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Pharm Exam 7 > L 3-4 ICWS, Penicillins, Monobactams, Carbapenems > Flashcards

L 3-4 ICWS, Penicillins, Monobactams, Carbapenems Flashcards

1
Q

What molecules make up the peptidoglycan layer of bacteria?

A

N-acetylglucosamine and N-acetylmuramic acid

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2
Q

Fosfomycin

A

Inhibitor of cell wall synth.
Inhibits very early steps of peptidoglycan synth inside the cell
Not used often

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3
Q

Cycloserine

A

ICWS
Structural analog of D-alanine which is incorporated into peptidoglycan synth inside the cell
Off market

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4
Q

Bacitracin

A

ICWS

Prevents transport of peptidoglycan out of cell to make the wall

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5
Q

Glycopeptides

A

ICWS
Vancomycin & Teicoplanin
Inhibit subunit addition to build peptidoglycan backbone

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6
Q

Beta-Lactams

A

ICWS
Prevent transpeptidation
Penicillins, Cephalosporins, Carbapenems, monobactams

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7
Q

Why are ICWS bactericidal and how are they affected by protein synth inhibitors?

A

ICWS are bactericidal because they cause lysis of the cell when it tries to grow and does autolysis in order to increase the wall size

Inhibitors of protein synth prevent the cell from trying to grow so ICWS can’t work until the cell breaks its own wall and tries to build it larger

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8
Q

What is the defining feature of Penicillins and central to their MOA?

A

Beta-lactam ring
Essential for preventing transpeptidation
Penicillinases work by breaking this ring and inactivating the drug

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9
Q

Where do Penicillins fall on the Ph scale?

A

All Penicillins are acidic

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10
Q

Features of Natural Penicillins and drugs in group

A 
Best against g(+), have some g(-) and some anaerobic
Quickly inactivated by beta-lactamases
No anti-pseudomonal
Eliminated in kidney–fast!
Pen G-IV
Pen V-oral
Never given intrathecal–seizures
High protein binding

Penicillin G, V

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11
Q

Penicillin G

and combinations

A

Natural penicillin
IV/IM only
Many uses, only works in cells that are actively growing
Not effective in Mycoplasma or Chlamydia
+ potassium: IV/IM
+ benzathine: IM, used in long-term prophylaxis, rheumatic fever, DOC for syphilis
+ procaine: IM, makes a salt that allows prolonged effect

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12
Q

Penicillin V

A

Natural penicillin

Better acid resistance allowing for oral administration

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13
Q

Penicillinase resistant penicillins

Drugs and characteristics

A

Decreased g(+) coverage but increased g(-) and anaerobe compared to penicillins
DOC against penicillinase producing Staph aureus except for MRSA
Unique penicillin in that uses hepatic metabolism and renal excretion
Nafcillin: IV/IM
Oxacillin: oral
Dicloxacillin: oral
Methicillin: no longer used because of interstitial nephritis

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14
Q

Nafcillin

A

Penicillinase resistant penicillin

IV/IM admin

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15
Q

Oxacillin

A

Penicillinase resistant penicillin

Oral admin

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16
Q

Dicloxacillin

A

Penicillinase resistant penicillin

Oral admin

17
Q

Methicillin

A

Penicillinase resistant penicillin

no longer used because of interstitial nephritis

18
Q

What penicillin causes interstitial nephritis?

A

Methicillin

This is why it is no longer on the market

19
Q

Extended spectrum penicillins

Characteristics and drugs

A

Decreased g(+) but good g(-) and anaerobe coverage
Covers E. coli, Salmonella, Shigella, H. flu, Proteus
No klebsiella
No Pseudomonas
Acid-resistant allowing oral admin
Kidney excretion

Ampicillin
Amoxicillin

20
Q

Ampicillin

A

Extended spectrum penicillin

21
Q

Amoxicillin

A

Extended spectrum penicillin

22
Q

Anti-pseudomonal penicillins

Characteristics and drugs

A

Same coverage as extended spectrum with addition of some enteric g(-)
Proteus, Enterobacter, Providencia, Serratis
Not klebsiella
Used against Pseudomonas and Acinetobacter
Sensitive to B-lactamase
Acid sensitive
Renal excretion
Must be used with aminoglycosides to prevent resistance

Piperacillin
Ticarcillin

23
Q

Piperacillin

A

Anti-pseudomonal penicillin

IV Only

24
Q

Ticarcillin

A

Anti-pseudomonal penicillin

IV Only

25
Q

What are the beta-lactamase inhibitors?

A

Clavulanic acid
Sulbactam
Tazobactam

26
Q

Penicillin + Beta-lactamase inhibitor combinations

A

Ampicillin + Sulbactam: parenteral, anaerobes
Amoxicillin + Clavulanic Acid: (Augmentin) oral, used often in Peds clinics
Piperacillin + Tazobactam: (Zosyn) IV
Ticarcillin + Clavulanic Acid: (Timentin) IV

27
Q

Augmentin

A

Amoxicillin + Clavulanic acid, oral, used in peds clinics

28
Q

Zosyn

A

Piperacillin + Tazobactam: (Zosyn) IV

29
Q

Timentin

A

Ticarcillin + Clavulanic Acid: (Timentin) IV

30
Q

What can be given to help slow the excretion of penicillins by the kidney?

A

Probenacid

31
Q

Penicillin G toxicity

A

Major problem is hypersensitivity
Ampicillin rash: common 3-14 days later, not allergic, common with EBV, kids, amoxicillin also
Excess Na/K causing cardiac and renal toxicity
Soft frothy stools and diarrhea
Superinfections of staph, pseudomonas, proteus, yeast causing enteritis

32
Q

Monobactams

A

Aztreonam (Azactam)
Only one ring structure allows resistance to beta-lactamases
Good g(-), poor to none g(+)/anaerobes
No cross-sensitivity w/other penicillin derivatives

33
Q

Aztreonam (Azactam)

A 
Monobactam
Good resistance to beta-lactamase
Good g(-)
Poor g(+), anaerobes
No cross-sensitivity to other penicillins
34
Q

Carbapenems

A

ICWS
Beta-lactam dependent
IV admin
Similar to penicillins in coverage–broad

Imipenem: requires cilastatin co-admin, causes seizures–caution in head trauma, CNS disorders, brain lesions
Meropenem: not sensitive to dehydropeptidase in kidney
Ertapenem: stable against beta-lactamases, broad action esp enterobacteriaceae, IV/IM

35
Q

Imipenem

A

Carbapenem
Requires co-administration with Cilastatin to overcome breakdown by dehydropeptidase in the kidney
Can cause seizures–caution in head trauma, CNS disorders, brain lesions

36
Q

Meropenem

A

Carbapenem
Not sensitive to dehydropeptidase like Imipenem
Less likely to cause seizures like Imipenem
Broad spectrum

37
Q

Ertapenem

A

Carbapenem
Stable against beta-lactamases
Broad action, esp. against enterobacteriaceae
IV/IM

Pharm Exam 7 (5 decks)

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