Antimicrobials I

Question 1

What are the 2 natural penicillin?

Answer 1

Pen G and Pen VK

Question 2

What is the mechanism of Pen G and Pen VK?

Answer 2

Inhibit Transpeptidase (penicillin binding protein)
Bactericidal
Penicillinase sensitive

Question 3

Clinical use of Pen G and Pen VK

What makes Pen V different than Pen G?

Answer 3

Common strep, pneumo, entero, meningococci, Treponema pallidum

Pen VK is acid stable and so it is orally active

Question 4

What are the toxicity/contraindications for Pen G and Pen VK?

Answer 4

Hypersensitivity rxns
Hemolytic anemia
Cross Sensitivity

Question 5

What are the Penicillinase Resistant Penicillins? 3

Answer 5

Nafcillin, Methicillin, Dicloxacillin, Oxacillin

Question 6

What is the mechanism of action for Penicillinase resistant penicillins? (Naf, Meth, Oxa and Diclox)

Answer 6

Same as Penicillin = Inhibit Transpeptidase (penicillin binding protein)
BUT these are narrow spectrum and are penicillinase resistant

Question 7

Clinical use of Penicillinase Resistant Penicillins?1

Answer 7

Anti Staphylococcal penicillins!
Nafcillin is the Drug of choice for Staph infxns

USE NAF FOR STAPH

Question 8

Toxicity/contraindications for Penicillinase resistant penicillins

Answer 8

headache

metallic taste

Question 9

Name the aminopenicllins (2)

Answer 9

Ampicillin and Amoxicillin

Question 10

What is the MOA for aminopenicillins (ampi, amoxicllin)

Answer 10

Same as penicillins = Inhibit Transpeptidase (penicillin binding protein)
BUT wide spectrum when combined w/ clavulanic acid

Question 11

Clinical use of aminopenicillins

Answer 11

Gram + and Gran - rods
Drug of choice for Listeria Monocytogenes and Enterococci
Drug of choice of prophylaxis of Infective endocarditis

• Amping up AMO helps kills wide spectrum of entero
• AmOxicillin has better Oral bioavailibility

Question 12

Toxicity and Contraindications of aminopenicillins?

Answer 12

Hypersensitivity rxns
Ampicillin rash
C. diff infection

Question 13

Name the Anti-pseudomonal penicillins (3)

Answer 13

Ticarcillin
Carbenicillin
Piperacillin

Question 14

MOA of Anti-pseudomonal penicillins?

Answer 14

Same as penicillins = Inhibit Transpeptidase (penicillin binding protein)
BUT extended specrtum

Question 15

Clinical use of Anti-pseudomonal penicillins?

Answer 15

Pseudomonas and Gram - rods
Synergistic with aminoglycosides

TCP Takes Care of Pseudomonas

Question 16

Toxicity and contraindications of antipseudomonal penicillins?

Answer 16

Hypersensitivity rxns

Question 17

Cool fact about Piperacillin

Answer 17

Piperacillin is the broadest spectrum penicillin

Question 18

Name the 1st generation Cephalosporins?

Answer 18

Cefazolin, Cephalexin

LIN, XIN

Question 19

Name the 2nd generation of Cephalosporins

Answer 19

cefoxitin, cefaclor, cefuroxime

TIN, LOR, OXIME

Question 20

Name the 3rd generation of cephalosporins

Answer 20

Ceftriaxone, Cefotaxime, Ceftaxidime, Cefdinir

TRI TAX TAZ DINIR

Question 21

Name the 4th gen of cephalosporins

Answer 21

Cefepime

Question 22

Name the 5th gen of cephalosprins

Answer 22

Ceftaroline

LAST IN LINE

Question 23

MOA for cephalosporins?

Answer 23

Penicillinase resistant

Question 24

Clinical use of 1st gen of cephalosporins?

Answer 24

Proteus mirabilis
E. Coli
Klebsiella pneumo

PEcK

Question 25

Clinical use for 2nd gen of cephalosporins?

