- 1 year ago
Antibiotics are the medication that help to eradicate the microorganisms from our body.
Here are the cell wall synthesis inhibitors which kill bacteria by inhibiting the formation of their outermost protective layer.
Cell wall synthesis inhibitors include
B-Lactam Rings inhibitors
- Penicillin
- Cephalosporin
- Monobactam
- Carbapenem
B-Lactamase inhibitors
Here are the cell wall synthesis inhibitors which kill bacteria by inhibiting the formation of their outermost protective layer.
Cell wall synthesis inhibitors include
B-Lactam Rings inhibitors
- Penicillin
- Cephalosporin
- Monobactam
- Carbapenem
B-Lactamase inhibitors
Category
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LearningTranscript
00:00It's Medicosus Perfectionalis. Let's continue our antibiotics course. Today, we'll discuss the cell wall synthesis inhibitor and the cell membrane disruptors.
00:08Let's talk about the antibiotics coverage.
00:11Penicillin covers gram-positive cocci, gram-positive rods, gram-negative cocci such as Nosuria meningitidis and
00:20Trypanema peldum, which is syphilis.
00:23Penicillin cannot
00:25go into the CNS because it cannot pass through the blood-brain barrier
00:31except when the meninges are
00:34inflamed, such as in Nosuria meningitidis. You have a meningitis. Your meninges are inflamed. Now
00:42penicillin can actually reach your brain to treat the meningitis. Other than that, penicillin cannot enter the CNS.
00:50Alright, cephalosporin.
00:52Wide broad spectrum. First and second generation, they focus more on the gram-positives. Third and fourth,
00:58they focus more on the gram-negatives. Carbapenems, gram-positive cocci, gram-negative rods,
01:05including Pseudomonas, and they cover Enterobes. Next, we have Monobactam, such as the one and only
01:12Estreonam. It only covers gram-negative rods,
01:16including Pseudomonas. Let's talk about
01:19Vancomycin, the van. The van
01:21was positive for cocci and rods, if you remember the van of the last video.
01:27You remember the red man in the van? Yes, that's Vancomycin.
01:32Aminoglycoside, they cover the gram-negative rods. And
01:37aminoglycosides are
01:40synergistic with beta-lactams.
01:42Next is the Tetracycline, short with a T, causing teeth discoloration, teeth problems, and bone growth
01:50problems, and growth stunting. It's a very broad spectrum drug. It covers gram-positive
01:56cocci and rods, gram-negative cocci and rods, and some spirochetes. Here is your dark field microscopy,
02:03specifically Lyme disease by the Borrelia burgdorferi, which can cause
02:09Bilateral Bell's palsy, as well as third-degree heart block, and the famous
02:15target rash.
02:17Macrolides, gram-positive cocci and rods, gram-negative cocci and rods,
02:24especially Neisseria and
02:26Chlamydia. So gonorrhea and chlamydia
02:29macrolides should cover you. What are those macrolides?
02:34Erythromycin, azithromycin,
02:36clarithromycin. Which one is the least toxic?
02:42Azithromycin. Azithromycin has ZIP, or zero side effects.
02:48Azithromycin, ZIP. Not zero, I mean very few.
02:53Clindamycin, remember Linda, my Catholic nun. Gram-positive cocci and
03:00anaerobes, other than the abdomen and
03:03pelvis, because if the anaerobes are in the abdomen and pelvis, we use metronidazole, not clindamycin.
03:10The sulfonamide, they are very good for gram-positive cocci and rods, gram-negative cocci and rods,
03:18Chlamydia, and don't forget
03:20Nucardia. Nucardia can cavitate your lungs. Let's talk about quinolones, such as
03:26ciprofloxacin or anifloxacin. We have gram-positive
03:31diplococci, such as
03:33pneumococci. We call them respiratory
03:36quinolones or respiratory fluoroquinolones.
