B-Lactams Antibiotics with other B-lactamase inhibitors

Question 1

CLASS I 𝝱-lactamase Inhibitors

Answer 1

• Clavam (Clavulanic acid)
  -> Amoxicillin and Clavulanic acid (Co-
  amoxiclav)
• Penams (Sulbactam, Tazobactam)
  -> Ampicillin and Sulbactam
  (Sultamicillin)
  -> Piperacillin and Tazobactam
  (Tazocin®, Piptaz®)
  -> Ceftolozane and Tazobactam
• Diazobicyclocarbamoyl sulfate (Avibactam)
  -> Ceftazidime and Avibactam

Question 2

CLASS II 𝝱-lactamase Inhibitors

Answer 2

Carbapems

Question 3

Narrow spectrum antibiotics and resistant to β-lactamases.

Answer 3

monobactams

Question 4

monobactams are active against gram negative rods primarily through _____ but not against gram-positive bacteria or anaerobes

Answer 4

binding to PBP3

Question 5

first clinically useful monobactam

Answer 5

aztreonam

Question 6

monobactams are limited only to _______(including Pseudomonas aeruginosa), and no activity against gram positive and anaerobes

Answer 6

aerobic gram negative rods

Question 7

are monobactams cross reactive with penicillins?

Answer 7

no

Question 8

toxicity levels of monobactams?

Answer 8

relatively non-toxic

Question 9

Widest spectrum among the β-lactam antibiotics.

Answer 9

carbapenems

Question 10

what is carbapenems used for?

Answer 10

for empiric therapy associated with wide variety of microorganisms

Question 11

clinically useful carbapenems

Answer 11

• Imipenem
• Meropenem
• Ertapenem
• Doripenem

Question 12

clinically useful carbapenems

Answer 12

• Imipenem
• Meropenem
• Ertapenem
• Doripenem

Question 13

what are carbapenems active against?

Answer 13

• gram negative rods (including Pseudomonas aeruginosa)
• gram positive bacteria
  -anaerobes

Question 14

list some carbapenems

Answer 14

• Imipenem (IV)
• Doripenem
• Ertapenem
• Metropenem

Question 14

list some carbapenems

Answer 14

• Imipenem (IV)
• Doripenem
• Ertapenem
• Metropenem

Question 15

what inactivates by renal dehydropeptidase (add cilastatin) and may cause seizures in patients with renal failure

Answer 15

Imipenem (IV)

Question 16

irritating and formulated with (1% lidocaine)

Answer 16

Ertapenem (IM/IV)

Question 17

are carbapenems cross reactive with penicillins?

Answer 17

yes

Question 18

mechanism of action of vancomycin

Answer 18

• Directly bind to the d-alanyl-d-alanine portion of the pentapeptide, which blocks the transpeptidation.
• It also inhibits a second enzyme,
  transglycosylase.

Question 19

clinical uses of vancomycin

Answer 19

• Effective agent against Pseudomembranous colitis
• Drug of choice for resistant infections such as MRSA and MRSE

Question 20

adverse effect of vancomycin where redness and rashes appear on the skin

Answer 20

red man syndrome

Question 21

bloodstream infections and endocarditis caused by (MRSA)

Answer 21

methicillin-resistant staphylococci

Question 22

combined with vancomycin for mengitidis caused by a penicillin-resistant strain of pneumococcus

Answer 22

combination with cefotaxime, ceftriaxone,
or rifampin

Question 23

adverse reaction of vancomycin that results in swelling or inflammation of the large intestine

Answer 23

pseudomembranous colitis (PO)

Question 24

another adverse reaction of vancomycin

Answer 24

red man syndrome

Question 25

mechanism of action of bacitacin

Answer 25

Prevent the dephosphorylation of the phospholipid that carries the peptidoglycan subunit across the cell membrane. This blocks the regeneration of the lipid carrier and inhibits cell wall synthesis.

Question 26

clinical use for bacitracin

Answer 26

for topical application to skin, wounds or mucous membranes

Question 27

mechanism of action for cycloserine

Answer 27

Inhibit cell wall synthesis by inhibiting the activity of alanine racemase and d-alanyl-d-alanine ligase.

Question 28

clinical uses of cycloserine

Answer 28

used as a second-line drug in the treatment of tuberculosis

Question 29

mechanism of action for polymyxins

Answer 29

Bind to cell membranes rich in phosphatidylethanolamine and destroying membrane functions of active transport and permeability barrier

Question 30

clinical use of polymyxins

Answer 30

were used primarily topically and rarely for systemic infections because of their toxicity and poor distribution to tissues

Question 30

clinically useful members of polymyxins

Answer 30

- Polymyxin E (colistin) - Polymyxin B

Question 31

act as cationic detergents (attach to and disrupt bacterial cell membranes); against gram (-) bacteria

Answer 31

Polymyxin B and E

Question 32

for multidrugresistant bacteria INHIBITOR OF PROTEIN SYNTHESIS

Answer 32

Colistin (polymyxin E)