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Pharmacology > L24: Other Cell Wall and Membrane Agents > Flashcards

L24: Other Cell Wall and Membrane Agents Flashcards

1
Q

Aztreonam is the only drug that belong to which of the following groups….
A. Carbapenems
B. Monobactam

A

B. Monobactam

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2
Q

Ertapenem, Meropenem, and Imipenem + Cilastatin belong to which of the following groups?
A. Carbapenems
B. Monobactam

A

A. Carbapenems

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3
Q

_____, a monobactam that is useful for allergies, is active against Gram (-)
aerobic organisms but has NO activity against Gram (+) or Anaerobes
A. Ertapenem
B. Meropenem
C. Aztreonam

A

C. Aztreonam

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4
Q

Aztreonam is not cross allergenic with other β-lactams, except ____

A

ceftazidime

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5
Q

The inhaled nebulizer form of Aztreonam is used for..
A. P. aeruginosa in CF pts
B. UTI’s
C. Seasonal allergies

A

A. P. aeruginosa in CF pts

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6
Q

Neutropenia and GI symptoms are side effects of which type of Aztreonam administration?
A. Parenteral
B. Inhalation

A

A. Parenteral

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7
Q

True or False: Aztreonam can be used to treat serious infections, such as: UTIs, abdominal/gynecological infections, pneumonia, meningitis, or sepsis

A

True

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8
Q

Imipenem, Meropenem, Ertapenem belong to which group?
A. Carbapenems
B. Monobactam

A

A. Carbapenems

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9
Q

Which of the following Carbapenems is degraded by dehydropeptidases?
A. Imipenem
B. Meropenem
C. Ertapenem

A

A. Imipenem

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10
Q

____: Imipenem formulated with cilastatin to
inhibit dehydropeptidase

A

Primaxin

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11
Q

Which of the following Carbapenems has greater Gram (-) activity and less gram (+) activity compared to Imipenem?

A. Imipenem
B. Meropenem
C. Ertapenem

A

B. Meropenem

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12
Q

Which of the following Carbapenems does NOT enter CNS, is NOT used for P. aeruginosa, and is not typically used for empiric
therapy?

A. Imipenem
B. Meropenem
C. Ertapenem

A

C. Ertapenem

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13
Q

True or False:Carbapenems are oral agents with exceptionally broad spectra

A

False - carbapenems are PARENTERAL agents with exceptionally broad spectra

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14
Q

True or False: Carbapenems are active against E. faecalis (gram +) while inactive against
E. faecium and ORSA

A

True

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15
Q

True or False: Carbapenems are only active against Gram (+) and Gram (-) microbes

A

False - also Anaerobes!

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16
Q

Carbapenems are mostly reserved for nosocomial infections, but they can be combined with
____ for Pseudomonas treatment

A

aminoglycoside

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17
Q

____ alters membrane protein responsible for drug transport to keep carbapenems out.

However, there’s no cross resistance because they use different channel
than other beta lactams.

A

Pseudomonas

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18
Q

True or False:
Monobactams are agents of choice in organisms expressing ESBLs

A

False – Carbapenems!

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19
Q

Carbapenems have a dual MOA, which combines strong inhibition of ___ with inhibition of ___ enzymes

A

PBP (penicillin binding protein) and b-lactamase

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20
Q

Carbapenems are unaffected by, or even inhibit many β-lactamases, including some ___

A

ESBL’s

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21
Q

Carbapenems are vulnerable to carbapenamases
(e.g.Klebsiella pneumo carbapenemase, KPC) and some metallo-β-lactamase.

How can you overcome this?

A

Combine carbapenem with new beta lactamase inhibitors

(vaborbactam, relebactam)

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22
Q

Why can carbapenems cause seizures?

A

Can enter CNS

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23
Q

Risk of C. difficile
infection is higher with
broad spectrum
antibiotics such as
______
A.
B.
C.

A

C. carbapenems

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24
Q

Risk of C. difficile
infection is higher with
broad spectrum
antibiotics such as
______
A. Monobactam
B. Relebactam
C. Carbapenems

A

C. Carbapenems

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25
Q

Which carbapenem is most apt cause AE (e.g seizures)?
A. Ertapenem
B. Imipenem
C. Meropenem

A

B. Imipenem

26
Q

True or False: Pseudomembranous
colitis is an AE associated with Monobactams

A

False - Pseudomembranous
colitis is an AE associated with Carbapenem !!!!

27
Q

___ is a cell wall inhibitor of
gram-(+) organisms, as well as bactericidal, that prevents peptidoglycan
crosslinking by binding to
terminal D-alanyl-D-
alanine moieties

A. Dalbavancin (Dalvance®)
B. Bacitracin
C. Polymyxin B
D. Vancomycin

A

D. Vancomycin

28
Q

For Vanco, resistance mechanisms
involve altered
peptidoglycan structure from alanine to ____

A

lactate

29
Q

Vanco exhibits intermediate resistance, what does this mean??

A

Creates thicker walls to sequester drug

30
Q

Why are Gram (-) bacteria not affected by Vanco??

