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Anti-Infectives Exam 2 > Lecture 1 - Clinically relevant organisms & Penicillins > Flashcards

Lecture 1 - Clinically relevant organisms & Penicillins Flashcards

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1
Q

For antibiotic to work….

A
  1. Enter bacterial cell
  2. reach its site of action
  3. bind to target that is involved in essential bacteria function
  4. significantly impair that function
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2
Q

Gram + Peptidoglycan layer is….

A

thick

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3
Q

Gram - Peptidoglycan layer is….

A

thin

have some other layers too on outer & inner sides

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4
Q

Enzymes vital for cell wall synthesis, cell shape, and structural integrity are…

A

Penicillin binding proteins

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5
Q

Gram - structure

A

Outer membrane (contains LPS, porins)

Periplasmic space = between inner/outer membrane (location of beta-lactamases)

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6
Q

Gram + color

A

purple

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7
Q

Gram - color

A

pink

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8
Q

Gram +, Aerobic, Cocci, Clusters, Coagulase +

A

Staphylococcus aureus

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9
Q

Gram +, Aerobic, Cocci, Clusters, Coagulase -

A

Other Staphylococcus species

  1. epidermis
  2. hominis
  3. haemolyticus
  4. capitus
  5. saprophyticus
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10
Q

Gram +, Aerobic, Pairs & Chains

A

Streptococcus spp.

Enterococcus spp.

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11
Q

Gram +, Aerobic, Rods

A

Listeria

Nocardia

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12
Q

Gram +, Anaerobic, Cocci

A

Peptostreptococcus

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13
Q

Gram +, Anaerobic, Rods

A

Clostridium spp. (spore-forming)
Propionibacterium
Actinomyces

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14
Q

Gram -, Aerobic, Rods, Lactose-fermenting

A

Enterobacteriaceae family (gut bacteria)

  1. Escherichia coli
  2. Klebsiella pneumoniae
  3. Enterobacter spp.
  4. Proteus mirabillis
  5. Salmonella spp.
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15
Q

Gram -, Aerobic, Cocci

A

Neisseria meningitidis
Neisseria gonorrhoeae
Moraxella catarrhalis

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16
Q

Gram -, Aerobic, Rods, Non-lactose fermenting

A

Non-enterobacteriaceae (usually nosocomial pathogens)

  1. Pseudomonas aeruginosa
  2. Acinetobacter baumannii
  3. Stenotrophomonas maltophilia
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17
Q

Gram -, Anaerobic, Rods (Bacilli)

A

Bacteroides spp.
Prevotella
Fusbacterium

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18
Q

Clinically important Atypical Organisms

A

Chlyamydia spp.
Mycoplasma spp.
Legionella spp.

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19
Q

Chlyamydia spp.

A

C. pneumonia

C. trachomatis

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20
Q

Mycoplasma spp.

A

M. pneumonia

M. genitalium

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21
Q

Legionella spp.

