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Pharmacology for Amjad > 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
Q

What are the 3rd generation Cephalosporins?

A

Ceftriaxone
Cefotaxime
Cefdinir
Cefixime

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26
Q

What is the 4th generation Cephalosporin?

A

Cefepime

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27
Q

What is the MOA of the monobactams?

A

PBP inhibitor

28
Q

What is the only drug in the monobactam family?

A

Aztreonam

29
Q

What are the important features to remember about Aztreonam?

A
  • Gram negative ONLY
  • Penetrates the BBB
  • Beta-lactamase resistance
30
Q

What is the key adverse effect seen with Aztreonam?

A

Mild hypersensitivity

31
Q

What is the MOA of the Carbapenems?

A

PBP inhibitors

32
Q

What is the spectrum of activity in the Carbapenems?

A

Both gram negative and positive

33
Q

Generally, when are the Carbapenems used?

A

Life-threatening infections

34
Q

What are the unique features of the Carbapenems?

A
  • Resistant to Beta-Lactamase

- Susceptible to Carbamenemase

35
Q

List the drugs that fall into the Carbapenem family.

A

Doripenem
Imipenen
Entapenem
Meropenem

36
Q

What are the key side effects seen with the Carbapenems?

A

GI disturbances

37
Q

What family of antibiotics does Vancomycin fall into?

A

Glycopeptide antibiotic

38
Q

What is the MOA of Vancomycin?

A
  • 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
Q

What is Vancomycin commonly used to treat?

A

Gram + bacteria e.g. MRSA

40
Q

What should you remember about Vancomycin and the CNS?

A
  • Poor CNS penetration

- However, still a good first choice to treat meningitis

41
Q

What is the key adverse effect seen with Vancomycin?

A

Red Man Syndrome

  • Flushing
  • Red neck
42
Q

What is the MOA of Bacitracin?

A

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
Q

What is the specificity of Bacitracin?

A

Both gram positive and negative

44
Q

What is unique about Bacitrain?

A

Commonly included in TOPICAL preparations (OTC)

45
Q

What type of drug is Fosfomycin?

A

Cell wall synthesis inhibitor

Similar to Bacitracin

46
Q

What is the specific MOA of Fosfomycin?

A

Prevents the synthesis of UDP-NAM–disaccharide (a component of peptidoglycan)

47
Q

What is Fosfomycin commonly used to treat?

A

UTIs

48
Q

What is the general MOA of protein synthesis inhibitor antibiotics?

A

Bind and inhibit the bacterial ribosome–70S

49
Q

In general, are the protein synthesis inhibitors bactericidal or bacteriostatic?

A

Bacteriostatic

50
Q

What are the two subunits of the bacterial ribosome?

A

50S and 30S

51
Q

Review the steps of protein synthesis.

A

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
Q

What class of antibiotics are the Aminoglycosides?

A

Protein synthesis inhibitors

53
Q

List the aminoglycosides?

A 
Streptomycin 
Gentamicin 
Kanamycin 
Amikacin
Tobramycin 
Neomycin
54
Q

How are aminoglycoside antibiotics commonly used?

A

In combination with Beta-Lactams for SERIOUS gram negative infections

55
Q

What part of the bacterial ribosome is inhibited by the aminoglyocisdes?

A

30S subunit by preventing the tRNA molecules from entering the A site

56
Q

What are the key adverse effects associated with the Aminoglycosides?

A

1) Nephrotoxicity

2) Ototoxicity

57
Q

How do the Aminoglycosides differ from the general pattern of the protein synthesis inhibitors?

A

Generally BACTERICIDAL

58
Q

What antibiotic class are the Macrolides?

A

Protein synthesis inhibitors

59
Q

List the Macrolides.

A

Erythromycin
Clarithromycin
Azithromycin

60
Q

What is the target of the Macrolides?

A

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
Q

What are the key side effects associated with the Macrolides?

A

GI disturbances

62
Q

How do the Macrolides alter GI physiology?

A

Motilin receptor agonists

63
Q

What class of antibiotic are the Tetracyclines?

A

Protein synthesis inhibitors

64
Q

What subunit of the bacterial ribosome do the Tetracycline block?

A

30S

65
Q

What is the specific MOA of the Tetracyclines?

A

The drug blocks the A site of the ribosome to prevent the charged tRNA from entering

66
Q

What nutrient interaction do you need to remember about the Tetracyclines?

A
  • Binds Ca++
  • Will result in GROWTH of calcified tissue

*Don’t use in growing kids or pregnant women

67
Q

What are two additional adverse effects that need to be remembered about the Tetracyclines?

A

1) Disrupt the normal flora (more than the other drugs)

2) Cause photosensitivity

Pharmacology for Amjad (64 decks)

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