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PBL 2.2.5 > Pharm 35: Bacterial Mass Murder > Flashcards

Pharm 35: Bacterial Mass Murder Flashcards

1
Q

Peptidoglycan aka

A

Murein

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2
Q

β lactam antibiotics inhibit _____ that mediate _____

A

β lactam antibiotics inhibit transpeptidase enzymes that mediate cross linking of sugar polymers

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3
Q

Fosfomycin MOA

A

Phophoenolpyruvate (PEP) analogue that inhibits bacterial (MurA)

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4
Q

Why doesn’t fosfomycin affect human cells

A

Structural differences in human and bacterial enzymes that act on PEP

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5
Q

Fosfomycin enters cells via ____

A

Glycerophosphate and G6P transporters

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6
Q

Fosfomycin is especially effective against

A

Gram negatives in urinary tract

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7
Q

Which GI bug is fosfomycin effective against

A

Enterococcus faecalis

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8
Q

Resistance to fosfomycin (common and E.coli)

A

Common: mutation in transporters (G6P and glycerophosphate)

E.Coli: Modification of enolpyruvate tranferase

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9
Q

Enolpyruvate transferase aka

A

MurA

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10
Q

Fosfomycin adverse effects

A

Mild and uncommon.

Headache, diarrhea, nausea

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11
Q

Oral fosfomycin drug interactions

A

Metoclopramide decreases GI absorbtion

Probenecid reduces renal clearance

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12
Q

Cycloserine MOA

A

Structural analogue of D-ALa inhibits alanine racemase and ligase

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13
Q

Racemase and ligase functions

A

Racemase: converts L-Ala to D-Ala

Ligase: joins D-Ala residues together

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14
Q

Cycloserine use

A

Second line for multidrug resistant TB

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15
Q

Cycloserine adverese effects

A

Neuro: seizures, psychosis, peripheral neuropathy

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16
Q

Cycloserine inhibits hepatic metabolism of _____

A

Phenytoin

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17
Q

Bacitracin MOA

A

Peptide antibiotic that intereferes with bactoprenol diphosphate dephosphorylation.

This makes bactoprenal lipid carrier infective and murein cannot be synthesized

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18
Q

Bacitracin unique amongst cell wall inhibitors because

A

It targets lipid and not peptide

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19
Q

Bacitracin requires ____ as cofactor

A

Divalent ions, Zn2+, Mg2+

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20
Q

Bacitracin use

A

Topical use for derm/eyes

Orally for gut decontamination prior to surgery (not absorbed)

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21
Q

Bacitracin systemic use

A

Not used systemically due to toxicity to marrow, kidney and neurons

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22
Q

Vancomycin activity

A

Bactericidal against gram-positive rods and gram positive cocci

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23
Q

Vancomycin, tela vancin, dalba vancin, orita vancin MOA

A

Lipoglycopeptides that interrupt peptidoglycan polymerization by binding to terminus of D-Ala-D-Ala murein monomer unit.

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24
Q

van drugs with lipid side chain

(and what does it do?)

A

Telavancin and oritavancin

Lipid chain anchors to bacterial membrane, enhancing drug binding

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25
Q

Dalbavancin has enhanced activity against

A

Coagulase negative staphylococci

Enteroccoci

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26
Q

Dalbavancin and oritavancine elimination

A

Long half life, once a week dosing

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27
Q

IV Vanco used for

A

MRSA pneumonia, sepsis, and endocarditis

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28
Q

IV telavancin used for

A

MRSA/Strep skin and pneumonia

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29
Q

Oral vanco for C.diff due to

A

Poor GI absorption

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30
Q

Vancomycin side effects

A

Red man syndrome: histamine release causing skin flushing and and rash

Nephrotoxicity, otoxic (esp with other meds)

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31
Q

Van drug without nephrotoxicity

A

Dalbavancin

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32
Q

Antibiotics that bind mess up coagulation tests results

A

Telavancin, oritavancin, daptomycin

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33
Q

van drug resistance comes from

A

Plasmide encoded VanH or VanA

These make D-Ala-D-lactate instead of D-Ala-D-Ala

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34
Q

β lactam mechanism

A

Inhibition of murein cross linking

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35
Q

β lactam ring inhibits cross linking how

A

Causes formation of dead-end complexes via suicide inhibition

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36
Q

Factor that affects β lactam bactericidalicity

A

Bactericidal only for actively dividing bacteria

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37
Q

4 β lactam families

A

Peniccillins
Cephalosporins
Monobactams
Carbepenems

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38
Q

Factor in β lactam activity against gram negs

A

Hydrophillics can make it through outer membrane, hydrophobics are ineffective

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39
Q

Hydrophilic β lactams

A

Ampicillin
Amoxiciillin
Piperacillin
Ticacillin

P A T A ( mete las patas en el agua)

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40
Q

Bugs that are inherently resistant to all β lactams (why)

A

Intracellular bacteria

41
Q

MRSA mechanism of resistance

A

Transpepitidase mutations to not bind β-lactam

42
Q

Main form of resistance against β-lactams

A

Plasmid encoded β-lactamase

43
Q

Bugs that make extended spectrum β-lactamases

A

Klebsiella pneumonia

E. Coli

44
Q

β-lactamase inhibitors

A

CAST
Clavulanic acid
Avibactam
Sulbactam
Tazobactam

45
Q

β-lactams act synergistically with [drug class].