A

Too large to penetrate OM

31
Q

True or False: Vanco is a drug of last resort for strains highly resistant to beta-lactams. If it is sensitive fo beta-lactam, you should NOT use it

A

False -
Vanco is a drug of last resort for strains highly resistant to beta-lactams. If it is sensitive fo beta-lactam, you SHOULD use it

32
Q

____ is standard treatment for ORSA (including: endocarditis). However, it can be given orally for C. dif in the gut or IV for catheters, spinal meningitis, or enterococcus infection

A

Vanco

33
Q

For systemic therapy, vancomycin is
given by ____ ___ infusion
A. Slow, IM
B. Fast, IM
C. Slow, IV
D. Fast, IV

A

C. Slow, IV

34
Q

Under which conditions will Vanco get into the blood stream? the CNS?

A

CNS
- High dose
- Inflamed meninges

BS
- High dose
- Inflamed GI

35
Q

_____: drug-
induced release of histamine.This is not an allergic reaction, not involve IgE. Prevented by gradual Vanco infusion
over several hours

A

Red man syndrome

36
Q

True or False: Ototoxicity and Nephrotoxicity (Mississippi mud) are AE associated with vanco

A

True

37
Q

_____: is a lipoglycopeptide derivative of vancomycin, has BBW for nephrotoxicity, and treats skin infections caused ORSA (Gram +)

A. Dalbavancin
B. Telavancin
C. Bacitracin

A

B. Telavancin

38
Q

____ is a glycopeptide notable for long
half life (8.5 days), which treats ORSA and Staph that is resistant to vancomycin

A. Dalbavancin
B. Telavancin
C. Bacitracin
D. Vancomycin

A

A. Dalbavancin

39
Q

Bacitracin— a mixture of polypeptides produced
by Bacillus subtilis—inhibits _____ reactions necessary for cell wall synthesis
A. deamination
B. phosphorylation
C. dephosphorylation
C. alkylation

A

C. dephosphorylation

40
Q

Which of the following works via: prevention of transport of cell wall
materials to site of synthesis?

A. Dalbavancin
B. Telavancin
C. Bacitracin
D. Vancomycin

A

C. Bacitracin

41
Q

___ and ___ are resistant to Bacitracin

A

1) Enterobacteriaceae
2) Pseudomonas

42
Q

Why is Bacitracin commonly given topically?

A

IV results in severe nephrotoxicity

43
Q

Three primary uses of Bacitracin?

A

1) C. difficile colitis - oral
2) Conjunctivitis
3) Irrigate meninges

44
Q

____ are cationic detergents that destabilize the Gram (-) cell membrane AND increase bacterial cell permeability

A

Polymyxins

45
Q

____ is a mixture derived
from Bacillus polymyxa

____ is polymyxin E, from Bacillus colistinus

A. Polymyxin B; Colistin
B. Colistin; Polymyxin B

A

A. Polymyxin B; Colistin

46
Q

True or False: Neosporin is a formulation
of neomycin, bacitracin,
and polymyxin B

A

True

47
Q

____ can be: topical, ophthalmic, otic,
parenteral

______: parenteral only!

A. Polymyxin B; Colistin
B. Colistin; Polymyxin B

A

A. Polymyxin B; Colistin

48
Q

Parenteral dosing of ____ are the last resort for
drug resistant gram (-) meningitis, respiratory,
septicemia, UTI

A

Polymyxins

49
Q

What are the two primary AE associated with polymyxins?

A

1) Neurotoxicity
2) Nephrotoxicity

50
Q

____ inhibits early step in
cell wall synthesis and is an analogue of phosphoenolpyruvate
A. Vancomycin
B. Fosfomycin
C. Polymyxin B or E
D. Daptomycin

A

B. Fosfomycin

51
Q

Which of the following drugs inhibits enolpyruvate transferase to BLOCK
synthesis of UDP-N-acetylglucosamine,
a cell wall component + precursor of N-acetylmuramic acid??
A. Vancomycin
B. Fosfomycin
C. Polymyxin B or E
D. Daptomycin

A

B. Fosfomycin

52
Q

Which of the following is active against gram (+/-) + is used for uncomplicated E. coli and Enterococcus faecalis UTIs??
A. Vancomycin
B. Fosfomycin
C. Polymyxin B or E
D. Daptomycin

A

B. Fosfomycin

53
Q

Fosfomycin achieves high
concentration in and is in pregnancy cat B:
A. blood
B. urine
C. saliva
D. feces

A

B. urine

54
Q

____ is a pore-forming membrane
destabilizer of gram-positive bacteria.

Involves calcium-dependent insertion into membrane, leads to DEPOLARIZATION, loss
of membrane integrity, and leaking of K+, ATP, etc.

A. Vancomycin
B. Fosfomycin
C. Polymyxin B or E
D. Daptomycin

A

D. Daptomycin

55
Q

Uses of Daptomycin?

A

1) Resistant strains of MRSA, VRE
2) Complicated staph/strep skin infections
3) Bacteremia, endocarditis

56
Q

True or False: Daptomycin is given IM and can be used use for community-acquired pneumonia

A

False - given IV and can NOT be used use for community-acquired pneumonia

57
Q

Why does one have dark brown urine with Daptomycin use? Why does this occur?

A

High amounts of myoglobin

  • Toxic to muscle
58
Q

True or False: Most cell-wall targeted agents are β-lactams that use their
resemblance to peptidoglycan to inhibit bacterial enzymes

A

True

59
Q

True or False: Bacteria can express β-lactamases and alter their PBPs to
escape

A

True

60
Q

β-lactamase inhibitors can be paired with ____ abx
to increase their spectrum and efficiency

A

β-lactam antibiotics

Pharmacology (53 decks)

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