03:40Gram-negative diplococci, such as Neisseria. So gram-positive diplococci, gram-negative
03:46diplococci. Here we have the pneumococci, here we have Neisseria and
03:50gram-negative rods. Metronidazole is for the anaerobes. It's also for protozoa,
03:56bacterial vaginosis, and
03:59eradication of the H. pylori.
04:01Remember to eradicate the H. pylori, we use Oclam.
04:06What's O? It's the famous omeprazole, which is a proton pump inhibitor. What's the CL?
04:15Clarithromycin, which is a macrolide. What's the M?
04:19Amoxicillin, which is a freaking penicillin.
04:22Antimicrobials are either antibacterial, antifungal, antiviral, or
04:26antiparasitic. Humans have a cell membrane, but no cell wall. Bacteria have a cell wall.
04:32It's made of beta-lactam. That's why we're talking about beta-lactam
04:37antibiotics, because they destroy the cell wall of the bacteria, or they inhibit its synthesis.
04:44Antibacterials are cell wall synthesis inhibitor, or cell wall or cell membrane, cell wall, beta-lactam, vancomycin,
04:51basic trace, cell membrane, depto, and polymyxin. Protein synthesis inhibitor, 30S or 50S. 30S, amine, no, or
04:58tetracycline with the T. 50S, all the others, including macrolides, the famous three. E-rithromycin,
05:04clarithromycin, azithromycin, which one is the least toxic?
05:09Azithromycin.
05:10Nucleic acids in this inhibitor, we have direct acting and indirect acting. Direct, such as guanylone, nitroferantoin, and
05:17rifamycin, or rifampin. The indirect or folate inhibitors, such as TMP-SMX, for UTI, and
05:23for PCP pneumonia. So TMP-SMX, UTI,
05:30PCP pneumonia, pneumocystis jaureveti pneumonia.
05:35Pyrimethamine and sulfadiazine for toxoplasmosis. Let's talk about antibiotics.
05:40We have antibacterial, antifungal, antiviral, and antipersidic. The antibacterial are either
05:45cell wall or cell membrane disruptor, protein synthesis inhibitors, nucleic acids, and the scenarios. Let's talk about the cell wall.
05:53Cell wall include beta-lactam, glycoprotein, such as vancomycin,
05:58non-classified, such as betatrazine. What are the beta-lactams? Penicillin, cephalosporin, carbapenem,
06:04monobactam, such as the one and only, astreonam. The cell membrane disruptors are the depto,
06:10myosin, and the polymyosin. Depto-myosin causes muscle problem and rhabdomyolysis.
06:15Polymyosin forms pores in the membrane. Hashtag osmosis. Let's talk about the protein synthesis inhibitor.
06:21We have the 30S inhibitors, such as only two, aminoglycosides, and
06:27tetracycline. 50S inhibitors are all the others, including macrolides, clindamycin, etc.
06:32We have nucleic acid synthesis inhibitor, direct acting DNA or RNA or protein. They inhibit
06:38translation or transcription, all of the stuff, including the quinolones, which destroys your cartilage,
06:45nitroferantoin, which makes your urine brown, and
06:48rifampin, which makes your urine orange slash red. Folate inhibitors, including the combinations
06:55TMP, SMX, for UTI and PCP, as well as
06:59pyrimethamine sulfodiazine for
07:01toxoplasmosis.
07:03The bacteria has cell wall on the outside and a cell membrane on the inside. Let's disrupt the cell wall.
07:09You can use beta-lactam, vancomycin, or basitracin. Let's disrupt the cell membrane. You can use depto-myosin or polymyosin.
07:17Let's inhibit the folate, TMP, SMX, or pyrimethamine sulfodiazine. Let's inhibit the DNA,
07:24quinolones, the famous flocs, or nitroferantoin, which will make your urine brown.
07:28Let's inhibit the RNA synthesis by inhibiting the enzyme called DNA-dependent RNA polymerase.
07:35You can give rifampin. It will make your urine orange slash
07:40yellow slash red. Next, you can inhibit the protein synthesis slash
07:45translation. You can use 30S inhibitors, such as aminoglycosides and tetracycline. You can inhibit the 50S, such as
07:53macrolides,
07:55vancomycin, streptogramin, chloramphenicol, and lenisolid. Remember, lenisolid is is used for
08:01Versa.
