University:
University of North Carolina at Chapel Hill
Course:
NURS 312 | Pharmacology
Academic year:

2020
Views:

131

Pages:

1
Author:

Nesbyenvkk

1.1 – “PPrince e Penicilllins ceess Elllen’s New Hope pe”: • β-lactam antibiotics all contain a 4 membered β-lactam ring (ringed planet). Include penicillins, cephalosporins, carbapenems, and all share similar MOAs & pharmacologic properties. • Bacterial peptidoglycan cell wall is synthesized by repeating D-alanyl-D-alanine oligopeptides (coccoid Death Star with D-ALA scaffolding). Penicillin binding proteins (PBPs) remove the terminal alanine in the process of forming crosslinks between peptides (Planetary Building Project workers). β-lactams inhibit this transpeptidation reaction by covalently binding PBPs, preventing bacterial cell wall synthesis. Effective in actively growing cells. • Bactericidal. • Work particularly well against G+ cell wall (e.g. staph & strep) (purple coccoid spaceships behind Death Star) • Penicillin (Princess Ellen holding purple pencil, fighting off the agalactiae empire.) o Penicillin V is the oral, acid stable form (V-ship in front of acid yellow nebula). Indicated in minor infections. Poor bioavailability, narrow spectrum, 4 qid dosing ▪ Oral form is acid. ▪ First line for streptococcal pharyngitis (red throat) and other infections caused by Group A strep ▪ Both V and G can treat post-strep rheumatic fever (Heart shaped planet Sydenham is very inflamed) o Penicillin G is the IV form (ivy rope distracting Princess Ellen). Benzathine salts of Penicillin G may be given via IM injection ▪ Left sided endocarditis caused by S. bovis, S. viridans (green emperor with miter hat) ▪ Group B strep infection for neonates of infected mothers; given intrapartum for group B strep prophylaxis for fetus (GBS galactic baby) ▪ Actinomyces israelii (Israeli flags on hyphae-like transport vehicles) ▪ C. perfringens (transport driver with road rash) ▪ Pasteurella multocida. Dog bites oft treated with β-lactams, as well as more broad-spectrum antibiotics like ampicillin, piperacillin (space dog) ▪ Single dose of benzathine treats primary, secondary, & early latent syphilis (running soldier with characteristic red boots & gloves on palms & soles) ▪ N. meningitidis, if isolate is penicillin sensitive (soldier wearing red mohawk helmet – recurrent symbol for meningitis; Gred, with diplococci-like booster packs) o Most common mechanism of resistance is production of β-lactamases, often expressed by plasmid genes (Ray gun has a plasmid-like ring around it). May also have PBP or porin mutations. o Generally well tolerated. Adverse reactions: ▪ Type 1 hypersensitivity (IgE mediated) (Rebel ship shooting what look like IgE missiles) • Up to 10% of people claim hypersensitivity, but 90% of those are skin test negative • 10% of those with a true hypersensitivity have cross reactivity with cephalosporins. More likely to cause a reaction if patient has had ⊕ skin test reaction and had definite IgE mediated reaction. ▪ Drug induced autoimmune hemolytic anemia. Will have ⊕ direct coombs test (IgG missiles attacking RBC shaped asteroids) ▪ Interstitial nephritis d/t mononuclear cells entering interstitium of the kidney. Blue cells on histology (kidney shaped nebula with blue stars)