Diebel Drugs!

Question 1

what is the central structure of cell wall inhibitors?

Answer 1

thiaziolidine ring + beta lactam ring + variable side chain

Question 2

How do cell wall inhibitors stop cross linking of cell wall?

Answer 2

Bacteria pick up beta lactam ring. Thaizolidine ring gets locked into active site. Covalenet bond forms in active site and blocks transpeptidation.

Question 3

What cell wall inhibitors are penicillinase resistant?

Answer 3

Dicloxacillin, Nafcillin, Methicillin, Oxacillin.

Question 4

What cell wall inhibitors are antipseudomonal?

Answer 4

Piperacillin

Ticarcillin

Question 5

How do cephalopsorins work?

Answer 5

Have distinct outside ring from pencillin - trick transpeptidase into picking it up and blocks cell wall formation.

Question 6

Cephalosporins

absorption?

Renal clearace?

cross reactive?

Answer 6

poorly absorbed in small intestine.

Renal clearance except ceftriaxone.

Yes, do not take with strong hypersensitivity to penicillin.

Question 7

Side effects of cephalosporins:

Answer 7

Pseudomembrane colitis.

Hypersensitivity.

+ coombs test - type II hypersnesitivity

Question 8

1st generation cephalosporins

Answer 8

cefazolin

cephalexin

work against gram + cocci, some gram negative

Question 9

2nd gen Cephalosporins

Answer 9

Cefaclor, Cefoxitin, Cefuxorxime

more broad - target more gram negative.

Question 10

3rd gen Cephalosporins

Answer 10

Cefotaxime, Ceftazdime, Ceftriaxone

gram+, gram -, enteric bacteria w/beta lactamses.

Question 11

4th gen Cephalosporins

Answer 11

cefepime

gram +, gram - , pseudomonas

Question 12

5th gen Cephalosporins

Answer 12

Ceftaroline

MRSA

Question 13

What do the cephalsporins not cover against?

Answer 13

LAME

L=listeria

A = atypicals (mycoplasma, chlaydmia)

M = mrsa except fifth

E = enterococci

Question 14

How do carbapenems work?

Answer 14

block transpeptidase rxn and cell wall formation.

BacteriCIDAL.

Question 15

when are carbapenems used

Answer 15

in hosptials whne other antibiotics aren’t working. Broad spectrum.

Beta-lactamase resistant.

Question 16

Side effects of carbapenems:

Answer 16

GI distress.

Skin rash.

CNS toxicity.

cross reactive w/penicillins

Eosinophilia.

Seizures in elderly.

Question 17

Why must imipenem be adminstered w/cilastatin?

Answer 17

block renal dihydropeptidase I to decrease inactivation of drug.

Question 18

How does vancomycin work?

Answer 18

inhibits cell wall synthesis by binding to D-alanyl-D-alaine precursors.

Blocks peptidoglycan polyermization - transglycoslyation.

Question 19

Side effects of vanco:

Answer 19

Red man syndrome - flushing, hypotension, pruritis

Renal function impairment

Question 20

How does linezolid work?

Answer 20

binds to 50S subunit of ribosome - prevents it from being put together & blocks initiation complex formation.

CIDAL but static at low concentrations.

Question 21

What does linezolid work against?

Answer 21

gram +

MRSA

VRE

4 MRSA if vanco fails

Question 22

side effects of linezolid

Answer 22

Bone marrow suppression

GI intolerance

Headache

Question 23

Resistance to linezolid?

Answer 23

point mutation in ribosomal RNA.

Question 24

How do tetracyclines work?

Answer 24

Stop protein synthesis by binding to 30S subunit and preventing attachment of aminoacyl-tRNA.

STATIC.

limited CNS penetration

Question 25

What are tetracycline drugs used for?

Answer 25

Boreelia burgdorferi. Mycoplasma pneumonia. Intracellular bugs - ricketsia, chlamydia.

Question 26

Side effects of tetracyclines:

Answer 26

**NOT w/pregnancy.** not with antacids or milk. GI distress. Teeth discoloration and bone growth stopping in **kids**. Photosensitivity.

Question 27

How do **macrolide drugs work?**

Answer 27

Inhibit **translocation** by binding to the 23S RNA of the **50S subunit - prevents elongation of the peptide chain** Bacteriostatic.

Question 28

What tetracycline drug can be used with renal failure?

Answer 28

Doxycyline - it's fecally eliminated

Question 29

What is the resistance of tetracyclines?

Answer 29

Decreased **uptake**. increased **efflux** by **bacterial plasmid** encoded transport pumps.

Question 30

What are examples of macrolide drugs?

Answer 30

Azithromycin Clarithromycin Erythromycin

Question 31

What do macrolides work against?

Answer 31

Atypical pneumonias - mycoplasma, Chlamydia, Legionella. STIs - chlmaydia Gram + cocci (strep infections w/penicilin allergy) Bordetella pertussis.

Question 32

What is the resistance of macrolides?

Answer 32

methylation of 23S rRNA binding site that prevents drug binding.

Question 33

Side effects of macrolides

Answer 33

GI intolerance. Arrhythmia - prolonged QT hearing loss (reversible) metallic taste. increase concnetration of theophylline and coagulants. clarith and eryth inhibit cyp450.

Question 34

how do quinolones work?

Answer 34

Bind to **bacterial DNA gyrase and topoisomerase IV** - leads to formation of double strand breaks preents relaxation of + supercoils infterferes with separation of DNA into daughter cells during cell division. CIDAL

Question 35

What are quinolones used for?

Answer 35

gram negative bacilli. enterobacteriaceae Haemophilus. Neisseria Moraxella catarhalis. p. aeruginosa (levofloxacin) Staphylococci.

Question 36

What are teh side effects of quinolones?

Answer 36

GI AE. **not w/pregnancy** confusion - pentrates CNS. C. diff candida vaginitis. cartilage damage tendon rupture in \> 60 + prednisone

Question 37

What shouldn't you take while on quinolones?

Answer 37

antacids - chelates cations like Ca, Fe, Al, and Zi Avoid diary and Ca fortified juice.

Question 38

How do **oseltamivir and zanamivir** work?

Answer 38

Inhibit **NA enzyme** leading to decreased virus release. Must use early in infection.

Question 39

Oseltamavir Use (age) Side effects

Answer 39

1 year older and with pregnancy GI, headache, fatigue.

Question 40

Who can you use Zanamivir with?

Answer 40

7 or older not w/COPD or asthma