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PBL 2.2.5 > Pharm 35: Bacterial Mass Murder > Flashcards

Pharm 35: Bacterial Mass Murder Flashcards

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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
Dalbavancin has enhanced activity against
Coagulase negative staphylococci Enteroccoci
26
Dalbavancin and oritavancine elimination
Long half life, once a week dosing
27
IV Vanco used for
MRSA pneumonia, sepsis, and endocarditis
28
IV telavancin used for
MRSA/Strep skin and pneumonia
29
Oral vanco for C.diff due to
Poor GI absorption
30
Vancomycin side effects
Red man syndrome: histamine release causing skin flushing and and rash Nephrotoxicity, otoxic (esp with other meds)
31
*Van* drug without nephrotoxicity
Dalbavancin
32
Antibiotics that bind mess up coagulation tests results
Telavancin, oritavancin, daptomycin
33
*van* drug resistance comes from
Plasmide encoded VanH or VanA These make D-Ala-D-lactate instead of D-Ala-D-Ala
34
β lactam mechanism
Inhibition of murein cross linking
35
β lactam ring inhibits cross linking how
Causes formation of dead-end complexes via suicide inhibition
36
Factor that affects β lactam bactericidalicity
Bactericidal only for actively dividing bacteria
37
4 β lactam families
Peniccillins Cephalosporins Monobactams Carbepenems
38
Factor in β lactam activity against gram negs
Hydrophillics can make it through outer membrane, hydrophobics are ineffective
39
Hydrophilic β lactams
Ampicillin Amoxiciillin Piperacillin Ticacillin P A T A ( mete las patas en el agua)
40
Bugs that are inherently resistant to all β lactams (why)
Intracellular bacteria
41
MRSA mechanism of resistance
Transpepitidase mutations to not bind β-lactam
42
Main form of resistance against β-lactams
Plasmid encoded β-lactamase
43
Bugs that make extended spectrum β-lactamases
*Klebsiella pneumonia* *E. Coli*
44
β-lactamase inhibitors
CAST Clavulanic acid Avi*bactam* Sul*bactam* Tazo*bactam*
45
β-lactams act synergistically with [drug class]. How
Aminoglycosides β-lactams make holes in the mebrane to increase uptake
46
Most common β-lactam adverse effects
**Hypersensitivities** Lupus-like drug reactions Hemolytic anemia
47
β-lactam without cross reactivity to penicillins or carbapenems
Aztreonam (cross reacts with ceftazimide)
48
Penicillin G vs V
G: IV V: GI
49
Penicillin G common use
Pneumoccus *S. Pyogenes* *Neisseria* Spirochetes
50
Penicillin G AEs
Hypersensitivity and rash **seizures at high doses**
51
Anstistaphylococcal penicillins
***M-DONC*** Methicillin Dicloxacillin Oxacillin Nafcillin Cloxacillin
52
β-lactam that induces CYP3A4 enzyme
Nafacillin
53
Oxaccilin major AE
Reversible hepatotoxicity
54
Amino penicillins additional advantage
Positively charged R group facilitates diffusion through porin channels
55
IV ampicillin is used to treat
Invasive enterococcal infections *Listeria* meningitis
56
Oral amoxillin use
Simple ENT infecitions Endocarditis prevention in dentistry H. Pylori
57
Amoxicillin adverse effect
Rash
58
Amino penicillins and corresponding β-lactamase inhibitors
Amoxicillin: Clavulanic acid Ampicillin: Sulbactam
59
Ticarcillin advantages/disadvantages
Negative R chain: makes diffusion harder but increases β-lactamase resistance To overcome diffusion, use high dose
60
Piperacillin use and advantages
Both positive and negative R chains Used against *Klebsiella* and enterococci
61
Piperacillin corresponding β-lactam
Tazobactam
62
Cephalosporins difference to penicillins
Six member instead of five member β-lactam ring
63
First gen cephalosporin names
Ce**fa**zolin Ce**pha**lexin Ce**fa**droxil
64
First gen cephalosporins use
UTIs, klebsiella
65
Surgical prophylaxis cephalosporin
Cefazolin
66
Cefuroxime use
Community pneumonias *H. Influenza*
67
Cefotetan and Cefoxitin use
*Bacteroides* PID and Intrabdominal infections
68
Third gen cephalosporins spectrum
Less effective against gram positive, More effective against enterobacteria
69
Ceftriaxone uses
S. pneumo Gnonorreah Lyme dx
70
Ceftriaxone major AE
Cholestatic hepatitis
71
Ceftazidime spectrum/use
**Psuedomonas aeruginosa** Hosp. acquired gram negs Minimal use vs. gram positives
72
Drug used empirically for neutropenic patients with fever
Ceftazidime
73
Cefepime AEs
Myoclonus Encephalopathy Red blood cell automminunity **without** hemolysis
74
Ceftaroline use
IV use for community pneumonia and skin infections
75
Fifth gen cephalosporin
Ceftaroline
76
Disulfiram like reaction (what is it, which antibiotiocs?)
Raction that causes alcohol intolerance **Cefotetan** and Cefoperazone
77
Antibiotics that interefere with Vitamin K
Cefotetan and Cefoperazone
78
Aztreonam activity
Most gram negs No gram positive activity
79
Aztreonam usefulness
Usefull when penicillin allergy
80
Aztreonam use (plus routes)
Inhaled for CF infection prevention IV for systemic infections
81
Carbapenems actvitity
Broad spectrum, Not active against MRSA, VRE and *Legionella*
82
Imipenem dosing consideration
Deactivated by renal enzyme DHP1, must be co-administered with **cilastin**
83
Carbepenems AEs
Hypersensitivities, IV site phlebitis
84
Imipenem and meropenem AEs
High concentration can cause seizures
85
Daptomycin MOA
Specifics unknown, but integrates into gram positvie membranes, causing pores
86
Daptomycin activity and use
Heavy hitter MRSA, VRE **Bacteremia**
87
Daptomycin adveres effects
Myopathy Eosinophilic pneuomonia
88
Ethambutol activity and MOA
**Bacteriostatic** MOA: inhibits arbinosyl transferase to decrease arabinogalactan synthesis
89
When is RIP vs RIPE used
RIPE if local **ionazid** resistance is over 4%
90
Pyrazinamide and Isoniazid MOA
Inhibit mycolic acid synthesis Pyrazinamide: Inhibits FAS1 Ionazid: Inhibits FAS2
91
Ethonamide MOA and use
Inhibition of FAS2 (second line INH)
92
Ethambutol side effects
Optic neuritis Reversible
93
Pyrazinamide AEs
Arthralgias/ Hyperuricemia (gout) **Hepatotoxicity**
94
INH AEs
Mild hepatotoxicity (no cessation needed) Peripheral neuropathy P450 shit Serotonin syndrome
95
Ethambutol resistance by
mutations to arabinosyl transferase Overexpression of arabinosyl transferase
96
INH resistance how
Inactivation of catalase peroxidase *inhA* mutations
97
Pyrazinamide resistance
Via pyrazinamidase mutation, prodrug wont get metabolized
98
Pyrazinamide kinetics
Prodrug metabolised to **pyrazinoic acid** (active form)
99
IM Carbapenems
Imipenem Ertapenem

PBL 2.2.5 (11 decks)

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