drugs

Question 1

Carbapenems

Answer 1

A class of drugs that are the broadest spectrum of beta-lactams. G+/G-
reserved for resistant infections.

Question 2

Imipenem

Answer 2

-Class: Cardapenems
given with Cilastatin (primaxin) IV/IM
-resists most Beta-lactamases. 
-Increase the risk of C.difficile infection
-seizure (1.5%)

Question 3

Cilastatin (a drug given with imipenem)

Answer 3

inhibits a non beta-lactamase, dehydropeptidase, in kidney proximal tubules that normally metabolizes imipenem. This increases the levels of imipenem and prevents generation of a nephrotoxic metabolite

Question 4

Meropenem

Answer 4

Class: Carbapenems
not metabolized by dehydropeptidase
Fewer seizures (0.5%)

Question 5

Ertapenem

Answer 5

Class: Carbapenem

once a day dosing

Question 6

Doripenem

Answer 6

Class: carbapenem
injection for complicated intra-abdominal infections & UTIs.
NOT to be used for pneumonia; increased risk of death and decrease cute rates compared to imipenem/cilastatin

Question 7

General uses of Carbapenems

Answer 7

resistant infections:

• UTIs
• bone, joint and skin infections
• intra-abdominal & gynecological infections, bacterial septicemia
• lower respiratory tract infections

Question 8

What is Carbapenem-resistant Klebsiella pneumonia (CRKP)?

Answer 8

an infection that is being found in nursing homes and such that are effecting the elderly. (particularly patients on ventilators).

Question 9

Rx interactions for Carbapenems

Answer 9

decreases levels of valproic acid which increases the risk of seizures!

Question 10

Aztreonam

Answer 10

class: misc. Beta-lactams and other inhibitors of cell wall synthesis
- a monobactam with a stand alone b-lactam ring. Active only against G- aerobes.
- Resists most b-lactamases of G- organisms

Question 11

Mechanism of aztreonam

Answer 11

binds PCN-binding protein-3 (PBP-3) of G- bacteria creating long unstable filamentous bacteria that lyse.

• IV/IM excreted unchanged in urine
• adjust dose for renal failure.
• crosses inflamed meninges

Question 12

Vancomycin

Answer 12

class: misc. Beta-lactams and other inhibitors of cell wall synthesis
- IV for MRSA or nonresistant Staph if allergic to B-lactams.
- Not absorbed orally but has been used for local action for pseudomembranous colitis.

Question 13

Mechanism of Vancomycin

Answer 13

Binds to D-ala-D-ala terminus and prevents removal of terminal D-ala of pentapeptide chain attached to N-acteylmuramic acid residues of peptidoglycan.

Question 14

Side effects of Vancomycin

Answer 14

Ototoxicity
Nephrotoxicity
Red man syndrome- after rapid IV–>flushing upper body and face, hypertension, tachycardia and shock.

Question 15

Telavancin

Answer 15

class: misc. Beta-lactams and other inhibitors of cell wall synthesis
derived from vancomycin given IV as one time does for hospital acquired and ventilator-associated bacterial pneumonia from S.aureus only and for G+ complicated skin and skin structure infections.

Question 16

Mechanisms of Telavancin

Answer 16

1. inhibits cross linking
2. disrupts bacterial membrane potential and increases membrane permeability
   Net effect: Lysis
   potentially teratogenic. Avoid in pregnant women

Question 17

Oritavancin

Answer 17

class: misc. Beta-lactams and other inhibitors of cell wall synthesis
- single IV dose over 3 hrs for adults with acute bacterial skin and skin structure infections (ABSSSI) from susceptible G+ organisms including MRSA

Question 18

Mechanisms of Oritavancin

Answer 18

1. binds stem peptide of peptidoglycan precursors thus inhibiting polymerization
2. binds peptide brigding segments of cell wall thus inhibiting cross linking
3. disrupts membrane integrity…depolarization, increases permeability and cell death!

Question 19

Side effects of Oritavancin

Answer 19

headache, nausea, vomiting, diarrhea, limb and SQ abscesses.
Watch for C.diff induced colitis.

Question 20

Dalbavancin

Answer 20

class: misc. Beta-lactams and other inhibitors of cell wall synthesis
a cidal semisynthetic lipoglycopeptide for ABSSSI, Binds D-alanyl-D-alanine terminus of pepitdoglycan, prevents cross linking.

Question 21

Side effects of Dalbavancin

Answer 21

nausea, diarrhea, and headache.

Question 22

Bacitracin

Answer 22

class: misc. Beta-lactams and other inhibitors of cell wall synthesis
Vidal against various G+ cocci & bacilli
Nephrotoxic

Question 23

Mechanism of Bacitracin

Answer 23

lipid carrier transports the NAG/NAM complex to the outside of the cell where it is attached to the growing end of the peptidoglycan chain.

Question 24

Uses of Bacitracin

Answer 24

Topical for minor cuts and scrapes.

Ophthalmic ointment for ulcerative blepharitis and bacterial conjunctivitis due to various Gram +/- organisms.

Question 25

Fosfomycin

Answer 25

class: misc. Beta-lactams and other inhibitors of cell wall synthesis for short course treatment for uncomplicated UTIs in women

Question 26

Mechanism of Fosfomycin

Answer 26

Inhibits enolpyruvate transferase blocking the addition of phosphoenolpyruvate to UDP-N-acetylglucoasmine. The 2nd step in the synthesis of the Park Nucleotide Net effect: inhibition of the cell wall synthesis.

Question 27

Aminoglycosides

Answer 27

``` Class of drugs Amino sugars attached in glycoside links to an aminocyclitol ring. very polar given through IV some given orally to clean out bowel. ```

Question 28

Mechanisms of Aminoglycosides

Answer 28

enter periplasmic space for gram negative bacteria through porin channels. Pass through inner membrane by flowing down their electrochemical gradient. 1. inhibit initiation of protein synthesis 2. cause misreading got mRNA creating faulty proteins that insert into the membrane causing leakage and creating pores that facilitate Rx uptake

Question 29

Are Aminoglycosides effective against anaerobes?

Answer 29

No, because they pass through the inner cells membrane by flowing down their electrochemical gradient created by the ETC. As anaerobes they do not have an ETC and thus cannot pass through the cell membrane.

Question 30

Mechanism of Aminoglycosides Syngergism

Answer 30

inhibiting cell wall synthesis, B-lactams facilitate penetration of ahminoglycosides Mostly vs. G- and G+ coverage. b-lactams for synergism

Question 31

Gentamicin

Answer 31

Class of aminoglycosides topical cream/ointment for burns, wounds and prevent catheter infections. ophthalmic for superficial ocular infections.

Question 32

Tobramycin

Answer 32

Class of ahminoglycosides generally interchangeable with gentamicin. possibly less ototoxic than gentamicin IV.

Question 33

Amikacin

Answer 33

Class of amino glycoside Enzyme resistant. IV: For nosocomial infections that resist gentamicin and tobramycin

Question 34

Streptomycin

Answer 34

Class of aminoglycosides...IV

Question 35

Kanamycin

Answer 35

Class of ahminoglycosides | rarely used....IV

Question 36

Neomycin

Answer 36

Class of aminoglycosides....oral. Oral prep for bowel surgery. topical antiinfectant

Question 37

Parmomycin

Answer 37

to kill cysts of Entamoeba histolytic which cause amebic dysentery

Question 38

Side effects of Aminoglycosides

Answer 38

can cause NEUROMUSCULAR Block leading to respiratory paralysis during anesthesia when also using a neuromuscular blocker.