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Pharmacology > Cell Wall Syn Inhibitors > Flashcards

Cell Wall Syn Inhibitors Flashcards

1
Q

What are the 4 Beta Lactams

A

Penicillins, Cephalosporins, Carbapenems, Aztreonam

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2
Q

What are the two extended spectrum penicillins

A 
Aminopenicillins (Amp & Ammox)
Antipseudomonal penicllins (piper and ticar)
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3
Q

What is the importance of PBPs and where are they located

A

It is an enzyme needed for cell wall synthesis and located on bacterial cytoplasmic membrane

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4
Q

When can beta lactams kill bacteria

A

They can kill only when bacteria are actively growing and synthesizing cell wall

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5
Q

What are the four mechanisms of resistance to B Lactams

A

B Lactamase, Change in PBP structure, Change in porin structure (impaired penetration of the drug to PBP), Efflux Pumps

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6
Q

Who has a greater sensitivity to B Lactamases? Penicillins or cephalosporins

A

Penicillins do. The cephalos arent as sensitive to the lactamases

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7
Q

Which lactamases hyrdolyze both penicillins and cephalos?

A

Extended Spectrum B Lactamases (ESBL)

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8
Q

Which class of penicillins are resistant to penicillinases and cephalosporinases

A

Carbapenems

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9
Q

What is the mechanism of resistance for MRSA, PRSP, and resistant Enterococci species?

A

Altered PBPs to methicillin for MRSA, penicillin for PRSP and Enterococci. These bugs produce PBPs with a low affinity of binding to B lactams

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10
Q

What is the mechanism for gram - bugs?

A

Gram (-) bugs have outer cell wall. B Lactams cross this outer membrane and enter via PORIN CHANNELS. Absence or improper porin channels impair drug entry. This is the case with Pseudomonas.

Gram (-) may also have an efflux pump

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11
Q

What are the natural penicillims

A

G & V bc they can purified from mold

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12
Q

What is the spectrum for natural penicillins? (Basically, who do they work on?)

A

Mostly gram+ and non b lactamase producing anaerobes

-Strep (pyogenes, viridians, pneumococci (susceptible)

  • Enterococci (thats susceptible)
  • Treponema Pallidum for Syphillus (Spirochete)
  • Leptospira (Sprirochete)
  • Clostridium species (except C. diff…thats metronizadole)
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13
Q

What is Peni G used for and how is it administered?

A

Group A Strep
Dental Infections
Given Orally

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14
Q

What is Peni V used for and how is it administered?

A

Pneumococcal Pneumonia (susc)
Strep Endocarditits
Neurosyphillis
Given IV

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15
Q

What is Benzathine Penicillin, what is it used for, and how is it given?

A

It is a form of penicillin that is long lasting and slowly absorbed into the circulation. Use this when low doses of prolonged time intervals are needed

Syphilis
Group A Strep
Erysipelas/Cellulits
Given IM

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16
Q

How is neurosyphilis treated?

A

With IV penicillin for two weeks OR…

Daily IM benzathine penicillin PLUS probenecid

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17
Q

What is probenecid and how does it work?

A

Probenecid is a drug that raises blood levels of penicillin, this impairs renal tubular secretion of penicillin

It promotes renal clearance of uric acid by blocking urate anion exchangers in prox tubule

Used to treat gout

18
Q

What is nafcillin?

A

It is an antistaphylococcal that is RESISTANT to penicillinases.

Oxacillin is an alternative

Use Naf for Staph
MSSA Endocarditis or Strep Cellulitis

MRSA resistant

75% of S. Epidermidis is resistant

Can cover strep, but not as good as natural PCN

19
Q

Dicloxacillin is the older version of which penicillin

hint: its a very narrow spectrum lactam

A

Nafcillin.

Methicillin is also an older version of this type

20
Q

What are the penicillins that are resistant to lactamases and what do they treat?

A

MNO

They are used to treat MSSA (methicillin sensitive)

75% of S. epidermidis are resistant

Covers strep as well but not as good as natural penicillins

21
Q

What is a advantage that wide spectrum lactams have over narrow/very narrow?

A

Better activity against gram- bc they can penetrate their outer membrane much better

Still resistant to lactamases tho

22
Q

What are the two aminopenicillins?

A

Ampiciilin; IV or PO
Ampicillin + Sulbactam; IV

Ammoxicillin PO (better absorbed than ampi)
Ammox + Clav Acid; PO
23
Q

What bugs/infections are the aminopenicillins used for?

A

Used for:

UTI
Otitis
Sinusitis
Bites

Bugs:
Strep
Some Enterococci, H. Influenza, Enterobactericiae
Listeria
Anaerobes
24
Q

What are the Ureidopenicillins?

A

These are aka the Antipseudomonal penicillins.

Pipercillin with Tazobactam (commonly used)
Ticarcillin with Clav Acid (rarely used)

25
Q

What do the antipseudo’s do and what advantage do they have over aminopenicillins?

