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Pharmacology Exam 2 (Lauren) > Inhibitors Of Cell Wall Synthesis > Flashcards

Inhibitors Of Cell Wall Synthesis Flashcards

1
Q

What is bacitracin’s spectrum?

A

Gram +

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2
Q

What are the 4 natural penicillins?

A

Penicillin G

Benzathine penicillin

Procaine penicillin G

Penicillin V

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3
Q

What is the DOC for salmonella?

A

TMP-SMZ

Quinolone

Cephalosporin (3rd gen)

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4
Q

How is bacitracin administered?

A

Topical

Rarely parenterally

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5
Q

What is the DOC for Helicobacter Pylori?

A

tetracycline or amoxicillin + bismuth+ metronidazole

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6
Q

What are the two major uses for antipseudomonal penicillins?

A

Pseudomonas

Acinetobacter

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7
Q

What is the DOC for Strep pneumoniae?

A

Penicillin

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8
Q

Are B-lactamase inhibitors helpful against MRSA

A

No

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9
Q

Do 2nd gen cephalosporins have any antipseudomonal activity?

A

No

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10
Q

What is the DOC for surgical prophylaxis?

A

Cefazolin

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11
Q

What effect will protein synthesis inhibitors have on the action of cell wall synthesis inhibitors?

A

It will prevent the action of cell ICWS drugs because it will prevent the production of autolysins

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12
Q

What causes the loss of cell wall integrity after B-lactam treatment?

A

The bacteria’s own autolysins that are constantly degrading the old cell wall

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13
Q

Why is vancomycin a drug of last resort?

A

Due to the emergence of VRE (vancomycin resistant enterococci)

And the need for effective MRSA treatment

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14
Q

What happens when you combine fosfomycin with a B-lactam, aminoglycoside, or fluoroquinolone?

A

Synergistic effect

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15
Q

Is ampicillin rash a hypersensitivity reaction?

A

No

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16
Q

What is the spectrum of fosfomycin?

A

G+ and G-

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17
Q

Do extended spectrum penicillins have any antipseudomonal activity?

A

No

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18
Q

Do natural penicillins have any antipseudomonal activity?

A

No

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19
Q

what is the DOC for Neisseria gonorrhoeae?

A

Ceftriaxone

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20
Q

What are the 2 antipsuedomonal penicillins?

A

Piperacillin

Ticarcillin

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21
Q

What must imipenem be given with? Why?

A

Cilastatin. Because imipenem is inactivated by human renal dihydropeptidases and cilastatin will inhibit them.

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22
Q

What is another name for penicillinase producing staph aureus?

A

MSSA

Methicillin sensitive staph aureus

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23
Q

What is the DOC for moraxella catarrhalis?

A

TMP-SMZ

Cephalosporin (2nd or 3rd gen)

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24
Q

What cephalosporin has the broadest coverage against enterobacteriaceae, MSSA, and Pseudomonas?

A

Cefepime

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25
Q

What is the only natural penicillin that is oral?

A

Penicillin V

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26
Q

Does cefepime (4th gen ceph) have any antipseudomonal activity?

A

Yes

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27
Q

What are the two sugars in the backbone of peptidoglycan?

A

NAM

NAG

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28
Q

Which first gen cephalosporin is oral?

A

Cephalexin

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29
Q

Does ampicillin rash itch, cause fever, or arthrlagias?

A

No, that would be some sort of hypersensitivity reaction, and you would want to take them off the medication

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30
Q

What two steps of of cell wall synthesis are done by penicillin binding proteins?

A

Transglycosylation- joining NAG-NAM

Transpeptidation- cross linking the peptides

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31
Q

What is the DOC for listeria?

A

Ampicillin +/- aminoglycoside

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32
Q

What is the DOC for MSSA? (Penicillinase producing S. Aureus)

A

Penicillinase-resistant penicillins

(Nafcillin,
Dicloxacillin
Oxacillin)

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33
Q

What is the only 4th gen cephalosporin?

