ABx II Flashcards by tcarlso 3

What are the abx that are cell wall synthesis inhibitors?

PCN
Cephalosporins
Monobactam
Glycopeptides
Polypeptides
Carbapenems
Phosphoenolpyruvate

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What are the three general classes of protein synthesis inhibitors?

Tetracyclines
Aminoglycosides
Macrolides

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What are the four abx that cause DNA damage, inhibit gyrase, or inhibit folate?

Sulfonamides
Trimethoprim
Fluoroquinolones
Metronidazole

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What are the two components of the cell wall?

NAM and NAGs

N-acetylmuramic acid, N-acetylglucosamine

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True or false: peptidoglycan is only found in gram positive bacteria?

False-both

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What are the molecules that attach NAMs and NAGs together?

5 amino acids in a species-specific sequence

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What is the enzyme that joins monomers to form NAM-NAG chains?

Transglycosylases

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What are the enzymes that bind NAMs and NAGs to AAs?

Transpeptidases

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What is the role of penicillin binding proteins?

play a role in the synthesis and maintenance of bacterial cell wall peptidoglycan

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What is the MOA of beta-lactam abx?

Binds to and inhibits the PBP enzymes, which play a role in the synthesis and maintenance of bacterial cell wall peptidoglycan

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What are the four types of beta-lactams?

PCN
Cephalosporins
Monobactam
Carbapenem

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Are beta-lactams bactericidal or bacteriostatic?

Bactericidal

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What is the enzyme that causes resistance to beta lactams?

Beta lactamases

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What are the four major PCN compounds?

PCN G
PCN V
Amoxicillin
Methicillin

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What is the most common adverse effect of beta-lactam abx?

Hypersensitivity

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What are the CNS adverse effects of beta lactams?

Confusion

Hallucinations

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What are the blood adverse effects of beta lactams?

Hemolytic anemia

Thrombocytopenia

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What secondary infections are pts more susceptible to following beta lactam use?

Vaginal candidiasis

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If there is a mild reaction to a beta lactam, should you consider another beta lactam?

Yes, but only for a MILD reaction.

If severe, then no

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Are PCN G/V broad or narrow spectrum? Beta lactamase sensitive?

Narrow

Beta lactamase sensitive

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Are methicillin, Nafcillin, oxacillin broad or narrow spectrum? Beta lactamase sensitive?

Very narrow

Resistant

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Are ampicillin/amoxicillin broad or narrow spectrum? Beta lactamase sensitive?

Broad

Sensitive

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Are piperacillin, ticarcillin, azlocillin, broad or narrow spectrum? Beta lactamase sensitive?

Extended spectrum

Sensitive

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What is the drug that is coadministered with PCN abx to inhibit beta lactamase?

Clavulanic acid

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What is the MOA of clavulanic acid?

Beta lactamase inhibitor

What are the key adverse effects of beta lactamase inhibitors?

Similar to PCN

What agents are used if there is a sensitivity to PCNs?

Cephalosporins

What is the MOA of cephalosporins?

Bind to PBPs

What is the key adverse effect of cephalosporins?

Hypersensitivity

What are first generation cephalosporins good to treat? Second? Third? 4th?

1. Gram positive cocci 2. above plus some gram - 3. above and many gram neg rods 4. broad

What are the two 1st generation cephalosporins?

Cefazolin | Cephalexin

What are the three second generation cephalosporins?

Cefotetan Cefaclor Cefuroxime

What are the four third generation cephalosporins?

Ceftriaxone Cefotaxime Cefdinir Cefixime

Which generation of cephalosporins are effective in CNS treatment?

3 and 4

What is the one 4th generation cephalosporin?

Cefepime

Are any of the cephalosporin generations beta lactamase resistant? If so, which one(s)?

4th generation resistant

What is the only monobactam drug?

Aztreonam

What is the MOA of monobactams? Is it beta lactamase resistant?

Inhibit PBPs | Beta lactamase resistant

Can Monobactams penetrate the CNS?

Yes

What is the major adverse effect with monobactam?

Hypersensitivity

What are the four carbapenems?

Doripenem Imipenem Ertapenem Meropenem

Imipenem needs to be administered with what? Why?

Cilastatin | imipenem is inactivated in the kidney. Cilastatin prevents this

Are most carbapenems beta lactamase resistant or sensitive? Which are outside this rule?

All Resistant

What is the MOA of carbapenems?

