Pharmacology Ii Exam 2 - Melchert

Front 1

Gram(-) Cocci - Members

Back 1

a. Neisseria gonorrhoeae (Gonococcus)
b. Neisseria meningitidis (Meningococcus)
c. Moraxella (Branhamella) catarrhalis
d. Acinetobacter

Front 2

Gram (+) Cocci - Members

Back 2

a. Streptococcus pneumoniae (Pneumococcus)
b. Streptococcus pyogenes (Group A, B Hem)
c. Streptococcus agalactiae (Group B, B Hem)
d. Strepto(Entero)coccus faecalis/faecium (Group D)
e. Viridans Streptococci (mutans, mitis, salivarius)
f. Anaerobic Streptococci (Pepto-, Peptostrepto-)
g. Staphylococcus aureus
h. Staphylococcus epidermidis

Front 3

Gram(+) Bacilli - Members

Back 3

c. Listeria monocytogenes
g. Clostridium difficile

Front 4

Spirochetes - Members

Back 4

d. Treponema pallidum

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Mycoplasma - Members

Back 5

a. Mycoplasma pneumoniae

Front 6

Rickettsiae and Chlamydiae - Members

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h. Chlamydia (Chlamydophila) pneumoniae

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Miscellaneous Obligate Anaerobes

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a. Peptococcus
b. Peptostreptococcus
d. Bacteroides fragilis
g. Propionibacterium acnes

Front 8

Gram (-) Bacilli - Enterobacteriaceae - Members

Back 8

1. Esherichia coli
2. Klebsiella pneumonia
3. Salmonella
4. Shigella
5. Serattia
6. Proteus (mirabilis, vulgaris)
7. Enterobacter (aerogenes, cloacea)
8. Citrobacter
14. Morganella morganii

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Gram (-) Bacilli - Pseudomonads - Members

Back 9

1. Pseudomonas aeruginosa

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Gram (-) Bacilli - Aerobic Coccobacilli - Members

Back 10

1. Hemophilus influenzae

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Gram (-) Bacilli - Miscellaneous - Members

Back 11

1. Legionella pneumophila

Front 12

Gram (-) Bacilli - Spirillaceae- Members

Back 12

1. Helicobacter pylori
2. Campylobacter jejuni

Front 13

Natural Penicillins - Members

Back 13

1. penicillin G (and procaine and benzathine)
2. penicillin V

Front 14

Penicillinase-Resistant Penicillins - Members

Back 14

1. nafcillin
2. methicillin (for MRSA)
3. oxacillin (for sensitivity testing)

Front 15

Aminopenicillins - Members

Back 15

1. ampicillin and ampicillin/sulbactam
2. amoxicillin and amoxicillin/clavulanate

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Antipseudomonal Penicillins - Members

Back 16

1. piperacillin and piperacillin/tazobactam
2. ticarcillin and ticarcillin/clavulanate

Front 17

1st Generation Cephalosporins - Members

Back 17

1. cefazolin
2. cepharadine (oral)
3. cephalexin (oral)
4. cefadroxil (oral)

Front 18

2nd Generation Cephalosporins - Members

Back 18

1. cefuroxime
2. cefoxitin (Bacteroides)
3. cefotetan (Bacteroides)
4. cefuroxime axetil (oral)
5. cefaclor (oral)
6. cefprozil (oral)
7. ceftibuten (oral)

Front 19

3rd Generation Cephalosporins - Members

Back 19

1. ceftriaxone (meningitis)
2. cefotaxime (meningitis)
3. ceftizoxime (meningitis, Bacteroides)
4. ceftazidime (Pseudomonas)
5. cefixime (oral)
6. cefpodoxime proxetil (oral)
7. cefditoren pivoxil (oral)

Front 20

4th Generation Cephalosporins - Members

Back 20

1. cefepime
2. ceftobiprole (MRSA)

Front 21

Carbapenems - Members

Back 21

1. imipenem/cilastatin
2. meropenem
3. ertapenem
4. doripenem

Front 22

Monobactams - Members

Back 22

1. aztreonam

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Glycopeptides - Members

Back 23

-only ones that aren't B-lactams on this test
-poor GI absorption
1. vancomycin
2. teicoplanin
3. oritavancin
4. dalbavancin
5. televancin

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Normal Bacterial Flora - Stomach

