Resp Pharm 4

Front 1

Stage 1 of cell wall synthesis

Back 1

- occurs in the cytoplasm and results in the synthesis of MurNAc-pentapeptide
- D-cycloserine

Front 2

Stage 2 of cell wall synthesis

Back 2

occurs on the membrane surface and results in synthesis of MurNAc-GlcNAc its attachement
- Vancomycin and Bacitracin

Front 3

Stage 3 of cell wall synthesis

Back 3

- occurs in the periplasm (-) or on the outside (+)
– it requires no energy
- cross-linking enzymes exchange the DADA peptide bond for a DAG peptide cross-link

Front 4

B-lactam mechanism

Back 4

- structural similarity to the DADA carboxyl terminus
- react w/ PBP's to form a stable complex & inactivate

Front 5

efficacy of b-lactams in (+) vs (-)

Back 5

- in (+), depends on ability to bind PBP
- in (-), depends on ability to bind PBP and ability to cross outer membrane

Front 6

Resistance to B-lactams (5)

Back 6

- Production of a B-lactamase
- ↓ perm of outer membrane
- express efflux pump
- inability to activate autolytic enzymes
- mutations in PBP's

Front 7

what organisms produce B-lactamase?

Back 7

- Staph aureus
- H. influenzae
- N. gonorrhoeae
- (-) enteric rods

Front 8

what organisms tend to express efflux pumps for B-lactams?

Back 8

- N. gonorrhoeae
- P. aeruginosa
- S. typhimirium
- usually in concert w/ ß-lactamase, porin mutations and mutations in PBPs

Front 9

what organisms tend to have the inability to activate autolytic enzymes (and are resistant to B-lactams)

Back 9

- staph
- strep
- listeria
- makes Ab static and not cidal

Front 10

what organisms tend to have mutations in PBP's

Back 10

- staph aureus
- N. gonorrhoeae
- H. influenzae
- Strep pneumoniae

Front 11

resistance to vancomycin

Back 11

- Only in E. faecium and E. faecalis
- plasmid mediated
- genes form a depsipeptide that vancomycin can't recognize

Front 12

vancomycin mechanism

Back 12

binds w/ high affinity to DADA carboxyl terminus to prevent incorporation in stage 2

Front 13

Vancomycin Pharmacokinetics

Back 13

- oral if GI infections (poorly absorbed)
– IV if other
– 6 hr half life
– eliminated unchanged in kidney

Front 14

vancomycin toxic effects

Back 14

- Severe ototoxicity and nephrotoxicity if high []’s
- Hypersensitivity reactions ovserved

Front 15

vancomycin antimicrobial activity

Back 15

- 1st choice for MRSA and pen-resistant Strep pneum (can be in combo w/ 3rd gen or rifampin)
- alternative for Staph aureus, various Strep, C. difficile

Front 16

Penicillin pharmokinetics

Back 16

- widely distributed except CSF, eyes, prostate
- penV, oxacillin, amoxicillin are oral
- penG, piperacillin, ticarcillin are parenteral
– minial metabolism and renal excretion

Front 17

Penicillin side effects

Back 17

- Anaphylaxis
- hypersensitivity
- neurotoxicity

Front 18

PenG and PenV for (+) cocci

Back 18

- strep groups A, B, C, and G
- E. faecium and E. faecalis (endocarditis and only w/ a aminoglycoside)
- Strep pneum (pneumococcus or diplococcus - resistant strains becoming more common)

Front 19

PenG and PenV for (+) bacilli

Back 19

- anthrax
- C. perfringens
- C. tentani

Front 20

PenG and PenV for (-) cocci

Back 20

– N. meningitidis

Front 21

PenG and PenV for enteric (-) bacilli

Back 21

- syphilis and other spirochetes
- Actinomycetes israelii
- V is an alternative to G for treating Strep. A, B, C, and G and pneumoniae

Front 22

PenG and PenV antimicrobial spectrum (only groups)

Back 22

- (+) cocci
- (+) bacilli
- (-) cocci
- enteric (-) bacilli

Front 23

Penicillinase-resistant penicillins

Back 23

- for penicillinase-producing Staph
- oxacillin & nafcillin

Front 24

ampicillin and ampillin + sulbactam

Back 24

- oral, penicillinase susceptilbe
– good for penG bacteria, and GDS
– also for (-) bacilli like H. influenzae, E. coli, P. mirabilis, Shigella and S. typhi

Front 25

amoxicillin & amoxicillin + clavulanate

Back 25

– oral, penicillinase susceptilbe
– good for penG ones, and GDS – also for (-) bacilli like H. influenzae, E. coli, P. mirabilis, Shigella and S. typhi

Front 26

ticarcillin and ticarcillin + clavulanate

Back 26

- IV, penicillinase susceptilbe
– good in P. aeruginosa
– alternative for aerobic (-) bacilli like E. coli and Proteus mirabilis

Front 27

piperacillin and piperacillin + tazobactam

Back 27

- used parenterally, good in 50% of Klebsiella and some (-) bacilli (if serious, add aminoglyocside)
- penicillinase susceptilbe
- T is a B-lactimatase inhibitor

Front 28

cephalexin

Back 28

- 1st generation cephalo
– best against (+) cocci
– use for surface infections
– give orally

Front 29

cefuroxime

Back 29

- 2nd generation cephalo
– best for (-) like sinusitis, otitis or LRIs like H. influenzae, B. fragilis and N. gonorrhoeae
– Parenteral admin

Front 30

ceftriaxone

Back 30

- 3rd generation cephalo
- good for (-) bacilli like H. flu and N. gonorrhoeae
- can cross BBB so good foor E. coli or K. pneumoniae
- good for meningitis w/ (-) bacilli (P aeruginosa)
- parenteral admin

Front 31

cefotaxime

Back 31

- 3rd generation cephalo
- good for (-) bacilli like H. flu and N. gonorrhoeae
- can cross BBB so good foor E. coli or K. pneumoniae
- good for meningitis w/ (-) bacilli (P aeruginosa)
- parenteral admin

Front 32

ceftazidime

Back 32

- 3rd generation cephalo
- good for (-) bacilli like H. flu and N. gonorrhoeae
- can cross BBB so good foor E. coli or K. pneumoniae
- parenteral admin

Front 33

cephalospoin considerations

Back 33

- don’t give if hx of Pen anapyhlaxis
– ok if hypersensitiviy or resistance

Front 34

cephalospoin side effects

Back 34

- pain when given IM
- disulfiram-like reaction w/ alcohol
- hypoprothrombinemia and serious bleeding
– risk of superinfections is ↑ w/ 2nd and 3rd generation