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Cell wall and membrane active antibiotics Flashcards

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1
Q

List the B lactams

A
  • Penicillins
  • cephalosporins
  • carbapenams
  • mono act and
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2
Q

What are the naturally occurring penicillins

A

Penicillin G and penicillin V

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3
Q

What’s penicillin G mode of administration

A

IV and IM

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4
Q

What is penicillin V mode of administration

A

Oral

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5
Q

What’s the mechanism of action of natural penicillins

A

Bind to penicillin binding proteins to block cross linking of peptidoglycan in cell wall

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6
Q

What are the uses of natural penicillins

A

Against gram + organisms, some gram - mainly N meningitidis and spirochete T pallium (Blactamase sensitive)

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7
Q

Natural penicillins adverse effects

A

Drug induced interstitial nephritis, hypersensitivity reactions

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8
Q

What is penicillin G indicated for

A

Erysipleas by S pyogens
Gas gangrene by C perfringes
Endocarditis by S viridans

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9
Q

List the antistaphylococcal penicillins

A

Nafcillin
Dicloxacillin
Cloxacillin
Methicillin

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10
Q

antistaphylococcal penicillins mechanism of action

A

Same as natural penicillins

Bind to penicillin binding proteins to block cross linking of peptidoglycan in cell wall

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11
Q

antistaphylococcal penicillins indications

A

Given for S aureus except MRSA

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12
Q

Why can’t antistaphylococcal penicillins work on MRSA

A

They have altered PBP

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13
Q

Why are antistaphylococcal penicillins resistant to B lactamase

A

They have Bulky R group blocking access to B lactam

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14
Q

antistaphylococcal penicillins adverse effects

A

Hypersensitivity and interstitial nephritis

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15
Q

List extended spectrum penicillin

A

Amoxicillin

Ampicillin

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16
Q

Amoxicillin mode of administration

A

Oral

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17
Q

Ampicillin mode of administration

A

I.V

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18
Q

What are extended spectrum penicillin sensitive to?

A

Penicillinase

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19
Q

How to protect extended spectrum penicillin against B lactamases

A

By combining them with B lactamases inhibitors like (Clavulanic acid and sulbactam)

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20
Q

What are extended spectrum penicillin given for ?

A

Giver for HHELPSS

  • H influenza
  • H pylori
  • E coli
  • listeria monocytogenes
  • proteus mirabilis
  • shigella
  • salmonella
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21
Q

