SING- EXAM 3 - Cell Wall/Membrane Inhibitors

FYI: BACTERIA REVIEW!!!

What are examples of G+, G- and atypicals:

(not on test, but remembering this stuff helps)

Gram-positive bacteria (e.g., Streptococcus, Staphylococcus, Enterococcus)
Gram-negative bacteria (e.g., E. coli, Klebsiella, Salmonella, Shigella, Pseudomonas)
Atypicals (e.g., Chlamydophilia, Legionella, Mycoplasma)

FYI: BACTERIA REVIEW!!!!

What are MDROs? Examples?

(not on test, but remembering this stuff helps)

• multidrug resistant organisms (aka smart bacteria that have learned how to not be killed by our abx)

• Methicillin-Resistant Staphylococcus aureus (MRSA)

• Vancomycin-Resistant Enterococci (VRE)

• Carbapenem-Resistant Enterobacteriaceae (CRE)

• Extended-Spectrum Beta-Lactamase (ESBL)-Producing Organisms

Names of natural penicillins:

• Penicillin V Potassium

• Penicillin G aqueous, procaine, benzathine

Names of aminopenicillins

• amoxicillin

• ampicillin

Names of anti-staphylococcal penicillins:

• methicillin

• oxacillin

• nafcillin

• dicloxacillin

Name of extended-spectrum penicillins (PCN+BLI):

(FYI: different from what austins says as extended)

•  Amoxicillin/clavulanate

• Ampicillin/sulbactam

• Piperacillin/tazobactam

Name 1st gen cephalosporins:

• cefazolin

• cephalexin

“sounds like cefa”

Name 2nd gen cephalosporins:

• cefuroxime

• cefotetan

• cefoxitin

“fur, fox, tan”

Name 3rd gen cephalosporins:

• ceftriaxone

• cefotaxime

• ceftazidime

• cefdinir

• cefpodoxime

Name 4th gen cephalosporins:

• cefepime

Name 5th gen cephalosporins:

(from austin: 5th gen/newer cephalosporins)

• ceftaroline

• ceftobiprole

Name 6th gen cephalosporins (cephalosporin +BLI)

• Ceftazidime/avibactam

• Ceftolozane/tazobactam

• Cefepime/enmetazobactam

Name siderophore cephalosporins:

cefiderocol

Name the carbapenems:

• ertapenem

• meropenem

• doripenem

• imipenem + cilastatin

Name the carbapenem + BLI combos:

• Meropenem/vaborbactam

• Imipenem/cilastatin/relebactam

Name the monobactam:

Aztreonam

Name the glycopeptide:

vancomycin

Name the lipoglycopeptides:

• Telavancin

• Dalbavancin

• Oritavancin

Name the lipopeptide:

Daptomycin

List the polymyxins:

• Colistimethate

• Polymyxin B

MOA of b-lactams:

• bind to PBPs—> involved in the cross-linking of peptidoglycan= inhibit cell wall synthesis

MOA of cilastatin:

dehydropeptidase inhibitor

MOA of glycopeptides and lipoglycopeptides:

binds to D-alanyl-D-alanine to inhibit bacterial cell walls

MOA of lipopeptide:

(don’t confuse with lipoglycopeptides!!!)

binds to G+ cell membranes= causes rapid depolarization and cell death

MOA of polymyxins:

acts as a cationic detergent that damages the bacterial cell membrane of G- bacteria—> leaking—> inhibits bacterial cell wall

MOA of fosfomycin:

inhibits PYRUVAL transferase—> inhibits bacterial cell wall

Label the following as bacteriostatic or bactericidal:

• beta-lactams

• glycopeptides

• lipoglycopeptides

• lipopeptides

• polymixins

• fosfomycin

• nitrofurantoin

ALL BACTERICIDAL!!!!!!!!!!!!

What penicillin should not be used PO even though it is available PO?

ampicillin (amoxicillin has better oral absorption and is better tolerated)

List each of the following as TIME-dependent, CONC-dependent, or AUC:MIC dependent

• beta-lactams

• glycopeptides and lipoglycopeptides

• lipopeptide

• polymyxins

• beta-lactams- time-dependent

• glycopeptides and lipoglycopeptides- AUC:MIC

• lipopeptide- conc-dependent

• polymyxins- conc-dependent

What is the target for vancomycin in the body?

