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Pharmacotherapy V > Exam 1 Resistance Mechanisms > Flashcards

Exam 1 Resistance Mechanisms Flashcards

1
Q

What is the treatment of choice for ESBL producing bacteria?

A

Carbapenems

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2
Q

What organisms often have ESBL?

A

E. coli, K. pneumoniae

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3
Q

What is the common type of ESBL that is inhibited by tazobactam?

A

CTX-M

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4
Q

What is the name of the inducible beta-lactamase?

A

AmpC (Group 1)

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5
Q

What organisms have an inducible beta-lactamase?

A

SPICE organisms:

Serratia, Pseudmonas, Proteus vulgaris, Providencia, Morganella, Citrobacter, Enterobacter, Acinetobacter

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6
Q

Name the strong inducers of AmpC beta-lactamase

A

Penicillin G, Ampicillin, 1st generation cephalosporins, cefoxitin

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7
Q

With what organism/drug combination do you risk selection of stably derepressed AmpC mutants?

A

SPICE/3rd generation cephalosporins

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8
Q

What is the name of a common serine carbapenemase?

A

KPC = Klebsiella pneumoniae carbapenemase

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9
Q

Among the following, which are plasmid-mediated:

ESBL, KPC, AmpC, NDM, VanA, PMQR, ermB, mcr-1

A

ESBL, KPC, NDM, VanA, PMQR, mcr-1

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10
Q

What is the drug of choice for a KPC-producing bacteria?

A

Ceftazidime-avibactam

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11
Q

What is the drug of choice for a NDM-producing bacteria?

A

Ceftazidime-avibactam (for avibactam component to protect aztreonam) + aztreonam

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12
Q

What resistance mechanism causes MRSA?

A

production of new PBP due to mecA gene

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13
Q

What is the mechanism of vancomycin resistance in enterococci?

A

Alteration of cell wall precursors (to D-Ala-D-Lac or D-Ala-D-Ser)

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14
Q

What is the primary mechanism of resistance for S. pneumoniae?

A

change in PBP

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15
Q

What is the name of a metallo-B-lactamase?

A

NDM = new dehli metallo-beta-lactamase

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16
Q

What is a unique mechanism of resistance to aminoglycosides?

A

enzymes that add chemical groups to the structure

17
Q

What is the most dangerous vancomycin resistance gene in enterococci?

A

VanA (high resistance, transmitted via plasmid)

18
Q

Where is the ermB gene found and what does it do?

A

ErmB is found in S. pneumoniae and it causes a change in the ribosomal structure, causing resistance to macrocodes and clindamycin

19
Q

If Pseudmonas is resistant to imipenem but NOT meropenem, what is the likely resistance mechanism?

A 
Decreased permeability (porins)
Meropenem is the one affected more by efflux
20
Q

If Streptococcus pneumoniae is resistant to macrolides but not to clindamycin, what is the likely resistance mechanism?

A

Efflux pumps via mefA gene

If resistant to both, ribosomal change via ermB gene

21
Q

What is PMQR and where is it found?

A

Plasmid-mediated quinolone resistance; found in K. pneumoniae

22
Q

What is mcr-1?

A

Gene encoding resistance to colistin that is on a plasmid

Pharmacotherapy V (10 decks)

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