Term
| What are the intracellular parasites? |
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Definition
Chlamydia and Rickettsia (Bartonella, Ehrlichia, Coxiella)
Shigella and Salmonella (Not obligate. Use AP + BLI) |
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Term
| Which bugs lack accessibility of peptidoglycan? |
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Definition
Mycoplasma (No cell wall)
Mycobacteria (Waxy Cell Wall)
Encapsulated Bugs ( Strep. Pneumonia, H. Influenzae, N. Meningitis, Kleb. Pneumonia)
Gram Negative: OM can impede B-Lactams.
Viruses, Fungi, Protozoa (No peptidoglycan) |
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Term
| Which Gram - Rods are destroyed in vitro, but not in vivo? |
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Definition
Brucella (zoonotic)
Bordatella Pertussis (whooping cough) |
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Term
| What are "Essential" Binding Proteins? |
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Definition
Builders (10%)
Glycosylase Links Sugars
Peptidases links Amino Acids |
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Term
| What are "Non-essential" binding proteins? |
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Definition
Digesters (90%)
90% of a Penicillin dose will be taken up by "non-essential" PBPs. We need a high enough dose so that we can still bind up the "Essential" PBPs. |
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Term
| Reactivity of a Beta-Lactam |
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Definition
Ring Strain and Non-coplanar
Rxns occur by: Acid/base catalyzed, Nu, Enzyme catalyzed |
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Term
| Toxicity of a Beta-Lactam |
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Definition
| A free floating Beta-Lactam that the ring has opened is toxic. |
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Term
| What are the Natural Penicillins (NP)? |
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Definition
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Term
| What are the Anti-staphylococcal Penicillins (ASPs)? |
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Definition
Methicillin, Nafcillin
Isoxazoles (Dicloxacillin, Oxacillin) |
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Term
| What are the Amino Penicillins (APs)? |
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Definition
|
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Term
|
Definition
Ureidos (Piperacillin, Mezlocillin, Azlocillin)
Carboxypenicillins (Ticarcillin, Carbenicillin) |
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Term
| What do all penicillins require? |
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Definition
Bicyclic Ring (5 membered with sulfur next to Beta Lactam)
Amide group off of the 6th
What is different is what is connected off the carbonyl of the amide |
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Term
|
Definition
-Original Penicillin- Benzyl Penicillin
-Limited spectrum |
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Term
|
Definition
-Added an oxygen next to the amide
-Stabilized to gastric acid
-Limited Spectrum |
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Term
|
Definition
-Won't bind as well to Pseudomonas and Gram -
-Bind well to Enterococci and Listeria
-Often used in combo with an aminoglycoside
-An AP may be preferred though.. |
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Term
|
Definition
ASP- target staphylococcal
-Kidney Toxicity
-Acid--> orally non-stable ---> IV only |
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Term
|
Definition
ASP- target staphylococcal
-changed methicillin structure to be less toxic
-Acid--> orally non-stable ---> IV only
ONLY penicillin NOT primarily eliminated renally. BILIARY. |
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Term
| Isoxazoles(Oxacillin, Cloxacillin, Dicloxacillin, Flucloxacillin) |
|
Definition
Inductive/ Resonance withdraw added
So Acid/Orally stable, Lipophilic (distribution), and still effective against MSSA |
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Term
|
Definition
All of these are effective against Staph/Strep because:
-the extra bulk prevents BLase binding affinity so it's effective against staph/strep that has BLases
-the bulk also prevents PBP binding outside of Staph and Strep
-Will also affect G+ Anaerobes
-Effective against all Strep except PBP strains of S. Pneum (PRSP)
-Not effective against Enterococci, MRSA, MRSE
-Can't get into G- rods in the first place
-You would never combine an ASP with a BLI (doesn't do anything) |
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Term
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Definition
Amino Penicillins
Increased spectrum
Low gut solubility
Acid Stable!- stays in gut and kills microflora (CDAD)
Potentially effective against Enterobacteria, but not Pseudomonas |
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Term
|
Definition
Amino Penicillins
Increased spectrum
Added a -OH to increase gut solubility
Potentially effective against Enterobacteria, though not Pseudomonas. |
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Term
|
Definition
Will need a BLI against a BLase
Staph/ Strep
Potentially effective against Enterobacteria (like E. Coli, though not Pseudomonas)
Do bind better to enterococci and Listeria
Often used in combo with aminoglycosides |
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Term
|
Definition
ESPs: Carboxy Penicillins
Di-anion. Acid added instead of base.
Renal elimination.
Takes Na with and leaves K in body |
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Term
|
Definition
ESPs Carboxy Penicillins
Di-anion. Acid added instead of base.
Renal elimination.
The Di-NA salt form can be dangerous for CHF pts.
May result in hypokalemia at the ion exchange pumps in the kidney |
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Term
|
Definition
ESPs: Ureido Penicillins
Gets 90% of Ureido use in USA. Others are mezlocillin and azlocillin.
IV ONLY! |
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Term
|
Definition
Can be effective against many Gram - bugs
Can even target pseudomonas (though not Burholderia or Stenotrophomonas)
Pseudomonas has a modified OM that blocks entry that only ESPs can get in. Even then, a BLI is probably necessary.
**Piperacillin/Tazobactam is the preferred penicillin treatment in emergency for Pseudomonas and Enterobacteria. |
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Term
| What are the Beta Lactamase Inhibitors? |
|
Definition
Sulbactam- IV
Tazobactam- IV; Blocks AmpC
Clavulanic Acid- Oral
**None target C'ase** |
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Term
|
Definition
Works by inhibiting BLases so that the BLactam can work.
Will work if:
-the penicillin would normally kill the bug if the bug didn't have the BLase
-if the BLI can target the BLase
-IV only will not work as an oral combination |
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Term
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Definition
Chew up only the Penicillins
All BLIs work |
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Term
|
Definition
Chew up Penicillins and some Cephs.
All BLIs work
-assume enterobacteriaceae are BSBL's |
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Term
|
Definition
Chew up all Penicillins and almost all Cephs
BLI's "sometimes" work |
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Term
|
Definition
Chew up all but Carbapenems
Only Tazo works. |
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Term
| BLI Targets: Carbapenamases |
|
Definition
Chew up everything.
No BLI's work |
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