Term
Carbapenemases are a type of ___s that ___.
Name 3 types of Carbapenemases. |
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Definition
A type of B-Lactamase that hydrolyze specific things. Made by certain bacteria to destroy certain antibiotics.
Class A, B, and D carbapenemases |
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Term
TEM, SHV, and CTX-M are ___s (be specific)
+ what they do |
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Definition
Are Class A B-lactamases
Hydrolize penecillins and cephalosporins, but not carbapenems |
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Term
| KPC (Klebsiella penumoniae carbapenemase) is a ___ that is transmissible to other ___ |
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Definition
A Class A B-Lactamase
Transmissible to other enterobacteriaceae |
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Term
| MBLs (metallo-beta-lactamases), IMP-1, IMP, VIM, GIM, SIM, and NDM-1 are ___s. |
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Definition
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Term
| Class D B-lactamases hydrolize ___ |
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Definition
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Term
MOA of B-Lactamase inhibitors, and when they're used.
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Definition
Bind the catalytic site of B-lactamase, so it can't hydrolize penicillins (bind directly to penicillin binding proteins of bacteria). Are "suicide" inhibitors.
Use in conjunction with penicillins |
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Term
| 3 B-Lactamase inhibitors approved for combination with penicillins |
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Definition
Clavulanic acid
Sulbactam
Tazobactam |
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Term
| 2 penicillins that can be paired with the B-lactamase inhibitor Clavulanic acid |
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Definition
| Amoxicillin or Ticarcillin |
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Term
| A penicillin that can be paired with the B-lactamase inhibitor Sulbactam |
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Definition
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Term
| A penicillin that can be paired with the B-lactamase inhibitor Tazobactam |
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Definition
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Term
Amoxicillin-Clavulanic Acid (aka Augmentin)
- absorption
- half life
- excreted by ___ |
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Definition
- Well aborbed in GI
- 1 hr serum half life
- Excreted by kidneys
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Term
Amoxicillin-Clavulanic Acid (aka Augmentin)
- what types of infections it's used for (clinical, not microbe names) (5) |
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Definition
- upper & lower respi. tract infection
- bronchitis
- UTI
- skin infection (like from bites)
- intra-abdominal & pelvic infection |
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Term
| Amoxicillin-Clavulanic Acid (aka Augmentin)does not work against what 6 microbes? |
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Definition
-Pseudomonas
-Serratia
-Enterobacter
-Citrobacter
-Resistant Staph. aureus
- Resistant Strep. pneumoniae |
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Term
Ampicillin-Sulbactam (aka Unasyn)
- half life
- administration |
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Definition
- 1 hr serum half-life
- IV/Intra-muscular administration |
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Term
| Ampicillin-Sulbactam (aka Unasyn) is used for what 4 types of infections? |
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Definition
Skin infections
Diabetic foot infections
Bites w/ infections
Intra-abdominal infections
Lower respiratory tract infections |
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Term
| Ampicillin-Sulbactam (aka Unasyn) is not used for ___ or ___ |
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Definition
| Not for empiric therapy in neutropenic host with fever, not for nosocomial infections |
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Term
Ticarcillin-Clavulanic Acid (aka Timentin)
- half life
- excretion |
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Definition
- 1 hr half life
- excreted via kidneys |
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Term
| Ticarcillin-Clavulanic Acid (aka Timentin) is effective against ___ (in general), and what 5 strains |
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Definition
Against B-lactamase producing gram- rods and anaerobes
Pseudomonas, Serratia, Acinetobacter, Enterobacter, and Citrobacter |
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Term
| Ticarcillin-Clavulanic Acid (aka Timentin) is not effective against ___ or ___ |
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Definition
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Term
| Ticarcillin-Clavulanic Acid (aka Timentin) are used to treat what 4 clinical scenarios? |
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Definition
- Nosocomial infections (polymicrobial)
- Neutropenic fevers (along with an aminoglycoside)
- Complicated intra-abdominal infections
- Pelvic infections |
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Term
Piperacillin-Tazobactam (aka Zosyn)
- half life
- excretion |
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Definition
- 1 hr half life
- excreted via kidneys |
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Term
| Piperacillin-Tazobactam (aka Zosyn) is active against what 5 types of microbes? |
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Definition
– Staphylococcus aureus (not MRSA)
– Streptococcus sp.
– Enterococcus sp.
