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36 Cards in this Set

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MOA vancomycin
binds ala-ala end of peptidoglycan and inhibits TRANSGLYCOSYLASE

prevents crosslinking and elongation
MOA bacitracin
interferes with regen of bactoprenol (the phospholipid carrier that helps to carry bacterial cell wall building blocks)
MOA B-lactams
block transpeptidation

bind to PBP and prevent crosslinking outside of the plasmamembrane
pt has severe diarrhea, fever, stool filled with mucous membrane...what do they have? caused by? DOC?
pseudomembranous colitis

overgrowth of c. diff in intestinal tract

DOC: Metronidazole
how does psedomembranous colitis and superinfection occur
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
what is ESBL?
extended spectrum b-lactamases

hydrolyzzes penicillins and cephs nad monobactams
Kleb pneumonia commonly produces what? so what is your drug of choice if this is the case?
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)
most common ESBL producer? another common one?
Kleb- most common

E. Coli
what is the mechanism of resistance to PCN, and 1/2 cephs?
resistance encoded in PLASMID

binds and disrupts b lactam bond (ring)
where are b-lactamases secreted in G+ and G- respectively?
G+: outside the cell wall

G-: periplasmic space
what is meant by allergic cross-sensitivity of PCN?
PCN has reactivity with other PCNs

release breakdown product: penicilloic acid which acts as a hapten leading to allergic response
what is the cross reactivity of cephs with PCN?
10%
diarrhea, HI intolerance, neurotoxicity and superinfection are considered what of PCNs?
Nonallergic/toxic effects
what are the B-lactamase inhibitors?
Clavulinic acid

Sulbactam

Tazobactam

(can't stop this!)
how do B-lactamase inhibitors work?
they look like PCN and bind irreversibly to the BLi
what is augmentin and how is it administered?
amoxicillin + clavulianic acid

orally

gives b-lactamase protection
allergic rxn is most common in what?
PCN (G or V)
what drug causes similar adverse effects to PCN G but includes bood dyscrasia, nephritis, and hepatotoxicity?
antistaph pens
can cause Na overload and should not be used in CHF or RF pts....
antipseudomonals
allergic rxns, blood dyscrasia, and pseudomembranous colitis can be adverse side effects of this drug
2nd gen cephs
this drug can cause ototoxiticity, nephrotoxicity, and red man flushing
vancomycin
why is bacitracin only used topically
nephrotoxic if oral
advantages of PCN G

2
low cost, low tox
what is resistant to PCN G
G-
Oxacillin is administered how?
IV only
how is oxacillin resistant to break down
bulky side chain stops b-lactamase from breaking it down
DOC for MSSA?
oxacillin
amoxicillin is administered how?
orally
ticaricillin is administered how?
IV or IM
piperacillin is given how
IV or IM
make sure you know the activity of the diff drugs....
see the previous sets..i am sleepy
penicillin route of elim?

what slows this?
renal secretion

remember probenicid can slow this down
route of elimination:

Cephalosporins
Kidney

half life greatest for 4>3>2>1
what are the orally effective cephs?
1st gen (except cefazolin is parenteral)

some 3rd gens
what beta lactams can kill pseudomonas?
antipsuedomonal penicillins (piper and ticar)

3/4 cephs

carbs and monobactams are alts for it (for serious infections)
what is the difference btw imipenem and meropenem
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