CellWallInhibitorsC

Question 1

What is the consequence of cell wall inhibitors ?

Answer 1

Cell death

Question 2

Cell wall inhibitors require what type of organism for maximum effect?

Answer 2

Actively proliferating microorganisms

Question 3

What are the beta-lactam compounds?

Answer 3

Penicillin, cephs, carbapenems, monobactams and beta-lactamase inhibitors

Question 4

What main characterist defines beta- lactam drugs?

Answer 4

Beta lactam ring

Question 5

What are the beta lactams inherently unstable to ?

Answer 5

pH- destroyed in acid

Question 6

Are beta lactams generally bacteriostatic or cidal?

Answer 6

Cidal- active against growing organisms

Question 7

What is penicillin MOA?

Answer 7

Interferes with the last step in bacterial cell wall synthesis

Question 8

Why does penicillin have no effect on protozoa, mycoplasma, viruses and fungus?

Answer 8

b/c they lack cell walls

Question 9

What are the 3 ways bacteria are resistant to penicillin?

Answer 9

Produce beta lactamase (inactivates drug), modify PBP target, and impair penetration of drug to target PBP

Question 10

What are the natural penicillins?

Answer 10

G or V

Question 11

What are the natural penicillins highly active against? What are they not active against?

Answer 11

Active: Gram + cocci, Not active: staphylococcus

Question 12

What are the indications for natural penicillin use? How are they administered?

Answer 12

Ts: URI/ LRI, throat, skin, and GU infections, G- IM, V- oral

Question 13

What are the aminopenicillins and how do they differ from the naturals?

Answer 13

Ampicillin and amoxicillin, Have Pen G activity AND improved coverage of gram ñ cocci and enterobacteriaceae

Question 14

What are the therapeutic uses of aminopenicillins?

Answer 14

URI ( otitis and sinusitis) uncomplicated UTI, meningitis, and salmonella

Question 15

What is augmentin composed of?

Answer 15

Amoxicillin and calvulonic acid

Question 16

What are the penicillinose-resistant penicillins?

Answer 16

Nafcillin, oxacillin, dicloxacillin

Question 17

Do the penicillinose-resistant penicillins have a narrow or broad spectrum use?

Answer 17

Narrow

Question 18

What are the indications for penicillinose-resistant penicillins ?

Answer 18

Tx staph infections with increased beta lactam production. Cellulitis and endocarditis

Question 19

What are the penicillinose-resistant penicillins not active against?

Answer 19

Gram ñ or anaerobic organisms

Question 20

What are the antipseudomonal penicillins? How do they differ from natural penicillins?

Answer 20

Piperacillin, ticarcillin, and carbenicillin. Pen G activity AND gram ñ coverage including pseudomonas

Question 21

What are the beta-lactamse inhibitors and what do they act as?

Answer 21

Clavulanic acid, sulbactam, and tazobactam ì suicide inhibitorsî ñ potent, irreversible inhibitors of many lactamases

Question 22

Adding B lactamase inhibitors increases coverage of what organisms?

Answer 22

H influenzae, staph, and moraxella catarrhalis

Question 23

Which penicillins are oral admin ONLY?

Answer 23

Pen V and amoxicillin with or without clavulanic acid

Question 24

Which penicillins are IV ONLY?

Answer 24

Antipseudomonal penicillins. Piperacillin with or without tazobactam

Question 25

Which penicillins are oral or IV?

Answer 25

Nafcillin , Ampicillin

Question 26

What are the depot forms of penicillin admin?

Answer 26

Procaine and benzathin penicillin G

Question 27

How are most penicillins eliminated?

Answer 27

Kidney, actively secreted into urine

Question 28

Which penicillins are excreted via biliary excretion?

Answer 28

Antipseudomonal and nafcillin

Question 29

What can block active secretion of penicillin?

Answer 29

Probenecid

Question 30

What are some ADRs of penicillin?

Answer 30

GI upset, diarrhea, and secondary infections

Question 31

What are drug specific penicillin reactions?

Answer 31

Oxacillin- hepatitis, Nafcillin- neutropenia, Ticarcillin/carbencillin- abnormal platelet aggregation

Question 32

What are the 2 PCN drug interactions?

Answer 32

TCN- tetracycline or other bacteriostatic agents, Anti-pseudomonal PCN affects warfarin metabolism

Question 33

Are cephalosporins bactericidal or static?

Answer 33

bacteriocidal

Question 34

How is there increases cephalosporin resistance?

Answer 34

Mutations carried on plasmids

Question 35

Cephalosporin generation 1 covers what type of organisms?

Answer 35

Aerobic gram +, Above the diaphragm, anaerobes/CA gram ñ Skin infections, acute otitis media, pharyngitis, UTI, prophylaxis for clean surgery, septic arthritis

Question 36

What are the 1st generation drugs and the routes?

Answer 36

Cefazolin ( IV), Cephalexin (PO)

Question 37

What are the 2 categories of 2nd generation cephs and their routes and indications

Answer 37

1-Added gram negative coverage, IV/PO- cefuroxime, cefaclor, cefprozil, Sinusitis, otitis, bronchitis, CAP, skin infections, UTI 2-added anaerobic coverage IV: cefotetan, cefoxitin Abdominal and gyno infections

Question 38

What was the main added feature for 3rd generation ?

Answer 38

Gram negative coverage and penetration of the BBB

Question 39

What are the 3rd generation cephs and their routes?

Answer 39

Oral: cefpodoxime, cefdinir, cefixine, cefditoren, cefibuten IV/ IM: cefotaxime, ceftriaxone(long Ω life) IV: ceftazidime- increased antipseudomonal coverage

Question 40

What are indications for use of 3rd generation cephs?

Answer 40

Wide variety of serious infections that may be resistant to other antimicrobial agents Broad spectrum Meningitis, pneumonia, sepsis, peritonitis, neisseria gonorrhea

Question 41

What is the 4th generation ceph? Can it be taken orally?

Answer 41

Cefepime, NO - IM/IV

Question 42

What does generation 4 have good coverage against? What is it used for?

Answer 42

Gram +, -, anaerobic ( h influenzae, n. meningitides, n. gonorrheae, p. aeruginosa )Intraabdominal infections, resp tract infections, skin infection

Question 43

Is vancomycin a bactericidal or static?

Answer 43

bactericidal

Question 44

What are the 2 mechanisms of vancomycin resistance?

Answer 44

Acquired or innate

Question 45

Does vancomycin work against gram ñ organisms?

Answer 45

NO, only gram +

Question 46

What is vancomycin reserved for?

Answer 46

Pt allergic to beta latams with serious gram + infections or MRSA

Question 47

When is oral vancomycin indicated?

Answer 47

c.diff induced colitis ONLY

Question 48

What are the ADR of vancomycin?

Answer 48

Red man syndrome, ototoxicity, nephrotoxicity

Question 49

What is ovitavanan used for?

Answer 49

Gram + , including MRSA

Question 50

What is daptomycin used for/ reserved for?

Answer 50

Omplicated skin infections, bacteremia, osteomyelitis, Reserved for: pt allergic to beta lactams, MRSA, enterococcus spp

Question 51

What is dalbavacin and what is it used for?

Answer 51

Lipoglycopeptide which prevents cross linking and stabilization of cell wall interfering w/ cell wall synthesis. Bactericidal against staph aureus and strep pyogens

Question 52

What are indications for dalbavacin ?

Answer 52

Skin infection and IVPB

Question 53

What are clinical uses of bacitracin?

Answer 53

Nephrotoxic, gram + cocci and bacilli so limited to topical use. Locally for wounds, antibiotic ointment, or cleaning wounds in surgery