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Pharmacology > EXAM #4: ANTIBIOTICS II > Flashcards

EXAM #4: ANTIBIOTICS II Flashcards

1
Q

Describe the composition of peptidoglycan.

A

Peptidoglycan is composed of repeating monomers of NAM-NAG-pentapeptide

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2
Q

What is NAM?

A

N-acetylmuramic acid

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3
Q

What is NAG?

A

N-acetylglucosamine

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4
Q

What is the function of the Penicillin-Binding Proteins?

A

Forming peptidoglycan by creating the NAM-NAG bonds

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5
Q

What category of antibiotics inhibit the PBPs?

A

Beta-Lacam antibiotics

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6
Q

What drugs are part of the B-Lactam family of antibiotics?

A

Penecillin
Cephalosporins
Monobactams
Carbapenems

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7
Q

Are the B-Lactams bacteriostatic or bactericidal?

A

Bactericidal

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8
Q

What enzyme can cause drug resistance in the B-Lactams?

A

Beta-Lactamase, which hydrolyzes the Lactam ring that is integral to this class of antibiotics

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9
Q

List the antibiotics that fall into the PCN family.

A 
PCN G 
PCN V  
Amoxicillin 
Methicillin 
Nafcillin 
Oxacillin 
Ampicillin 
Piperacillin 
Ticarcillin 
Azlocillin

All end in “cillin”*

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10
Q

What are the key adverse effects seen with the PCN family of antibiotics?

A

Hypersensitivity

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11
Q

If a patient has a severe reaction to a PCN-type antibiotic, what should you be concerned about?

A

Hypersensitivity to ALL Beta-Lactam drugs, not JUST the PCNs

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12
Q

What is unique about the drug Methicillin?

A

This is a synthetic PCN-type drug that is RESISTANT to Beta-Lactamase

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13
Q

What PCN-type drugs are narrow spectrum?

A 
PCN G 
PCN V 
Methicillin*
Nafcillin*
Oxacillin*

*Note that all three are “v. narrow spectrum” and are ALL resistant to Beta-Lactamase

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14
Q

What PCN-type drugs are broad spectrum?

A 
Ampicillin 
Amoxicillin 
Piperacillin
Ticarcillin
Azlocillin
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15
Q

What is the utility of Beta-Lactamase inhibitors?

A
  • Side-setting drug resistance mechansim

- These drugs can be CO-ADMINISTERED with PCN-type drugs

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16
Q

What is the hallmark Beta-Lactamase inhibitor?

A

Clavulanic acid

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17
Q

How is Clavulinc acid commonly administered?

A

Co-administration with Amoxicillin as AUGMENTIN

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18
Q

If a patient has a mild hypersensitivity reaction to PCN-type drugs, what family of drugs should you consider?

A

Cephalosporins

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19
Q

Generally, how do the Cephalosporins differ from the PCN-type drugs?

A

More resistant to Beta-Lactamase

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20
Q

What is the key adverse reaction to the Cephalosporins?

A

Hypersensitivity

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21
Q

What is the theme in terms of specificity/generation in the Cephalosporins?

A
  • There are 4 generations - 1 is narrow (gram positive only)
  • 4 is the broadest (gram positive and negative)
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22
Q

What is the theme in Cephalosporin generations and CNS penetration?

A

3rd and 4th generation Cephalosporins penetrate the BBB

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23
Q

What are the first generation Cephalosporins?

A

Cefazolin

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24
Q

What are the 2nd generations cephalosporins?