Back 24

normally sterile, except for transient carriage of food-borne bacteria

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Normal Bacterial Flora - Small Bowel

Back 25

a. Duodenum: normally sterile
b. Jejenum/Ileum: Gram(-) aerobes, Enterobacteriaceae, Strep. faecalis (Enterococci), Lactobacilli, and Mycobacterium

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Normal Bacterial Flora - Large Bowel

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normally very rich in bacterial flora
a. Obligate anaerobes: Bacteroides sp., Gram(+) anaerobic cocci, Clostridium sp.
b. Gram(-): Enterobacteriaceae (mainly E. coli)
c. Gram(+): Strep faecalis (Enterococci)

Front 27

Normal Bacterial Flora - Upper Respiratory Tract

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a. Nose, nasopharynx, and sinuses: Staphylococcus epidermidis and aureus, Streptococci [Strep. pyogenes (Group A, B-hemolytic) and Strep. pneumoniae (Pneumococcus)], Hemophilus sp., Neisseria sp.
b. Mouth and throat: Streptococci Viridans Group (S. mitis, S. salivarius), Diphtheroids (Corynebacterium sp.), anaerobes (Fusobacterium, Peptococci, Peptostreptococci), Staph. epidermidis, and some Spirochetes

Front 28

Normal Bacterial Flora - Skin

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a. Perineum and "dirty" hands: gut flora
b. Peripheral areas: Staph. epidermidis, Staph. aureus, and Diphtheroids (Corynebacterium sp. and Propionibacterium acnes)
c. Post-antibiotics: Strep faecalis (Enterococci), Gram(-) bacilli, and yeast (Candida)

Front 29

Normal Bacterial Flora - Genital Tract

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a. Males and females: skin flora in lower urethra
b. Adult vagina: Lactobacilli, Diphtheroids, anaerobes, and yeast (Candida)

Front 30

Likely Bacterial Pathogens - Meningitis (CNS)

Back 30

N. meningitidis
Strep. pneumoniae
H. influenzae
Listeria monocytogenes
Post-trauma (Staph. aureus and Enterobacteriaceae)

Front 31

Likely Bacterial Pathogens - Otitis media (CNS)

Back 31

Strep. pneumonia
H. influenzae
M. catarrhalis
Strep. pyogenes

Front 32

Likely Bacterial Pathogens - Gallbladder

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Enterobacteriaceae
Strep. faecalis
Bacteroides

Front 33

Likely Bacterial Pathogens - Mild-to-Moderate Diarrhea (Gastroenteritis)

Back 33

Enterotoxigenic E. coli
Shigella
Salmonella
Campylobacter jejuni

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Likely Bacterial Pathogens - Severe Diarrhea (Gasteroenteritis)

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Enteroinvasive E. coli
Shigella
Salmonella
Clostridium difficile

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Likely Bacterial Pathogens - Gastric and duodenal ulcer (Gastroenteritis)

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Helicobacter pylori

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Likely Bacterial Pathogens - Heart (endocarditis)

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Streptococci Viridans group
Enterococci
Staphylococci

Front 37

Likely Bacterial Pathogens - Uncomplicated UTI

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Enterobacteriaceae (E. coli)
Enterococci

Front 38

Likely Bacterial Pathogens - Complicated UTI

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Enterobacteriaceae (E. coli)
Enterococci
Pseuodomonas aeruginosa

Front 39

Likely Bacterial Pathogens - Bronchitis (Lungs)

Back 39

Strep. pneumoniae (Pneumococcus)
Mycoplasma pneumoniae
H. influenzae
M. catarrhalis
Chlamydia pneumonniae

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Likely Bacterial Pathogens - Community-acquired pneumonia (Lungs)

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Strep. pneumoniae (Pneumococcus)
Mycoplasma pneumoniae
H. influenzae
M. catarrhalis
Chlamydia pneumoniae
Legionella pneumonphila

Front 41

Likely Bacterial Pathogens - Hospital-acquired pneumonia (Lungs)

Back 41

Strep. pneumoniae
Mycoplasma pneumoniae
H. influenzae
M. catarrhalis
Chlamydia pneumoniae
Klebsiella pneumoniae
Pseudomonas aeruginosa

Front 42

Likely Bacterial Pathogens - Inflammatory acne (Skin)

