Pharm Beta-Lactam Antibiotics And Other Cell Wall Synthesis Inhibitors

Front 1

What are the major antibiotics that inhibit bacterial cell wall synthesis?

Back 1

Penicillins and Cephalosporins, which are beta-lactams

Front 2

What type of drug are beta-lactams?

Back 2

Bactericidial drugs

Front 3

What are the steps of beta-lactams?

Back 3

1) binding to penicillin-binding proteins in the bacterial cytoplasmic mm; 2) inhibition of transpeptidation reaction (cross-links the peptidoglycan chain of the cell wall); 3) activation of autolytic enzyme that cause lesions in the bacterial cell wall.

Front 4

What is a major form of resistance to beta-lactams?

Back 4

Beta-lactamses (penicillinases) by most staphylococci and many gram-negatives.

Front 5

Pencillin G is useful for what and is the DOC for?

Back 5

Gram-positive cocci, and DOC for spirochetes (Treponema pallidum), Neisseria meningococcal (but NOT N. gonorrhoeae).

Activity against enterococci is enhanced with aminoglycoside.

Front 6

Penicillin G is not useful for?

Back 6

Staphyloccous aureus, Neisseria gonorrhoeae and many strains of pneumonococci.

Front 7

What drugs are used to treat known or suspected staph infections?

Back 7

I MET a NAsty OX (beta-lactamase resistant penicillins: METHicillin, NAFcillin, and OXacillin)

Front 8

Ampicillin and amoxicillin (wide spectrum penicillinase-susceptible drugs) are used for?

Back 8

Similar to penicillin G but also:

HELPS: (Haemophilus influenzae, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella)

(Enterococci, and these drugs are amongst the few effective against this bug!)

Gram-negative cocci and rods, gram-positive cocci

Front 9

TCP: Ticarcillin, Carbenicillin, Piperacillin (wide spectrum penicillinase-susceptible drugs) are useful for?

Back 9

TCP: Takes Care of Pseudomonas

Pseudomonas, Enterobacter, and Klebsiella

Front 10

What drug can be used with penicillin/ampicillin to have a synergistic effect against enterococcal and listerial infections (and broader gram negative coverage)?

Back 10

Aminoglycosides

Front 11

What are some allergic reactions with penicillin?

Back 11

Drug-indcued Coombs' positive hemolytic anemia; urticaria, severe prutirtius, fever, joint swelling, nephritis, and anaphylaxis

Front 12

What drug can result in pseudomembranous colitis?

Back 12

Clindamycin, cephalosporins, or any penicillin (amoxicillin)

Front 13

Oral penicillins can cause what GI upset?

Back 13

Nausea and diarrhea, which may be caused by overgrowth of gram-positive organisms or yeast.

Front 14

Cephalosporins bind with what?

Back 14

Penicillin-binding protein

Front 15

What type of drug is cephalosporins?

Back 15

Bactericidal

Front 16

What is the first generation of cephalosporins and what are they effective against?

PEcK

Back 16

Cefazolin and cephalexin:

Proteus mirabilis, E. coli, Klebsiella pneumoniae.

Effective against gram-positive cocci

Front 17

What is the second generation of cephalosporins and what are they effective against?

HEN PEcKS

Back 17

Cefoxitin, cefaclor, cefuroxime

H. influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens.

Less effective against Gram-positive cocci compared to the first generation, but more effective against gram-negative such as anaerobe (e.g., bacteroides fragilis) and sinus, ear, and respiratory infections caused by H. influenzae or M. catarrhalis.

Front 18

What is the third generation of cephalosporins and what are they effective against?

Back 18

Ceftazidime, ceftriaxone, cefotaxime:

Most penetrate the BBB: meningitis.

Gram-negative, and pneumoniae, meningitis, and gonorrhea

Front 19

What is the fourth generation of cephalosporins and what are they effective against?

Back 19

Cefepime

Broad activity, beta-lactamase-stable.

Combines gram-positive activity of first-generation with wider gram-negative spectrum of 3rd generation.

Against beta-lactamases (Enterobacter, Haemophilus, Neisseria, and some penicillin-resistant pneumococci)

Front 20

What is the allergic reaction against cephalosporins?

Back 20

From skin rash to anaphylactic shock. Disulfiram-like reaction with ethanol, and nephrotoxicity

Front 21

Although, there is a cross reactivity between penicillins and cephalosporins, and those who are allergic to penicillin can sometimes be treated with cephalosporin; however, if the PT has had a history of anaphylaxis to penicillin, can they be treated with cephalosporin?

Back 21

NO

Front 22

What drug is resistant to beta-lactamases produced by gram-negative rods (Klebsiella, Pseudomonas, and Serratia); and therefore can be used to treat against those infections?

Back 22

Aztreonam. It is only effective against Gram-negative (including Pseudomonas) and NOT gram-positive

Front 23

How does aztreonam work?

Back 23

Binds to PBP and blocks peptidoglycan cross-linking.

Front 24

What drug does not have a cross-allergen of penicillin?

Back 24

Aztreonam.

Note: for penicillin-allergic PTs and those with renal insufficiency who cannot tolerate aminoglycosides.

Front 25

What drug belongs to the class monobactam?

Back 25

Aztreonam

Front 26

Carbapenems are effective against?

Back 26

Broad spectrum includes PRSP strains (not MRSA), gram-negatie rods, gram-positive cocci, and anaerobes.

