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36 Cards in this Set
- Front
- Back
MOA vancomycin
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binds ala-ala end of peptidoglycan and inhibits TRANSGLYCOSYLASE
prevents crosslinking and elongation |
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MOA bacitracin
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interferes with regen of bactoprenol (the phospholipid carrier that helps to carry bacterial cell wall building blocks)
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MOA B-lactams
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block transpeptidation
bind to PBP and prevent crosslinking outside of the plasmamembrane |
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pt has severe diarrhea, fever, stool filled with mucous membrane...what do they have? caused by? DOC?
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pseudomembranous colitis
overgrowth of c. diff in intestinal tract DOC: Metronidazole |
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how does psedomembranous colitis and superinfection occur
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you get over treated with broad spectrum drugs
knocks out normal GI flora, letting c. diff set up shop and wreak havoc (diarrhea, etc) so you have to use metronidazole (DOC) or vanco to knock it out |
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what is ESBL?
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extended spectrum b-lactamases
hydrolyzzes penicillins and cephs nad monobactams |
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Kleb pneumonia commonly produces what? so what is your drug of choice if this is the case?
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ESBL
Carbapenems (remember 2 things; one is that if you have ESBL you cannot use pen, cephs, or monobactams; secondly, if it were NOT ESBL, you would want to use ceftizidime, a 3rd gen ceph) |
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most common ESBL producer? another common one?
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Kleb- most common
E. Coli |
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what is the mechanism of resistance to PCN, and 1/2 cephs?
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resistance encoded in PLASMID
binds and disrupts b lactam bond (ring) |
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where are b-lactamases secreted in G+ and G- respectively?
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G+: outside the cell wall
G-: periplasmic space |
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what is meant by allergic cross-sensitivity of PCN?
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PCN has reactivity with other PCNs
release breakdown product: penicilloic acid which acts as a hapten leading to allergic response |
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what is the cross reactivity of cephs with PCN?
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10%
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diarrhea, HI intolerance, neurotoxicity and superinfection are considered what of PCNs?
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Nonallergic/toxic effects
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what are the B-lactamase inhibitors?
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Clavulinic acid
Sulbactam Tazobactam (can't stop this!) |
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how do B-lactamase inhibitors work?
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they look like PCN and bind irreversibly to the BLi
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what is augmentin and how is it administered?
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amoxicillin + clavulianic acid
orally gives b-lactamase protection |
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allergic rxn is most common in what?
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PCN (G or V)
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what drug causes similar adverse effects to PCN G but includes bood dyscrasia, nephritis, and hepatotoxicity?
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antistaph pens
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can cause Na overload and should not be used in CHF or RF pts....
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antipseudomonals
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allergic rxns, blood dyscrasia, and pseudomembranous colitis can be adverse side effects of this drug
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2nd gen cephs
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this drug can cause ototoxiticity, nephrotoxicity, and red man flushing
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vancomycin
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why is bacitracin only used topically
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nephrotoxic if oral
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advantages of PCN G
2 |
low cost, low tox
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what is resistant to PCN G
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G-
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Oxacillin is administered how?
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IV only
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how is oxacillin resistant to break down
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bulky side chain stops b-lactamase from breaking it down
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DOC for MSSA?
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oxacillin
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amoxicillin is administered how?
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orally
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ticaricillin is administered how?
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IV or IM
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piperacillin is given how
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IV or IM
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make sure you know the activity of the diff drugs....
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see the previous sets..i am sleepy
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penicillin route of elim?
what slows this? |
renal secretion
remember probenicid can slow this down |
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route of elimination:
Cephalosporins |
Kidney
half life greatest for 4>3>2>1 |
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what are the orally effective cephs?
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1st gen (except cefazolin is parenteral)
some 3rd gens |
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what beta lactams can kill pseudomonas?
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antipsuedomonal penicillins (piper and ticar)
3/4 cephs carbs and monobactams are alts for it (for serious infections) |
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what is the difference btw imipenem and meropenem
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both are carbapenems but...
Imipenem is broken down rapidly by dehydropeptidase in the proximal renal tubule...so it is given with Cilastatin Meropenem has an increased stability to dipeptidase so it doesn't need cilastatin |