Exam 1a. Antibiotics Inhibiting Cell Wall Synthesis Flashcards by Isaiah Smith

Beta-Lactamase Inhibitor Combination Antibiotics

Sulbactam

Tazobactam

Avibactam

Clavulanic Acid

Penicillins and Cephalosporins are two major groups that have B-lactam structures

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Beta-Lactamase Inhibitor Combination Antibiotics: Indications

-Give with antibiotics to combat bacteria that produces BETA LACTAMASE

-BETA lactamase render normal antibiotics useless

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Penicillins

Natural = G/V

Penicillinase Resistant = Nafcillin

Aminopenicillin = Ampi and Amoxi

Extended Spectrum = Piperacillin

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General Penicillins: MOA

Inhibits the synthesis of cell wall by inhibiting transpeptidases

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General Penicillins Indications

-UTI-STI-PNA-ETC

-Bacteria must be growing and dividing

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General Penicillins Adverse Reactions

Urticaria

Pruritus

Angioedema

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General Penicillins: Interact with

-Interact with NSAID

-Interact with Oral Contraceptive

-Interact with Warfarin

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Natural PCNS

G and V

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Penicillin G and V: NSG Consideration

-1/2 life = 30 min

-Least toxic

-Used with aminoglycosides –> helps get into the cell and disrupt protein synthesis

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Penicillinase Resistant PCNS

Nafcillin

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Nafcillin: NSG consideration

-Treat staph bacteria. Anti staphylococcus pcns

-IV only

-Resist breakdown by the penicillinase enzyme

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Aminopenicillins

Ampicillin

Amoxicillin

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Ampicillin: Adverse Reaction

GI upset and rash

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Ampicillin: NSG consideration

1st broad spectrum

Give IV

Renal sensitive

Not using as much because of drug resistance

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Amoxicillin: Indications

Ear-nose-throat

Skin infections

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Amoxicillin: NSG considerations

-Very common pediatric patients

-Less SE vs ampicillin

-Kids and PO

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Extended Spectrum PCNS

Piperacillin

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Piperacillin: Indications

-Pseudomonas bacterial infections

(most broad spectrum. Broad spectrum = hard on kidneys)

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Piperacillin: Adverse Reactions

-platelet function

-renal dysfunction

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Piperacillin: NSG consideration

-Always given with a beta lactamase inhibitor

-Do not give with patients with renal dysfunction

General Cephalosporins: MOA

-Inhibits cell wall synthesis through same penicillin binding protein (inhibit transpeptidase)

General Cephalosporins: Adverse Reactions

N/V/D/C

Rash

General Cephalosporins: NSG considerations

-Often resistant to beta-lactamases (cephalosporinase)

-Cross sensitivity with PCN allergy

-Pregnancy Category B (safe)

1st Generation cephalosporins

Cefazolin

Cephalexin

Cephalexin: Indications

Skin infections and UTI's

Cefazolin: NSG consideration

IV only and is given as surgical prophylaxis Does not work against CNS infections

2nd generation cephalosporins

Cefuroxime Cefotetan Cefuroxime does not kill anaerobic bacteria or CNS infections

3rd Generation Cehpalosporins

Ceftriaxone Ceftazidime Cefotaxime dxx

Ceftriaxone: Indications

3rd generation used for CNS infections like meningitis

Ceftriaxone: NSG considerations

EXTREMELY long acting (once per day dosing benefit) (Can cross BBB to treat CNS infections) (Do not give to liver failure patients)

Ceftazidime: Indications

3rd generation Pseudomonas

4th generation cephalosporin

Cefepime

cefepime: NSG consideration

Give to patients when we are unsure of the type. This is very broad spectrum and cross the BBB

5th generation cephalosporin

Ceftaroline

Ceftaroline: Indications

Good Sam MRSA MSSA VRSA VISA

Ceftaroline: NSG consideration

-Does not work against Enterobacter, pseudomonas, ESBL, Klebsiella coverage -Needs to be renally dosed (monitor kidney levels)

General Carbapenems: MOA

Bactericidal and Cell wall inhibitor (same as previous two classes)

General Carbapenems: Adverse Reactions

Drug induced seizure activity

Carbapenems: NSG Consideration

-Broadest spectrum of all antibiotics -Last resort medications -All are IV and must be INFUSED OVER 60 Min

impienem / cilastin: Indications

Complicated infections Can penetrate BBB and meninges

impienem / cilastin: Adverse Reactions

-Seizures: Especially in elderly and with other meds that can induce them

impienem / cilastin: NSG considerations

-Combo of the carbapenem with dehydropeptidase inhibitor (cilastin) -Most broad spectrum -Binds to penicillin-binding proteins  inhibits the cell wall synthesis VERY resistant to BETA-LACTAMASE

meropenem: Adverse Reaction and NSG consideration

-Rash and Diarrhea -Does not degrade in kidneys -less seizure acitivity

Glycopeptide antibiotic

Vancomycin

Vancomycin: MOA

-Destroys by binding to bacterial cell wall --> producing immediate inhibition of cell wall synthesis and death

Vancomycin: Indications

-MDRS and PCN resistant infections -C.diff and pseudomembranous colitis

Vancomycin: Adverse Reactions

Toxic Side Effects: -Ototoxicity with high levels (reversible) -Immune-mediated thrombocytopenia -Nephrotoxic watch when using with other drugs -Watch with neuromuscular blockades (paralyzers)

Vancomycin: NSG consideration

-Works on Gram + infections  Including MRSA and PCN resistant pneumococcus -Kidneys eliminate drug; decrease doses for renal dysfunction -Peak and trough levels to keep therapeutic

Vancomycin: Red Man Syndrome

Rapid infusion. Flushing, rash, pruritis, urticaria, tachycardia, hypotension Infuse slowly and over long periods (usually not harmful)