2: B-lactams Flashcards

(44 cards)

1
Q

G(+) vs. G(-): color on gram stain

A

G(+): dark purple (crystal violet)

G(-): light pink (safranin)

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2
Q

G(+) vs. G(-): can drugs penetrate the outer layer?

A

G(+): drugs penetrate outer layer

G(-): drugs can’t penetrate outer layer, but some use porins

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3
Q

G(+) vs. G(-): where are B-lactamases located?

A

G(+): excrete B-lactamases through cell wall (need more)

G(-): B-lactamases confined to periplasmic space

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4
Q

G(+) vs. G(-): thickness of PG layer?

A

G(+): thick PG

G(-): thin PG

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5
Q

G(+) vs. G(-): number of membranes?

A

G(+): one membrane

G(-): two membranes (more lipoidal)

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6
Q

G(+) vs. G(-): L-Lys or DAP in PG?

A

G(+): L-Lys

G(-): DAP

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7
Q

B-lactam MOA

A

penicillin resembles D-Ala-D-Ala -> acylates Ser of PBP to form a stable product, inactivating PBP

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8
Q

what gives B-lactam ring its reactivity? 2 reasons

A
  1. carbonyl: tetrahedral intermediate 90* compressed angle -> 109* angle
  2. B-lactam carbonyl is more like a ketone carbonyl (N lone pair doesn’t overlap with C=O) -> more reactive
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9
Q

why don’t bacterial PBPs react with host protein?

A

bacteria have D-Ala; human proteins do not

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10
Q

4 mechanisms of resistance to B-lactmas

A
  1. decreased cell uptake
  2. mutant PBPs
  3. efflux pump
    * *4. bacterial B-lactamases (hydrolyze B-lactam ring)
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11
Q

what percent of people are allergic to B-lactams?

A

6-8% of US

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12
Q

cause of B-lactam allergenicity

A

due to drug acting as hapten and acylating host proteins

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13
Q

range of sx from B-lactam allergy

A

rash (urticaria) to anaphylaxis

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14
Q

why can’t B-lactams be structurally altered to reduce allergenicity?

A

b/c allergenicity originates in pharmacophore

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15
Q

how can you test for B-lactam allergy?

A

topical wheal and flare test

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16
Q

is penicillin degradation in acid reversible or not? what can catalyze degradation?

A

irreversible

-catalyzed by heavy metal ions

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17
Q

3 major degradation products of penicillin and mechanism of degradation

A
  1. benzylpenicillenic acid (eliminate a sulfhydryl from 2nd intermediate)
  2. Benzylpenillic acid (complex hydrolysis w/ ankemeric assistance)
  3. Benzylpenicilloic acid (basic solution (-OH))
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18
Q

how can penicillins be stabilized against degradation?

A

make R group more electronegative -> nucleophilicity of carbonyl is reduced

19
Q

effect of serum protein binding on penicillins

A
  • reduces bioavailability b/c less [free drug]
  • protects from degradation b/c degradation occurs on drugs in solution
  • does not change half life b/c fast dissociation rates/ renal excretion rate = limiting factor
20
Q

how does lipophilicity of R group change serum protein binding?

A

more lipophilic R = more highly protein bound

21
Q

excretion of penicillin

A

rapid:
- biliary
- renal: 10% glomerular filtration, 90% tubular secretion via anionic mechanism

22
Q

what happens to half life of penicillin if administered to patient with kidney disease?

A

increase half life

23
Q

how can one target the anionic mechanism of penicillin excretion to increase its half life?

A

administer penicillin with probenecid

24
Q

Benzylpenicillin (Pen G): R group

A

-benzyl R group

25
Benzylpenicillin (Pen G): B-lactamase sensitive?
yes
26
Benzylpenicillin (Pen G): activity
G(+) cocci + N. gonorrhea, H. influenzae drug of choice for treatment of more stuff than any other antibiotic
27
Benzylpenicillin (Pen G): admin
p.o. - large dose | parenteral = most effective
28
Benzylpenicillin (Pen G): toxicity/contraindications
- acute allergic reaction | - don't give with significant history of asthma/allergies
29
Methichillin: R group
ortho methoxy groups
30
Methichillin: B-lactamase sensitive?
no - steric hindrance of methoxyls prevents nucleophilic attack on C=O
31
Methichillin: admin
injection only (unstable in acid, so no oral)
32
Methichillin: activity
narrow - mostly for B-lactamase producing S. aureus
33
Methichillin: toxicity/contraindications
-inducer of B-lactamase, so only use when required
34
Methichillin: resistance mechanism
PBP2 (mutation in gene mecA)
35
Cephapirin: structure
cephalosporin w/ 6-member ring w/ S | -acetate at position 3
36
Imipenem: structure
carbapenem | -S replaced by methylene (greater ring strain)
37
Imipenem: B-lactamase sensitive? sensitive to anything else?
no - inhibits B lactamases but, hydrolyzed by renal dehydropeptidase-1 (can be overcome when given w/ cilastatin)
38
Imipenem: activity
G(+) and G(-) -serious infections of gut, GU tract, bone, skin, endocardium "magic bullet" - combo w/ cilastatin has broader activity than any other US antibiotic
39
Imipenem: admin
parenteral
40
Imipenem: toxicity/contraindications
good B-lactamase inducer, so only use when required
41
aztreonam: structure
- synthetic monobactam | - sulfamic acid in place of C=O
42
aztreonam: activity
almost completely G(-) - especially those by penicillin resistant dudes acquired in hospitals
43
aztreonam: toxicity/contraindications
-cross allergenicity only reported with ceftazidime (same R group)
44
aztreonam: what makes the B-lactam ring more reactive?
electronegativity of sulfamic acid