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76 Cards in this Set
- Front
- Back
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what is the target for Beta lactams
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PBP they bind to it and inhibit cell wall synthesis
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what are the natural penicillins
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Penicillin V-K
Penicillin G |
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what can be used to treat syphillis
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natural penicillin
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what is the causative agent of syphillis
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t. pallidum (gram -)
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what are the penicillinase resistant penicillins
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nafcillin
oxacillin dicloxacillin |
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what are the aminopenicillins
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amoxicillin
ampicillin bacampacillin |
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what are the carboxypenicillins
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carbenicillin
ticarcillin |
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what are the Ureidopenicillins
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azlocillin
mezlocillin pipercillin |
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what penicillins have coverage over gram+ only
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natural penicillins (penicillin v-k, penicillin g)
penicillinase resistant penicillins (nafcillin, oxacillin, dicloxacillin) |
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what penicillins have coverage over gram- only
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carboxypenicillin (carbenicillin, ticarcillin)
ureidopenicillin (azlocillin, mezlocillin, pipercillin) aminopenicillins (amoxicillin, ampicillin, bacampicillin) |
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what are the beta lactamase inhibitors
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sulbactam
tazobactam clavulanic acid |
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what is amoxicillin + clavulanate
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augmentin
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how do Beta lactamase inhibitors work
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they structurally look like beta lactams and the enzyme will try to hydrolyze them and they'll form a covalent bond inactivating them
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what enzymes are unaffected by Beta lactamase
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Bush class 1 enzymes
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how are Penicillins cleared
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renally unchanged
except for Nafcillin and Mezlocillin which are hepatically cleared |
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what class of penicillins are antistaphylococcal
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penicillinase resistant penicillins
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what are the drug interactions of penicillins
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aminoglycosides - they inactivate each other when given in same infusion bag
probenecid - it inhibits active renal secretion allowing PCN to achieve a high serum concentration |
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what are the adverse events of PCN
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GI, Skin, Hematologic, Metabolic, Hepatic, CNS
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all cephalosporins lack activity against what
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atypicals (all beta lactams lack this)
enterococcus MRSA (except 5th gen) S. maltophilia |
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what is amoxicillin + clavulanate
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augmentin
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what are the 1st gen cephalosporins
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cefazolin
cephalexin |
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cefelexin
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1st gen
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cefazolin
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1st gen
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what are the True cephalosporins
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cefuroxime
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what are the cephamycins
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cefotetan
cefoxitin |
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cefuroxime
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2nd gen true cephalosporin
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cefetetan
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2nd gen cephamycin
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cefoxitin
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2nd gen cephamycin
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what cephalosporin is most active against Bacteroides
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cephamycins
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what are Cephamycin good against
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anaerobic bacteria
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what are the Antipseudomonal cephalosporins
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3rd gen: ceftazidime, cefoperazone
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ceftazidime
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3rd gen antipseudomonal
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cefoperazone
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3rd gen antipseudomonal
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what are the cephalosporins that lack activity against P. aeruginosa
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3rd gen cefotaxime, ceftriaxone
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cefotaxime
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3rd gen no activity against P. aeruginosa
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ceftriaxone
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3rd gen no activity against P. aeruginosa
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what are the 4th gen cephalosporins
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cefepime
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what are the 5th gen cephalosporins
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ceftaroline
ceftobiprole |
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what beta lactam has activity against MRSA
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5th gen cephalosporins (ceftaroline, ceftobiprole)
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what cephalosporins can be used to treat meninigitis
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3rd and 4th gen
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cefepime
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4th gen
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ceftaroline
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5th gen
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cetobiprole
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5th gen
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how are the cephalosporins eliminated
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renally unchanged
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what are the adverse events of cephalosporins
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agents w/ MTT can interfere w/ formation of Vit K dependent clotting factors in the liver therefore increasing chances of bleeding
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what are the drug interactions of cephalosporins
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disulfiram like reaction w/ alcohol w/ ceoperazone
probenecid H2 antagonist, antacids (incomplete dissolution of drug at high pH) |
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what bug can hydrolyze carbapenems
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S. maltophilia
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what are the carbapenems
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imipenem
ertapenem meropenem doripenem |
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what B lactam has the broadest antimicrobial spectrum
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carbapenem (gram +/- and anaerobes)
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what carbapenem must be given w/ cilistatin and why
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imipenem must be given w/ cilistatin because when renally hydrolyzed the metabolite is toxic
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what carbapenem will have no activity against P. aeriginosa and Acinetobacter
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ertapenem
P. aeriginosa and Acinetobacter are usually indicated for lower tract infection |
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what are the adverse events of carbapenems
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part of the mechanism of action inhibits the GABA Rc which is repsonsible for neuroinhibition as a result there will be an increase in neurotransmissions which results in seizures/convulsions
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what are the monobactams
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aztreonam
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what beta lactam can be given if someone is hypersensitive to PCN
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monobactam typically can be given when someone is hypersensitive to any Beta lactam except ceftezidime
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what is the coverage of monobactams
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gram -
usually given in conjunction w/ something else |
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what are the mechanisms of resistance against Beta lactams
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beta lactamase
PBP alteration altering PCN permeability active efflux |
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what are the enzyme classifications
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Ambler - classify based on AA sequences and compare the AA residues of enzymes to see if homogenous
Bush - classified based on functional properties such as substrate speceficity and whether enzyme inhibited by inhibitors |
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what class of enzyme can hydrolyze carbapenems
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Bush class 3
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what class of enzyme is inhibited by EDTA and why
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Bush class 3 because the have a metal (Co/Zn) which is used to maintain their 3D chemical structure and EDTA is a chelator and will destroy the bacteria
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what are some bacteria that produce Beta lactamase
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S. aureus
H. influenza K. pneumoniae N. gonnorhea |
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what are the SPICE organism
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Seratia
P. aureginosa Indole + Proteus Citrobacter Enterobacter |
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if someone is infected w/ Bush Class 1 enzymes what should you avoid treating them with
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3rd generation cephalosporins because they may select out resistant mutants
avoid using pipercillin/tazobactam (IV)(tazocin/zosyn) |
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how do you treat someone infected w/ Bush Class 1 enzymes
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cefepime (more stable than 3rd gen cephalosporins)
carbapenems (stable against Beta latamase) |
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what class of enzyme is known to have ESBL
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bush class 2be
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how are ESBL transmitted to other bacteria
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plasmid mediated
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how are bush class 1 enzymes transmitted to other bacteria
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chromosomal mediated
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what bacteria are commonly seen w/ ESBL
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E. coli
K. pneumoniae |
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how do you treat someone infected by ESBL
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carbapenems
they are stable against ESBL |
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what is the drug of choice for treating ESBL
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carbapenems
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what should you avoid using when someone is infected w/ ESBL
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aztreonam and 3rd gen cephalosporins since they are both inactivated by ESBL
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what are the emerging Beta lactamases
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CTX-M (predominant ESBL)
VIM/IMP KPC OXA |
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which emerging Beta lactamases hydrolyze carbapenems
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VIM/IMP (Bush class 3)
KPC OXA |
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what happens when bacteria alter permeability to PCN
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they either decrease the amount or get rid of porins which is how bacteria attack gram negative bacteria
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how does efflux help bacteria against drugs
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they are capable of extruding drug out of the bacteria against the concentration gradient therefore reducing intracellular concentration
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how does altering PBP give bacteria resistance and what bacteria do this
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Beta lactams work by binding to PBP
MRSA and PCN resistant S. pneumoniae are known to do this |