08:03Vancomycin-resistant
08:05Staph aureus. Here are the antibiotics. Let's talk about the antibacterial,
08:10specifically the cell wall or the cell membrane. Let's focus on the cell wall,
08:14I mean the beta-lactams. They include penicillin, cephalosporins, carbapenems, monobactams,
08:19which is the one and only estreonam. Penicillins are
08:23natural penicillins or
08:26anti-staphylococcal penicillin, they are anti-staph aureus, or
08:30aminopenicillin or
08:33anti-pseudomonopenicillins. What are the natural penicillins? Penicillin G, which is
08:38injectable. Penicillin V, which is oral. How about methicillin?
08:43It's obsolete in history. Why history? Because it caused
08:48interstitial nephritis, severe nephrotoxicity. So now we use other drugs. Ox, Clox, Diclox, and Nef.
08:55So when I say this staph aureus is
08:59methicillin-sensitive, I mean it's Ox, Clox, Diclox, and Nef
09:04sensitive. Next we have the amino penicillin. It has the M amino, such as M-picillin and
09:11M-oxicillin. These two can cause rash in cases of infectious
09:16mononucleosis. The anti-pseudomonopenicillins are carbenicillin, ticercillin,
09:22pipericillin, azlucillin. Let's talk about beta-lactams that can cover
09:27pseudomonas. Which penicillin covers pseudomonas? The anti-pseudomonopenicillins. Yes!
09:34Carbenicillin, ticercillin, pipericillin, and azlucillin. How about syphilisporin? Only the third and fourth
09:41generations of syphilisporin. How about the carbapenems? Do they cover it? Yes, they do.
09:45How about the one and only Sgunan? Yes, it does. In the beginning, Staph aureus was sensitive to methicillin,
09:52I mean, Ox, Clox, Diclox, and Nef. We call them methicillin-sensitive Staph aureus.
09:57And then they develop resistant to methicillin, I mean, to Ox, Clox, Diclox, and Nef, and they are called MRSA.
10:04We invented a new drug called vancomycin to take care of the MRSA. But those bacteria are smarter.
10:10They became resistant to the vancomycin called Versa. Now
10:13we use lenisolid or daptomycin for the Versa. Case 3.
10:18This, by the way, is the same patient from the last lecture.
10:23The patient had a painless ulcer on his penis. The ulcer had a clean base,
10:29and it was only one ulcer, and he also had painless
10:33regional lymphadenopathy. The next step in diagnosis. Darkfield microscopy, culture of the base of the ulcer,
10:40needle biopsy of the inguinal lymph nodes, serum rapid plasma reagent, or FTA-ABS.
10:46Please pause.
10:49And the correct answer here is
10:53darkfield
10:55microscopy. This is primary syphilis. This is a chancre,
10:59painless ulcer in the penis, and painless lymphadenopathy. With the darkfield, you see the nice motile
11:05spirochetes. They are thin. They are like a filament.
11:09Just beautiful. How about culture of the base of the ulcer?
11:12It's impossible to culture syphilis from the base of the ulcer. Forget it.
11:18Forget it. It's not gonna happen. How about needle biopsy of the inguinal lymph node? Shut up.
11:23Serum rapid plasma reagent. Oh,
11:26right, and FTA-ABS. The first one is used for screening.
11:30The second one is used for confirmation, because the first one is sensitive,
11:35the second one is specific, but we do not use them in primary syphilis. Why not? In primary syphilis,
11:42it's very early on. They will be
11:45falsely negative.
11:47Falsely negative? What do you mean?
11:49I mean they will come back negative even though the patient actually has a freaking syphilis. High rate of false
11:56negative. So why not use them? We can use them in secondary syphilis, but not in primary syphilis. Again,
12:02we do not use them in primary syphilis because of the high false
12:07negative rate. The only thing that will diagnose primary syphilis is the dark field
12:13microscopy.