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Propionibacterium acnes

Front 43

Likely Bacterial Pathogens - Furuncle/boil, carbuncle, sties, impetigo (Skin)

Back 43

Staph. aureus, S. pyogenes

Front 44

Likely Bacterial Pathogens - Burn wound (Skin)

Back 44

Staph. aureus
Pseudomonas aeruginosa
Enterobacteriaceae (Serratia)

Front 45

Likely Bacterial Pathogens - Surgical Wound (Skin)

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Staph aureus
Strep. pyogenes
Enterobacteriaceae

Front 46

Likely Bacterial Pathogens - Bite Wounds

Back 46

Dog: Streptococci Viridans, Staph. epidermidis and aureus
Children: Streptococci Viridans, Staph. epidermidis and aureus, Diphtheroids (Corynebacterium), Peptostreptococci
Snake: Pseudomonas, Enterobacteriaceae

Front 47

MRSA Mechanism of Resistance

Back 47

a. Altered penicillin-binding proteins (PBPs)--the target of B-lactams, PBPs are enzymes that catalyze the synthesis of peptidoglycan for the outer layer
b. Confers "class resistance" of Staph. aureus to all B-lactams

Front 48

MRSA Treatment

Back 48

a. vancomycin is DOC
b. linezolid, trimethoprim/sulfamethoxazole, clindamycin, ciprofloxacin

Front 49

Vancomycin/Glycoprotein Intermediate/Insensitive Staph aureus Mechanism of Resistance

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plasmid-mediated transfer of vanA gene from VRE

Front 50

VISA/GISA/VRSA Treatment and Prevention

Back 50

Treatment: linezolid, oritavancin, dalbavancin, tetracylcines
Prevention: appropriate use of vancomycin, hand-washing, isolation

Front 51

Vancomycin-Resistant Enterococci (VRE) Mechanism of Resistance

Back 51

plasmid-mediated and inducible resistance, genes encode enzymes which modifies the cell wall peptidoglycan precursors so that vancomycin will not bind

Front 52

VRE Treatment

Back 52

quinupristin/dalfopristin, teicoplanin, oritivancin, linezolid

Front 53

MultiDrug-Resistant Strep pneumoniae (MDRP or DRSP) Mechanism of REsistance

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a. Altered penicillin-binding proteins (PBPs)--the target of B-lactams, PBPs are enzymes that catalyze the synthesis of peptidoglycan for the outer layer
b. Confers only "penicillin" resistance of Strep. pneumoniae because only the PBP with high affinity to penicillins is altered in Pneumococcus
c. Same mechanism confers "penicillin" resistance of N. gonorrhae, N. meningitidis, and H. influenzae

Front 54

MultiDrug-Resistant Strep. pneumoniae Treatment and Prevention

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Treatment: vancomycin, linezolid, rifampin
Prevention: vaccination against 23 serotypes which produce ~87% of infections

Front 55

Inhibition of Cell Wall Synthesis

Back 55

Inhibition of Transpeptidation
a. penicillins
b. cephalosporins
c. other B latams

Inhibition of Peptidoglycan Precursor Synthesis
a. glycopeptides
b. bacitracin

Front 56

Inhibition of Protein Synthesis

Back 56

Binding to 30S Ribosomal Subunit
a. aminoglycosides
b. tetracyclines
c. aminocyclitols

Binding to 50S Ribosomal Subunit
a. chloramphenicol
b. macrolides/ketolides
c. lincomycins
d. stretpogramins
e. oxazolidinones

Front 57

Inhibition of Nucleic Acid Synthesis

Back 57

Interference with Folic Acid Metabolism
a. sulfonamides
b. trimethoprim

Inhibition of DNA Gyrase
a. quinolones/fluoroquinolones

Inhibition of RNA Polymerase
a. rifamycins

Front 58

Mechanisms of Bacterial Resistance

Back 58

1. destruction of antibacterial compound
2. altered permeability to antibacterial compound
3. altered structure of antibacterial agent
4. altered target enzyme retaining function
5. altered metabolic pathway

Front 59

Extrachromosomal Resistance

Back 59

plasmid mediated
transduction: plasmid DNA is enclosed in bacteriophage and transferred to another bacterium
transformation: naked DNA diffuses from one bacterium to another (recombinant DNA)
conjugation: transfer DNA or plasmids by sex with use of pili
transposition: "jumping" of short DNA sequences

