Pharm Test 2 Antimicrobials: Cell Wall Synthesis Inhibitors New

Front 1

1)Cell wall synthesis inhibitors require...
2)The Beta Lactam Antibiotics are..
3)Beta Lactamases are...

4)Beta lactamase inhibitors

Back 1

1)actively proliferating bacteria
2)Penicillins, Cephalosporins, Carbapenems

3)bacterial enzymes (Penicillinases, Cephalosporinases) that hydrolyze beta lactam ring on the the beta lactam antibiotics

4)inhibit the beta lactamaze inhibitors and protect penicillins from inactivation

Front 2

5)Penicillin Binding Proteins are..
6)Transpeptidases are...
7)Why do penicillins have very little toxicity?
8)Main reason for increased level of resistance to Penicillins

Back 2

5)bacterial cytoplasmic membrane proteins

6)bacterial enzymes involved in cross linking of peptidoglycan chains (if no cross linking, cell wall will be weak and fall apart and will be of no use to bacteria)

7)Because they target the bacterial specific cell wall (mammals dont have cell wall)

8)Being prescribed wrong

Front 3

Penicillins

1)Structure

2)MOA
2b)How do the bacteria help in penicillins killing of the same bacteria
3)Inactive against organisms without...like...

Back 3

1)Are derivatives of 6-aminopenicillanic acid and have a B-lactam ring (the R group at end differs in the different penicillns, and decides how it is cleared)

2)inactivate Penicillin Binding Proteins (PBP) by binding covalently AND inhibits Transpeptidases AND makes Autolysins ->Inhibit cross linking (transpeptidation) ->destroying cell wall -> causing cells lysis -> BACTERICIDAL

2b)the bacteria notice the messed up cell wall and produce Autolysin, which hydrolyzes (and breaks down) the peptidoglycan cell wall (in attempt to remodel)

3)Cell Wall; Mycoplasma, Protozoa, Fungi, Viruses

Front 4

4)Resistance can develop d/t

5)What determines whether penicillin can reach PBP?
6)How do gram pos and gram neg reach the PBPs?
7)Why are penicillins ineffective against Pseudomonas aeruginosa

Back 4

4)PBP mutations (changes active site and Beta Lactam cant bind)

5)Size, Charge, Hydrophobicity

6)in gram pos, penicillin can easily cross membrane
in gram neg, penicillin must go through porins (channels) to get to PBP

7)pseudomonas aeruginosa is gram negative, but does NOT have channels, so penicillin CANT reach PBP

Front 5

Penicillin G

1)CU
2)DOC for
3)Resistance?

Back 5

1)Broad Spectrum
(Gram Pos, Gram Neg, Anaerobic, Spirochetes)

2)Syphillis

3)Any org that makes B-lactamase (thus must give with B-lactamase inhibitor)

Front 6

Penicillin V

1)Difference from G

Back 6

1)V is More acid stable than G, thus is given ORAL (V stands for vesco, which in latin means oral)

Front 7

1)What are the Antistaphylococcal Penicillins?

2)Whats special about them?

3)What are there uses restricted too

4)Which of them is not used clinically?

Back 7

1)Methicillin, Nafcillin, Oxacillin, Dicloxacillin

2)Are Beta Lactamse RESISTANT

3)only give to B-lactamase producing Staphylococci

4)Methicillin, because is TOO TOXIC (thus never pick Methicillin as answer)

Front 8

1)Which are the Extended Spectrum Penicillins

2)They are used for?

3)Ampicillin is DOC for
4)Both widely used to treat?
5)Is there resistance with these?

Back 8

1)Ampicillin, Amoxicillin

2)Gram Positive, and slightly more effective on Gram Negative
3)L. Mono
4)Respiratory tract infections
5)Yes, inactivated by Beta lactamases (thus must give with Beta lactamase inhibitors)

Front 9

1)What are the Antipseudomonal Penicillins?

2)Active against which bug?

3)Which is most potent of the drugs?

4)Restricted for what infections?

Back 9

1)Carbenicillin, Ticarcillin, Piperacillin

2)Pseudomonas aeruginosa (special because this gram neg bug does not have the porin to let normal antibiotic through

3)Piperacillin

4)DO NOT GIVE TO ANY RANDOM INFECTION, only P.aeruginosa

Front 10

1)What are the Repository Penicillins?

2)Why were they deveoped?

3)Penicillin G Procaine given how, and half life?

4)Penicillin G Benzathine given how; and half life?

5)Penicillin G Benzathine good for what problems?