– Most anaerobic bacteria
– Aerobic gram-negative bacteria |
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Term
| Piperacillin-Tazobactam is used to treat what 4 clinical scenarios? |
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Definition
- Nosocomial infections (polymicrobial)
- Neutropenic fevers (along with an aminoglycoside)
- Complicated intra-abdominal infections
- Pelvic infections |
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Term
| Piperacillin-Tazobactam is not active against ___, ___, or ___ |
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Definition
MRSA
Penicillin-resistant Strep. pneumo
Gram- bacteria with altered cell wall |
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Term
| 4 possible complications/side effects of penicillin-B-lactamase combination therapy |
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Definition
1. anaphylaxis
2. allergy
3. GI irritation
4. C. Difficile infection
5. Superinfection from bacteria or Candida |
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Term
| Aztreonam is a ___ that's active against ___ |
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Definition
A monobactam (a synthetic B-lactam coumpound attached to a sulfonic acid group, binds penicillin-binding-proteins)
Against AEROBIC gram- bacilli (including Pseudomonas) |
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Term
Aztreonam
- administration
- half life
- excretion |
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Definition
- IV or intramuscular
- 1.5-2 hr half life
- excreted by kidneys |
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Term
| Aztreonam is not active against ___, ___, or ___ |
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Definition
Gram + bacteria
Anaerobes
Enterococcus |
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Term
| Aztreonam is used to treat what 3 clinical scenarios? |
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Definition
– Complicated urinary tract infections
– Nosocomial gram-negative pneumonia/sepsis
– Neutropenic fevers (in conjunction with an aminoglycoside) |
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Term
| Antibitotic class of Vancomycin |
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Definition
Glycopeptide
is bactericidal |
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Term
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Definition
| Inhibits bacterial cell wall synthesis by binding to the D-alanyl-D-alanine terminus of the pentapeptide |
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Term
| Antimicrobial spectrum of Vancomycin |
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Definition
Gram + only
Includes:
Staphylococcus aureus (including MRSA)
Staphylococcus epidermidis
All Streptococci
Enterococcus faecalis
Corynebacterium jeikeium
Clostridium difficile
Oral anaerobes |
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Term
Vancymycin
- half life
- penetration (3)
- elimination |
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Definition
- 6 hr half life
- doesn't penetrate CSF (unless inflamed meninges), lung, or skin in diabetics
- Eliminated via kidneys
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Term
| Vancomycin killing rate depends on ___ |
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Definition
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Term
AUC/MIC is what? What is its significance in Vancomycin pharmacodynamics?
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Definition
Is the are inder the time concentration curve for the drug
Is the best predictor of efficacy in Vancomycin |
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Term
| What you want the MIC to be in order for Vancomycin to be clinically effective? |
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Definition
MIC < 1mcg/ml
If 2 or greater, high rate of clinical failure
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Term
| 5 clinical scenarios where vancomycin would be used. |
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Definition
–Bacteremia and endocarditis with Staphylococcus
aureus
–Vancomycin sensitive enterococcus (VSE)
bacteremia and endocarditis in penicillin allergic
patients
–Meningitis with penicillin-resistant, cephalosporin-
resistant Streptococcus pneumoniae
–Endocarditis prophylaxis for penicillin-allergic patients
– Clostridium difficile diarrhea unresponsive to
metronidazole (oral use)
So in other words, really bad infections where you can't use penicillin |
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Term
| 4 Drugs that can't be combine with Vancomycin and why |
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Definition
Ceftazidime- causes precipitation
- IV chloramphenicol, methicillin, corticosteroid, and sulfisoxazole
- Heparin- causes precipitation & decreased activity
- Cholestyramine- decreases activity of oral vancomycin |
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Term
| 6 main adverse reactions of Vancomycin |
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Definition
1. Phlebitis (inflamed vein)
2. "Red-man Syndrome"- flushing from too rapid of infusion (causes histamine release)
3. Rash
4. Leukpenia, eosinophilia
5. Ototoxicity
6. Nephrotoxicity (decreases creatinine clearance) |
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Term
| 2 microbes that sometimes have resistance to Vancomycin and why |
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Definition
Enterococci types Van A and Van B can have ligase mutations.
Staph. Aureus may have mutations (rare) |
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Term
Antibiotic class of Linezolid
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Definition
Oxazolidinone
is bacteriostatic (initially made for plant pathogens) |
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Term
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Definition
| Inhibits bacterial protein synthesis by binding to 50s subunit of ribosome (prevents 70s formation) |
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Term
| Linezolid is effective against what microbes? |
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Definition
Gram + microbes:
Staph. aureus (including MRSA)
Coagulase neg. staphylococci
Enterococcus faecium and faecalis
MDR Strep. pneumo
Group A,B,C,G Strep.