Front 60

Mechanism of Antibacterial Activity of Penicillins

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1. binds to penicillin-binding proteins (PBPs)
2. inhibits transpeptidase and cross-linking of peptidoglycan glycopeptides
3. inactivates inhibitors of autolytic (hydrolytic) enzymes of bacteria
4. cell lysis and death (bactericidal)

Front 61

Mechanisms of Resistance to Penicillins

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1. intrinsically resistant (altered structure of PBPs that decreases affinity for penicillins)
2. aquisition of genes for altered PBPs (plasmids, etc.) (eg MRSA)
3. permeability barrier (eg. gram(-) bacteria have impenetrable outer lipid bilayer)
4. B-lactamases (penicillinases, cephalosporins, B-lactamases)

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General Pharmacokinetics of Penicillins

Back 62

1. food adsorbs penicillins and decreases oral absorption
2. rapid elimination (t1/2 = 30-90 min), glomerular filtration and renal tubular secretion
3. very high concentrations are found in the urine, probenecid inhibits renal tubular secretion

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penicillin G

Back 63

benzylpenicillin; unstable in gastric acid so very poor and variable oral absorption, given by injection

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penicillin V potassium

Back 64

phenoxymethyl derivative, good oral absorption, plasma conc. 2-5X oral penicillin G, sole virtue over penicillin G

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Antibacterial Spectrum of Penicillins

Back 65

Drug of Choice for S. pyogenes, viridans Strep endocarditis, anaerobic Strep, meningococcus, T. pallidum, Actinomyces, B. anthracis, C. perfringens, E. rhusiopathiae, L. monocytogenes, S. moniliformis

General Activity: gram(+) and gram(-) cocci

Front 66

Bacteria Resistant to Penicillins

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a. formerly susceptible, now resistant: Gonococci, Pneumococci, Staphylococci
b. most strans of anaerobes are susceptible, except B. fragilis

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nafcillin

Back 67

Penicillinase-Resistant Penicillin
most active against penicillinase-producing staph

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Antibacterial Spectrum of Penicillinase-Resistant Penicillins

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a. these drugs are resistant to hydrolysis by Staphylococcal penicillinase
b. these drugs are less active than penicillin G against other penicillin-sensitive bacteria
c. these drugs are worthless for gram(-) bacteria
d. Drugs of Choice for most Staphylococcal diseases, despite MRSA

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Bacteria Resistant to Penicillinase-Resistant Penicillins

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a. MRSA (resistant to all PRPs, aminoglycosides, tetracyclines, erythormycin)
b. 40-60% of strains of S. epidermidis are also resistant to PRPs

Front 70

Antibacterial Spectrum of Aminopenicillins

Back 70

a. broader spectrum than the natural penicillins and PRPs
b. upper respiratory tract infections: S. pyogenes, S. pneumoniae, H. influenzae
c. excellent for L. monocytogenes (meningitis) in immunocompromised
d. general activity: increased gram(-) coverage

Front 71

Bacteria Resistant to Aminopenicillins

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a. resistance to penicillin implies resistance to the aminopenicillins
b. formerly susceptible, now resistant: H. influenzae, N. gonorrhoeae, Enterobacteriaceae

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Special Considerations of Aminopenicillins

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ampicillin undergoes enterhepatic recirculation, may interfere with oral contraceptives

Front 73

Antibacterial Spectrum of Antipseudomonal Penicillins

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a. increased activity against many strains of Pseudomonas, Enterobacter, and Proteus
b. piperacillin is also active for Klebsiella
c. general acitivty: increased gram(-) coverage

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Bacteria Resistant to Antipseudomonal Penicillins

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resistance to penicillin G implies resistance to antipseudomonal penicillins

Front 75

amoxicillin-clavulanate

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active against B lactamase-producing H. influenzae, gonococci, E. coli, and Staphylococci

Front 76

ticarcillin-clavulanate

Back 76

extends spectrum to gram(-) bacilli, Staph. aureus, Bacteroides, doesn't improve antipseudomonal activity

Front 77

ampicillin-sulbactam

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good activity against B lactamase-producing Staph. aureus, gram(-) aerobes and anaerobes, but not Pseudomonas