Front 27

What are the SE of carbapenems?

Back 27

CNS toxicity (Confusion, encephalopathy, seizures). Seizures can be reduced by reducing dosage in PTs with renal impairment. Partial cross-reactivity with penicillins.

Note: the significant SE limits its use to being the DOC for Enterobacter.

Front 28

What inactivates bacterial beta-lactamases, and added to amoxicillin or ampicillin to broaden the spectrum of coverage against gonococci, streptococci, E. coli, and H. influenzae?

Back 28

Clavulanic acid, sulbactam, tazobactam.

NOT against Enterobacter, Pseudomonas, and Serratia.

Front 29

What inactivates bacterial beta-lactamases and added to piperacillin to broaden the spectrum against gram-negative and S. aureus infections?

Back 29

Tazobactam

Front 30

What drug inhibits transglycosylase (by binding to D-Ala-D-Ala terminal) an enzyme involved in peptidoglycan elongation and cross-linking?

Back 30

Vancomycin

Front 31

What is vancomycin used for?

Back 31

Serious gram-positive resistant organisms, including S. aureus and Clostridium difficile (pseudomembranous colitis, but metronidazole is the DOC)

Front 32

SE of vancomycin?

Back 32

Nephrotoxicity, ototoxicity, thrombophlebitis, diffuse flushing--"red main syndrome"(due to histamine release) (can largely be prevented by pretreatment with antihistamines and slow infusion rate).

Front 33

MOA of cephalosporins involves inhibition of?

Back 33

Reactions involving transpeptidation; therefore, inhibiting peptidoglycan cross-linking.

Front 34

Vancomycin inhibits?

Back 34

Transglycoslase, preventing elongation of peptidoglycan by binding to D-alanine D-alanine to inhibit transpeptidation.

Front 35

What is the DOC for gonorrhea?

Back 35

Ceftriaxone

Front 36

What is the DOC for Treponema pallidum?

Back 36

Penicilling G.

If allergic, than doxycycline or tetracycline.

Front 37

A debilitated PT has a fever from a skin infection, which yields gram-positive cocci. DOC is?

Back 37

Nafcillin, which is resistant to penicillinases and S. aureus (but not MRSA) and common strep. Bacterial lesions are most likely staph or strep

Front 38

A women is treated for bacteremia with gram-negative bacilli. Records show that she has had severe rash, hypotension, and respiratory distress after penicillin V. What is the drug regimen?

Back 38

Aztreonam, which has no cross-reactivity between penicillins.

Front 39

PT presents with S. pneumoniae, but is penicillin G resistant. What is the treatment?

Back 39

Cefotaxime or ceftriaxone, which are the most active cephalosporins against penicillin-resistant pneumococci, and the addition of vancomycin or rifampin is recommended.

Front 40

What is the reason for resistance to penicillin G?

Back 40

Changes to penicillin binding protein.

Front 41

Diptheroid-like gram-positive rods in the CSF in an elderly PT are indicative of what? What is the DOC?

Back 41

Listeria monocytogenes. Ampicillin.

Listeria are common in neonates, the elderly PTs, and those who are immunocompromised.

Front 42

PT with severe anaphylactic reaction to penicillin G, has enterococcal endocarditis. What is the DOC?

Back 42

Vancomyin. Aminoglycoside may be added for synergistic effect.

Front 43

This drug has activity against Pseudomonas; however, when used alone, resistance emerges. The drug should not be used in penicillin-allergic PTs. Its activity against gram-negative rods is enhanced if used in combination with tazobactam. It is also effective against anaerobes (Bacteroides fragilis)

Back 43

Piperacillin

Front 44

Vancomycin is not susceptible to?

Back 44

Penicillinase

Front 45

Transpeptidase AKA?

Back 45

penicillin-binding protein

Front 46

What can be given with imipenem to increase its duration of action. It is the DOC for?

Back 46

Cilastain, which inhibits renal dihydropeptidase I (inactivates imipenem in the renal tubules)

DOC for Enterobacter.

Note: cilastatin is ALWAYS given with imipenem.

Front 47

What is similar to methicillin, in the sense that it is resistant to beta-lactamases?

Back 47

Aztreonam

Front 48

What are peptidoglycan and transpeptidases?

Back 48

Peptidoglycan are chains of polysaccharides and polypeptides that are cross-linked to form the bacterial cell wall.

Transpeptidases are bacterial enzymes involved in the cross-linking of linear peptidoglycan chains, the final step in cell wall synthesis.

Front 49

What spectrum do methicillin, nafcillin, and oxacillin fall under, and what is their main use? Which one is hardly used due to its nephrotoxic potential?

Back 49

Very narrow spectrum penicillinase-resistant drugs. Treatment of staph infections.

Methicillin is hardly used due to nephrotoxic potential

Front 50

What drugs belong to the class carbapenems, that have a low susceptibility to beta-lactamases, and structurally different than penicillin but retains the beta-lactam ring structure?

Back 50

Imipenem, meropenem, and ertapenem.

Front 51

What drug is less likely to cause seizures in the carbapenem class?

Back 51

Meropenem. It is not metabolized by renal dehydropeptidases.

Front 52

What drug has a spectrum similar to vancomycin and active against vancomycin-resistant strains of enterococci and staph?

What should be monitor with this drug and why?

Back 52

Daptomycin

Creatinine phosphokinase, since daptomycin may cause myopathy.