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Pharmacology > L24: Other Cell Wall and Membrane Agents > Flashcards

L24: Other Cell Wall and Membrane Agents Flashcards

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1
Q

Aztreonam is the only drug that belong to which of the following groups….
A. Carbapenems
B. Monobactam

A

B. Monobactam

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2
Q

Ertapenem, Meropenem, and Imipenem + Cilastatin belong to which of the following groups?
A. Carbapenems
B. Monobactam

A

A. Carbapenems

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3
Q

_____, a monobactam that is useful for allergies, is active against Gram (-)
aerobic organisms but has NO activity against Gram (+) or Anaerobes
A. Ertapenem
B. Meropenem
C. Aztreonam

A

C. Aztreonam

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4
Q

Aztreonam is not cross allergenic with other β-lactams, except ____

A

ceftazidime

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5
Q

The inhaled nebulizer form of Aztreonam is used for..
A. P. aeruginosa in CF pts
B. UTI’s
C. Seasonal allergies

A

A. P. aeruginosa in CF pts

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6
Q

Neutropenia and GI symptoms are side effects of which type of Aztreonam administration?
A. Parenteral
B. Inhalation

A

A. Parenteral

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7
Q

True or False: Aztreonam can be used to treat serious infections, such as: UTIs, abdominal/gynecological infections, pneumonia, meningitis, or sepsis

A

True

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8
Q

Imipenem, Meropenem, Ertapenem belong to which group?
A. Carbapenems
B. Monobactam

A

A. Carbapenems

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9
Q

Which of the following Carbapenems is degraded by dehydropeptidases?
A. Imipenem
B. Meropenem
C. Ertapenem

A

A. Imipenem

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10
Q

____: Imipenem formulated with cilastatin to
inhibit dehydropeptidase

A

Primaxin

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11
Q

Which of the following Carbapenems has greater Gram (-) activity and less gram (+) activity compared to Imipenem?

A. Imipenem
B. Meropenem
C. Ertapenem

A

B. Meropenem

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12
Q

Which of the following Carbapenems does NOT enter CNS, is NOT used for P. aeruginosa, and is not typically used for empiric
therapy?

A. Imipenem
B. Meropenem
C. Ertapenem

A

C. Ertapenem

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13
Q

True or False:Carbapenems are oral agents with exceptionally broad spectra

A

False - carbapenems are PARENTERAL agents with exceptionally broad spectra

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14
Q

True or False: Carbapenems are active against E. faecalis (gram +) while inactive against
E. faecium and ORSA

A

True

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15
Q

True or False: Carbapenems are only active against Gram (+) and Gram (-) microbes

A

False - also Anaerobes!

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16
Q

Carbapenems are mostly reserved for nosocomial infections, but they can be combined with
____ for Pseudomonas treatment

A

aminoglycoside

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17
Q

____ alters membrane protein responsible for drug transport to keep carbapenems out.

However, there’s no cross resistance because they use different channel
than other beta lactams.

A

Pseudomonas

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18
Q

True or False:
Monobactams are agents of choice in organisms expressing ESBLs

A

False – Carbapenems!

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19
Q

Carbapenems have a dual MOA, which combines strong inhibition of ___ with inhibition of ___ enzymes

A

PBP (penicillin binding protein) and b-lactamase

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20
Q

Carbapenems are unaffected by, or even inhibit many β-lactamases, including some ___

A

ESBL’s

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21
Q

Carbapenems are vulnerable to carbapenamases
(e.g.Klebsiella pneumo carbapenemase, KPC) and some metallo-β-lactamase.

How can you overcome this?

A

Combine carbapenem with new beta lactamase inhibitors

(vaborbactam, relebactam)

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22
Q

Why can carbapenems cause seizures?

A

Can enter CNS

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23
Q

Risk of C. difficile
infection is higher with
broad spectrum
antibiotics such as
______
A.
B.
C.

A

C. carbapenems

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24
Q

Risk of C. difficile
infection is higher with
broad spectrum
antibiotics such as
______
A. Monobactam
B. Relebactam
C. Carbapenems