A

Think of antipseudomonas

They have gram+, gram- and anaerobic activity like aminos BUT…
They have ANTI-PSEUDOMONAL activity

Used this for nosocomial infections

26
Q

Reactions to the Penicillins

A

5-8% claim allergy

Multiple types of allergy ie anaphylaxis, and Rash.
-Ampicillin cause rash with EBV, possibly due to circulating Abs to ampicillin

Diarrhea - Ammox + Clav Acid

Seizure, esp with decr creatinine clearance

Interstitial nephritis, methicillin is the culprit bc it is neprhotoxic so rarely used

Neutropenia (w/Naf), hemolytic anemia/thrombocytopenia

27
Q

What lactam is used for Listeria

A

Aminopenicillins (Ammox/Ampi)

Also cover g+ and some g-

28
Q

Describe the spectrum, mode of administration and indications for 1st generation cephalosporins

A

There are two 1st generation cephalos:
Cefazolin (IV)
Cephalexin (PO)

Spectrum:
Mostly G+
-Staph (Not MRSA) & Strep Pyogenes (Not Enterococcus)

Indications:
Skin Infections, Surgical Prophylaxis

29
Q

Describe the spectrum, mode of administration and indications for 2nd generation cephalosporins

A

The 2nd gen cephalos are:
Cefoxitin, Cefotetan, Cefuroxime (all IV)
Cefaclor (PO, sounds like cefaclORAL)

Spectrum:
G+ cocci (some)
G- rods (some, ie E. Coli, Klebs, Proteus, H. Influ)
Anaerobes ( ie Bacteroides; only with Cefoxitin & Cefotetan)

Indications:
IV surgical/gyno infections
Otitis Media PO

30
Q

Describe the spectrum, mode of administration and indications for 3rd generation cephalosporins

A

The third gen cephalos are:
Ceftriaxone, Cefotaxime, Ceftazidime, Cefoperazone (all IV)
Cefdinir, Cepodoxime, Cefixime (PO)

Spectrum:
G+ cocci (pneumococcus, streptococcus)
G- cocci (meningococci, gonococci)
G- Rods
H. Influenza
NO ANEROBES, MRSA, ENTEROCOCCUS, LISTERIA
31
Q

What two 3rd generation cephalos cover pseudomonas

Hint: Raz and Taz

A

CefTAZadime and CefapeRAZone

32
Q

How is ceftriaxine given and how is excreted. What does the mode of excretion imply about its solubility?

A

It is given once daily IV and excreted through the biliary tract. This means its lipid soluble and can cross the blood brain barrier. Therefore it is used to treat meningitis (Cefotaxime as well), community acquired pneumonia, gonorrhea, and otitis media

33
Q

What is the 4th generation cephalosporin and what does it treat?

A

Cefepime
More resistant to lactamases
Same coverage as 3rd gen + pseudomonas
Hospital acquired infections and NEUTROPENIC FEVER

34
Q

What are the adverse reactions to cephalos

A

Same as penicillins
Allergy, rash, nephrotitis, hematologic
X reactivity with PCNs
Cephalos with a methylthiotetrazole group
(cefamandole, cefmetazole, cefaperazone, cefotetan) cause HYPOPROTHROMBINEMIA and bleeding as well as disulfiram effect

35
Q

What are the carbapenems and what are they used for?

A

Imipenum, meropenum, ertapenum, doripenum. (All IV)
Imipenum is the GORILLApenum bc it has a wide spectrum ie G+, anaerobes, G- (but not MRSA)

Used for:

  • Febrile Neutropenia (when someone has low neutrophils and they get a fever. I think this is the same as neutropenic fever that cefepime is used for)
  • Resistant Organisms
36
Q

What is imipenum given with and why?

A

Given with cilastatin that is an inhibitor of the enzyme Renal Dehydropeptidase I that deactivates imipenum in the renal tubules. This causes the drug to stay around longer.

May cause seizures if there is renal failure bc it cant be metabolized and it will build up and go mess with your brain

37
Q

What is aztreonam and what is used for? What is its advantage?

A

It is a monobactam that doesnt have cross reactivity with B lactams and it is used for G- rods ie Klebs, Serratia, Pseudomonas

Used for UTIs, safe for those allergic to penicillin

38
Q

What is Vanco, how does it work, and what bugs is it used against?

A

It is a Glycopeptide that inhibits cell wall synthesis by binding to the D-Ala - D-Ala portion of the NAM building block. Resistance is by replacing D-Ala with D-Lac (VRSA/VRE)

It is used against MRSA/C. Diff and is bactericidal. Not as efficient in killing as PCNs.

39
Q

What is the spectrum for Vanco and what are the bugs it can kill? What infections is it used to treat?

A

Spectrum: G+
S. Aureas and Epidermidis, S. pyogenes, pneumococcus, viridans
C. Diff (orally), some Enterococcus

Indications:
MRSA/MRSE esp seen in catheter related infections, C. Diff, Meningitis due to PRSP, Enterococcal infections

Use in synergy with aminoglycoside

(Note that catheters are breeding ground for S. epidermidis)

40
Q

What are the adverse effects of Vanco?

A

Red Man Syndrome
-It is caused by histamine release that causes itching, flushing. This is prevented by prolonging infusion time

Ototoxicity and Nephrotoxicity (bc renally cleared) esp when used w/aminoglycoside

41
Q

What is daptomycin and what is it used for?

A

Daptomycin is a drug that binds to CYTOPLASMIC membranes and form Ca dependent structures that cause an efflux of K+ which causes depolarization of the membrane

  • DO NOT GIVE TO PNEUMONIA PATIENTS bc lung surfactant will inactivate the drug.
  • Use against VRSA/VRE
  • CAREFUL! It can cause myopathy so monitor CPK levels

Pharmacology (17 decks)

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