Exam 2: Inhibitor Of Cell Wall Synthesis I

Question 1

What is the composition of peptidoglycan?

Answer 1

• A backbone of alternating sugars, NAGs and NAMs
• A chain of 4 amino acids links to NAM
• A peptide bridge that cross links the tetrapeptide chains

Question 2

What is the target of all Beta Lactam antibiotics?

Answer 2

Penicillin binding proteins

Question 3

What is the enzyme that facilitates transglycosylation and transpeptidation?

Answer 3

Penicillin binding protein

Question 4

What causes cell death from antibiotics that inhibit cell wall synthesis?

Answer 4

Osmotic lysis

Question 5

What is transglycosylation?

Answer 5

Joining of the NAG and NAMs together

Question 6

What is transpeptidation?

Answer 6

Forming cross links of pentapeptides

Question 7

What are the 5 areas that inhibitors of cell wall synthesis target?

Answer 7

1) transglycosylation
2) transpeptidation
3) NAG reduction to NAM
4) transport across the inner membrane
5) Amino acid mimicry

Question 8

What are the natural penicillins?

Answer 8

Penicillin B
Penicillin V
Benzathine penicillin
Proclaine Penicillin G

Question 9

What are the penicillinase resistant penicillins?

Answer 9

Nafcillin
Dicloxicillin
Oxacillin
*Methicillin

Question 10

What are the extended spectrum pencillins?

Answer 10

Ampicillin

Amoxicillin

Question 11

What are the antipseudomonal penicillins?

Answer 11

Piperacillin

Ticarcillin

Question 12

What does pencillinase do?

Answer 12

It binds to the beta-lactam ring and hydrolyzes the ring, inactivating the antibiotic

Question 13

What has the highest antibacterial activity against certain G+ bacteria, including anaerobic bacteria?

Answer 13

Natural penicillins

Question 14

What are natural penicillins inactivated by?

Answer 14

B-lactamase (penicillinase)

Question 15

How are natural penicillins elimated from the body?

Answer 15

Active transport in the kidney

Question 16

If an drug is acid resistant, what should the route of administration be?

Answer 16

PO

Question 17

Do natural penicillins have antipseudomonal activity?

Answer 17

No.

Question 18

What type of bacteria are penicillinase resistant pencillins effective against?

Answer 18

G positive, but lower activity when compared to natural penicillins.
-No antipseudomonal activity

Question 19

How are penicillinase resistant penicillins excreted from the body?

Answer 19

Hepatic metabolism and renal excretion

Question 20

What is the mechanism of resistance for MRSA?

Answer 20

It produces an alternate PBP, which decreases the affinity of B-lactam antibiotics for PBPs

Question 21

Can B-lactams be used to treat MRSA?

Answer 21

No, except for ceftaroline

Question 22

What kind of bacterial do extended spectrum penicillins work on?

Answer 22

• Extended G- coverage (E. Coli, salmonella, shigella, H influenzae).
• Lower G+ coverage
• No antipseudomonal activity

Question 23

What is the drug of choice for lysteria infections?

Answer 23

Extended spectrum penicillins (Ampicillin, Amoxicillin)

Question 24

What are the 4 types of B-lactam antibiotics?

Answer 24

Penicillins, cephalosporins, monobactrams, and carbapenems

Question 25

Are extended spectrum penicillins acid resistant? What does this mean?

Answer 25

Yes, they are taken orally

Question 26

What ampicillin rash?

Answer 26

A generalized dull maculopapular rash generally appearing 3-14 days after the start of therapy. This is not an allergic or hypersensitivity reaction and patient does not need to be taken off of the ampicillin

Question 27

What bacteria do antipseudomonal penicillins target?

Answer 27

Major use is for pseudomonas aeruginosa and acinetobacter (lethal), but also targets bacteria covered by extended spectrum penicillins plus some additional enteric gram negative bacilli.

Question 28

How are antipseudomonal penicillins excreted?

Answer 28

Renal excretion

Question 29

Are antipseudomonal penicillins acid resistant? What does this mean?

Answer 29

No they are acid sensitive, they must be taken parenterally

Question 30

When treating P. Aeruginosa with an antipseudomonal penicillin, what else should be given to avoid resistance?

Answer 30

Aminoglycosides

Question 31

What does the addition of a beta lactamase inhibitor do to antibiotics such as ampicillin, amoxicillin, or piperacillin?

Answer 31

It extends the spectrum because it doesn’t let beta lactamase break down the drug

Question 32

If you have a combination product with a beta lactamase inhibitor, will it work against MRSA?

Answer 32

Nope

Question 33

What Beta lactamase inhibitor is ampicillin normally paired with?

Answer 33

Sulbactam, which forms Unasyn

Question 34

What Beta lactamase inhibitor is amoxicillin normally paired with?

Answer 34

Clavulanic acid, which formed augmentin

Question 35

What Beta lactamase inhibitor is piperacillin normally paired with?

Answer 35

Tazobactam, which forms Zosyn

Question 36

What Beta lactamase inhibitor is Ticarcillin normally paired with?

Answer 36

Clavulanic acid, which forms Timentin

Question 37

What are the toxicities that penicillin can have?

Answer 37

- Allergy - electrolyte imbalance - GI disturbance - Superinfection

Question 38

What are the 5 pharmacokinetic factors of penicillins?

Answer 38

1) good tissue penetration 2) bad CNS penetration 3) mostly renal elimation (except for penicillinase resistant) 4) filtration and tubular excretion 5) Probenecid inhibits renal elimination

Question 39

What prescriptions are given for H. Pylori (Gram -)?

Answer 39

Bismuth + metronidazole + tetracycline or amoxicillin

Question 40

What prescriptions are given for lysteria (gram +) species?

Answer 40

Ampicillin and possibly aminoglycosides

Question 41

How is strep pneumoniae (gram +)treated?

Answer 41

Penicillin

Question 42

How is strep pyogenes (gram +)treated?

Answer 42

Penicillin and Clindamycin

Question 43

How is strep agalactiae (gram +) treated?

Answer 43

Penicillin and possible aminoglycosides

Question 44

How is Viridans strep (gram +)treated?

Answer 44

Penicillin

Question 45

How is methicillin resistant bacteria (gram +) treated?

Answer 45

Vancomycin

Question 46

How are the leptospira and treponema species (spirochetes) treated?

Answer 46

Penicillin

Question 47

How is early Borrelia Burgdorferi treated?

Answer 47

Amoxicillin

Question 48

What is the DOC for N. Meningitides, S. Pneumoniae, Strep A and B, enterococcus, Actinomyces, Leptospira, and treponema?

Answer 48

Natural penicillins

Question 49

What is the DOC for Beta lactamase staphylococcus aureus (MSSA)?

Answer 49

Penicillinase resistant pencillins (Nafcillin, Dicloxacillin, Oxacillin)

Question 50

What is the gold standard antibiotic treatment for G+ infections?

Answer 50

Natural Penicillins

Question 51

What are the three other antibiotics that are cell wall inhibitors, but not B-lactams?

Answer 51

- Vancomycin - Bacitracin - Fosfomycin