How

A

Aminoglycosides

β-lactams make holes in the mebrane to increase uptake

46
Q

Most common β-lactam adverse effects

A

Hypersensitivities

Lupus-like drug reactions

Hemolytic anemia

47
Q

β-lactam without cross reactivity to penicillins or carbapenems

A

Aztreonam

(cross reacts with ceftazimide)

48
Q

Penicillin G vs V

A

G: IV
V: GI

49
Q

Penicillin G common use

A

Pneumoccus

S. Pyogenes
Neisseria

Spirochetes

50
Q

Penicillin G AEs

A

Hypersensitivity and rash

seizures at high doses

51
Q

Anstistaphylococcal penicillins

A

M-DONC

Methicillin
Dicloxacillin
Oxacillin
Nafcillin
Cloxacillin

52
Q

β-lactam that induces CYP3A4 enzyme

A

Nafacillin

53
Q

Oxaccilin major AE

A

Reversible hepatotoxicity

54
Q

Amino penicillins additional advantage

A

Positively charged R group facilitates diffusion through porin channels

55
Q

IV ampicillin is used to treat

A

Invasive enterococcal infections

Listeria meningitis

56
Q

Oral amoxillin use

A

Simple ENT infecitions

Endocarditis prevention in dentistry

H. Pylori

57
Q

Amoxicillin adverse effect

A

Rash

58
Q

Amino penicillins and corresponding β-lactamase inhibitors

A

Amoxicillin: Clavulanic acid

Ampicillin: Sulbactam

59
Q

Ticarcillin advantages/disadvantages

A

Negative R chain: makes diffusion harder but increases β-lactamase resistance

To overcome diffusion, use high dose

60
Q

Piperacillin use and advantages

A

Both positive and negative R chains

Used against Klebsiella and enterococci

61
Q

Piperacillin corresponding β-lactam

A

Tazobactam

62
Q

Cephalosporins difference to penicillins

A

Six member instead of five member β-lactam ring

63
Q

First gen cephalosporin names

A

Cefazolin
Cephalexin
Cefadroxil

64
Q

First gen cephalosporins use

A

UTIs, klebsiella

65
Q

Surgical prophylaxis cephalosporin

A

Cefazolin

66
Q

Cefuroxime use

A

Community pneumonias

H. Influenza

67
Q

Cefotetan and Cefoxitin use

A

Bacteroides

PID and Intrabdominal infections

68
Q

Third gen cephalosporins spectrum

A

Less effective against gram positive,

More effective against enterobacteria

69
Q

Ceftriaxone uses

A

S. pneumo

Gnonorreah

Lyme dx

70
Q

Ceftriaxone major AE

A

Cholestatic hepatitis

71
Q

Ceftazidime spectrum/use

A

Psuedomonas aeruginosa

Hosp. acquired gram negs

Minimal use vs. gram positives

72
Q

Drug used empirically for neutropenic patients with fever

A

Ceftazidime

73
Q

Cefepime AEs

A

Myoclonus

Encephalopathy

Red blood cell automminunity without hemolysis

74
Q

Ceftaroline use

A

IV use for community pneumonia and skin infections

75
Q

Fifth gen cephalosporin

A

Ceftaroline

76
Q

Disulfiram like reaction (what is it, which antibiotiocs?)

A

Raction that causes alcohol intolerance

Cefotetan and Cefoperazone

77
Q

Antibiotics that interefere with Vitamin K

A

Cefotetan and Cefoperazone

78
Q

Aztreonam activity

A

Most gram negs

No gram positive activity

79
Q

Aztreonam usefulness

A

Usefull when penicillin allergy

80
Q

Aztreonam use (plus routes)

A

Inhaled for CF infection prevention

IV for systemic infections

81
Q

Carbapenems actvitity

A

Broad spectrum,

Not active against MRSA, VRE and Legionella

82
Q

Imipenem dosing consideration

A

Deactivated by renal enzyme DHP1, must be co-administered with cilastin

83
Q

Carbepenems AEs

A

Hypersensitivities, IV site phlebitis

84
Q

Imipenem and meropenem AEs

A

High concentration can cause seizures

85
Q

Daptomycin MOA

A

Specifics unknown, but integrates into gram positvie membranes, causing pores

86
Q

Daptomycin activity and use

A

Heavy hitter

MRSA, VRE

Bacteremia

87
Q

Daptomycin adveres effects

A

Myopathy

Eosinophilic pneuomonia

88
Q

Ethambutol activity and MOA

A

Bacteriostatic

MOA: inhibits arbinosyl transferase to decrease arabinogalactan synthesis

89
Q

When is RIP vs RIPE used

A

RIPE if local ionazid resistance is over 4%

90
Q

Pyrazinamide and Isoniazid MOA

A

Inhibit mycolic acid synthesis

Pyrazinamide: Inhibits FAS1

Ionazid: Inhibits FAS2

91
Q

Ethonamide MOA and use

A

Inhibition of FAS2

(second line INH)

92
Q

Ethambutol side effects

A

Optic neuritis

Reversible

93
Q

Pyrazinamide AEs

A

Arthralgias/ Hyperuricemia (gout)

Hepatotoxicity

94
Q

INH AEs

A

Mild hepatotoxicity (no cessation needed)

Peripheral neuropathy

P450 shit

Serotonin syndrome

95
Q

Ethambutol resistance by

A

mutations to arabinosyl transferase

Overexpression of arabinosyl transferase

96
Q

INH resistance how

A

Inactivation of catalase peroxidase

inhA mutations

97
Q

Pyrazinamide resistance

A

Via pyrazinamidase mutation, prodrug wont get metabolized

98
Q

Pyrazinamide kinetics

A

Prodrug metabolised to pyrazinoic acid (active form)

99
Q

IM Carbapenems

A

Imipenem

Ertapenem

PBL 2.2.5 (11 decks)

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