins?

Answer 11

1. ticaracillin
2. piperacillin
3. azlocillin
4. carbinicllin

Question 12

What are the extended spec penicillins mainly used for?

Answer 12

pseudomonas

Question 13

Which of the groups of penicllins are B lactamase resistant?

Answer 13

very narrow spec - M,N,O

Question 14

Name some B lactamse inhibitors?

Answer 14

clavulonic acid, sulfbactam, tazobactam

Question 15

What is augmentin?

Answer 15

amoxicillin and clavulanate

Question 16

How are penicillins eliminated?

Answer 16

active tubular secretion

except Naficillin and oxacillin - Bile

Question 17

What are the first generation cephalosporins?

Answer 17

cefazolin, cephalexin

Question 18

What are the second generation cephalosporins?

Answer 18

cefotetan, cefaclor, cefuroxime

Question 19

What are the third generation cephalosporins?

Answer 19

ceftriaxone, cefotaxime, cefdinir, cefixime

Question 20

what are the 4 organisms that cephalosporins aren’t effective against?

Answer 20

LAME
L - listeria
A - atypicals
M - MRSA
E - Enterococci

Question 21

What is the fourth generation cephalosporin?

Answer 21

cefepime

Question 22

Which cephalosporins cross the BBB?

Answer 22

third and fourth generations plus cefuroxime

Question 23

How are the cephalosporins cleared?

Answer 23

renal clearance

except cefoperazone and ceftriaxone - eliminated in liver

Question 24

If there is allergies to lactams, what is your next drug of choice?

Answer 24

macrolides for gram positive

aztronam for gram negative rods

Question 25

Which antibiotics cause disulfiram like effects?

Answer 25

cefoperazone and metronidazole

Question 26

What are the carbapenams?

Answer 26

imipenem, meropenem, ertapenem, doripenem

Question 27

What are the carbapenams MOA?

Answer 27

inhibit cell wall synthesis | -resistant to B lactamases

Question 28

What are carbapenams mostly used for?

Answer 28

empirical use in nosocomial infections abdominal polymicrobial infections NOT MRSA

Question 29

What other drug is impinem always given with and why?

Answer 29

cilastatin | -prevent too rapid of metabolism

Question 30

How are carbapenams metabolized?

Answer 30

renal elimination

Question 31

What is the main s/e of carbapenams?

Answer 31

seizures

Question 32

What is the main use of aztreonam? Why are they a hidden gem?

Answer 32

IV drug used against gram neg rod - pseudomonas | -particularly useful if lactam allergy or renal dysfunction

Question 33

What is the MOA of vancomycin?

Answer 33

binds D-Ala-D- ala muramyl pentapeptide | -prevents elongation of peptidoglycan chains

Question 34

How does enterococcus have resistance to vancomycin? What do you use for VRE?

Answer 34

terminal D ala --> D lactate | linezolid and streptogratins

Question 35

What are the s/e of vancomycin?

Answer 35

- red man syndrome - vasodilation by histamine - ototoxicity - nephrotoxicity

Question 36

When would you be worried ab a B lactam allergy?

Answer 36

if it is IgE mediated

Question 37

What is daptomycin used for?

Answer 37

VRE and VRSA

Question 38

What are the first generation cephalosporins used for?

Answer 38

PEcKs P - proteus Ec - E coli K - klebsiella S - surgical prophylaxis

Question 39

What drug is the drug of choice for surgical prophylaxis

Answer 39

Cefazolin

Question 40

What are the second gen cephalosporins used for

Answer 40

HEN PEcKs all of the PEcKs + H - H flu **** E - enterobacter N - neisseria

Question 41

How is vanco given for C diff?

Answer 41

orally

Question 42

Which generation of cephs have inc incidence of C diff

Answer 42

third

Question 43

What drug specifically cannot be used for pneumonia? why?

Answer 43

daptomycin | inactivated by pulmonary surfactant