A

Cefepime

Aka granddaddy of cephalosporins

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34
Q

What is the DOC for MRSA

A

Vancomysin

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35
Q

What are the second generation cephalosporins?

A

Cefaclor- oral
Cefuroxime
Cefprozil-oral

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36
Q

What 3rd generation cephalosporins can penetrate the CNS?

A

Ceftriaxone

Cefotaxime sodium

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37
Q

What is the spectrum of antipseudomonal penicillins?

A

The same as extended spectrum penicillins, but with additional coverage of gram negative bacilli and pseudomonas

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38
Q

What are the main toxicities of cephalosporins?

A

Superinfection (esp with cefepime)

Disulfiram-like reaction

Allergy - 10% cross reactivity with PCN allergy

GI symptoms- esp diarrhea

Dose dependent renal tubular necrosis-synergistically with aminoglycosides

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39
Q

What are the “other” B-lactam drugs that are not penicillins or cephalosporins?

A

Monobactams-aztreonam

Carbapenems- imipenem, meropenem, ertapenem

40
Q

How does Fosfomycin inhibit cell wall synthesis?

A

Prevents NAG from becoming NAM

41
Q

As you go from 1st gen to 3rd gen cephalosporins, what happens to G+ and G- coverage?

A

G+ coverage goes down

G- coverage goes up

(At 4th generation (cefepime) you get better G+ coverage)

42
Q

What is the DOC for early Borrelia burgdorferi?

A

Amoxicillin

43
Q

Are antipseudomonal penicillins susceptible to B-lactamase?

A

Yes

44
Q

Why don’t we use bacitracin parenterally?

A

Serious nephrotoxicity

45
Q

Does aztreonam have any cross sensitivity with other B-lactams?

A

No…good for PCN allergic pts

46
Q

What is vancomycin’s spectrum?

A

EXCLUSIVELY gram +

47
Q

When do you give Vancomycin orally?

A

Superinfections of:
Staphylococcus
Clostridium Difficile

48
Q

What is the DOC for late Borrelia burgdorferi?

A

Ceftriaxone

49
Q

What do you HAVE to give antipseudomonal penicillins with?

A

Aminoglycoside

Pseudomonas is hypermutable

50
Q

What is the DOC for E. Coli, Klebsiella, or Proteus?

A

Cephalosporin (1st or 2nd gen)

Bactrim

51
Q

What are the 3 drugs in Neosporin?

A

Bacitracin- G+
Neomycin G-
Polymyxin G-

52
Q

What is the DOC for Staph aureus that does not produce B-lactamase

A

Penicillin

53
Q

What are the 4 classes of penicillins?

A

Natural penicillins

Penicillinase resistant

Extended spectrum

Antipseudomonal

54
Q

What is the DOC for penicillin resistant strep pneumoniae?

A

Ceftriaxone

Non PCN resistant would be treated with penicillin

55
Q

What drug can cause seizures in high levels?

A

Impinenem

56
Q

How does bacitracin inhibit cell wall synthesis?

A

Inhibits the transportation of NAG-NAM across the inner membrane

57
Q

Are natural penicillins readily inactivated by penicillinase?

A

Yes

58
Q

What are the 3rd generation cephalosporins?

A

Ceftriaxone
Cefotaxime Sodium
Ceftazidime
Cefixime-oral

(Tri-tax-taz- fix me)

59
Q

What class of drugs have the highest activity against G+ bacteria?

A

Natural penicillins

60
Q

Are most G+ cocci susceptible to first generation cephalosporins?

A

Yes, including MSSA.

They could be an alternative for PCN allergic people

61
Q

What is the DOC for B-lactamase producing enterobacter infections?

A

Imipenem or Meropenem

62
Q

What are the 3 carbapenems?

A

Imipenem
Meropenem
Ertapenem

63
Q

What are the B-lactamase inhibitors?

A

Clavulanic acid

Sulbactam

Tazobactam

64
Q

What is the DOC for Neisseria gonorrhoeae?

