Targeting Cell Membrane And Cell Wall Part 1

Question 1

What is an upper respiratory tract infection?

Answer 1

Sinusitis, otitis media ( middle ear infections), Pharyngitis and laryngitis

Question 2

What is a lower respiratory tract infection?

Answer 2

Infections of the lung (pneumonia)

Question 3

What is an upper urinary tract infections (UTI)

Answer 3

Infections of the kidneys (Pylonephritis)

Question 4

What is lower urinary tract infections?

Answer 4

These are bladder infections (cystitis)

Question 5

What is bacteremia?

Answer 5

It is bacteria in the blood

Question 6

What is sepsis?

Answer 6

It will be when your have bacteria in the blood as well as having significant evidence of inflammation

Question 7

What is neutropenia fever?

Answer 7

These will be pts with low neutrophil count and experience systemic fever at the same time

**immuno compromised pts

Question 8

What is the job of your Tcells

Answer 8

These will kill fungal cells

Question 9

What are neutrophils main job?

Answer 9

They fight bacteria and they will produce puss and kill thro phagocytosis

Question 10

What is meningitis?

Answer 10

It’s an infection of the membrane that is around the brain and the spinal cord

Question 11

What is infective endocarditis?

Answer 11

Infection of the heart valves and the endocardium

Question 12

What are intra -abdominal infections

Answer 12

Infections within the abdominal cavity

Apendacytis

Question 13

What are gastrointestinal infections?

Answer 13

Infections of the GI system

And include symptoms like diarrhea, nausea and vomiting

Question 14

What are the drugs that attack the cell membrane?

Answer 14

1. Lipopeptides
   
   • Daptomycin
2. Polyenes / Cyclopeptides
   
   • Polymyxin B - topical
   • Colistin

Question 15

What is the the MOA of Daptomycin?

Answer 15

It’s a large hydrophilic peptide with lipophilic component

This drug is poorly distributed to tissues outside of the blood

MOA: It will polymerize and form a channel in the MEMBRANE of the bacteria!!!

Bactericidal!

Question 16

What kind of infections is Daptomycin used for?

Answer 16

ONLY FOR GRAM POSITIVE BACTERIA!!!!!
**Gram negatives have two cells membranes so it does no good to break only the one, also this drug has TEICHOIC acid which is only in gram (+)

VERY GOOD FOR BACTEREMIA AND INFECTIVE ENDOCARDITIS!!!!!!

Works for ALL GRAM +

Question 17

Can you use Daptomycin in the lungs?

Answer 17

NO!!!!

The reason is because the lungs have surfactin, This is polar on one side and non polar on the other. This will prevent it from being able to polymerize and wont work!!!

Question 18

What are the adverse effects of daptomycin?

Answer 18

Muscle toxicity (you can not TAKE THIS WITH STATINS!!!!!!!!!)

Abnormal liver function test (hepatotoxic)

Question 19

What are the Polyenes / Cyclopeptides MOA?

Answer 19

MOA: bind to LPS on the outer membrane of Gram (-) (only found in gram (-)) then it will disrupt both the outer and inner membranes. (Like detergents)

These are bactericidal!

Colistin - IV

Polymyxin B - topical for gram (-)

Question 20

When would you use Colistin? What are the adverse effects?

Answer 20

ONLY as a last line agent for MDR Gram NEGATIVE bacteria of Pseudomonas or Acinetobacter

Adverse effects

1. Nephrotoxic which can very significant and common **
2. Neurotoxic (since its very lipophilic)

Question 21

Explain the process of how the bacterial cell wall is created?

Answer 21

1. That starts with biosynthesis of building blocks inside the cell wall NAG and NAM
2. These are then transferred out fo the cell into the cytoplasm
3. From here TRANSPEPTIDASES will start to build the all by adding them together OUTSIDE of the cell
4. You have autolysins which will break it down and help to recycle things (we want to promote this so that we can kill the wall)

Question 22

What are the glycopeptides?

Answer 22

They work OUTSIDE OF THE CELL

Vancomycin

Telavacin

Oritavancin

Dalbavancin

(Cousin TOD drives the vans)

**these are super huge

Question 23

What is the MOA of Vancomycin?

Answer 23

It inhibits cell wall synthesis!
*binds to the d-alanyl-dalanine terminals and prevents peptidoglycan synthesis!

WORKS FOR positive and is bactericidal!

Question 24

What are the pharmacokinetics for vancomycin?

Answer 24

POOR ORAL ABSORPTION!! Given IV (unless for C did)

MUST reduce dose for pt with renal impairment

Question 25

What are the adverse effects of vancomycin?

Answer 25

Redman Syndrome = infusion related which means that you need to slow down how fast you are pushing the med and it will correct it self (expand infusion time)

Nephrotoxicity which depends on dose

Question 26

What are the adverse effects of televancin, oritvancin and dalbavancin

Answer 26

1. Anaphylaxis
2. Infusion related (Redman’s)
3. hepatotoxic (AST &ALT)
4. CDAD risk

**Televancin has the worst side effect

Question 27

What are the glycopeptides used for?

Answer 27

Serious Gram-positive infection

1. Bloodstream infections
2. Bone infections
3. Pneumonia with MRSA

Vanco is first choice drug and the oral route can be used for C. Diff.

The vancins will be used for all types of gram (+) bacteria but are reserved for the VRE because of resistance that started to crop up

Question 28

What is Fosfomycin?

Answer 28

Monurol

MOA: blocks activity of MurA, which blocks the first committed step in (NAG and NAM) of peptidoglycan synthesis (CELL WALL SYNTHESIS)

DRUG CONCENTRATION IS ONLY HIGH ENOUGH IN THE URIN

THIS DRUG IS FOR UTI ONLY

Question 29

What is Bacitracin MOA?

Answer 29

It will work for Gram positive only

MOA: Disrupts the synthesis of peptidoglycan (CELL WALL)!!! ** disrupts Transport of NAG and NAM out of the bacteria

ADR: watch for topical rxn/ allergic response