A

C. Carbapenems

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25
Which carbapenem is most apt cause AE (e.g seizures)? A. Ertapenem B. Imipenem C. Meropenem
B. Imipenem
26
True or False: Pseudomembranous colitis is an AE associated with Monobactams
False - Pseudomembranous colitis is an AE associated with Carbapenem !!!!
27
___ is a cell wall inhibitor of gram-(+) organisms, as well as bactericidal, that prevents peptidoglycan crosslinking by binding to terminal D-alanyl-D- alanine moieties A. Dalbavancin (Dalvance®) B. Bacitracin C. Polymyxin B D. Vancomycin
D. Vancomycin
28
For Vanco, resistance mechanisms involve altered peptidoglycan structure from alanine to ____
lactate
29
Vanco exhibits intermediate resistance, what does this mean??
Creates thicker walls to sequester drug
30
Why are Gram (-) bacteria not affected by Vanco??
Too large to penetrate OM
31
True or False: Vanco is a drug of last resort for strains highly resistant to beta-lactams. If it is sensitive fo beta-lactam, you should NOT use it
False - Vanco is a drug of last resort for strains highly resistant to beta-lactams. If it is sensitive fo beta-lactam, you SHOULD use it
32
____ is standard treatment for ORSA (including: endocarditis). However, it can be given orally for C. dif in the gut or IV for catheters, spinal meningitis, or enterococcus infection
Vanco
33
For systemic therapy, vancomycin is given by ____ ___ infusion A. Slow, IM B. Fast, IM C. Slow, IV D. Fast, IV
C. Slow, IV
34
Under which conditions will Vanco get into the blood stream? the CNS?
CNS - High dose - Inflamed meninges BS - High dose - Inflamed GI
35
_____: drug- induced release of histamine.This is not an allergic reaction, not involve IgE. Prevented by gradual Vanco infusion over several hours
Red man syndrome
36
True or False: Ototoxicity and Nephrotoxicity (Mississippi mud) are AE associated with vanco
True
37
_____: is a lipoglycopeptide derivative of vancomycin, has BBW for nephrotoxicity, and treats skin infections caused ORSA (Gram +) A. Dalbavancin B. Telavancin C. Bacitracin
B. Telavancin
38
____ is a glycopeptide notable for long half life (8.5 days), which treats ORSA and Staph that is resistant to vancomycin A. Dalbavancin B. Telavancin C. Bacitracin D. Vancomycin
A. Dalbavancin
39
Bacitracin— a mixture of polypeptides produced by Bacillus subtilis—inhibits _____ reactions necessary for cell wall synthesis A. deamination B. phosphorylation C. dephosphorylation C. alkylation
C. dephosphorylation
40
Which of the following works via: prevention of transport of cell wall materials to site of synthesis? A. Dalbavancin B. Telavancin C. Bacitracin D. Vancomycin
C. Bacitracin
41
___ and ___ are resistant to Bacitracin
1) Enterobacteriaceae 2) Pseudomonas
42
Why is Bacitracin commonly given topically?
IV results in severe nephrotoxicity
43
Three primary uses of Bacitracin?
1) C. difficile colitis - oral 2) Conjunctivitis 3) Irrigate meninges
44
____ are cationic detergents that destabilize the Gram (-) cell membrane AND increase bacterial cell permeability
Polymyxins
45
____ is a mixture derived from Bacillus polymyxa ____ is polymyxin E, from Bacillus colistinus A. Polymyxin B; Colistin B. Colistin; Polymyxin B
A. Polymyxin B; Colistin
46
True or False: Neosporin is a formulation of neomycin, bacitracin, and polymyxin B
True
47
____ can be: topical, ophthalmic, otic, parenteral ______: parenteral only! A. Polymyxin B; Colistin B. Colistin; Polymyxin B
A. Polymyxin B; Colistin
48
Parenteral dosing of ____ are the last resort for drug resistant gram (-) meningitis, respiratory, septicemia, UTI
Polymyxins
49
What are the two primary AE associated with polymyxins?
1) Neurotoxicity 2) Nephrotoxicity
50
____ inhibits early step in cell wall synthesis and is an analogue of phosphoenolpyruvate A. Vancomycin B. Fosfomycin C. Polymyxin B or E D. Daptomycin
B. Fosfomycin
51
Which of the following drugs inhibits enolpyruvate transferase to BLOCK synthesis of UDP-N-acetylglucosamine, a cell wall component + precursor of N-acetylmuramic acid?? A. Vancomycin B. Fosfomycin C. Polymyxin B or E D. Daptomycin
B. Fosfomycin
52
Which of the following is active against gram (+/-) + is used for uncomplicated E. coli and Enterococcus faecalis UTIs?? A. Vancomycin B. Fosfomycin C. Polymyxin B or E D. Daptomycin
B. Fosfomycin
53
Fosfomycin achieves high concentration in and is in pregnancy cat B: A. blood B. urine C. saliva D. feces
B. urine
54
____ is a pore-forming membrane destabilizer of gram-positive bacteria. Involves calcium-dependent insertion into membrane, leads to DEPOLARIZATION, loss of membrane integrity, and leaking of K+, ATP, etc. A. Vancomycin B. Fosfomycin C. Polymyxin B or E D. Daptomycin
D. Daptomycin
55
Uses of Daptomycin?
1) Resistant strains of MRSA, VRE 2) Complicated staph/strep skin infections 3) Bacteremia, endocarditis
56
True or False: Daptomycin is given IM and can be used use for community-acquired pneumonia
False - given IV and can NOT be used use for community-acquired pneumonia
57
Why does one have dark brown urine with Daptomycin use? Why does this occur?
High amounts of myoglobin - Toxic to muscle
58
True or False: Most cell-wall targeted agents are β-lactams that use their resemblance to peptidoglycan to inhibit bacterial enzymes
True
59
True or False: Bacteria can express β-lactamases and alter their PBPs to escape
True
60
β-lactamase inhibitors can be paired with ____ abx to increase their spectrum and efficiency
β-lactam antibiotics

Pharmacology (53 decks)

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