PBP

What are the adverse effects of carbapenems?

N/v

What are carbapenems used for?

Severe infections

What is the one glycopeptide abx?

Vanco

Does vanco penetrate the CNS?

Not really

What is the MOA of vanco?

Prevents the elongation of the peptidoglycan cell wall structure by binding to the D-ala-D-ala

MRSA should be treated with what?

Vanco + ***metronidazole***(?)

What are the key adverse effects of vanco?

- Flushing (red man syndrome) | - Ototoxic and nephrotoxic

Vanco does not penetrate the CNS very well. Why is it so good for meningitis?

Getting some of it there via high doses is very effective

Is vanco a beta-lactam abx? MOA?

Yep | Prevents the elongation of the peptidoglycan cell wall structure by binding to the D-ala-D-ala

Red man syndrome = which abx side effect?

Vanco

What is vanco good to treat?

Gram positive + MRSA Enterococci C.diff

What is the MOA of bacitracin?

Blocks incorporation of amino acids and nucleic acids into the cell wall

What is bacitracin good for treating?

Broad spectrum for both gram positive and negative

What is the key adverse effect with bacitracin?

Hypersensitivity

Which Abx prevents the elongation of the peptidoglycan cell wall structure by binding to D-ala-D-ala pentapeptide?

Vanco

Which abx blocks the incorporation of amino acids and nucleic acids into the cell wall?

Bacitracin

What is the MOA of fosfomycin?

Blocks an early step in cell wall synthesis by preventing synthesis of UDP-N-acetylmuramic acid

Which abx Blocks an early step in cell wall synthesis by preventing synthesis of UDP-N-acetylmuramic acid?

Fosfomycin

What disease is fosfomycin usually used to treat?

UTIs

What type of bacteria can fosfomycin kill well?

Both gram + and gram -

What are the three major protein synthesis inhibitor abxs?

Aminoglycosides Macrolides Tetracyclines

Cell wall inhibition is generally bacteriostatic or bactericidal?

Bactericidal

Protein synthesis inhibition is generally bacteriostatic or bactericidal?

Bacteriostatic

What is the target of protein synthesis inhibiting abx?

50s and 30s subunit of prokaryotes

What are the ribosomes that are in prokaryotes?

50s and 30s, which form 70s

What is the first step of prokaryotic protein synthesis?

charged tRNA binds to A site

What is the second step of prokaryotic protein synthesis?

Peptidyl tRNA peptide bond formed between growing chain and A site

What is the third step of prokaryotic protein synthesis?

newly uncharged tRNA exits

What is the fourth step of prokaryotic protein synthesis?

The now longer amino acid chain translocates to the P site

What are the 6 aminoglycosides?

1. streptomycin 2. gentamicin 3. kanamycin 4. amikacin 5. tobramycin 6. Neomycin

-mycin suffix indicate what abx type? What are the three exceptions?

Aminoglycosides Erythromycin Clarithromycin Azithromycin =macrolides

Are aminoglycosides bacteriostatic or bactericidal?

Bactericidal

What is the MOA of aminoglycosides?

binds to 30s and blocks formation of initiation complex

What are the two key adverse effects of aminoglycosides?

Nephrotoxic | Ototoxic

What are aminoglycosides used to treat?

Used in combination with Beta lactams to treat serious gram -

What are the three macrolides?

erythromycin Clarithromycin Azithromycin

What is the MOA of macrolides?

Binds to 50s subunits and impairs the translocation to the P site

What abx binds to the 30s site? 50s?

``` 30s = aminoglycoside 50s = macrolides and tetracyclines ```

What are the key adverse effects of macrolides?

GI: n/v

What are macrolides used to treat? Bacteriostatic or bactericidal?

most gram + | Bacteriostatic

What are macrolides effects on the GI?

stimulate the GI Tract motility

What are the four tetracyclines?

1. Tetracycline 2. Minocycline 3. Tigecycline 4. doxycycline

What is the MOA of tetracycline?

Binds to 30 s subunit and prevent binding of a new aminoacyl to A site

What are tetracyclines used to treat?

Broad spectrum

What are the three key adverse effects of tetracyclines?

1. Binds Ca (reduced growth of bone) 2. Disrupts normal flora 3. Skin photosensitivity

What is the difference in MOA of tetracyclines and macrolides?

both bind to 50s subunit, but tetracyclines prevent new aminoacyl T site binding, whilst macrolides prevent translocation to the P site