A

Cefotetan
Cefaclor
Cefuroxime

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25
What are the 3rd generation Cephalosporins?
Ceftriaxone Cefotaxime Cefdinir Cefixime
26
What is the 4th generation Cephalosporin?
Cefepime
27
What is the MOA of the monobactams?
PBP inhibitor
28
What is the only drug in the monobactam family?
Aztreonam
29
What are the important features to remember about Aztreonam?
- Gram negative ONLY - Penetrates the BBB - Beta-lactamase resistance
30
What is the key adverse effect seen with Aztreonam?
Mild hypersensitivity
31
What is the MOA of the Carbapenems?
PBP inhibitors
32
What is the spectrum of activity in the Carbapenems?
Both gram negative and positive
33
Generally, when are the Carbapenems used?
Life-threatening infections
34
What are the unique features of the Carbapenems?
- Resistant to Beta-Lactamase | - Susceptible to Carbamenemase
35
List the drugs that fall into the Carbapenem family.
Doripenem Imipenen Entapenem Meropenem
36
What are the key side effects seen with the Carbapenems?
GI disturbances
37
What family of antibiotics does Vancomycin fall into?
Glycopeptide antibiotic
38
What is the MOA of Vancomycin?
- Prevents elongation of the peptidoglycan cell wall - Binds to the pentapeptide and sterically inhibits pentapeptide linkage - Specific target is the D-ala/ D-ala ****Note it is NOT binding to the PBP but IS still a Beta-Lactam antibiotic
39
What is Vancomycin commonly used to treat?
Gram + bacteria e.g. MRSA
40
What should you remember about Vancomycin and the CNS?
- Poor CNS penetration | - However, still a good first choice to treat meningitis
41
What is the key adverse effect seen with Vancomycin?
Red Man Syndrome - Flushing - Red neck
42
What is the MOA of Bacitracin?
Blocks incorporation of amino acids and nucleic acids into the cell wall of the bacteria *****Inhibits the building of the building blocks that are used to create the cell wall*****
43
What is the specificity of Bacitracin?
Both gram positive and negative
44
What is unique about Bacitrain?
Commonly included in TOPICAL preparations (OTC)
45
What type of drug is Fosfomycin?
Cell wall synthesis inhibitor *Similar to Bacitracin*
46
What is the specific MOA of Fosfomycin?
Prevents the synthesis of UDP-NAM--disaccharide (a component of peptidoglycan)
47
What is Fosfomycin commonly used to treat?
UTIs
48
What is the general MOA of protein synthesis inhibitor antibiotics?
Bind and inhibit the bacterial ribosome--70S
49
In general, are the protein synthesis inhibitors bactericidal or bacteriostatic?
Bacteriostatic
50
What are the two subunits of the bacterial ribosome?
50S and 30S
51
Review the steps of protein synthesis.
1) charged tRNA binds to the A site of the ribosome 2) Peptide bond formation between amino acid in A site and growing chain 3) Newly uncharged tRNA exits 4) Longer amino acid chain translocates into the P site
52
What class of antibiotics are the Aminoglycosides?
Protein synthesis inhibitors
53
List the aminoglycosides?
``` Streptomycin Gentamicin Kanamycin Amikacin Tobramycin Neomycin ```
54
How are aminoglycoside antibiotics commonly used?
In combination with Beta-Lactams for SERIOUS gram negative infections
55
What part of the bacterial ribosome is inhibited by the aminoglyocisdes?
30S subunit by preventing the tRNA molecules from entering the A site
56
What are the key adverse effects associated with the Aminoglycosides?
1) Nephrotoxicity | 2) Ototoxicity
57
How do the Aminoglycosides differ from the general pattern of the protein synthesis inhibitors?
Generally BACTERICIDAL
58
What antibiotic class are the Macrolides?
Protein synthesis inhibitors
59
List the Macrolides.
Erythromycin Clarithromycin Azithromycin
60
What is the target of the Macrolides?
50S subunit--disrupts the translocation of the growing amino acid chain from the A site to the P site to allow for a new amino acid to enter
61
What are the key side effects associated with the Macrolides?
GI disturbances
62
How do the Macrolides alter GI physiology?
Motilin receptor agonists
63
What class of antibiotic are the Tetracyclines?
Protein synthesis inhibitors
64
What subunit of the bacterial ribosome do the Tetracycline block?
30S
65
What is the specific MOA of the Tetracyclines?
The drug blocks the A site of the ribosome to prevent the charged tRNA from entering
66
What nutrient interaction do you need to remember about the Tetracyclines?
- Binds Ca++ - Will result in GROWTH of calcified tissue *Don't use in growing kids or pregnant women
67
What are two additional adverse effects that need to be remembered about the Tetracyclines?
1) Disrupt the normal flora (more than the other drugs) | 2) Cause photosensitivity

Pharmacology (64 decks)

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