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Anti-Infectives Exam 2 > Lecture 1 - Clinically relevant organisms & Penicillins > Flashcards

Lecture 1 - Clinically relevant organisms & Penicillins Flashcards

1
Q

For antibiotic to work….

A
  1. Enter bacterial cell
  2. reach its site of action
  3. bind to target that is involved in essential bacteria function
  4. significantly impair that function
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2
Q

Gram + Peptidoglycan layer is….

A

thick

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3
Q

Gram - Peptidoglycan layer is….

A

thin

have some other layers too on outer & inner sides

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4
Q

Enzymes vital for cell wall synthesis, cell shape, and structural integrity are…

A

Penicillin binding proteins

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5
Q

Gram - structure

A

Outer membrane (contains LPS, porins)

Periplasmic space = between inner/outer membrane (location of beta-lactamases)

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6
Q

Gram + color

A

purple

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7
Q

Gram - color

A

pink

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8
Q

Gram +, Aerobic, Cocci, Clusters, Coagulase +

A

Staphylococcus aureus

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9
Q

Gram +, Aerobic, Cocci, Clusters, Coagulase -

A

Other Staphylococcus species

  1. epidermis
  2. hominis
  3. haemolyticus
  4. capitus
  5. saprophyticus
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10
Q

Gram +, Aerobic, Pairs & Chains

A

Streptococcus spp.

Enterococcus spp.

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11
Q

Gram +, Aerobic, Rods

A

Listeria

Nocardia

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12
Q

Gram +, Anaerobic, Cocci

A

Peptostreptococcus

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13
Q

Gram +, Anaerobic, Rods

A

Clostridium spp. (spore-forming)
Propionibacterium
Actinomyces

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14
Q

Gram -, Aerobic, Rods, Lactose-fermenting

A

Enterobacteriaceae family (gut bacteria)

  1. Escherichia coli
  2. Klebsiella pneumoniae
  3. Enterobacter spp.
  4. Proteus mirabillis
  5. Salmonella spp.
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15
Q

Gram -, Aerobic, Cocci

A

Neisseria meningitidis
Neisseria gonorrhoeae
Moraxella catarrhalis

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16
Q

Gram -, Aerobic, Rods, Non-lactose fermenting

A

Non-enterobacteriaceae (usually nosocomial pathogens)

  1. Pseudomonas aeruginosa
  2. Acinetobacter baumannii
  3. Stenotrophomonas maltophilia
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17
Q

Gram -, Anaerobic, Rods (Bacilli)

A

Bacteroides spp.
Prevotella
Fusbacterium

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18
Q

Clinically important Atypical Organisms

A

Chlyamydia spp.
Mycoplasma spp.
Legionella spp.

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19
Q

Chlyamydia spp.

A

C. pneumonia

C. trachomatis

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20
Q

Mycoplasma spp.

A

M. pneumonia

M. genitalium

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21
Q

Legionella spp.

A

L. pneumophilia

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22
Q

4 Classes of Beta-Lactams

A

Penicllins
Cephalosporins
Carbapenems
Monobactam

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23
Q

Natural Penicillins

A

Penicillin G = IV
Benzathine Penicillin = IM
Penicillin V Potassium = PO

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24
Q

Natural Penicillins MOA

A
  1. Bind to penicillin binding proteins

2. Inhibit cross-linking of peptidoglycan in cell wall

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25
Q

Natural Penicillins MOR

A
  1. Beta-lactamase enzymes destroy abx (Gram -)
  2. Failure to penetrate outer membrane n reach site ( Gram - )
  3. Pumped out of cell via pump ( Gram - )
  4. Alteration of binding site ( Gram + )
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26
Q

Natural Penicillins Spectrum of Activity (Gram +)

A

Pen G = good v E. faecalis
Pen VK = not good v E. Faecalis

Limited/no activity vs S. aureus

** Treatment of choice for susceptible Strep spp.**

27
Q

Natural Penicillins Spectrum of Activity (Gram - )

A

Minimal activity

some activity against susceptible Neisseria meningitidis

No activity for Atypical

28
Q

Natural Penicillins Spectrum of Activity (Anaerobes)

A

Good against Gram + anaerobes (oral flora)

  • Actinomyces spp.
  • Peptostreptococci
  • Propionibacterium acnes

** Txm of choice against Clostridium perfringens **

Limited activity Gram - anaerobes due to resistance

29
Q

Natural Penicillins Spectrum of Activity (other)

A

** Txm of choice for Syphillis **

Spirochete, Treponema pallidum

If severe drug allergy, can use alternative agent for non-CNS disease

If neuropathy/ocular-syphilis, will desensitize to Penicillin and give

30
Q

Natural Penicillins M & E

A
  1. substrates of OTA 1/3
  2. Poor pen across BBB
  3. 1/2 life in normal renal function = 30-60min, q4h or continuous IV

Excreted in urine, mostly unchanged…req renal adjustment

31
Q

Natural Penicillins ADE

A

CNS, seizures at high doses
Hematologic = neutropenia
Hypersensitivity
Renal - AIN, Renal tubular disease

32
Q

Natural Penicillins Drug Interactions

A

Drugs that interact w/ OTA 1/3 (Pretomanid, Teriflunomide, Fexinidazole)

Probenecid, inc plasma lvls and used to extend 1/2 life

33
Q

Penicillinase-resistant Penicillins

A

Nafcillin (IV)
Oxacillin (IV)
Dicloxacillin (PO)

34
Q

Penicillinase-resistant Penicillins MOA

A

Bind to PBPs
Inhibit cross-linking of peptidoglycan in cell wall

  • Developed in response to penicillinase-producing S. aureus*

Acyl side chain prevented disruption of the B-lactam ring

35
Q

Penicillinase-resistant Penicillins Spectrum of Activity Gram +

A

** Txm of choice MSSA **

no activity against E. faecalis, MRSA

GOOD activity against penicillin-susceptible Strep. spp.

