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Pharm main > Cell Wall Inhibitors > Flashcards

Cell Wall Inhibitors Flashcards

1
Q

Classes of beta lactams

A

Penicillins
Cephalosporins
Monobactams
Carbepenems

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2
Q

Penicillins- MOA

A

Resemble D-ala-D-ala- bind to transpeptidase and inhibit the transpeptidation reaction
Activate autolytic enzymes

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3
Q

Penicillins- Static vs Cidal

A

Cidal

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4
Q

Penicillines- kinetics

A

metabolized in liver- Req dose change in renal failure
get into bile
DO NOT GET INTO CNS (unless there is inflammation) AND ACID LABILE SO INACTIVE IN ABSCESSES

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5
Q

Penicillin- excretion

A

Renal used to be given with probenecid to keep it in the blood

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6
Q

Penicillin- AE

A 
IgE mediated anaphylaxis
IgM/G- Type III hypersensitivity
Diarrhea
neuromuscular irritability
hematologic changes
drug fever
interstian nephritis
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7
Q

Narrow spectrum penicillins- Drugs

A

Pen G- Procaine, Benzocaine

Pen V- Phenoxy Penicillin

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8
Q

Narrow Spectrum- use

A 
Strep (GAS)
non penicillinase staph aureus
Anaerobes- actinomyces, clostridium
N. Meningitis
Treponemes
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9
Q

Narrow spectrum- when change dose

A

renal failure

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10
Q

Pen G-

A

IV
procain and benzathine- repository forms for longer half life
Procain causes strange beh

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11
Q

Pen V

A

oral

phenoxy penicillin

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12
Q

Very Narrow Spectrum- drugs

A 
Methacillin
Nafcillin
Oxacillin
Cloxacillin
Dicloxacillin
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13
Q

Very narrow- uses

A

staph except MRSA

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14
Q

Very Narrow- IV vs Oral

A

IV- methicillin, nafcillin, oxacillin

Oral- nafcillin, oxacillin, cloxacillin, dicloxacillin (clox and diclox- longer t1/2)

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15
Q

Very narrow -Kinetics

A

change dose in liver failure

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16
Q

Methacillin

A

change dose in Renal failure

AE- interstitial nephritis, rarely used except in lab tests

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17
Q

Nafcillin

A

MAJOR dose change in liver failure

AE- Neutropenia, Phlebitis

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18
Q

Oxacillin

A

AE- neutropenia, LFT’s

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19
Q

Extended Spectrum

A

Amoxicillin
Ampicillin
Pipercillin
Ticarcillin

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20
Q

Ampicillin/ Amoxicillin- use

A

com acquired- ENT and lung infxns

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21
Q

Ticarcillin/Pipercillin- use

A 
serious gram- infxn
use with aminoglycosides- E. Faecelis, Pseudomonas
B. Fragilis
Indole +
proteus
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22
Q

Extended spectrum- kinetics

A

Change dose in renal failure- except piperacillin

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23
Q

Amoxicillin

A

oral

AE- major acuse of pseudomembranous colitis

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24
Q

Ampicillin

A

IV

Can be a major cause of pseudomembranous colitis

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25
Q

Pipercillin

A

IV

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26
Q

Ticarcillin

A

IV

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27
Q

Extended spectrum + beta lactamase inhibitor

A

Amoxicillin + CA
Ampicillin + Sublactam
Pipercillion + tazobactam
Ticarcillin + CA

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28
Q

Extended spectrum+ beta lactamase uses

A 
used when dealing with beta lactamase producing organisms
bacteroides
moraxella
H. Flu
S. Aureus
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29
Q

Amox + CA

A

Oral
Upper and lower RTI- H. flu, moraxella
AE- diarrhea, pseudo membranous colitis

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30
Q

Amp + sublactam

A

IV
Dirty surgical prep
aspiration pneumonia

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31
Q

pip+ tazo

Ticar + CA

A

IV

shotgun therapy before know exact pathogen

32
Q

Cephalosporins- trends

A 
1 --> 3rd gen
dec in G+ coverage, but inc in G-
inc in CNS penetration
inc resistance to betalactamase
4th gen combines best of 3 w/ gram + coverage
5th gen
33
Q

Cephalosporins- kinetics

A

Renal Excretion with major dose change in renal failure except- cefotaxime, ceftriaxone (they are hepatic)

34
Q

Cephalosporin AE

A

super infection

pseudomembranous colitis

35
Q

1st gen cephalosporin- drugs

A

Cefazolin

Cephaloxin

36
Q

1st gen cephalosporin- use

A

Gram +

cost effective

37
Q

Cefazolin

A

staph/strep
clean surgical prophylaxis
possible UTI

38
Q

2nd gen cephalosporin

A

Cefotetan
Cefoxitin
Cefuroxime

39
Q

Cefotetan

A 
ANTABUSE LIKE RXN WITH ALCOHOL
t 1/2= 3.5 hours
comm acquired aerobes
serious intrabdominal and pelvic infections
combination of anaerobes- bacteroides
40
Q

