Cell Wall Active Antibiotics Outline.docx - Cell Wall...

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Cell Wall Active AntibioticsObjectives1.Describe the mechanism of action of the penicillins and cephalosporins and how resistance develops to them.2.Understand the function of beta-lactamase inhibitors in antibiotic combinations.3.Describe the pharmacologic effects, adverse effects, and general therapeutic uses of the penicillins using penicillin G, ampicillin, amoxicillin, and piperacillin as prototypes.4.Describe the pharmacologic effects, adverse effects, and general therapeutic uses of the cephalosporins using cephalexin, cefazolin, cefaclor, cefoxitin, and ceftriaxone as prototypes.5.Describe the pharmacologic effects, adverse effects, and general therapeutic uses of the carbapenems using imipenem as the prototype.6.Understand the mechanism of action and antimicrobial spectrum of vancomycin and aztreonam.TerminologyAminopenicillinAntistaphylococcal penicillinBactericidalBeta-lactamBeta-lactamaseCarbapenemExtended spectrum (antipseudomonal) penicillinHaptenMethicillin resistant Staphylococcus aureus (MRSA)PenicillinasePenicillin binding proteinTranspeptidasePrototype DrugsPenicillin GAmoxicillinAmpicillinPiperacillinAmpicillin/sulbactamAmoxicillin/clavulanatePiperacillin/tazobactamCefazolinCephalexinCeftriaxoneImipenemAztreonamVancomycin1
Reading AssignmentLehne’s Pharmacology for Nursing Care, 9thedition—Chapters 84 and 85 OutlineI.Medication Class OverviewA.Penicillins1.Beta-lactam antibiotics2.Mechanism of Action: Weaken bacterial cell wall allowing water to enter cell and cause rupture of the bacteriaBactericidalantibiotics (but only to bacteria undergoing active growth and division). Weaken cellwall by inhibition of transpeptidases and disinhibition of autolysins; this decreases peptidoglycancrosslinking in the cell wall and breaks down parts of the cell well; molecular targets are known collectively as penicillin-binding proteins (PBPs)3.Mechanism of Bacterial Resistancea.The gram-negative cell envelope—Three cell layers (cytoplasmic membrane, thin cell wall, and outermembrane); only some penicillins can cross the outer membraneb.Penicillinases (beta-lactamases)—Enzymes that cleave beta-lactam ring, making penicillins inactive c.Alteration of penicillin binding proteins4.Classification—Based on antimicrobial spectrum; four major groups (narrow-spectrum that are penicillinase-sensitive; narrow-spectrum that are penicillinase-resistant; broad-spectrum penicillins [aminopenicillins]; and extended-spectrum penicillins)II.Prototype Drug – Penicillin GA.Medication Class: Narrow spectrum penicillin; penicillinase sensitive penicillinB.Mechanism of Action: Cell wall active antibiotic; bactericidal to several gram positive bacteria; most gram negative bacteria are resistantC.Antimicrobial spectrum—Effective against gram positive (except penicillinase-producing staphylococci), some anaerobic bacteria, and spirochetes; resistance with beta-lactamase production, gram negative bacilliD.Adverse Effects: Allergic reactions;

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