Anti Microbial - Cell Wall Synthesis Inhibitors

Front 1

What are the two major categories of cell wall synthesis inhibitors?

Back 1

Beta lactams
Non beta lactams

Front 2

What are the major categories of beta lactams?

Back 2

Penicillins
Cephalosporins
Carbapenems
Monobactams

Front 3

What categories are penicillins broken into, and list the drugs of each category.

Back 3

1) Standard (Penicillin G, Penicillin V, Procaine Penicillin, Benzathine Penicillin)
2) Anti-staph (Methicillin, Nafcillin, Dicloxicillin)
3) Amino (Ampicillin, Amoxicillin)
4) Anti-pseudomonas (Pipercillin (givin with beta-lactamase inhibitor and aminoglycoside))

Front 4

What is the MOA of beta lactams?

Back 4

Bind PBP
Inhibit transpeptidation
Inhibit crosslinking

Front 5

What is the MOA of resistance of penicillins?

Back 5

1) Beta lactamase/Penicillinase
2) Structural change in PBP
3) Change in porin structure

Front 6

What's the major use(s) of standard penicillins?

Back 6

Syphillis (Treponema pallidum)

Front 7

Uses of anti-staph drugs?

Back 7

Tx staph aureus (methicillin is not used anymore, but nafcillin and dicloxacillin are, UNLESS resistant).

Front 8

Use(s) of amino/broad spectrum penicillins?

Back 8

Listeria, and Gram + cocci (not staph)
Gram - , E.coli, H. influenza, H. pylori
Borrellia (Lyme disease)

Front 9

Anti-pseudomonas/extended spectrum use(s)?

Back 9

Pseudomonas

Front 10

Adverse effect of ampicillin/amoxicillin?

Back 10

Pseudomembranous collitis

Front 11

Two general Adverse effects for beta lactams?

Back 11

GI upset
Hypersensitivity/Allergic reactions

Front 12

If a pt is allergic to a cephalosporin, what would be the adjustments you'd make to his/her tx and why? Do this for both gram + bacteria, along with gram - rods.

Back 12

1) Pt allergic to cephalosporin
2) Skip using penicillin because of partial cross-reactivity.
3a) If gram (+), use macrolides.
3b) If gram (-) ROD, use Aztreonam.

Front 13

Name two 1st gen cephalosporins.

Bonus question: What bacteria are they good against, and what's use?

Back 13

Cephalexin
Cefazolin

Bonus:
1) Gram+, some gram- (not LAME)
2) Surgical prophylaxis, 24 hr half life

Front 14

Name some important 2nd gen cephalosporins.

Back 14

Cefuroxime (first ceph to cross BBB/tx meningitis)
Cefoxitin
Cefotetan (AE = disulfiram)

(Fox + Tetan tx B.fragilis)

Front 15

Name some important 3rd gen cephalosporins (5 of them, think of mnemonic)

Bonus question: Uses/AE for each.

Back 15

Ceftriaxone
Cefixime
Cefotaxime
Cefoperazone (AE: disulfiram)
Ceftazidime (tx pseudomonal inf, AE = neutropenia)

Use: Empirical Sepsis and Meningitis (not opera)

TRI and FIX = gonorrhea

NOT USEFUL AGAINST LAME (e = enterococcus)

(Mnemonic, TRI and FIX the TAXes, so we can go to the OPERA and watch TAZ)

Front 16

If cephalosporins are weak against LAME (listeria, atypicals, MRSA, and enterococcus), what are the appropriate treatments for each?

Back 16

Listera = Ampicillin/Amoxicillin (in combination with aminoglycosides, and probably beta-lactamase inhibitor)
Atypicals = Macrolides/Tetracyclines
MRSA = Vancomycin
Enterococcus = Ampicillin/Amoxicillin (in combination with aminoglycosides, and probably beta-lactamase inhibitor)

Front 17

Imipenem must be givin with what (but not in the same formula, just seperate injections)

Back 17

Cilastin (it inhibits renal dehydropeptidase, preventing breakdown of imipenem)

Front 18

Adverse effect of imipenem, seen in about half the pts that take it?

Back 18

Seizures

Front 19

Aztreonam is typically used when?

Back 19

When pt is allergic to cephalosporins/penicillins but needs to tx Gram (-) RODS.

Front 20

What's the MOA of vancomycin?

Back 20

1) Binds to D-ala-D-ala muramyl pentapeptide, which
2) prevents TransGLYCOSYLation, thus preventing
3) ELONGATION of peptidogylcan chains



(Has nothing to do with PBPs, that's beta-lactam MOA)

Front 21

Uses of Vancomycin include?

Back 21

1) MRSA
2) Enterococci
3) C.difficile (NOT Drug of choice)

Front 22

If MRSA's mecanism of resistance is to change PBP, what's VRSA's mecanism of resistance?

Back 22

Change D-ala-D-ala to D-ala-D-lac

Front 23

Adverse effects of vancomycin include?

Back 23

Red-man syndrome (hypersensitivity type 1), Nephrotoxicity, Ototoxicity, Neuomuscular junction blockade

Front 24

Does vancomycin cross BBB?

Back 24

No