400-600 mcg*h/ml

What is the bioavailability of vancomycin?

very poor oral absorption—> no PO for systemic infection

All beta-lactams LACK activity against what bacteria?

ATYPICAL

Fill in the following table about spectrum and penicillins:

Class	G+	G-
Natural Penicillins
Aminopenicillins
Anti-staph penicillins
Extended-Spectrum Penicillins

Class	G+	G-
Natural Penicillins	streptococci enterococci anaerobes	T. pallidum (syphillus)
Aminopenicillins	streptococci enterococci some VRE LISTERIA monocytogenes NO MSSA	PEK H. pylori B. burgdorferi
Anti-staph penicillins	streptococci staphylococci MSSA
Extended-Spectrum Penicillins	streptococci enterococci MSSA	HNPEK anaerobes

PEK= (proteus, e. coli, klebsiella)

HNPEK= (H. influenzae, Neisseria, PEK)

Fill in the following table about spectrum and cephalosporins:

Class	G+	G-
1st gen
2nd gen
3rd gen
4th gen
5th gen

Class	G+	G-
1st gen	streptococci MSSA	PEK
2nd gen	streptococci MSSA	HNPEK anaerobes (B. fragilis)
3rd gen	streptococci some MSSA exception: ceftazidine	HNPEK SPACE HACEK
4th gen	streptococci MSSA	HNPEK SPACE PSEUDOMONAS
5th gen	streptococci MSSA MRSA	enteric G- rods (weaker than 4th)

ALL cephalosporings lack coverage against what organism?

ENTEROCOCCUS (and most anaerobes)

Natural penicillins are DOC for what organisms?

• penicillin G—> syphilis

• Penicillin VK—> strep throat

Only penicillin class with Listeria monocytogenes coverage?

aminopenicillins

The extended-spectrum penicillin ZOSYN has what additional coverage?

• PSEUDOMONAS

• SPACE

What cephalosporings cover pseudomonas?

• ceftazidime

• cefepime

What 6th gen cephalosporin covers CRE (KPC)? (IS 1st line tx)

Avycaz (ceftazidime/avibactam)

What 6th gen cephalosporin and siderophore covers DTR-P. aeruginosa?

• Zerbaxa (Ceftolozane/taxobactam)—> 1st line tx

• cefiderocol

Carbapenems cover what G+ and G-?

• G+

  • MSSA

  • streptococci

  • anaerobes

  • some enterococci

• G-

  • HNPEK

  • SPACE

  • INCLUDES ESBL!!!!!!!!!!!!!

  • pseudomonas

What carbapenem has a narrow spectrum than the others? What doesn’t it cover?

ertapenem- pseudomonas, acinetobacter, enterococcus

What organisms do Carbapenem + BLI combos cover than carbapenems do not?

KPC producing organisms (carbapenem-resistant enterobacterales)

Monobactams over cover what kinds of bacteria?

G-, including pseudomonas

Fill in the following table about spectrums:

Class	G+	G-
Glycopeptides and Lipoglycopeptides
Lipopeptide
Polymyxins

Class	G+	G-
Glycopeptides and Lipoglycopeptides	broad G+ activity MSSA MRSA Streptococci C. diff	NONE
Lipopeptide	broad G+ activity MSSA MRSA Streptococci Enterococci VRE
Polymyxins		broad G- activity enteric G- rods CRE PSEUDOmonas

PO VANCOMYCIN covers what?

C. diff

What is the drug of choice for VRE?

lipopeptide—> DAPTOMYCIN

Fosfomycin and nitrofurantoin cover organisms that cause what type of infection?

uncomplicated cystitis

Which of the following covers Pseudomonas?

a. Fosfomycin

b. nitrofurantoin

a

Which of the following covers VRE?

a. Fosfomycin

b. nitrofurantoin

a

In addition to being the DOC for syphilis, Penicillin G is also used for what?

intrapartum antibiotic prophylaxis against GBS

What penicillin is DOC for strep pharyngitis (GAS)?