A

L. pneumophilia

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22
Q

4 Classes of Beta-Lactams

A

Penicllins
Cephalosporins
Carbapenems
Monobactam

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23
Q

Natural Penicillins

A

Penicillin G = IV
Benzathine Penicillin = IM
Penicillin V Potassium = PO

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24
Q

Natural Penicillins MOA

A
  1. Bind to penicillin binding proteins

2. Inhibit cross-linking of peptidoglycan in cell wall

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25
Natural Penicillins MOR
1. Beta-lactamase enzymes destroy abx (Gram -) 2. Failure to penetrate outer membrane n reach site ( Gram - ) 3. Pumped out of cell via pump ( Gram - ) 4. Alteration of binding site ( Gram + )
26
Natural Penicillins Spectrum of Activity (Gram +)
Pen G = good v E. faecalis Pen VK = not good v E. Faecalis Limited/no activity vs S. aureus ** Treatment of choice for susceptible Strep spp.**
27
Natural Penicillins Spectrum of Activity (Gram - )
Minimal activity some activity against susceptible Neisseria meningitidis No activity for Atypical
28
Natural Penicillins Spectrum of Activity (Anaerobes)
Good against Gram + anaerobes (oral flora) - Actinomyces spp. - Peptostreptococci - Propionibacterium acnes ** Txm of choice against Clostridium perfringens ** Limited activity Gram - anaerobes due to resistance
29
Natural Penicillins Spectrum of Activity (other)
** Txm of choice for Syphillis ** Spirochete, Treponema pallidum If severe drug allergy, can use alternative agent for non-CNS disease If neuropathy/ocular-syphilis, will desensitize to Penicillin and give
30
Natural Penicillins M & E
1. substrates of OTA 1/3 2. Poor pen across BBB 3. 1/2 life in normal renal function = 30-60min, q4h or continuous IV Excreted in urine, mostly unchanged...req renal adjustment
31
Natural Penicillins ADE
CNS, seizures at high doses Hematologic = neutropenia Hypersensitivity Renal - AIN, Renal tubular disease
32
Natural Penicillins Drug Interactions
Drugs that interact w/ OTA 1/3 (Pretomanid, Teriflunomide, Fexinidazole) Probenecid, inc plasma lvls and used to extend 1/2 life
33
Penicillinase-resistant Penicillins
Nafcillin (IV) Oxacillin (IV) Dicloxacillin (PO)
34
Penicillinase-resistant Penicillins MOA
Bind to PBPs Inhibit cross-linking of peptidoglycan in cell wall * Developed in response to penicillinase-producing S. aureus* Acyl side chain prevented disruption of the B-lactam ring
35
Penicillinase-resistant Penicillins Spectrum of Activity Gram +
** Txm of choice MSSA ** no activity against E. faecalis, MRSA GOOD activity against penicillin-susceptible Strep. spp.
36
Penicillinase-resistant Penicillins Spectrum of Activity (Gram -, Anaerobes, Atypical)
** No activity **
37
Penicillinase-resistant Penicillins M & E ( Nafcillin/Oxacillin)
Naficillin = moderat CYP3A4 inhib Good for CNS infections, high CSF pen 90-95% protein bound Short 1/2life, dose Q4h No dose adjustment, N excreted through poop, O = urine/bile
38
Penicillinase-resistant Penicillins M & E (Dicloxacillin)
Rapid/ incomplete absorption affected by food 95-99% protein bound Low CSF pen 45min 1/2 life = q6h Excreted in poop/urine = no renal dose adjustment
39
Penicillinase-resistant Penicillins ADE
``` GI (dicloxacillin) Hepatic (N + O) Hematologic (N + O) Renal (N + O) Local (N + O) inj site ```
40
Penicillinase-resistant Penicillins DI
Cyp3A4 substates will be effected by Nafcillin - Antifungl azaleas, anti-epileptics, statins, transplant meds Dicloxacilin - Transplant meds... Sirolimus, tacrolimus, mycophenolate (CYP3A4) - Carbamazepine = CYP3A4 - Fosphenytoin/ Phenytoin CYP2C19 - Omeprazole = CYP2C19 Decreases lvls of these meds
41
Aminopenicillins
Ampicillin (IV) | Amoxicillin (PO)
42
Aminopenicillins MOA
1. Bind to PBS | 2. Inhibit cross-linking peptidoglycan in cell wall
43
Aminopenicillins Spectrum of activity Gram +
** Txm of choice for E. Faecalis ** Limited/no activity against Staph aureus. Same as penicillin against Strep spp., but broader ** Txm of choice for Listeria monocytogenes) **
44
Aminopenicillins Spectrum of activity Gram -
Limited activity overall E.coli + P.mirabilis can be susceptible, especially in younger patients w/o prior exposure H.influenzae covered if B-lactamase negative Atypical = no activity
45
Aminopenicillins Spectrum of activity Anaerobes
Good against Gram + anaerobes (oral flora) - Actinomyces spp - Peptostreptococci - Propionibacterium acnes Limited agents Gram - due to resistance
46
Aminopenicillins M & E (Ampicillin)
Distributes well into bile, pens CSF w/ inflamed meninges 10-18% Protein bound 1/2 life 1-2hrs, extended up to 20hrs excreted in urine unchanged ~90%, renal adjustment req
47
Aminopenicillins M & E ( Amoxicillin)
widely distributed 20% protein bound 1/2 life = 2hrs excreted in urine unchanged, ~60%, renal adjustment req
48
Aminopenicillins ADE
GI = Amoxicillin Dermatologic = Ampicillin Hematologic = Ampicillin Renal (AIN) = Ampicillin
49
Aminopenicillins DI
no significant DI
50
Penicillin + Beta-lactamase inhibitors
Ampicillin/ subactam (IV) Amoxicillin/clavulanate (PO) Piperacillin/ tazobactam (IV)
51
Penicillin + Beta-lactamase inhibitors MOA
1. Bind to PBPs 2. Inhibit Cross-lining of peptidoglycan in cell wall B-lactamase inhibitors have specific spectrums of activity and affinities for certain enzymes
52
Penicillin + Beta-lactamase inhibitors Spectrum of Activity Gram +
no activity against MRSA Added activity against MSSA Activity against Strep spp.
53
Amox / Clav & Amp/sulb are active against....
** Txm of choice for *** H.influenza & M. catarrhalis (community acquired pneumonia) P. multocida & Capnocytophaga species (animal bites) susceptive E.coli, Klebsiella pneumoniae, P. mirabilis
54
Drug preferred in Acinetobacter baumannii is....
ampicillin/sulbactam due to sulbactam
55
Piperacillin/Tazobactam has more activity against...
all Gram -, including more resistant E.coli, Klebsiella, and Proteus spp. active agents Pseudomonas aeruginosa**
56
Penicillin + Beta-lactamase inhibitors Spectrum of activity Anaerobes
Txm of choice against Gram + anaerobes causing oropharyngeal infections - Actinomyces spp. - Peptostreptococci - P. acnes Txm of choice agents Gram - anaerobes
57
Penicillin + Beta-lactamase inhibitors have Atypical coverage?
nah
58
Sulbactam M & E
Widely distributed Protein bound 38% 1/2 life 1-1.3hrs Excretion urine w/in 8hrs, dose adjusted renal
59
Clavulanic acid M & E
Protein bound 1/2 life 1hr Urine excretion, dose adjusted renal
60
Piperacillin/tazobactam M & E
widely distributed | excreted in urine, dose adjusted renal
61
Penicillin + Beta-lactamase inhibitors ADE
``` GI (amoxicillin/Clav) Dermatologic Hematologic Hepatic Renal ```
62
Penicillin + Beta-lactamase inhibitors DI
Piperacillin/tazobactam + Vanco = increase risk of nephrotoxicity
63
If want to cover Strep & E. coli then give....
Piperacillin & Tazobactam

Anti-Infectives Exam 2 (8 decks)

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