Back 10

1)Penicillin G Procaine, Penicillin G Benzathine

2)To prolong duration of Penicillin G (inc half life)

3)IM (because of risk of procaine toxicity if given IV); 12 to 24 HOURS

4)IM; 3 to 4 WEEKS (thus only need to give 1 injection and lasts 3 to 4 weeks)

5)Syphillis, Rheumatic Fever Prophylaxis, Strep Pharyngitis (good for these because dont need to dose as often

Front 11

1)Why give Penicillin and Aminoglycoside together?

2)What should you never do when combining the 2?

Back 11

1)Synergistic: Penicillin breaks cell wall, allowing aminoglycosides in to do there job

2)Put in the same IV (infusion fluid) because will form an INACTIVE complex

Front 12

Penicillin Resistance

1)How do you get it?

2)How does ORSA(MRSA) get its resistance (now called ORSA because methicillin not used clinically)

Back 12

1)Inactivation by B-lactamase
Modification of target PBPs
Impaired Penetration (cant reach PBP)
Efflux

2)Alterged Target PBP (thus beta lactam cant bind

Front 13

1)Out of all the penicillins, which ones are given only Oral (thus used for Minor Infections)

2)Which of the Penicillins can be given orally or IM/IV

3)Which 2 drugs given only IM

Back 13

1)Penicillin V
Amoxicillin and Clavulanic Acid
Carbenicillin (the Indanyl Ester form, because it protects it from first pass metabolism)

3)The sustained release Penicillin G Procaine and Penicillin G Benzathine

2)Carbenicillin (the indanyl ester form is given oral; the carbenicillin for is given IV/IM)

Front 14

1)What impairs the absorption of orally administered Penicillns? What is the Excpetion?

2)Which Penicillin is GI absorption really not effecive?

3)Which drug that is reserved for Beta Lactam resistant Staph is absorbed well Orally

Back 14

1)Food; Amoxicillin not impaired

2)Nafcillin

3)Dicloxacillin

Front 15

1)Do penicillins go into CSF well?

2)What 2 organs are penicillins ineffective in?

3)How are most penicillins excreted? What the half life of most?

4)What drug inhibits penicillin excretion?
5)What is the exception to the penicllins that are excreted through kidney, and thus give this drug if have Kidney Disease?
6)Where else are penicillins excreted?

Back 15

1)NO, unless inflamed in meningitis (then it will go in)
2)Prostate and Eye (cant reach good levels)

3)Through kidney (mostly via tubular secretion, not filtration); 30 min to 1 hour (but if have kidney disease half life can excrete to 20 hours)

4)Probenicid (blocks secretion) (thus get toxic levels of antibiotics) (but also used for advantage, because then can give lower levels of penicillin)(useful on battlefield, when have short supply of penicllin)
5)Nafcillin (is excreted through Bile) (thus if Kidney Disease, GIVE THIS)
6)Breast Milk

Front 16

1)Why do some patients get hypersensitivity reactions to Penicillins?

2)If allergic to Penicillins,can also be allergic to? Why?

Back 16

1)The penicillin has Penicilloic Acid (get maculopapular rash->shock) (very rare) (thus if claim to have reaction to penicillins, go with ALTERNATIVE)

2)Cephalosporins; Because both have Beta lactam

Front 17

Penicillin AE

1)Are?
2)AE assoc with Methicillin
3)AE assoc with Nafcillin
4)AE assoc with Ampicillin, Amoxicillin
5)AE assoc with Oxacillin
5)AE assoc with Ampicillin

Back 17

1)Diarrhea (all antibiotics can cause this)
Neurotoxicity
Blood Problems
GI Upset, Secondary infections

2)Interstitial Nephritis
3)Nafcillin
4)Maculopapular Rash (will look the same as the hypersensitivity reaction, but is different, doesnt mean are allergic to drug)
5)Hepatitis
6)Pseudomembranous Colitis

Front 18

1)DOC for Syphillis
2)Bugs Resistant to Penicillin G

3)Use Penicillin V mainly for...
4)DOC for Staph Infections (but these drugs are resistant to?)

Back 18

1)Penicillin G
2)Pneumococci, S. aureus, N. gonorrhea (but can treat with giving Beta lactamase inhibitor)

3)Oropharyngeal Infections
4)Methicillin, Nafcillin, Oxacillin, Dicloxycillin (ORSA)

Front 19

1)DOC for Enterococcal Carditis
2)DOC for H. influenzae
3)DOC for Proteus miribalis
4)DOC for Shigella

Back 19

1-4 = Ampicillin, Amoxicillin

Front 20

1)The Beta lactamase inhibitors are

2)How do they work?