Answer 25

``` H. flu Entero Neisseria Proteus mirabilis E. Coli Klebsiella pneumo Serratia marcescens ``` HENPEcKS

Question 26

Clinical use for 3rd gen cephalosporins?

Answer 26

Cross BBB -- gram + and - cocci, gram - bacilli, meningitis, anaerobes and gonococci and pseudomonas

Question 27

Clinical use for 4th gen cephalosporins?

Answer 27

Pseudomonas

Question 28

Clinical use for 5th gen cephaplosporins?

Answer 28

covers MRSA

Question 29

Toxicity and contraindications of Cephalosporins?

Answer 29

Hypersensitivity rxns, increasing toxicity of aminoglycosides, C. diff inxn

Question 30

MOA of Aztreonam

Answer 30

Same as penicilliin = Inhibit Transpeptidase (penicillin binding protein) BUT a monobactam and penicillinase resistant

Question 31

Clinical use of Aztreonam?

Answer 31

Works synergistically with aminoglycosides Gram -, aerobic rods like serratia, pseudomonas, klebsiella Tx SPiKe

Question 32

Toxicity and contraindications of Aztreonam?

Answer 32

C diff, hematological disorders, fever, diarrhea, cellulitis

Question 33

Name the Carbapenems

Answer 33

Imipenem (must be administered with Cilastin) Meropenem Ertapenem

Question 34

MOA of carbapenems?

Answer 34

Same as penicillin = Inhibit Transpeptidase (penicillin binding protein) BUT is broad spectrum and penicillinase resistant

Question 35

Clinical use of carbapenems?

Answer 35

Gram + cocci, Gram - rods, anaerobes = imipenem is the broadest anitbacterial available Drug of choice for eneterobacteria

Question 36

Toxicity and Contraindications for carbapenems?

Answer 36

Seizures, GI distress, Rash, Skeletal muscle toxicity

Question 37

MOA of Vancomycin

Answer 37

Inhibits cell wall formation by binding D-Ala portions of cell wall precursors

Question 38

Clinical use of vancomycin?

Answer 38

Tx multidrug resistant gram + Staph aureus C. diff

Question 39

Toxicity and contraindications of vancomycin?

Answer 39

nephrotoxic ototoxic thrombophlebitis Red man syndrome The red man will NOT take vanco

Question 40

MOA of Bacitracin

Answer 40

Blocks peptidoglycan synthesis

Question 41

Clinical use of bacitracin

Answer 41

Topical tx

Question 42

Toxicity and contraindications of bacitracin?

Answer 42

Nephrotoxic and Ototoxic

Question 43

MOA of Daptomycin

Answer 43

Inserts in cell membrane and forms ion channels - bactercidal

Question 44

Clinical use of daptomycin?

Answer 44

Vanco and methicillin resistant gram + bacteria

Question 45

Toxicity and contraindications of daptomycin?

Answer 45

headache, GI upset, insomnia, rhabdomyolosis

Question 46

Amoxicillin and clavulanic acid =

Answer 46

augmentin

Question 47

ampicillin and sulbactam =

Answer 47

unasyn

Question 48

piperacillin and taxobactam =

Answer 48

zosyn

Question 49

Name all the drugs (or categories) that target cell wall synthesis -- there are 11.

Answer 49

``` Natural Penicillins Penicillinase resistant Aminopenicillins Anti-pseudomonal penicillins Cephalosporins Aztreonam Carbapenems Vancomycin Bacitracin Daptomycin ```

Question 50

How do Beta lactam drugs work?

Answer 50

Bind to the Transpeptidase penicillin binding protein and prevent transpeptidation! Transpeptidation covalently bonds chains of peptidoglycan, making rigid cells walls. Without a rigid cell wall, bacteria undergo lysis.

Question 51

What do all Beta Lactam drugs need to work?

Answer 51

Require actively proliferating organisms, need organisms with peptidoglycans, and should be dosed for T>MIC (Type II TIme dependent dosing)

Question 52

Name the Beta Lactam drugs:

Answer 52

Natural penicillins, Aminopenicillins, penicillinase resistant penicillins, antipseudomonal penicllins, cephalosporins and carbapenems

Question 53

Name the non Beta Lactam drugs

Answer 53

Bacitracin, Vancomycin and daptomycin