Br Pharmacology: Beta-Lactams And Cell Wall Inhibitors

Front 1

How are penicillins excreted? How is nafcillin excreted? ampicillin?

Back 1

1) unchanged in urine
2) bile
3) bile

Front 2

Are beta-lactams cidal or static? Cephalosporins?

Back 2

both are cidal

Front 3

What is the MOA of penicillins?

Back 3

1) bind PBPs on bacterial cytoplasmic membrane
2) inhibit transpeptidation
3) activate autolytic enzymes

Front 4

What are inhibitors of beta-lactamases?

Back 4

1) clavulanic acid
2) sulbactam
3) tazobactam

Front 5

Which organisms alter PBP to resist penicillins?

Back 5

1) PRSP
2) entorcocci
3) Staph

Front 6

How do gram- rods like Psuedomonas resist penicillins?

Back 6

alter porin to prevent penicillin accumulation

Front 7

Is penicillin G broad or narrow spectrum? What bacteria are they used for?

Back 7

1) narrow
2) non resistant:
a. strep
b. meningococci
c. gram+ rods
d. spirochetes

Front 8

What is penicillin V used for?

Back 8

oropharyngeal infections

Front 9

What are examples of very-narrow-penicillinase resistant drugs?

Back 9

1) methicillin
2) nafcillin
3) oxacillin

Front 10

What are examples of wider spectrum penicillinase-susceptible drugs? What should they be given with?

Back 10

1) ampicillin
2) amoxicillin
3) piperacillin
4) ticarcillin
Note: use beta-lactamase inhibitor

Front 11

Which 7 bacteria are ampicillin and amoxicillin used for?

Back 11

1) H influenzae
2) E coli
3) L monocytogenes
4) proteus mirabilis
5) M cattarhalis
6) Salmonella
7) enterococci

Front 12

Which 3 bacteria are piperacillin and ticarcillin used for?

Back 12

1) PSEUDOMONAS
2) enterobacter
3) Klebsiella

Front 13

What are toxic effects of penicillin?

Back 13

1) urticaria
2) pruitus
3) fever
4) joint swelling
5) HEMOLYTIC anemia
6) nephritis
7) anaphylaxis

Front 14

What is the adverse effect of methicillin?

Back 14

interstitial nephritis

Front 15

What is the adverse effect of nafcillin?

Back 15

neutropenia

Front 16

What are the adverse effects of ampicillin?

Back 16

1) maculopapular rash that is not allergic
2) psuedomembraneous colitis

Front 17

How are cephalosporins eliminated from body? How are ceftriaxone and cefoperazone treated?

Back 17

1) tubular secretion
2) bile

Front 18

Do cephlosporins normally enter the CNS?

Back 18

no only when there is inflammation

Front 19

What is the MOA of cephs? Are they cidal or static?

Back 19

1) bind PBPs similar to penicillins
2) cidal

Front 20

How does resistance occur with cephs? Are they effective against MRSA?

Back 20

1) beta-lactamases
2) altered PBPs
3) MRSA is resistant

Front 21

What are 1st gen cephs used against?

Back 21

1) gram+ cocci
2) E coli
3) K pneumoniae
4) Proteus mirabilis

Front 22

Which 2 cephs are 1st gen?

Back 22

1) cefazolin (IV)
2) cephalexin (oral)

Front 23

What are 2nd gen cephs active against?

Back 23

1) less gram+ than 1st gen but more gram- than 1st gen
2) H influenziae
3) Enterobacter aerogenes
4) Niesseria
5) Proteus mirabilis
6) E coli
7) K pneumoniae
8) S marcessans

Front 24

What are examples of 3rd gen cephs?

Back 24

1) ceftazidime
2) cefoperazone- can't cross BBB
3) cefotaxime
4) ceftriaxone

Front 25

Which cephs are used against PRSP?

Back 25

1) ceftriaxone
2) cefotaxime

Front 26

Which 3rd gen ceph is used for pseudomonas?

Back 26

ceftazidime

Front 27

Which 3rd gen ceph is used for gonorrhea?

Back 27

ceftriaxone

Front 28

What is cefepime? what is it used for?

Back 28

1) 4th gen ceph
2) wide gram+ and gram- coverage
3) psuedomonas
4) gram+ bacteria

Front 29

Can cephs be given to someone that is allergic to penicillin?

Back 29

no

Front 30

What are allergic toxicities of Cephs?

Back 30

1) skin rashes
2) anaphylatic shock

Front 31

Why shouldn't cephs be given to someone also taking aminoglycosides?

Back 31

increased risk of nephrotoxicity

Front 32

Which cephs contain methylthiotetrazole? What reaction can occur?

