Inhibitors of bacterial cell wall synthesis 2

Question 1

Third-generation cephalosporins

Answer 1

Cefdinir
Cefotaxime
Ceftazidime
Ceftriaxone

Question 2

Third-generation cephalosporins active against

Answer 2

Wider range of gram-negative organisms including enteric gram-negative bacilli (Enterobacteriaceae), H. influenzae, and M. catarrhalis

Question 3

Fourth-generation cephalosporin

Answer 3

Cefepime

Question 4

Fourth-generation cephalosporin active against

Answer 4

P aeruginosa, Enterobacteriaceae, S aureus, and S pneumoniae. It is highly active against Haemophilus and Neisseria sp.

Question 5

Carbapenem with high affinity for PBP-2

Answer 5

Imipenem

Question 6

Carbapenem that binds both PBP-2 and PBP-3

Answer 6

Meropenem

Question 7

Cefoxitin - Clinical use

Answer 7

Surgical prophylaxis for gram-neg

Question 8

Cefoxitin - Adverse effects

Answer 8

Hypersensitivity (rare, cross-sensitivity to penicillins):
Anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia

Local irritation: pain after IM injection, thrombophlebitis after IV

Renal toxicity (intersitial nephritis, tubular necrosis)

Question 9

Ceftazidime - Clinical use

Answer 9

AVYCAZ: ceftazidime + avibactam

Intraabdominal infections
UTIs
Pneumonia

P. aeruginosa and other gram-negative bacteria

Question 10

Ceftazidime - Special considerations

Answer 10

Resistant to some Class-C β-lactamases such as Amp C cephalosporins, TEM, SHV

Question 11

Ceftazidime, Cefpodoxime, Cefotaxime, Ceftriaxone - Adverse effects

Answer 11

Hypersensitivity (rare, cross-sensitivity to penicillins):
Anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia

Local irritation: pain after IM injection, thrombophlebitis after IV

Renal toxicity (intersitial nephritis, tubular necrosis)

Question 12

Cefpodoxime, Cefotaxime - Clinical use

Answer 12

Gonorrhea

Question 13

Ceftriaxone - Clinical use

Answer 13

Gonorrhea, UTIs, otitis, meningitis, pneumonia, Lyme disease – Gonococci, pneumococci, meningococci, B. burgdorferi, H. influenzae

Question 14

Cefepime - Clinical use

Answer 14

Intraabdmonial infections
UTIs
Pneumonia
Skin and soft tissue infections

Drug-resistant gram-negative bacilli, including Citrobacter and Enterobacter species

Question 15

Cefepime - Adverse effects

Answer 15

Drug induced encephalopathy
Hypersensitivity (rare, cross-sensitivity to penicillins):
Anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia

Local irritation: pain after IM injection, thrombophlebitis after IV

Renal toxicity (intersitial nephritis, tubular necrosis)

Question 16

Ceftaroline - Clinical use

Answer 16

Community-acquired pneumonia
Skin and soft tissue infections

MRSA, Drug resistant pneumococci

Question 17

Ceftaroline - Adverse effects

Answer 17

Hypersensitivity (rare, cross-sensitivity to penicillins):
Anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia

Local irritation: pain after IM injection, thrombophlebitis after IV

Renal toxicity (intersitial nephritis, tubular necrosis

Question 18

Azetreonam - Clinical use

Answer 18

Aerobic gram-negative bacilli

Enterobacter, Citrobacter, Klebsiella, Proteus, P. aeruginosa

UTIs, gynecological, intra-abdominal, skin, lung infections
Pneumonia
Meningitis
Sepsis

Question 19

Azetreonam - Special considerations

Answer 19

Cross-sensitivity for penicillin is not common

Not stable to Amp C β-lactamase, extended spectrum β-lactamases

Question 20

Azetreonam - Adverse effects

Answer 20

Hypersensitivity reactions
Thrombophlebitis
Skin rashes
Increases level of serum aminotransferase

Question 21

Carbapenems - Clinical use

Answer 21

Active against gram (-) rods- P. Aeruginosa, and gram (+) org.
Endocarditis
Pneumonia
UTIs
Pelvic, skin, soft tissue, intra-abdominal inf.
Meningitis, febrile neutropenia,
sepsis

Question 22

Imipenem - Special considerations + Contraindications

Answer 22

Resistant to most b-lactamases but not carbapenemase of metallo b-lactamase.

Excessive levels of imipenem in patients with renal failure may lead to seizures

Question 23

Carbapenems - Adverse effects

Answer 23

Cross-sensitivity with penicillin allergy
Seizures in patients with epilepsy 
Diarrhea
Vomiting
Anemia
Leukopenia
Thrombocytopenia
Altered bleeding time

Question 24

Imipenem - Interactions

Answer 24

Cilastatin: dehydropeptidase inhibitor that increases time of activity of imipenem.

Question 25

Vancomycin - Clinical use

Answer 25

Gram-positive cocci and bacilli, MRSA Streptococcal and enterococcal infections caused by penicillin-resistant organisms, including endocarditis and necrotizing fasciitis Meningitis caused by penicillin-resistant strain of pneumococcus (in combination with cefotaxime, ceftriaxone, or rifampin) Bacillus, Clostridium, Cornyebacterium species Bone and joint, skin and soft tissue infections Pneumonia Septicemia Endocarditis

Question 26

Vancomycin, Telavancin - Adverse effects

Answer 26

Reduced nephro- and ototoxicity now compared to before Hypotension and erythematous rash with to quick infusion (called red man syndrome) Vestibular dysfunction (ataxia, vertigo, nystagmus, nausea) Cochlear dysfunction (tinnitus, hearing loss) Irritating to tissue -->phlebitis at site of injection Chills, fever

Question 27

Vancomycin - Interactions

Answer 27

Aminoglycosides and amphothericin B: Increased nephrotoxicity

Question 28

Telavancin - Clinical use

Answer 28

Skin and soft tissue inf by MSSA+ MRSA + vancomycin-sensitive E. faecalis

Question 29

Telavancin - Contraindications

Answer 29

Do not administer to pregnant women, it is teratogenic

Question 30

Bacitracin - Clinical use

Answer 30

Gram-positive cocci, including staphylococci and streptococci Skin and eye infections Combined with polymyxin and neomycin

Question 31

Bacitracin - Special considerations

Answer 31

Used only for topical treatment

Question 32

Bacitracin - Adverse effects

Answer 32

Very nephrotoxic

Question 33

Fosfomycin - Clinical use

Answer 33

Enterococci and many gram-negative enteric bacilli, including E. coli, Citrobacter, Klebsiella, Proteus, Serratia marcescens Uncomplicated UTIs by E. coli or E. faecalis

Question 34

Fosfomycin - Adverse effects

Answer 34

Diarrhea

Question 35

Bacitracin - MoA

Answer 35

Inhibition of regeneration of bactoprenol phosphate (C55-isoprenyl P)

Question 36

Fosfomycin - MoA

Answer 36

Inhibiton of enolpyruvyl transferase, blocks the addition of phosphoenolpyruvate to UDP-GlcNAc, prevents synthesis of UDP-MurNAc

Question 37

Cephalosporins - MoA

Answer 37

Binds to PBPs, inhibiting cross-linking of peptidoglycan -> inhibition of bacterial cell wall synthesis.

Question 38

Carbapenems - MoA

Answer 38

Binds to PBPs, inhibiting cross-linking of peptidoglycan -> inhibition of bacterial cell wall synthesis.

Question 39

Vancomycin - MoA

Answer 39

Binds to peptidoglycan and prevents cross linking. Inhibit cell wall synthesis.