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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
Pipercillin
IV
26
Ticarcillin
IV
27
Extended spectrum + beta lactamase inhibitor
Amoxicillin + CA Ampicillin + Sublactam Pipercillion + tazobactam Ticarcillin + CA
28
Extended spectrum+ beta lactamase uses
``` used when dealing with beta lactamase producing organisms bacteroides moraxella H. Flu S. Aureus ```
29
Amox + CA
Oral Upper and lower RTI- H. flu, moraxella AE- diarrhea, pseudo membranous colitis
30
Amp + sublactam
IV Dirty surgical prep aspiration pneumonia
31
pip+ tazo | Ticar + CA
IV | shotgun therapy before know exact pathogen
32
Cephalosporins- trends
``` 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
Cephalosporins- kinetics
Renal Excretion with major dose change in renal failure except- cefotaxime, ceftriaxone (they are hepatic)
34
Cephalosporin AE
super infection | pseudomembranous colitis
35
1st gen cephalosporin- drugs
Cefazolin | Cephaloxin
36
1st gen cephalosporin- use
Gram + | cost effective
37
Cefazolin
staph/strep clean surgical prophylaxis possible UTI
38
2nd gen cephalosporin
Cefotetan Cefoxitin Cefuroxime
39
Cefotetan
``` ANTABUSE LIKE RXN WITH ALCOHOL t 1/2= 3.5 hours comm acquired aerobes serious intrabdominal and pelvic infections combination of anaerobes- bacteroides ```
40
Cefoxitin
used for- intraabdominal/ pelvic infections combination of anaerobes- bacteroides comm acquired aerobes
41
Cefuroxime
can get into CNS Staph/ Strep, serious pediactric meningitis and pneumonia serious adults pneumonia
42
3rd gen cephalosporins
Cefotaxime Ceftazadime Ceftriaxone Cefoperazone
43
3rd generation distribution
CNS
44
3rd gen useage
hospital acquired gram - EXCEPT PSEUDOMONAS | use in combo with other agents against anerobes
45
Cefotaxime
significant hepatic metabolism- so less dose change during renal failure DOC IN MENINGITIS
46
Ceftriaxone
``` Biliary excretion t1/2= 8 hrs cost effective in outpt therapy same use as cefotaxime AE- BILLIARY SLUDGE, diarrhea ```
47
Cetazidime
PSEUDOMONAS- synergy with aminoglycosides against pseudomonas hospital acquired gram-
48
Cefoperazone
Antabuse like rxn to alcohol
49
4th gen- drug
Cefepime
50
Cefepime
combines gram + of 1st gen w/ other charecteristics- H. flu, pseudomonas only use for serious hospital acquired infections
51
5th gen
Cefatroline- can be used against MRSA
52
Monobactam
Azobactam
53
Monobactam- admin
IV
54
monobactam- use
aerobic gram negative rods (only aminoglycosides also work on these)
55
Monobactam- advantages
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
Carbepenems
Imipenem Meropenem Ertapenem
57
Carbepenems- admin
IV
58
Carbepenem- spectrum
broadest spectrum penicillins work agaisnt anything except MRSA...ish
59
Carbepenems\- use
Shotgun therapy | can cause emergence of resistant MRSA or Candida
60
Imipenem
UTI when combined with Cilastatin- for urinary concentration | AE- seizures esp in those with renal damage or elderly
61
Ertapenem
out pt IV tx
62
Vancomycin- admin
IV- systemic infxn | Oral- pseudomembranous colitis
63
Vancomycin- kinetics
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
Vanco- spectrum
cidal for all gram +
65
Vanco- use
MRSA/MRSE/PRSP serious staph/strep when allergic to beta lactams bac endocarditis pseudomembranous colitis
66
Vanco- AE
REDMAN SYNDROME- erythema, itching, hypotension- histamine mediated, means administering the drug to quickly Dose related nephro and ototoxicity- related to time in trough
67
Vanco- MOA
binds to D-ala-D-ala- inhibiting transglycosylation
68
Vanco MOR
pasmid mediated changing of D-ala-D-ala to D-ala-D-lactate
69
Telavancin
Vanco on steroids inc MRSA activity AND nephrotox CI in pregnancy
70
Daptomycin- kinetics
t1/2 = 9 hrs concentration dependent killing with long post antibiotic effect= 1/day dosing renal excretion
71
Daptomycin- spectrum
cidal against gram +
72
Daptomycin- use
resistant gram + infxn esp when need cidal ie infective endocarditis
73
Daptomycin- CI
inactivated in lung so dont use for lung infxn (inactivated by surfactant)
74
Daptomycin- AE
skeletal muscle myalgia, waekness and inc muscle enzymes synergistic tox w/ statins watch kidney enzymes
75
Fosfomycin- MOA
inhibits enolpyruvate transferasae- preventing formation of N- acetylmuranic acid so bac cant make the peptidoglycan background
76
Fosfomycin- use
concentrates in Urinary system so good for UTI.

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