12:15Antibacterials are cell wall or cell membrane, protein synthesis inhibitor, nucleic acid synthesis inhibitor.
12:20Let's talk about the cell wall, which is today's topic. You have cell wall and cell membrane. Focus on the cell wall, beta-lactams,
12:28vancomycin, beta-tracers. Let's focus more on the beta-lactams, penicillins, cephalosporins,
12:34monobactam, carbapenems. If this slide is not clear, please use the downloadable PDF to make it clear.
12:41Here is the nice antibiotics and here are antibacterial. Cell wall, let's talk about the cell wall, beta-lactams.
12:48We have four. Penicillin, cephalosporin, carbapenem, the one and only S3 on M, which is a monobactam.
12:55Penicillins are natural penicillin,
12:57anti-staph penicillin, amino penicillin, anti-pseudomole penicillin. Natural include penicillin G and penicillin B.
13:03How about the anti-staph? Ox, clox, diclox, and naf. Use the naf for staph.
13:09Or how about methicillin? Forget it. It's not gonna happen. We do not use it anymore.
13:13Amino, ampicillin, amoxicillin. They can cause rash in
13:19infectious mononucleosis, also known as kissing disease in teenagers.
13:25Next we have anti-pseudomole, bicarbenicillin, ticaricillin, pipericillin, and acetylsaline.
13:30Let's talk about the cephalosporins. First generation, second generation, third generation, fourth generation, fifth generation.
13:36Of course, remember ceptriaxone, because tri, it's a third generation cephalosporin.
13:41How about the fifth? Remember ceptaroline is a fifth generation cephalosporin.
13:47Does it cover MRSA? Yes, it does. Does it cover pseudomonas?
13:51No, it does not. The only two that cover pseudomonas are third and fourth generations.
13:57The carbapenems, amipenem, which
14:01have to be, it has to be used with celestatin, otherwise your kidney will suffer.
14:07Also, meropenem, duripenem, and ertopenem. Amipenem, merodenem, duripenem, ertopenem.
14:12Amipenem, meropenem, duripenem, ertopenem.
14:15Monobactams, such as the one in oleastreonam, the only thing that's great about streonam is that there is no cross
14:23allergenicity between the streonam and penicillins or cephalosporins.
14:28So if the patient is allergic to penicillin, give them streonam.
14:32Cephalosporins are lame. They cannot cover LAME. What do you mean by lame? I mean listeria,
14:40atypicals, MRSA, and enterococci.
14:43First generation, remember those two.
14:47Cefazolin, cefalexin. Cefazolin, cefalexin.
14:50Lexin has an X, so it's used for surgical prophylaxis with an X. Also, the scissors, which is used by the surgeon,
14:57looks like an S. It's not called the scissors. I'm just joking with you.
15:02It prevents staph aureus wound infection. That's why we use cefalexin for surgical prophylaxis.
15:08Enough with number one. How about second generation? It's for influenza and klebsiella.
15:13Streptenbacteroides. Everything here is two because it's the second generation. Influenza and klebsiella.
15:20Streptenbacteroides.
15:22Remember that one and two are better for covering the gram positives.
15:27Three and four are better for covering the gram negatives. Let's talk about three. The famous ceftriaxone.
15:34Very important for gram negative sepsis and gram negative meningitis, such as Neisseria meningitidis.
15:42Serious stuff.
15:44Also, it can be added with aminoglycoside. It's called synergy, which means one plus one equals three, which is a mathematical
15:52insanity, but a pharmacological reality. It cannot cover MRSA, listeria, or atypicals.
15:57Fourth generation, it can cover pseudomonas. It is beta-lactamase resistant.
16:03The fifth generation ceftaroline is good for MRSA, but not for pseudomonas. Side effects of cephalosporins in
16:10general, they can cause hypersensitive reaction, although to a lesser extent than the penicillins.