What makes augmentin

A

Amoxicillin + clavulanic acid

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22
Q

What makes Unasyn

A

Ampicillin + sulbactam

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23
Q

List antispeudomonal penicillins

A

Ticarcillin

Piperacillin

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24
Q

Which B lactamase inhibitor ticarcillin

A

Clavulunic acid

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25
Which B lactamase inhibitor piperacillin
Tazobactam
26
Why do we add B lactamase inhibitors to antispeudomonal penicillins
They are B lactamase sensitive
27
Antispeudomonal penicillins clinical uses
Given for P arguenosa and gram - rods
28
List all B lactamase inhibitors
``` CAST Clavulanic acid Avibactam Sulbactam Tazobactam ```
29
Piperacillin + tazobactam gives coverage against
Bacteroides species
30
What also covers bacetroides species
Ampicilin and sulbactam
31
What does Hyper sensitivity to penicillin presents with
Skin rash Urticaria Anaphylactic shock
32
Adverse effects of penicillins
Drug induced Coombs + haemolytic anemia Nephritis -> methicillin Neurotoxicity
33
Penicillin x cephalosporins cross reactivity
Patents with penicillin allergy can be safely given cephalosporins if—> 1- allergy is not suggestive of IgE mediated 2- reaction occurred more than 10 years ago
34
What are cephalosporins
B lactam drugs that inhibit cell wall synthesis; but less susceptible to penicillinase
35
List the Bacteria not covered by 1st to 4th generation of cephalosporins
``` LAME Listeria monocytogenes Atypicals MRSA Enteroccoci ```
36
What are the drugs of first generation cephalosporins
Cefazolin and cephalexin
37
What is first generation cephalosporins used for
Gram + cocci and PEcK ( proteus mirbilis, E. coli, klebsiella)
38
What is cefazolin specially used for
It is used before surgery to prevent S aureus wound infection
39
What are the drugs of second generation cephalosporins
Cefuroxime, Cefozitin and Cefotetan
40
What are second generation cephalosporins used for
Gram + cocci and PEcK ( proteus mirbilis, E. coli, klebsiella) and HENS ( H influenza, Entrobacter, Neisseria and Serratia)
41
What does cefoxitin and cefotetan cover on their own while other second generation doesn’t cover
B. Fragilis
42
What are the third generation cephalosporins
Ceftriaxone and ceftazidime
43
What are third generation cephalosporins used for
Serious gram negative infections resistant to other B lactamas
44
Special characteristic of ceftriaxeone and clinical uses due to it
Can cross BBB to CSF to treat meningitis, gonorrhea and Lyme disease
45
What is Cefotaxime
It’s a 3rd generation cephalosporins that acts like Ceftriaxeone
46
Special characteristic of Ceftazidime
Works agains Pseudomonas arugenosa
47
What are the drugs of fourth generation cephalosporins
Cefepime
48
What are the 4th generation cephalosporins used for
They have increased activity against Pseudomonas
49
What are the drugs of 5th generation cephalosporins
Ceftaroline
50
What is ceftaroline 5th generation cephalosporins used against
It covers MRSA
51
Cephalosporins adverse effects
Disulfram like reaction, allergic reaction and nephrotoxicity
52
What happens in disulfram like reactions
Disulfram blocks aldehyde dehydrogenase —> build up of acetaldehyde
53
What drugs cause disulfram like reactions
Cephalosporins, sulfonamides and metronidazole
54
Why should we not take cephalosporins with aminoglycosides
Because that increases nephrotoxicity
55
What are the drugs of carbapenams
``` DIME Doripenem Imipenem Meropenem Ertapenem ```
56
When are carbapenams given
Given when there is a 10/10 life threatening infection
57
Carbapenams mechanism of action
Imipenem is a broad spectrum B lactamase resistant carbapenem
58
What are carbapenams always administered with and why
Cilastin - it inhibits dihydropeptidase to decrease metabolism of drug in renal tubules to reduce nephrotoxicity
59
Carbapenems adverse effects
They can cause seizures
60
Which drugs are monobactam
Aztreonam
61
What is azetreonam a monobactam active against
Aerobic gram negative bacilli, resistant to B-lactamases
62
Vancomycin mode of administration
IV
63
When is vancomycin given orally
Exclusively given orally for pseudomembranous colitis
64
Vancomycin mechanism of action
Inhibits cell wall peotidoglycan formation by binding to D-ala-D-ala
65
How can bacteria become resistant to vancomycin
By altering their D-ala-D-ala to D-ala-D-lac
66
Vancomycin clinical uses
Active against gram positive only —> MRSA, streptococci, entrococci and C. Difficile
67
Vancomycin adverse effects
Nephrotoxicity, ototoxicity and red man syndrome
68
Which bacteria has emerging resistance against vancomycin
Enterococcus fascium
69
What is bacitracin used for
Gram positive bacteria like Staph and strep
70
What is fosfomycin mechanism of action
Blocks cell wall synthesis by inhibiting enolpyruvate transferase
71
Which drug can be given to pregnant women with UTI?
Fosfomycin
72
Fosfomycin clinical uses
UTI by Ecoli and E. decal is and FIRST LINE for acute cystitis
73
Daptomycin mechanism of action
It’s a bacteriocidal, lipopeptide that disrupts cell membrane of gram + cocci by creating transmembrane channels
74
What is used for skin infections by MRSA
Daptomycin daily I.V
75
DAPTOMYCIN clinical uses
Used in MRSA, VRE - vancomycin resistant enterococci -> not used for pneumonia
76
Daptomycin side effects
Myopathy and rahbdomyolysis
77
List the polymyxin drugs
Polymyxin B and E
78
What is another name for polymyxin E
Colistin
79
Polymyxin mechanism of action
Disrupts cell membrane integrity causing leakage of cellular components
80
Polymyxin clinical uses
Against gram negative bacteria | - multi drug resistant gram negative bacteria !!
81
Polymyxins adverse effects
Nephrotoxicity, neurotoxicity and respiratory failure

Pharmacology (33 decks)

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