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Pharmacology > Penicillins > Flashcards

Penicillins Flashcards

0
Q

How does fosfomycin inhibit cell wall synthesis?

A

Fosfomycin prevents the reduction of NAG to NAM and prevents transglycosylation. It stops one of the first steps in peptidoglycan synthesis

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1
Q

5 points antibiotics can target peptidoglycan synthesis:

A
  1. Transglycosylation
  2. Transpeptidation
  3. NAG-NAM reduction
  4. AA mimicry
  5. Transportation out of the cell
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2
Q

How does cycloserine inhibit cell wall synthesis?

A

Cycloserine is a structural analog of D-ala (part of the pentapeptide chain)

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3
Q

What part of peptidoglycan synthesis does bacitracin inhibit?

A

Bacitracin interferes with the transportation of the peptidoglycan subunits across the inner cell membrane

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4
Q

How do glycoproteins such as vancomycin inhibit cell wall synthesis?

A

Vancomycin sterically inhibits the addition of subunits to the NAG/NAM backbone

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5
Q

What are the four classes of penicillins?

A

Natural penicillins, penicillinase resistant penicillins, extended spectrum penicillins, antipseudomonal penicillins

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6
Q

What ICWS antibiotics are beta-lactams?

A

Penicillins, cephalosporins, monobactams, carbapenems

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7
Q

What other drugs (non beta lactams) are ICWS?

A

Cycloserine, vancomycin, fosfomycin, and bacitracin

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8
Q

What are the natural penicillins and their mode of administration?

A
  1. Penicillin G - IV,IM, PO?
  2. Benzathine penicillin - IM
  3. Procaine Penicillin G - IM
  4. Penicillin V - PO (acid resistant)
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9
Q

List the penicillinase resistant penicillins and their mode of administration?

A
  1. Nafcillin - IV, IM
  2. Oxacillin - PO
  3. Dicloxacillin - PO
  4. Methicillin -testing only!
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10
Q

List the extended spectrum penicillins and the mode of administration

A
  1. Ampicillin - PO
  2. Amoxicillin - PO
  3. Bacampicillin
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11
Q

Characteristics of natural penicillins:

A
  1. Best G+ coverage (includes anaerobes)
  2. Some G- coverage
  3. Inactivated by penicillinase
  4. Not antipseudomonal
  5. Renal excretion
  6. Poor CNS penetration
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12
Q

Characteristics of penicillinase resistant penicillins:

A
  1. Less G+ coverage
  2. Some G- coverage
  3. Resistant to penicillinase
  4. Not antipseudomonal
  5. Some are acid resistant
  6. Liver metabolism and renal excretion
  7. DOC-penicillin resistant staphylococcus aureus (MSSA)
    • -> 20% will also be methicillin resistant
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13
Q

Characteristics of the extended spectrum penicillins:

A
  1. Lower G+ activity
  2. Extended G- activity
  3. Not antipseudomonal
  4. Inhibited by penicillinase
  5. Urinary excretion
  6. Acid resistant
  7. DOC- lysteria infections
    * **ampicillin rash is not an allergic reaction. No need to stop the antibiotic
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14
Q

Characteristics of antipseudomonal penicillins:

A
  1. Similar coverage to extended spectrum penicillins
  2. Most often used for pseudomonas aeruginosa and acetinobacter infections
  3. Often used in combination with aminoglycosides
  4. Tend to be acid sensitive
  5. Renal excretion
  6. Penicillinase sensitive
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15
Q

List the three penicillinase inhibitors:

A

Clavulonic acid, sulbactam and tazobactam

16
Q

Penicillins can have an extended spectrum with the addition of a penicillinase inhibitor. What are these combos and their methods of administration?

A
  1. Ampicillin + sulbactam (IV/IM)
  2. Amoxicillin + clavulonic acid (PO)
  3. Piperacillin + tazobactam (IV)
  4. Ticarcillin + clavulonic acid (IV)
17
Q

How can bacteria develop resistance to penicillins?

A
  1. Production of beta-lactamase
  2. Alter the PBP (target of penicillins)
  3. Decrease permeability of the membrane
  4. Autolytic enzymes not activated
  5. Lack of a cell wall
18
Q

where are PBPs located? and where are beta lactamases located if they are present

A

PBPs are located in they cytoplasmic membrane while beta-lactamases are located in the periplasmic space

19
Q

what is peptidoglycan composed of?

A
  1. backbone of alternating sugars (NAG and NAM)
  2. pentapeptide chain
  3. crossbridge (D-gln and D-ala)
20
Q

MRSA mechanism of resistance

A

not due to beta lactamase therefore penicillinase resistant antibiotics are not effective. they change the PBP to a version that most penicillins are incapable of binding to. they alter it to PBP2a

21
Q

Toxicity due to penicillin:

A
  1. allergic reaction
  2. electrolyte imbalance
  3. GI disturbance
  4. superinfections
22
Q

what does probenecid do?

A

it decreases renal excretion

23
Q

Helicobacter pylori treatment:

A

bismuth+metrondiazole+tetracycline or amoxacillin

24
Q

treatment of pseudomonas aeruginosa

A

antipseudomonal penicillin + aminoglycosides

25
Q

streptococcus pneumoniae

A

penicillin

26
Q

strep pyogenes (group A treatment)

A

penicillin, clindamycin

27
Q

streptococcus agalactiae treatment (group B)

A

Penicillin + aminoglycosides

28
Q

viridans streptococci treatment

A

penicillin

29
Q

s. aureus beta lactamase negative treatment

A

penicillin

30
Q

s aureus beta lactamase positive

A

penicillinase resistant penicillins

31
Q

s. aureus methicillin resistant

A

vancomycin

32
Q

enterococcus species

A

penicillin + aminoglycosides

33
Q

listeria species treatment

A

ampicillin + aminoglycosides

34
Q

Treatment for early borrelia burgdorferi

A

amoxicillin

35
Q

Leptospira species treatment

A

penicillin

36
Q

Toxicity due to penicillin:

A
  1. allergic reaction
  2. electrolyte imbalance
  3. GI disturbance
  4. superinfections
37
Q

what does probenecid do?

A

it decreases renal excretion

38
Q

treponema species treatment

A

penicillin

Pharmacology (7 decks)

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