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piperacillin-tazobactam

Back 78

equivalent to ticarcillin-clavulanate, but also doesn't improve antipseudomonal activity

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Spectrum of 1st Generation Cephalosporins

Back 79

SS PEK
Staph
Strep
Proteus
E. coli
Klebsiella

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Spectrum of 2nd Generation Cephalosporins

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HEN PEKM
Haemophilus influenza
Expanded Enterobacteraciae
Neisseria
Proteus
E. coli
Klebsiella
M. catarrhalis
+/- bacteroides

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Spectrum of 3rd Generation Cephalosporins

Back 81

HENPEKME
even more expanded Enterobacteraceae
+/- pseudomonas
+/- staph, strep

Front 82

cefotetan

Back 82

a methylthiotetrazole, better anaerobic coverage

Front 83

cefoxitin

Back 83

a cephamycin

Front 84

cefotaxime

Back 84

DOC for initial empiric therapy for meningitis in noncompromised hosts

Front 85

ceftriaxone

Back 85

DOC for penicillinase-producing gonococcus

Front 86

antibacterial spectrum of imipenem/cilastatin

Back 86

very broad; gram(+) cocci (except MRSA and Enterococcus), Enterobacteriaceae, Pseudomonas (but many strains are resistant), anaerobes including B. fragilis, Acinetobacter (also many strains becoming resistant)

Front 87

Therapeutic Uses of imipenem/cilastatin

Back 87

severe UTIs, lower RTIs, intraabdominal, gynecological, skin, bone, and joint infections
especially useful for severe mixed infection by nosocomial bacteria

Front 88

Adverse effects of imipenem/cilastatin

Back 88

N/V is most common, some hypersensitivity and some cross-reactivity in pen-allergic patients, increased LFTs

Front 89

Antibacterial Spectrum of meropenem

Back 89

same as imipenem, but some imipenem-resistant Pseudomonas are sensitive, active against Pseudomonas and Acinetobacter; less activity against gram(+) cocci than imipenem

Front 90

Antibacterial Spectrum of doripenem

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same as imipenem, active against Pseudomonas and Acinetobacter, less activity against gram(+) cocci than imipenem

Front 91

Antibacterial Spectrum of ertapenem

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same as imipenem, but most Pseudomonas and Acinetobacter species are resistant, less activity against gram(+) cocci than imipenem

Front 92

Antibacterial Spectrum of aztreonam

Back 92

very similar to aminoglycosides, mostly gram(-), aerobic organisms
gram(+) and anaerobes are resistant, Enterobacteriaceae coverage is excellent, also good for Pseudomonas aeruginosa, H. influenzae, N. gonorrhoeae

Front 93

Mechanism of Antibacterial Action of vancomycin

Back 93

a. vancomycin binds with high affinity to d-alanyl-d-alanine terminus of peptidoglycan precursors
b. thus, it inhibits earlier steps in cell wall synthesis than B-lactams
c. cell lysis and death, rapidly bactericidal in rapidly dividing, susceptible bacteria
d. only bacteriostatic for enterococci

Front 94

Mechanisms of Resistance to vancomycin

Back 94

enterococcal resistance: expression of a unique enzyme that modifies the cell wall peptidoglycan precursors so that they no longer bind vancomycin, plasmid-mediated, and inducible

Front 95

Antibacterial Spectrum of vancomycin

Back 95

a. primarily active for gram(+) bacteria
b. DOC for MRSA
c. potential second-line agent for C. difficile (pseudomembranous colitis)
d. most strains of enterococci are sensitive, but increasing resistance
e. only used for very severe infection by S. pyogenes, S. pneumonia, and Viridans Strep.
f. essentially all species of gram(-) bacilli and mycobacteria are resistant (probably impermeable)

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Adverse Effects of vancomycin

Back 96

a. some hypersensitivities varying from rash to anaphylaxis
b. rapid IV injection may cause extreme flushing ("red-neck" syndrome)
c. significant toxicities: ototoxicity, nephrotoxicity (caution when administering w/ aminoglycosides)

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Antibacterial Spectrum of oritavancin

Back 97

most Strep and Staph strains including anaerobic Strep (Peptostreptococci)
activity against Enterococcus is independent of Van A-C
also active against Propionibacterium acnes and Clostridium perfringens
significance is activity against MRSA, VISA, VRE, and MDRP