inhibitors of cell synthesis Flashcards
Method of Penicillin resistnace
Penicillinase
Some Bacteria can produce penicillinase binds to the beta lactam ring which inactivates it becuase it cant bind to the target.
* same thing as B lactamase !
Natural Penicllins
Penicillin IV, IM,
Bezathine penicillin IM depot
Procaine Penicillin G IM
Penicillin V Oral (acid resisT)
Natural Penicillins Use
GOLD Stadard for G+ infection - not really for G- readily inactivated by B lactamases - elimination in the kidney (probenecid will reduce elim) - poor CNS
Penicillinase Resistance Penicillins
Nafcillin (IM IV)- super sick or can take oral me Dicloxacillin- oral oxacillin- oral methicillin - only hepatic metabolism
Penicillinase Resistance Pencicillins USe
Only slightly lower than G+ that natural - some G- - no antipseudomonal activity -hepatic metabolism and renal excretion DOC for MSSA
MRSA mechanism of resistance
produces an alternate PBP which decreases affinity of B lactam
* only ceftarolin is the B lactam can be used to fight MRSA
Extended specrum penicillins
Ampicillin-oral
amoxicillin- oral
Extended spectrum penicillins
Extended G- and lower G+
- no antipseudomonal act
- resistance developed frewuently
- acid resistance
- suseotable to B lactamase
- **DOC for lysteria
Ampicillin rash
* not a hypersensiticty**
- correlation with Hx of EBV
maculopapular rash dull red
central clearing
Antpseudomonal Penicillins
Piperacillin
ticarcillin
** are not ever given orally perential becuase want 100% F
Antipseudomonal pen. char.
Major use Pseudomonas
spectrum: bacteria covered by estended spectrum pen and som gram - bacilli
acid sensitive
renal excresion
* always taken in combination with aminoglycosides!!!!
B lactamase inhibitors that we combine with penicilin
Ampicillin amoxicillin pipercillin* Ticarcilin* *** cannot prescribe these without a B lactamase inh!! reminder will not work on MRSA
Main toxicity for penicillin
hypersensivity!!!
electrolyte imbalances
GI disturbnce
superinfections
First generation Cephalosporisn
Cefazolin- IV IM
Cephalexin- Oral
First gen Cephal
Good G+!!! most are suceptable MSSA mod G- ^ B lactamase resistance Renal excretion DOC- Cefazolin for surgery
Second Gen Cephalosporins
Cefaclor-oral
Cefuroxime-IV IM
cefprozil- oral
Sec Gen Ceph
lower G+ and better G-
some acid resistant
renal secretion
3rd generation Ceph
Ceftiaxone- excellent CNS pen IV IM DOC for neisseria
Cefotaxime SOdium- CNS pen IV IM
Ceftazidime- p. aeruginosa IV IM
Cefixime- oral
3rd gen cephal qualt
- much more active against enerobacteruaceae
-Pseudomonas aeruginosa activity - kidney excretion
Ceftriacone DOC = gonorrhoeae
** cannot give to neonates**
4th gen cephal drug
qualities
Cefepime IV
- similar coverage to 3rd gen but antipseudomonal!!
- better G+ coverage (since the others ones were going down)
BROADEST COVERAGE: enterobacteriaceae, MSSA, Pesudomonas
** empirical therapy in a very very sick patient***> can change once you have the results back
5th gen cephal drugs and qual
Ceftaroline -IV
NO antipseudomonal activity
- binds to PBP2A ( MRSA and VRSA coverage!! only ceph that cant fight MRSA)
-G+ and G-
Monobactams
- Aztreonam
- B lactam ring
- relatively resistant to B lactamases
- ONLY against serobi G- rods
- can treat pseudomonas
- parenteral adminstration
- few side effects
- NO CROSS sensitivity with other B lactams > good for penn allergy
Carbapenems
Imipenem ; cilastin
Meropenem
Ertapenem
Imipenem and Mropenem
_IV and broad spectrum anerobes G+ G-
- stable against B lactamases
- Can cause seizure!!!! used caustiously in renal failure or history of CNS disorders
** Meropenem is less likely to cause seizure
DOC- Blactamases producing enterobacter infections