Back 20

1)Clavulanic Acid, Sulbactam, Tazobactam

2)They contain Beta lactam ring, but do NOT have antibacterial Activity. (NEVER GIVE THESE ALONE) They bind to and inactivate Beta Lactamases

Front 21

Cephalosporins

1)Structure
2)MOA
3)resistance?
4)Not active against which 2 bugs?

Back 21

1)Have a Beta lactam ring, and are derivatives of 7-Amino-cephalosporanic acid
2)Same as penicillins -> BACTERICIDAL
3)Same as penicillins because same MOA (cant switch something that is resistant to penicillin to cephalosporin and expect to work)

4)Enterococci and L. mono

Front 22

1)What are the 2 First Gen Cephalosporins?

2)are substitutes for what?
3)Resistant to?
4)Are not good at killing?
5)CU for?

Back 22

1)Cefazolin, Cephalexin

2)Penicillin G (thus if dont have penicillin G, can give these) (but use Penicillin G first)
3)Staph (d/t beta lactamase)
4)B. fragilis

5)Gram Pos, AND P.miribalis, E.coli, and K.pnumoniae

Front 23

1)What are the 2 Second Gen Cephalosporins?

2)How Differ from first gen?

3)Has Additional Activity again

Back 23

1)Cefaclor, Cefoxitin

2)Have extended gram Neg coverage (but weaker activity against gram Pos)

3)Enterobacter aerogenes, H. influenzae, Neisseria

Front 24

3rd Gen Cephalosporins

1)How differ from 1st and 2nd?
2)DOC for?
3)Ceftriaxone or Cefotaxime are DOC for?
4)Ceftazidine with Cefoperazone can work against?

Back 24

1)Even more effect on gram Neg

2)E. coli
3)Meningitis
4)P. aeruginosa

Front 25

1)What is the 4th Gen Cephalosporin?

2)How must you give it?
3)CU

Back 25

1)Cefepime

2)Parenteral
3)Very Wide Spectrum

Front 26

Cephalosporins

1)Kinetics
2)Which Gen can reach high levels in CSF
3)Which Gen can cross placenta?
4)How are they eliminated?
5)What are the exceptions to elimination?

Back 26

1)Very Poorly absorbed orally

2)Third Generation
3)ALL GENS
4)mainly Kidneys (thus be careful in patients with Kidney Failure!!)
5)Ceftriaxone and Cefoperazone are excreted in Bile into feces (SO GIVE TO THOSE WITH KIDNEY FAILURE)

Front 27

Cephalosporins

1)AE
2)AE of giving IM
3)AE of giving IV
4)Which drugs can cause HYPOprothrombinemia? Why? How do you prevent?

5)What else can methyl-thiotetrazole groups cause?

Back 27

1)Hypersensitivity (same as penicillins, and cross reactivity can occur)
2)Pain at Infection Site
3)Thrombophlebitis
4)Cefamandole, Cefoperazone, Cefotetan; they contain a MEthyl-Thiotetrazole Group; give Vitamin K1 to prevent

5)Disulfiram reactions, thus those drugs also CANT BE GIVEN WITH ALCOHOL (cant break down alcohol)

Front 28

Cephalosporins (when know not resistant)

1)1st Gen DOC for
2)2nd Gen DOC for
3)3rd Gen DOC for
4)4th Gen used for

Back 28

1)Surgical Prophylaxis
2)Sinus/Ear/RT infections
3)E.coli/Gonorrhea/S.typhi
4)Gram Neg Orgs (Enterobacter, Haemophilus, Neisseria)

Front 29

Carbapenems

1)Structure
2)Why special
3)CU
4)Given How? Does it go into CSF?
5)Excreted Though

Back 29

1)Beta lactam antibiotics
2)Resist hydrolysis by Beta Lactamases

3)Beta lactamase producing Gram Pos and Neg;
P. aeruginosa

4)IV (thus not for minor infections); Yes when inflamed in meningitis
5)Kidney (WATCH FOR KIDNEY PROBS

Front 30

Carbapenems

5)What are the 2 called?
6)One of them has a bad effect; Which one, and what is effect, and how do you protect against it?