36
Q

Penicillinase-resistant Penicillins Spectrum of Activity (Gram -, Anaerobes, Atypical)

A

** No activity **

37
Q

Penicillinase-resistant Penicillins M & E ( Nafcillin/Oxacillin)

A

Naficillin = moderat CYP3A4 inhib

Good for CNS infections, high CSF pen

90-95% protein bound

Short 1/2life, dose Q4h

No dose adjustment, N excreted through poop, O = urine/bile

38
Q

Penicillinase-resistant Penicillins M & E (Dicloxacillin)

A

Rapid/ incomplete absorption affected by food

95-99% protein bound

Low CSF pen

45min 1/2 life = q6h

Excreted in poop/urine = no renal dose adjustment

39
Q

Penicillinase-resistant Penicillins ADE

A 
GI (dicloxacillin)
Hepatic (N + O)
Hematologic (N + O)
Renal (N + O)
Local (N + O) inj site
40
Q

Penicillinase-resistant Penicillins DI

A

Cyp3A4 substates will be effected by Nafcillin
- Antifungl azaleas, anti-epileptics, statins, transplant meds

Dicloxacilin
- Transplant meds… Sirolimus, tacrolimus, mycophenolate (CYP3A4)

  • Carbamazepine = CYP3A4
  • Fosphenytoin/ Phenytoin CYP2C19
  • Omeprazole = CYP2C19

Decreases lvls of these meds

41
Q

Aminopenicillins

A

Ampicillin (IV)

Amoxicillin (PO)

42
Q

Aminopenicillins MOA

A
  1. Bind to PBS

2. Inhibit cross-linking peptidoglycan in cell wall

43
Q

Aminopenicillins Spectrum of activity Gram +

A

** Txm of choice for E. Faecalis **

Limited/no activity against Staph aureus.

Same as penicillin against Strep spp., but broader

** Txm of choice for Listeria monocytogenes) **

44
Q

Aminopenicillins Spectrum of activity Gram -

A

Limited activity overall

E.coli + P.mirabilis can be susceptible, especially in younger patients w/o prior exposure

H.influenzae covered if B-lactamase negative

Atypical = no activity

45
Q

Aminopenicillins Spectrum of activity Anaerobes

A

Good against Gram + anaerobes (oral flora)

  • Actinomyces spp
  • Peptostreptococci
  • Propionibacterium acnes

Limited agents Gram - due to resistance

46
Q

Aminopenicillins M & E (Ampicillin)

A

Distributes well into bile, pens CSF w/ inflamed meninges

10-18% Protein bound

1/2 life 1-2hrs, extended up to 20hrs

excreted in urine unchanged ~90%, renal adjustment req

47
Q

Aminopenicillins M & E ( Amoxicillin)

A

widely distributed

20% protein bound
1/2 life = 2hrs

excreted in urine unchanged, ~60%, renal adjustment req

48
Q

Aminopenicillins ADE

A

GI = Amoxicillin
Dermatologic = Ampicillin
Hematologic = Ampicillin
Renal (AIN) = Ampicillin

49
Q

Aminopenicillins DI

A

no significant DI

50
Q

Penicillin + Beta-lactamase inhibitors

A

Ampicillin/ subactam (IV)
Amoxicillin/clavulanate (PO)
Piperacillin/ tazobactam (IV)

51
Q

Penicillin + Beta-lactamase inhibitors MOA

A
  1. Bind to PBPs
  2. Inhibit Cross-lining of peptidoglycan in cell wall

B-lactamase inhibitors have specific spectrums of activity and affinities for certain enzymes

52
Q

Penicillin + Beta-lactamase inhibitors Spectrum of Activity Gram +

A

no activity against MRSA

Added activity against MSSA

Activity against Strep spp.

53
Q

Amox / Clav & Amp/sulb are active against….

A

** Txm of choice for ***
H.influenza & M. catarrhalis (community acquired pneumonia)

P. multocida & Capnocytophaga species (animal bites)

susceptive E.coli, Klebsiella pneumoniae, P. mirabilis

54
Q

Drug preferred in Acinetobacter baumannii is….

A

ampicillin/sulbactam due to sulbactam

55
Q

Piperacillin/Tazobactam has more activity against…

A

all Gram -, including more resistant E.coli, Klebsiella, and Proteus spp.

active agents Pseudomonas aeruginosa**

56
Q

Penicillin + Beta-lactamase inhibitors Spectrum of activity Anaerobes

A

Txm of choice against Gram + anaerobes causing oropharyngeal infections

  • Actinomyces spp.
  • Peptostreptococci
  • P. acnes

Txm of choice agents Gram - anaerobes

57
Q

Penicillin + Beta-lactamase inhibitors have Atypical coverage?

A

nah

58
Q

Sulbactam M & E

A

Widely distributed
Protein bound 38%
1/2 life 1-1.3hrs
Excretion urine w/in 8hrs, dose adjusted renal

59
Q

Clavulanic acid M & E

A

Protein bound
1/2 life 1hr
Urine excretion, dose adjusted renal

60
Q

Piperacillin/tazobactam M & E

A

widely distributed

excreted in urine, dose adjusted renal

61
Q

Penicillin + Beta-lactamase inhibitors ADE

A 
GI (amoxicillin/Clav)
Dermatologic
Hematologic
Hepatic
Renal
62
Q

Penicillin + Beta-lactamase inhibitors DI

A

Piperacillin/tazobactam + Vanco = increase risk of nephrotoxicity

63
Q

If want to cover Strep & E. coli then give….

A

Piperacillin & Tazobactam

Anti-Infectives Exam 2 (8 decks)

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