Cefoxitin

A

used for- intraabdominal/ pelvic infections
combination of anaerobes- bacteroides
comm acquired aerobes

41
Q

Cefuroxime

A

can get into CNS
Staph/ Strep, serious pediactric meningitis and pneumonia
serious adults pneumonia

42
Q

3rd gen cephalosporins

A

Cefotaxime
Ceftazadime
Ceftriaxone
Cefoperazone

43
Q

3rd generation distribution

A

CNS

44
Q

3rd gen useage

A

hospital acquired gram - EXCEPT PSEUDOMONAS

use in combo with other agents against anerobes

45
Q

Cefotaxime

A

significant hepatic metabolism- so less dose change during renal failure
DOC IN MENINGITIS

46
Q

Ceftriaxone

A 
Biliary excretion
t1/2= 8 hrs
cost effective in outpt therapy
same use as cefotaxime
AE- BILLIARY SLUDGE, diarrhea
47
Q

Cetazidime

A

PSEUDOMONAS- synergy with aminoglycosides against pseudomonas
hospital acquired gram-

48
Q

Cefoperazone

A

Antabuse like rxn to alcohol

49
Q

4th gen- drug

A

Cefepime

50
Q

Cefepime

A

combines gram + of 1st gen w/ other charecteristics- H. flu, pseudomonas
only use for serious hospital acquired infections

51
Q

5th gen

A

Cefatroline- can be used against MRSA

52
Q

Monobactam

A

Azobactam

53
Q

Monobactam- admin

A

IV

54
Q

monobactam- use

A

aerobic gram negative rods (only aminoglycosides also work on these)

55
Q

Monobactam- advantages

A

Aminogloycosides are the only other drug that work on aerobic gram negative rodes, but are assoc with nephrotoxicity, monobactams avoid this
NO CROSS ALLERGENICITY WITH OTHER BETA LACTAMS

56
Q

Carbepenems

A

Imipenem
Meropenem
Ertapenem

57
Q

Carbepenems- admin

A

IV

58
Q

Carbepenem- spectrum

A

broadest spectrum penicillins work agaisnt anything except MRSA…ish

59
Q

Carbepenems- use

A

Shotgun therapy

can cause emergence of resistant MRSA or Candida

60
Q

Imipenem

A

UTI when combined with Cilastatin- for urinary concentration

AE- seizures esp in those with renal damage or elderly

61
Q

Ertapenem

A

out pt IV tx

62
Q

Vancomycin- admin

A

IV- systemic infxn

Oral- pseudomembranous colitis

63
Q

Vancomycin- kinetics

A

t1/2= 6 hrs so can be given every half day or day
Renal excretion- adjust in renal failure
distributes everywhere except- CNS, eye, prostate

64
Q

Vanco- spectrum

A

cidal for all gram +

65
Q

Vanco- use

A

MRSA/MRSE/PRSP
serious staph/strep when allergic to beta lactams
bac endocarditis
pseudomembranous colitis

66
Q

Vanco- AE

A

REDMAN SYNDROME- erythema, itching, hypotension- histamine mediated, means administering the drug to quickly
Dose related nephro and ototoxicity- related to time in trough

67
Q

Vanco- MOA

A

binds to D-ala-D-ala- inhibiting transglycosylation

68
Q

Vanco MOR

A

pasmid mediated changing of D-ala-D-ala to D-ala-D-lactate

69
Q

Telavancin

A

Vanco on steroids
inc MRSA activity AND nephrotox
CI in pregnancy

70
Q

Daptomycin- kinetics

A

t1/2 = 9 hrs
concentration dependent killing with long post antibiotic effect= 1/day dosing
renal excretion

71
Q

Daptomycin- spectrum

A

cidal against gram +

72
Q

Daptomycin- use

A

resistant gram + infxn esp when need cidal ie infective endocarditis

73
Q

Daptomycin- CI

A

inactivated in lung so dont use for lung infxn (inactivated by surfactant)

74
Q

Daptomycin- AE

A

skeletal muscle myalgia, waekness and inc muscle enzymes
synergistic tox w/ statins
watch kidney enzymes

75
Q

Fosfomycin- MOA

A

inhibits enolpyruvate transferasae- preventing formation of N- acetylmuranic acid so bac cant make the peptidoglycan background

76
Q

Fosfomycin- use

A

concentrates in Urinary system so good for UTI.

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