Back 32

1) cefmandole
2) cefoperazone
3) cefotetan
4) hypoprothrombinemia
5) disulfuram like effect

Front 33

What is an example of a monobactam? What is it effective against?

Back 33

1) Aztreonam
2) Klebsiella
3) Pseudomonas
4) Serratia

Front 34

What is aztreonam not effective against?

Back 34

gram+ or anearobes

Front 35

What is the MOA of aztreonam? Do they work in against or with aminoglycosides?

Back 35

1) binds PBP3
2) with

Front 36

What are toxic effects of aztreonam?

Back 36

1) superinfection
2) vertigo
3) headache
4) rare hepatotoxic

Front 37

Can aztreonam be given to someone allergic to penicillins and cephs?

Back 37

yes

Front 38

What are examples of carbapenems?

Back 38

1) imipenem
2) meropenem
3) ertapenem

Front 39

What are the carbapenems active against?

Back 39

1) gram + cocci
2) gram - rods
3) anaerobes
Note: somewhat resistant to beta-lactams

Front 40

What is DOC for enterobacter?

Back 40

imipenem

Front 41

What is imipenem given with? why?

Back 41

1) cilastatin
2) imipenem is inactivated by renal dehydropeptidase I and cilastatin inactivates this enzyme
3) note also reduces toxic metabolite

Front 42

What are toxic effects of imapenem/cistatin?

Back 42

1) GI distress
2) skin rash
3) CNS toxicity (confusion, encephalopathy, seizures)

Front 43

Which carbapenem can be given that does not have the CNS effects?

Back 43

meropenem because it is not metabolized by dehydropeptidase

Front 44

Beta lactamase inhibitors are more active against beta-bactames coded where?

Back 44

1) plamsid-coded
2) not active against chromosomal coded

Front 45

What is the MOA of vancomycin?

Back 45

1) bacteriocidal
2) binds D-Ala-D-Ala terminal of peptidoglycan and inhibits transglycosylation

Front 46

What is vanomycin used for?

Back 46

1) MRSA
2) PRSP
3) C difficile if metronidazole not working

Front 47

What drug is similar to vancomycin?

Back 47

teicoplanin

Front 48

what are toxic effects of vancomycin?

Back 48

1) chills, fever, phlebitis
2) ototoxic
3) nephrotoxic
4) RED MAN SYNDROME

Front 49

What is the MOA of fosfomycin?

Back 49

1) inhibits cytosolic enopyruvate transferase
2) prevents formation of N-acetylmuramic acid

Front 50

What is the MOA of bacitracin? What are its adverse effects?

Back 50

1) inhibits lipid transporter a late stage of gram+ cell wall synthesis
2) nephrotoxic

Front 51

What is the MOA of cycloserine?

Back 51

1) blocks incoporation of D-Ala into side-chain of peptidoglycan

Front 52

What are toxic effects of cycloserine?

Back 52

1) tremors
2) seizures
3) psychosis

Front 53

When is cycloserine used?

Back 53

resistant TB

Front 54

What is the MOA of daptomycin? what is active against?

Back 54

1) similar to vancomycin
2) vanco resistant enterococci and staph

Front 55

What needs to be monitored when taking daptomycin? why?

Back 55

1) creatine phosphokinase
2) myopathy

Front 56

Type of resistance found with vancomycin

Back 56

Point mutation
note: d-ALA to d-LAC

Front 57

Meningitis prophylaxis in exposed patients

Back 57

Rifampin

Front 58

Penicillins active against penicillinase secreting bacteria

Back 58

Methicillin, nafcillin, and dicloxacillin

Front 59

Cheap wide spectrum antibiotic DOC for otitis media

Back 59

Amoxicillin

Front 60

Class of antibiotics that have 10% cross sensitivity with penicillins

Back 60

Cephalosporins

Front 61

PCN active against pseudomonas

Back 61

Carbenicillin, piperacillin and ticarcillin

Front 62

Antibiotic causing red-man syndrome, and prevention

Back 62

"Vancomycin, infusion
at a slow rate and antihistamines"

Front 63

Treatment of resistant pseudomembranous colitis

Back 63

ORAL vancomycin

Front 64

Cephalosporins able to cross the BBB

Back 64

Cefuroxime (2nd) generation, Ceftazidime, Ceftriaxone

Front 65

Cephalosporins NOT able to cross the BBB

Back 65

Cefixime (3rd) generation

Front 66

Cephalosporin causes kernicterus in neonates

Back 66

Ceftriaxone or cefuroxime

Front 67

Lactam that can be used in PCN allergic patients

Back 67

Aztreonam