What penicillin is DOC for endocarditis prophylaxis during dental procedures?

What penicillin is DOC for acute otitis media?

What penicillin is DOC for MSSA infection?

What penicillin is DOC for aspiration PNA?

• GAS—> Penicillin VK

• Endocarditis pro—> amoxicillin

• AOM—> amoxicillin

• MSSA—> any antistaph penicillin (oxacillin, naficillin, dicloxacillin)

• aspiration PNA—> Unasyn (ampicillin/sulbactam)

What penicillin is used empirically in neonates and older adults (>50 YO) for meningitis? For coverage of what organism?

ampicillin—> listeria monocytogenes

What penicillin is used as an alternative tx for Lyme’s disease? (1st line is doxy)

amoxicillin

What pencillins AND cephalosporins can be used for impatient and outpatient CAP?

• impatient

  • extended spectrum penicillins

  • Ceftriaxone—> 3rd gen

• outpatient

  • amoxicillin

  • extended spectrum penicillins

  • Cefuroxime—> 2nd gen

What penicillins are used empirically for nosocomial infections or HAP/WAP?

extended-spectrum penicillins (like Zosyn)

What cephalosporin is ALTERNATIVE DOC for MSSA infections?

What cephalosporin is DOC for severe S. pneumoniae infections? (lowkey not in the pp so I chatgpt’ed)

What cephalosporin is DOC for gonorrhea?

What cephalosporin is DOC for febrile neutropenia?

• alternative for MSSA—> Cefazolin

• severe S. pneumoniae—> 3rd gen (Ceftriaxone/Rocephin or Cefotaxime)

• gonorrhea—> ROCEPHIN + DOXY

• febrile neutropenia—> 4th gen (cefepime)

Answer the following about cephalosporins:

• What generation is used to treat non-purulent SSTIs?

• commonly used for surgical ppx?

• What agents are commonly used for abdominal surgical ppx?

• Used to treat complicated UTIs/pyelonephritis/intra-abdominal infections?

• empirically for nosocomial infections or HAP/VAP?

• non-prulent SSTIs—> 1st gen

• surgical prophylaxis—> Cefazolin

• abdominal surgical prophylaxis—> Cefamycins

• complicated UTIs/pyelonephritis/intra-abdominal infections—> ceftriaxone (Rocephin)

• empirically—> 4th gen (cefepime)

WHAT CEPHALOSPORIN IS USED EMPICALLY for meningitis and WHAT IS THE DOSE?

Ceftriaxone (Rocephin)—> 2g IV q12h

Carbapenems are the DOC for what type of resistance?

ESBL-E

What beta-lactams in general tx CRE (KPC)? (remember KPC= resistant to carbapenems)

• Avycaz (cephalosporin)

• meropenem/vaborbactam (carbapenem+ BLI)

• polymyxins

• plazomicin

Monobactams are used via inhaled for tx of what?

cystic fibrosis

Monobactams are used for pseudomonal infections in patients with what allergy?

beta-lactam allergt

What are 4 uses of vancomycin?

• __ line for severe _____ infections

• for purulent _____

• oral form is alt 1st line agent for _______

• used empirically for_____________________

• 1st line for severe MRSA infections

• for purulent SSTIs

• oral form is alt 1st line agent for C. diff infections

• used empirically for nosocomial infections, HAP/VAP, and meningitis

What is used for SSTIs, specifically in cases where 1 time dosing regimens may be advantageous?

• lipoglycopeptides—> specifically Dalbavancin, Orithavancin

Lipopeptides are used for MDR Gram____ infections.

Gram + infections (lipopeptides—> daptomycin)

Lipopeptides like daptomycin should never be used to treat what kinds of infections?

PULMONARY INFECTIONS LIKE PNEUMONIA!!!!—> neva for the lungs

Polymyxins are used last-line for tx of what type of resistant organism? Should these be used alone?

• polymyxins—> highly resistant G- organisms

• not used alone, only in combo

Colistimethate is used via inhaled form for tx of what?

cystic fibrosis

For Fosfomycin and Nitrofurantoin what is their only indication?

uncomplicated cystitis