16:16They can lead to vitamin K deficiency, which will lead to deficiency of the vitamin K
16:21dependent factors, such as coagulation factors 2, 7, 9, and 10.
16:26Prothrombin 7, 9, 10. Prothrombin 7, 9, 10.
16:29Don't forget the prothrombin, because it's the most important one in these factors.
16:33They have disulfiram-like action, do not drink alcohol while on cephalosporin, and they can lead to
16:41nephrotoxicity, like the penicillins. In the previous lectures,
16:44we have talked about another drug that had disulfiram-like action. If you say metronidazole, you are amazing.
16:53Penicillin, cephalosporin, carbapenem, monobactam. Let's talk about carbapenem.
16:57Remember, amipenem, which has to be combined with celestatin,
17:01otherwise, your kidney will suffer. High doses of amipenem, like high doses of any penicillin, can cause
17:08seizures. Those carbapenems can cover E. coli,
17:12Enterobacter, Siderobacter, Klebsiella, Proteus, Pseudomonas, Serratia. Again, E. coli,
17:19Enterobacter, Siderobacter, Klebsiella, Proteus,
17:22Pseudomonas, Serratia. They do not cover MRSA. They do not cover Enterococci.
17:29Meropenem and duripenems can cover Pseudomonas. The only one that needs celestatin is the amipenem,
17:37but meropenem, duripenem, ertopenem do not require celestatin, because they are not metabolized by the renal
17:45Dehydropeptidase 1. Beta-lactam antibiotics are penicillin, cephalosporin, carbapenems, monobactam,
17:53monobactam, such as the one and only estreonam. The only thing that's good about estreonam,
18:00it has no cross-allergenicity with penicillin. If the patient is allergic to penicillin, do not
18:06give other penicillins. You're stupid. Do not give cephalosporins. Your parents or cousins
18:11do not give carbapenems, because still can have an allergic reaction. You can give monobactams,
18:19macrolides or doxycycline. The beta-lactam antibiotics are penicillin, cephalosporin,
18:25carbapenems, monobactam, such as the one and only estreonam. For vancomycin, remember the red man
18:33syndrome. Remember in the previous video there was a van and the van had a red man and the van
18:39had a positive sign on the back of the van because it covers gram-positive cocci, there are
18:45some cocci, and gram-positive rods. Red man syndrome is due to histamine release. Daptomycin, we'll talk
18:53about the D mnemonic later. For now, just remember it can destroy your muscle, causing
19:00rhabdomyolysis. With rhabdomyolysis, all of the electrolytes that were inside the cell
19:08are now outside of the cell, because the cell ruptured. You'll have potassium, hyperkalemia,
19:14hyperphosphatemia, hypocalcemia, because when you have high phosphate, you'll have low calcium,
19:20and dark red urine. This is called hematuria with no red blood cells, because it's not actually
19:27hematuria, it's not actually blood, it's a myoglobin, not a hemoglobin. All right, please
19:33answer this case and let's get out of here. Same patient with a painless ulcer on his penis and a
19:40painless regional lymphadenopathy. What's the next best treatment option? Five doses of oral cefepim,
19:48one dose of intramuscular procaine penicillin, three doses of intramuscular benzophen penicillin,
19:53also S-penicillin G, you give 2.4 million units, seven doses of oral penicillin B, one dose of
19:58intramuscular ceftriaxone, three doses of oral clindamycin, one dose of intramuscular benzophen
20:04penicillin or penicillin G, 2.4 million units. Please pause, and the answer here is G. This is
20:13primary syphilis. If you're talking about primary syphilis, here is the correct answer. One dose,
20:19just one dose, one injection, intramuscular injection of penicillin G, also known as
20:25benzothiine penicillin, this is 2.4 million units. How about secondary syphilis? We will
20:32still use penicillin G, but it's a different dose, but again intramuscular penicillin G.
20:38Treatment of syphilis is penicillin. Please do not forget that. What if the patient is
20:44allergic to penicillin? You can give doxycycline. You can give azithromycin.
20:51Thank you so much for watching. I'll see you in the next video.
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