Cornybacterium
Listeria monocytogenes
Bacillus
Neisseria
Mycobacterium
Etc. |
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Term
Inezolid
- absorption
- penetration
- half life |
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Definition
- 100% oral absorption
- penetrates CSF
- 6 hr half life |
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Term
| Linezolid is used to treat what 3 clinical scenarios? |
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Definition
- Vancomycin resistant Enterococcus
- Community acquired or nosocomial pneumonia
- skin infections from Staph. or Strep. (w/o osteomyelitis)
** Basically, for resistant Staph. and Strep. infections** |
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Term
| A major drug interaction of Linezolid. |
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Definition
| Is a weak inhibitor of MAO, so can cause serotonin toxicity when combined with SSRI or SNRIs (or on its own apparently) |
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Term
| 6 Major adverse reactions of Linezolid |
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Definition
GI upset
Headache
Rash
Myelosuppression (thrombocytopenia, leukopenia, anemia)
Peripheral and optic neuropathy w/ lactic acidosis
Serotonin syndrome
Increased blood pressure when also taking tyramine (make more NE) |
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Term
What is the mechanism of bacterial resistance to Linezolid?
If this occurs, what 2 other drugs will it possibly be resistant to? |
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Definition
A single point mutation in bacterial 23s rRNA of the 50s subunit
Resistant to chloramphenicol and quinupristin-dalfopristin (they also bind the 23s rRNA domain) |
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Term
Deptomycin
- Antibiotic class
- Derived from ___ |
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Definition
Antibiotic class: Cyclic lipopeptide
Derived from Streptomyces roseoporus
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Term
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Definition
Calcium-dependent depolarization of
bacterial cell wall.
Lipophilic tail of the drug inserts into the
bacterial membrane forming a channel that
causes efflux of intracellular potassium with
depolarization of the cell membrane |
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Term
| Daptomycin is active against ___ |
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Definition
Active against gram+ organisms
- Staphylococcus aureus (Methicillin-susceptible and –
resistant strains)
- All groups of Streptococci
- Enterococcus faecalis and Enterococcus faecium (Vancomycin susceptible and –resistant strains).
- Anaerobic organisms: Clostridium perfringens, Peptostreptococcus.
- Corynebacterium jeikeium, Leuconostoc,
Lactobacillus |
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Term
Daptomycin
- Administration
- Penetration
-Excretion |
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Definition
Poor oral bioavailability.
Low penetration into lung, bone, and CSF
8 hr half life
Excreted via kidneys. |
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Term
| Daptomycin activity is ___ dependent |
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Definition
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Term
| 2 interesting pharmacodynamic properties of Daptomycin |
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Definition
Has a prolonged post-antibiotic effect
Inactivated by alveolar surfactants |
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Term
Daptomycin
- what used for
- what not used for |
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Definition
Used for serious Staphylococcus aureus or Enterococcus infections (blood stream or endocarditis) that is unresponsive to Vancomycin
NOT for pneumonia |
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Term
| Drug that Daptomycin interacts with and what happens when it does |
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Definition
| Interacts with HMG-CoA reductase inhibitors (-statins) to increase CPK and myopathy |
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Term
| 4 Major adverse reactions of Daptomycin |
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Definition
GI upset (constipation)
CPK elevation and myopathy
Rhabdomyolysis
Eosinophilic pneumonia |
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Term
Rifamycins include ___, ___, and ___.
& which one is most commonly used |
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Definition
rifampin, rifapentine, and rifabutin
Rifampin most commonly used |
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Term
Rifampin
- Antibiotic class |
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Definition
Complex macrocyclic drug produced by
Streptomyces mediterranei |
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Term
| Rifampin is effective against ___ and ___ |
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Definition
Bactericidal against actively replicating Mycobacterium tuberculosis & other Mycobacteria
Active against intracellular, slowly replicating and nearly dormant organisms in necrotic foci
Against most gram +s, as well as E. coli, Pseudomonas, Proteus, and Klebsiella |
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Term
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Definition
| Inhibition of DNA-dependent RNA polymerase by binding to the polymerase subunit and blocking elongation of RNA |
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Term
Rifampin
- Absorption
- Penetration
- Concentrates where? |
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Definition
- Complete oral absorption
Penetrates CSF and most tissues
- 5xs higher intracellular concentration than extracellular (especially in PMNs) |
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Term
|
Definition
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Term
| List the drug interactions for Rifampin (5) |
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Definition
Induces the Cytochrome P450 system, so:
- Induces metabolism of HIV medication protease inhibitors (eg. Rifabutin) and non-nucleoside reverse transcriptase inhibitors
- Induces metabolism of oral anticoagulants
- Induces metabolism of theophylline
- Induces metabolism of oral contraceptives |
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Term
| 6 Adverse reactions to Rifampin |
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Definition
Rash, flushing
Fever
GI upset
Thrombocytopenia & acute hemolytic anemia
Hepatitis |
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Term
| What causes bacterial resistance to Rifampin? |
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Definition
missense mutations in rpoB gene
Causes alteration in the RNA polymerase
Resistance develops rapidly so use in combination therapy |
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Term
| What microbe is usually highly resistant to Rifampin? |
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Definition
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