Back 30

5) Imipenem, Meropenem

6)Imipenem; forms a nephrotoxic metabolite; Give with Cilastatin (thus never give Imipenem alone)

Front 31

7)General AE of Carbapenems
8)High Levels of Imipenem (mostly d/t renal failure) can cause:

Back 31

7)N/V/D
Allergic Reactions (some cross reactivity with Penicillins, not as much as cephalosporins)
8)Seizures

Front 32

9)When do you use Carbapenems

10)Carbapenems are Beta Lactam of Choice for:

Back 32

9)Only when bug resistant to other drugs
Mixed Aerobic and Anaerobic Infections*

10)Enterobacter infections
Gram Negatives that make Extended spectrum Beta Lactamases

Front 33

Monobactams

1)What is the 1 drug
2)Structure
3)CU
4)Resistance?

Back 33

1)Aztreonam
2)Has a beta lactam ring NOT fused to another ring
3)Aerobic Gram Neg Rods (including Pseudomonas)
NO ACTIVITY on GRAM POS or ANAEROBES (THUS IS VERY GOOD CHOICE FOR GRAM NEG INFECTION)

4)Beta lactamases have no effect on it, so can use on Gram Neg that are resistant to other beta lactam antibiotics

Front 34

Monobactam

1)How is it given?

Back 34

1)IV/IM (thus NOT for minor infections)

2)GI Upset
Relatively Nontoxic
Little Cross Reactivity (so CAN give if allergic to other Beta lactams)

Front 35

Vancomycin

1)Structure; STatic or Cidal?
2)Why Special (what bugs used for)
3)CU

Back 35

1)a bacterial glycoprotein; Bactericidal

2)effective against multi drug resistant orgs (MRSA ENTEROCOCCI) (THUS NOT A FIRST LINE DRUG)

3)Mainly Beta Lactam REsistant Gram Pos (staph)
Strongly allergic PAtients

Front 36

Vancomycin

4)MOA
5)Why can its MOA be bad?

6)What bugs can you not use for it?

Back 36

4)inhibits cell wall synthesis and peptidoglycan polymerization (does it by binding to D-ALA-D-ALA terminus of peptidoglycan) (thus prevents CROSS LINKING and ELONGATION) (thus has different effect then penicillins)

5)If even a slight mutation in D-ALA-D-ALA binding site, will become resistant to Vancomycin (D-ALA replaced by D-Lactate)

6)GRAM NEG ORGS (because are intrinsically resistant)

Front 37

Vancomycin

7)How do you give?
8)What is only time you can give Vancomycin Orally?

9)Does it go into CSF? How is it excreted?

Back 37

7)Must be IV (slow 60-90 min infusion for systemic infection or prophylaxis) (has very poor oral absorption) (thus another reason only for serious infections)

8)to treat enterocolitis from C. diff

9)YES!; Kidney

Front 38

Vancomycin

10)AE
11)What AE occurs if drug is allowed to accumulate (eg: kidney failure)

12)If combine with another drug which has same side effect (Aminoglycoside), can cause?

Back 38

10)Fever, Chills, Phlebitis at infection site (thus give slow administration to get dec risk of having these Side effects)
RED MAN(RED NECK) Syndrome (flushing on face and torso related to high infusion rate)
Hypersensitivity (rash to anaphylaxis)

11)Dose Related HEaring Loss
12)Nephrotoxicity

Front 39

13)Vancomycin DOC for
14)When cant use Penicillin because allergic, Vancomycin synergistic with Aminoglycoside to treat

Back 39

13)MRSA(ORSA)

14)Enterococcal Endocarditis

Front 40

Daptomycin

1)Cidal or STatic
2)CU
3)Does not work against:

Back 40

1)Bacteriocidal (static at lower conc)
2)Vancomycin Resistant Strains of Enterococci and S. aureus (only used for this)

3)Gram Neg

Front 41

Daptomycin

4)MOA
5)AE
6)Because of AE, what must u reccommend patient stops?

Back 41

4)binds to cell membrane via calcium dependednt insertion of kuoud tail -> depolarizes cell membrane with K+ EFFLUX -> Cell death (thus DIFF MOA from rest)

5)GI (all antibiotics have it)
Inc Creatine Phosphokinases

6)Statins (they also elevate Creatine Phosphokinases)

Front 42

Bacitracin (Neosporin)

1)Structure
2)MOA
3)CU
4)AE; thus used only?

Back 42

1)Peptide antibioitc

2)interferes with LATE stage cell wall synthesis
3)Gram Pos
Prevent TOPICAL infections of skin

4)MARKED NEPHROTOXICiTY (thus used only Topical)

Front 43

Fosfomycin

1)MOA
2)CU

Back 43

1)inhibits EARLY stage of cell wall synthesis by inhibiting cytoplasmic enzyme Enolpyruvate Transferase

2)Gram Pos AND Gram Neg (rare for drug to do this)
Uncomplicated UTI's