A

Ceftriaxone

Cefixime

65
Q

Does 5th gen ceph (Ceftaroline) have antipseudomonal activity?

A

No

66
Q

What are the penicillins that can be taken orally?

A

VODKA

Penicillin V

Oxacillin

Doxacillin

K -nothing

A- Ampicillin/amoxicillin

67
Q

What is MRSA’s mechanism of resistance?

A

Producing an alternate PBP that no B-lactam can bind to

**except for ceftaroline

68
Q

What makes ertapenem different from imipenem and meropenem?

A

Less active against pseudomonas

69
Q

What is the only B-lactam that is active against MRSA and VRSA?

A

Ceftaroline

Can bind to the mutated PBP

70
Q

What is the unnamed/5th gen cephalosporin?

A

Ceftaroline fosamil

71
Q

What is used for uncomplicated lower UTIs in women?

A

Fosfomycin

72
Q

What is the DOC for Group A Strep pyrogenes

A

Penicillin

Clindamycin

73
Q

What are the adverse effects of vancomycin?

A

Ototoxic
Nephrotoxic
“Red man” syndrome

74
Q

What is aztreonam’s spectrum?

A

Aerobic G- rods ONLY

Including pseudomonas, Serratia, klebsiella, proteus

75
Q

What are the 2 first generation cephalosporins

A

Cefazolin

Cephalexin- oral

76
Q

What is the major side effect of penicillins?

A

Allergy

77
Q

Would Cefepime make a really good drug to use for empirical therapy?

A

Yes, it has a very broad coverage and is resistant to B-lactamases

78
Q

Will B-lactam antibiotics be effective in a non-growing cell?

A

NO

79
Q

What are the 2 antipseudomonal penicillins?

A

Piperacillin

Ticarcillin

80
Q

What are the 4 penicillinase resistant penicillins?

A

Nafcillin

Dicloxacillin

Oxacillin

Methicillin** lab use only

81
Q

What is the mechanism of action of cephalosporins?

A

Block transpeptidation of peptidoglycan

They are B-lactam

82
Q

What is the advantage that Cephalosporins have over Penicillins?

A

They have increased resistance to B-lactamase

83
Q

Do 3rd gen cephalosporins have Pseudomonal activity?

A

Yes.

Ceftazidime combined with an aminoglycoside. Remember pseudomonas always gets 2

84
Q

What is the DOC for listeria?

A

Extended spectrum penicillins-

Ampicillin or amoxicillin

85
Q

What step of cell wall synthesis is inhibited by B-lactam antibiotics?

A

Transpeptidation (cross-linking)

86
Q

What drug should NOT be used in neonates, as it displaces bilirubin?

A

Ceftriaxone

Not OK for baby with Gonorrhea

87
Q

What are the 2 extended spectrum antibiotics?

A

Ampicillin

Amoxicillin

88
Q

What is the DOC for Viridans streptococci?

A

Penicillin

89
Q

What 4 antibiotics sometimes have B-lactamase inhibitors combined with them?

A

Ampicillin

Amoxicillin

Piperacillin

Ticarcillin

90
Q

How does vancomycin work?

A

Prevents transpeptidation by binding to the terminal D-ala-D-ala

91
Q

What is the DOC for enterococcus species?

A

Penicillin +/- aminoglycoside

92
Q

What is the DOC for Staph aureus that produces B-lactamase

A

Penicillinase-resistant penicillin

93
Q

What is the only monobactam?

A

Aztreonam

94
Q

What is the spectrum of imipenem and meropenem?

A

Broad spectrum

95
Q

What is the DOC for C. Diff superinfections?

A

Oral vancomycin

96
Q

Do natural penicillins have good CNS penetration?

A

No, not unless there is inflammation

97
Q

When you add an inhibitor to ampicillin does it stay oral?

A

No it becomes parenteral.

Amoxicillin+inhibitor stays oral (augmentin)

Pharmacology Exam 2 (Lauren) (7 decks)

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