inhibitors of cell synthesis

Question 1

Method of Penicillin resistnace

Penicillinase

Answer 1

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 !

Question 2

Natural Penicllins

Answer 2

Penicillin IV, IM,
Bezathine penicillin IM depot
Procaine Penicillin G IM
Penicillin V Oral (acid resisT)

Question 3

Natural Penicillins Use

Answer 3

GOLD Stadard for G+ infection
- not really for G-
readily inactivated by B lactamases 
- elimination in the kidney (probenecid will reduce elim) 
- poor CNS

Question 4

Penicillinase Resistance Penicillins

Answer 4

Nafcillin (IM IV)- super sick or can take oral me
Dicloxacillin- oral
oxacillin- oral 
methicillin 
- only hepatic metabolism

Question 5

Penicillinase Resistance Pencicillins USe

Answer 5

Only slightly lower than G+ that natural
- some G- 
- no antipseudomonal activity
-hepatic metabolism and renal excretion
DOC for MSSA

Question 6

MRSA mechanism of resistance

Answer 6

produces an alternate PBP which decreases affinity of B lactam
* only ceftarolin is the B lactam can be used to fight MRSA

Question 7

Extended specrum penicillins

Answer 7

Ampicillin-oral

amoxicillin- oral

Question 8

Extended spectrum penicillins

Answer 8

Extended G- and lower G+

• no antipseudomonal act
• resistance developed frewuently
• acid resistance
• suseotable to B lactamase
• **DOC for lysteria

Question 9

Ampicillin rash

Answer 9

* not a hypersensiticty**
- correlation with Hx of EBV
maculopapular rash dull red
central clearing

Question 10

Antpseudomonal Penicillins

Answer 10

Piperacillin
ticarcillin
** are not ever given orally perential becuase want 100% F

Question 11

Antipseudomonal pen. char.

Answer 11

Major use Pseudomonas
spectrum: bacteria covered by estended spectrum pen and som gram - bacilli
acid sensitive
renal excresion
* always taken in combination with aminoglycosides!!!!

Question 12

B lactamase inhibitors that we combine with penicilin

Answer 12

Ampicillin
amoxicillin
pipercillin*
Ticarcilin*
*** cannot prescribe these without a B lactamase inh!!
reminder will not work on MRSA

Question 13

Main toxicity for penicillin

Answer 13

hypersensivity!!!
electrolyte imbalances
GI disturbnce
superinfections

Question 14

First generation Cephalosporisn

Answer 14

Cefazolin- IV IM

Cephalexin- Oral

Question 15

First gen Cephal

Answer 15

Good G+!!! most are suceptable
MSSA 
mod G-
^ B lactamase resistance 
Renal excretion 
DOC- Cefazolin for surgery

Question 16

Second Gen Cephalosporins

Answer 16

Cefaclor-oral
Cefuroxime-IV IM
cefprozil- oral

Question 17

Sec Gen Ceph

Answer 17

lower G+ and better G-
some acid resistant
renal secretion

Question 18

3rd generation Ceph

Answer 18

Ceftiaxone- excellent CNS pen IV IM DOC for neisseria
Cefotaxime SOdium- CNS pen IV IM
Ceftazidime- p. aeruginosa IV IM
Cefixime- oral

Question 19

3rd gen cephal qualt

Answer 19

• much more active against enerobacteruaceae
  -Pseudomonas aeruginosa activity
• kidney excretion
  Ceftriacone DOC = gonorrhoeae
  ** cannot give to neonates**

Question 20

4th gen cephal drug

qualities

Answer 20

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

Question 21

5th gen cephal drugs and qual

Answer 21

Ceftaroline -IV
NO antipseudomonal activity
- binds to PBP2A ( MRSA and VRSA coverage!! only ceph that cant fight MRSA)
-G+ and G-

Question 22

Monobactams

- Aztreonam

Answer 22

• 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

Question 23

Carbapenems

Answer 23

Imipenem ; cilastin
Meropenem
Ertapenem

Question 24

Imipenem and Mropenem

Answer 24

_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

Question 25

Ertaoenem

Answer 25

high stable agaist B lactamses
- G+ G- and anareboic
IV and IM

Question 26

Vancomycin mechanism/ res

Answer 26

Prevents transpeptidation of the peptiglycan - binds to D-ala and mask the binding site
* if you change terminal AA then the Vancomycin cant bind and the bacteria now has resistance

Question 27

Vancomycin use

Answer 27

DOC for MRSA!!!!!!!
only for G+ infection
- given orally for Cdiff (DOC!!!) and Staphylococcus > these are the only two reasons to give oral abx
- drug of LAST choice except in MRSA or C diff

Question 28

Vancomycin Adverse effects

Answer 28

-nephrotoxic
ototoxic
-red man syndrome - a histamine flush

Question 29

Fosfomycin mech

Answer 29

inhibits of cell wall synthesis at the synthesis of peptigoglycan
prevents NAG to NAM reduction

Question 30

Fosfomycin

Answer 30

G+ and G-
orally and excreted by kidney
used for uncomplcated in UTI
can do combo with other inhiitors of cell wall synthesis

Question 31

Bacitracin mech

Answer 31

interferes with final dephos step in phospolipid carrieer cycle so cant transport NAG-NAM across the inner membran

Question 32

Bacitracin use

Answer 32

Parenteral rare and topical
Mainly G+
commonnly combines with neomycin and polymyxins ( think neosporrin to get G-)
used to precent superficial skin and eye infections